Psychology of Substance-Related Disorders

Sleep Disorders

• Recurrent episodes of irrepressible need to sleep, lapsing into sleep or napping with cataplexy, hypocretin deficiency, and evidence from polysomnography showing REM sleep latency ≤ 15 mins, occurring 3x/week for at least 3 months.

Obstructive Sleep Apnea Hypopnea

• At least 4 obstructive apneas or hypopneas per hour of sleep, or evidence from polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep.
• Apnea: absence of airflow, Hypopnea: reduction in airflow.

Central Sleep Apnea

• Evidence by polysomnography of 5 or more central apneas per hour of sleep.
• Cheyne-Stokes Breathing: an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea.

Sleep-Related Hypoventilation

• Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels.

Circadian Rhythm Sleep-Wake Disorders

• Persistent or recurrent pattern of sleep disruption due to alteration of the circadian system or misalignment between the endogenous circadian rhythm, leading to excessive sleepiness or insomnia, or both.

Non-REM Sleep Arousal Disorders

• Incomplete awakening from sleep: sleepwalking or sleep terrors, cannot remember anything when they woke up, occurring mostly in childhood and non-rem sleeps, and producing rapid and complete awakening without confusion, amnesia, or motor activity.

Nightmare Disorder

• Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity, occurring during REM sleep, and upon awakening, individuals become oriented and alert.
• Appear in children exposed to acute or chronic psychosocial stressors.

REM Sleep Behavior Disorder

• Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors, occurring during REM sleep.

Sexual Dysfunctions

• During REM sleep, upon awakening, the individual is completely awake, alert, and not confused.

Restless Legs Disorder

• Urge to move the legs, usually accompanied or in response to uncomfortable and unpleasant sensations of the legs, during rests, sense of relief during movement, and worse in the evening, occurring 3x/week for at least 3 months.

Delayed Ejaculation

• Delay or absence of ejaculation, associated with highly frequent masturbation, use of masturbation techniques not easily duplicated by a partner, and marked disparities between sexual fantasies during masturbation and the reality of sex with a partner, occurring at least 6 months.
• Less coital activity, higher levels of relationship distress, sexual dissatisfaction, lower subjective arousal, anxiety about their sexual performance, and general health issues than sexually functional men.

Erectile Disorder

• Difficulty having, maintaining an erection, and decrease in erectile rigidity, associated with low self-esteem, low self-confidence, and a decreased sense of masculinity, and may experience depressed mood, occurring at least 6 months.

Sexual Disorders

• Female Sexual Interest/Arousal Disorder: absent/reduced interest in sexual activity, associated with problems in experiencing orgasm, pain experienced during sexual activity, infrequent sexual activity, couple-level discrepancies in desire, no sexual thoughts or fantasies, no initiation, no sexual excitement or pleasure during sex, distressing low desire associated with depression, thyroid problems, anxiety, urinary incontinence, and other medical factors.
• Genito-Pelvic Pain/Penetration Disorder: difficulties in vaginal penetration during intercourse, vaginal pain during intercourse or penetration attempts, anxiety about anticipating vulvovaginal or pelvic pain.
• Male Hypoactive Sexual Disorder: persistently deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity, sometimes associated with erectile and/or ejaculatory concerns.
• Premature (Early) Ejaculation: ejaculation approx. 1 min following vaginal penetration or even before the individual wishes it, complain a sense of lack of control over ejaculation, and report apprehension about their anticipated inability to delay ejaculation on future sexual encounters.
• Voyeuristic Disorder: intense arousal from observing an unsuspecting naked person for at least 6 months, nonconsensual, associated with childhood sexual abuses, substance misuse, sexual preoccupation/hypersexuality, and at least 18 yrs old.
• Exhibitionistic Disorder: intense arousal from exposing genitals to an unsuspecting person for at least 6 months, nonconsensual.
• Frotteuristic Disorder: intense arousal from touching or rubbing genitals against a nonconsenting person for at least 6 months, nonconsensual.
• Sexual Masochism: intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer for at least 6 months.
• Sexual Sadism: intense sexual arousal from the physical suffering of another person for at least 6 months.

Explaining Substance-Related and Addictive Disorders

• Substance: chemical compounds that are ingested to alter mood or behavior.
• Psychoactive substances: alter mood, behavior, or both.
• Substance Use: ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning.
• Substance Intoxication: physiological reaction to ingested substances.
• Substance Use Disorders: how much of a substance is ingested is problematic.
• Physiological Dependence: meaning the use of increasingly greater amounts of the drug to experience the same effect (tolerance) and a negative physical response when the substance is no longer ingested (withdrawal).

Alcohol

• Produced when certain yeast react with sugar and water, then fermentation takes place.
• Depressant: inhibitions are reduced, and we become more outgoing, with more drinking, alcohol depresses the brain, which impedes the functioning.
• Withdrawal Delirium (Delirium Tremens): condition that can produce frightening hallucinations and body tremors.
• Breathalyzer: measures levels of intoxication.
• GABA: seems to be particularly sensitive to alcohol.
• The Glutamate system: involved in why alcohol affects our cognitive abilities.
• Two types of organic brain syndromes: may result from long-term alcohol use, Dementia and Wernicke-Korsakoff Syndrome.
• Fetal Alcohol Syndrome: a condition that affects the fetus.
• Alcohol Dehydrogenase: metabolizes alcohol.
• Korsakoff syndrome: a chronic memory disorder caused by a severe deficiency of thiamine (vitamin B-1).

Four-Stage Model for the Progression of Alcoholism

• Pre-Alcoholic Stage: drinking occasionally with few serious consequences.
• Prodromal Stage: drinking heavily but with few outward signs of a problem.
• Crucial Stage: loss of control, with occasional binges.
• Chronic Stage: primary daily activities involve getting and drinking alcohol.

Other Substances

• Caffeine: most common psychoactive substance, a gentle stimulant.
• Cannabis (Marijuana): reactions include mood swings or even dream-like experiences.
• Hallucinogens: most common, LSD, produced synthetically in the laboratory.
• Phencyclidine (PCP): is snorted, smoked, or injected intravenously, and it causes impulsivity and aggressiveness.
• Inhalant: solvents, aerosol sprays, gases, nitrites, usually found at home or workplace.
• Opioid: natural chemicals in the opium poppy that have a narcotic effect, relieves pain and induces sleep.
• Sedative, Hypnotic, or Anxiolytic: calming, sleep-inducing, and anxiety-reducing.

Cocaine, Tobacco, and Alcohol

• Cocaine: increases alertness, produces euphoria, increases blood pressure and pulse, and causes insomnia and loss of appetite.
• Tobacco: contains nicotine and is linked with signs of negative affect such as depression, anxiety, and anger.
• Acute alcohol withdrawal: can last 4-5 days and only occurs after an extended period of heavy drinking.

Gambling Disorder

• Persistent and recurring gambling behavior: present for at least 12 months.
• At least 4 symptoms within 12 months.
• Gambling disorder onset: can occur during adolescence or young adulthood, but in other individuals, it may manifest during middle or even older adulthood.
• Progression of gambling disorder: appears to be more rapid in women than in men.

Oppositional Defiant Disorder

• Diagnosed when angry, irritable mood, argumentative/defiant behavior against authority figures: present for at least 6 months.
• Other symptoms: annoys others, blames others for their mistakes.
• Two of the most common co-occurring disorders: ADHD and CD.
• Oppositional Defiant Disorder precedes: the development of conduct disorder.
• Common in children: with the childhood-onset subtype.
• Conveys risk: for the development of anxiety disorders and MDD.
• Oppositional Defiant Disorder is linked: with an increased risk for a number of problems in adjustment as adults.
• Less severe than CD: and does not include aggression toward people, property, or IED.

Int### Disruptive Mood Dysregulation Disorder (DMDD)

• Diagnosis can only be made when recurrent problematic impulsive aggressive outbursts occur before age 10
• First-time diagnosis should not be made after 18 years
• Differentiated from ODD by broader array of provocations and physical assault
• Co-morbid with depressive disorders, anxiety disorders, PTSD, Bulimia, Binge-eating, and substance use disorder

Conduct Disorder

• Pattern of behavior violating basic rights of others or societal norms/rules
• May include bullying, initiating fights, physical cruelty, destroying property, and theft
• Onset may occur in preschool years, but first significant symptoms usually emerge during middle childhood to middle adolescence
• ODD is the most common precursor to the childhood-onset type
• Physically aggressive symptoms = childhood, nonaggressive symptoms = adolescence
• May be diagnosed in adults, but onset is rare after age 16
• Childhood-onset type predicts worse prognosis and increased risk of criminal behavior in adulthood
• Both ODD and CD diagnoses can be given if criteria are met
• Both ADHD and CD diagnoses can be given if criteria are met
• Diagnosis requires substantial levels of aggressive or nonaggressive conduct problems during periods without mood disturbance
• IED diagnosis is only given when recurrent impulsive aggressive outbursts warrant independent clinical attention

Pyromania

• Purposeful fire setting on more than one occasion
• Advance preparation for starting a fire
• Arousal before the act, fascination with fire and situational context
• Not done for monetary gain or other reasons
• Separate diagnosis not given when fire setting occurs as part of CD, manic episode, or antisocial personality disorder

High Co-Occurrence

• High co-occurrence of substance-use disorders, gambling, depressive, bipolar disorders, and other disruptive impulse-control and conduct disorders

Kleptomania

• Failure to resist impulses to steal objects not needed for personal use
• Attempt to resist the impulse, aware that the act is wrong and senseless
• Increase tension before committing the theft
• Pleasure after committing the theft
• Often feels depressed or guilty about the thefts
• Associated with compulsive buying, depressive, bipolar, anxiety, eating, personality, substance-use, and other disorders

Personality Disorders

Cluster A

Paranoid

• Excessively mistrustful and suspicious of others without justification
• Problems with close relationships
• Overt argumentativeness, complaining, or hostile aloofness
• Need for control over those around them
• Rigid, critical of others, and unable to collaborate
• More common among relatives with schizophrenia
• Maybe due to early mistreatment or traumatic childhood experiences
• Associated with prior history of childhood mistreatment, externalizing symptoms, bullying, and adult appearance of interpersonal aggression
• "I cannot trust people"
• Too much use of projection
• Males = Females
• May experience brief psychotic episodes
• May develop MDD, Agoraphobia, and OCD

Schizoid

• Difficulty expressing anger, even in response to direct provocation
• Tendency to turn inward and away from the outside world
• Childhood shyness is reported as a precursor to later personality disorder
• "Relationships are messy and undesirable"
• Males>Females
• Sometimes experience brief psychotic episodes

Cluster B

Histrionic

• Overly dramatic, almost like acting
• Express emotions in an exaggerated manner
• Characterized by social dominance
• More likely to get divorced or never get married
• Have a tendency to get bored with their usual routine
• Histrionic and antisocial co-occur more often
• "Ako ang bida"
• Females>Males

Borderline

• Unstable moods and relationships, poor self-image
• Pattern of undermining themselves at the moment the goal is about to be realized
• May feel more secure with transitional objects than interpersonal relationships
• Often feel empty, at high risk of dying by their own hands
• Often engage in suicidal behaviors
• Turbulent relationships, fearing abandonment but lacking control over their emotions

Narcissistic

• Consider themselves different from others, deserving special treatment
• Unreasonable sense of self-importance, preoccupied with themselves, lacking sensitivity and compassion
• Grandiosity
• Very sensitive to criticism
• Interpersonal relationships impaired due to self-preoccupation, entitlement, need for admiration, and disregard for others' sensitivities
• "I am the greatest in the world"
• Males>Females

Antisocial

• History of failing to comply with social norms
• At least 18 years of age
• Evidence of CD before 15 years old
• Irresponsible, impulsive, and deceitful
• Lacking in conscience and empathy, selfishly taking what they want, violating social norms and expectations
• CD will be given if the criteria for Antisocial PD is not met
• Underarousal Hypothesis: psychopaths have abnormally low levels of cortical arousal
• Fearlessness Hypothesis: psychopaths possess a higher threshold for experiencing fear than most other individuals
• "I am entitled to break rules"
• Males>Females
• May experience dysphoria, including complaints of tension, inability to tolerate boredom, and depressed mood

Cluster C

Avoidant

• Detachment from social relationships and limited range of emotions
• Difficulty expressing anger, even in response to direct provocation, contributing to the impression of lacking emotion
• Tendency to turn inward and away from the outside world
• Childhood shyness is reported as a precursor to later personality disorder
• "Relationships are messy and undesirable"
• Males>Females
• Sometimes experience brief psychotic episodes

Dependent

• Rely on others to make ordinary and important decisions, due to unreasonable fear of abandonment
• Characterized by pessimism and self-doubt, and tend to belittle their abilities and assets
• Take criticism and disapproval as proof of their worthlessness, and lose faith in themselves
• Agree with others' opinions just to avoid rejection
• Feel uncomfortable or helpless when alone
• "I need people to survive and be happy"
• Females > Males

Obsessive-Compulsive

• Perfectionist, fixated on details, and need to control
• This preoccupation with details prevents them from completing much of anything
• Need to control
• When criteria for both OCD and OCPD are met, both diagnoses can be given
• "I am a perfectionist; everything should be done under my control and liking"
• Males > Females