Substance Use Disorders PDF

Substance Use Disorders PSY 301 Chapter 10 Dilek Demi epe Saygılı, PhD.  DSM-5 Criteria for
Substance Use Disorder Problematic pattern of use that impairs functioning. Two or more symptoms within a 1 year period: Failure to meet obligations Repeate...

Substance Use Disorders PSY 301 Chapter 10 Dilek Demi epe Saygılı, PhD.  DSM-5 Criteria for
Substance Use Disorder Problematic pattern of use that impairs functioning. Two or more symptoms within a 1 year period: Failure to meet obligations Repeated use in situations where it is physically dangerous Repeated relationship problems Continued use despite problems caused by the substance Tolerance Withdrawal Substance intended taken for a longer time or in greater amounts than E o s to reduce or control use do not work Much time spent t ing to obtain the substance Social, hobbies, or work activities given up or reduced Continued use despite knowing problems caused by substance Craving to use the substance is strong  Substance Use Disorders Categorize by Alcohol speci c substance: Amphetamine Cannabis Cocaine Gambling (new to DSM-5) Hallucinogen Inhalant Opioid Phencyclidine Sedative/hypnotic/anxiolytic Tobacco  Substance Use Disorders Addiction: – Severe substance use disorder Having six or more severe symptoms, such as: Tolerance – Larger doses needed; lower dosage does not produce typical e ect Withdrawal – Negative physical and psychological e ects from stopping usage (E.g., muscle pain, twitching, sweats, vomiting, diarrhea, insomnia) Using more than intended amounts T ing unsuccessfully to stop Having physical or psychological problems made worse by drug Experience problematic relationships – With physiological dependence: Presence of either tolerance or withdrawal – Without physiological dependence: Absence of either tolerance or withdrawal  Alcohol Use Disorder Delirium tremens (DTs) – Can occur suddenly when blood alcohol levels drop – Results in: Deliriousness Tremulousness Hallucinations – Primarily visual; may be tactile Polydrug abuse – Many users abuse multiple substances e.g., cigarettes, cocaine, marijuana 85% of alcohol abusers are smokers  Prevalence of Alcohol Abuse Lifetime prevalence: 17% Binge drinking – 5 drinks in sho period (e.g., within an hour) – 39.4% prevalence among college students Heavy use drinking – 5 drinks, 5 or more times in a 30-day period 12.5% prevalence among college students antisocial Often comorbid with personality borderline disorders, and mood disorders, and anxiety disorders  Sho -term E ects of Alcohol small Entersintestine the bloodstream quickly through E ects va by concentration – Concentration varies by gender, height, weight, liver e ciency, food in stomach Interacts with – Stimulates several GABA neural receptors systems Reduces tension – Increases dopamine and serotonin Produces pleasurable e ects – Inhibits glutamate receptors Produces cognitive di culties (e.g., slowed thinking, memo loss) Ealcohol ect ofcontent) ingesting large amounts (.08 blood –– Signi Poor cant motor decision impairment making – Poor awareness of errors made  Long-term E ects of Alcohol Malnutrition Cirrhosis of the liver Damage to endocrine glands and pancreas Hea failure Erectile dysfunction Hype ension Stroke Capilla hemorrhages – Facial swelling and redness, especially in nose Destruction of brain cells – Especially areas impo ant to memo  Fetal Alcohol Syndrome Heavy alcohol intake during pregnancy – Leading cause of mental retardation – Fetal growth slowed – Cranial, facial and limb anomalies occur Total abstinence by pregnant women recommended  Tobacco Use Disorder Nicotine – Addicting agent of tobacco – Stimulates dopamine neurons in mesolimbic area Involved in reinforcing e ect Cigarette smoking cause or exacerbate: – Cancer, cardiovascular disease – Sudden infant complications death syndrome and pregnancy are Secondhand smoke: at greatest risk ose living with smokers  E-Cigarettes Look like cigarettes except: – Are made of plastic or metal – Are lled with liquid nicotine that is mixed with other chemicals and often with avors People inhale and exhale vapors (“vaping”)  Marijuana Drug derived from dried and crushed leaves and owering tops of the hemp plant (Cannibis sativa) Synthetic marijuana contains a i cially created chemicals similar to those contained in cannabis Marijuana is considered an illicit drug In DSM-5, called Cannabis use disorder  E ects of Marijuana Psychological Physiological – Feelings of sociability relaxation and Bloodshot and itchy eyes – Rapid shifts of emotion D mouth and throat – Inte eres with attention, memo , Increased appetite and thinking Reduced pressure within the Decline in IQ over time eye – Heavy doses can induce Increased BP hallucinations and panic Damage to lung structure and – Di cult to regulate dosage function in long-term users Eappear ects take 30 minutes to Smoke more than intended Habitual use leads to tolerance waiting for e ects Withdrawal symptoms also – Inte ere with cognitive obse ed functioning Impairs memo motor skills , complex  Opiates Group of addictive sedatives that in moderate doses relieve pain and induce sleep – Opium – Morphine – Heroin – Codeine Synthetic sedatives – Separate catego from DSM-5 sedative/hypnotic/anxiolytic use disorder Pain medications that can be legally prescribed, including hydrocodone and oxycodone.  E ects of Opiates Produce euphoria, coordination drowsiness, and lack of – Loss of inhibition, increased self-con dence – Severe letdown after about 4 to 6 hours Heroin – Rush and OxyContin Intense feelings of warmth and ecstasy following injection Stimulate receptors of the body’s opioid system Tolerance develops and withdrawal occurs – Muscle soreness and twitching, tea ulness, yawning – Become more severe and also include cramps, increase in HR and BP, insomnia, and vomiting chills/sweating, Withdrawal from heroin may begin within users who have built up high tolerance 8 hours of the last injection in Withdrawal lasts about 72 hours Exposure to infectious intravenous drug use agents (e.g., HIV) through  Stimulants: Amphetamines A person becomes ale , euphoric, outgoing, feels boundless energy and self-con dence Amphetamines – Synthetic stimulants Dexedrine, Adderall – Taken orally or intravenously – Trigger release of and block reuptake of norepinephrine and dopamine – Produce high levels of energy, sleeplessness – Reduce appetite, increase HR, constrict blood vessels in skin and mucous membranes – High doses can lead to: Ne ousness, agitation, irritability, confusion, paranoia, hostility – Tolerance can develop after only 6 days’ use Stimulants: Methamphetamine Methamphetamine («c stal meth» or «ice») – Amphetamine derivative – Can be taken orally, intravenously, or intranasally (sno ing) Immediate high, or rush, that can last for hours – Good feeling crashes and person becomes agitated Cravings are strong, lasting several years after use is discontinued Chronic use damages brain – Impacts dopamine and serotonin systems – Reduction in brain volume – Damage to areas associated with reward and decision making  Crack Stimulants: Cocaine – Form of cocaine that quickly become popular in the ’80s – Rock c stal that is heated, melted, and smoked – Cheaper than cocaine Alkaloid obtained from coca leaves – Reduces pain – Produces euphoria – Heightens sexual desire – Increases self-con dence and indefatigability Blocks reuptake of dopamine in mesolimbic areas of brain Overdose: – Chills, nausea, insomnia, paranoia, hallucinations; possibly hea attack and death Not all users develop tolerance – Some become more sensitive Hallucinogens, LSD Ecstasy, and PCP – d-lysergic acid diethylamide Hallucinogen e ects include: – Colo ul visual hallucinations – Psychedelic trip: expansion of consciousness Ecstasy (molly) – Chemically similar to mescaline and amphetamines – Acts on serotonin – Increase feelings of intimacy and enhances mood – Improves interpersonal relations – muscle tension, depersonalizationnausea, anxiety, depression, confusion, PCP (phencyclidine) – Angel dust – Animal tranquilizer – Causes severe paranoia and violence – Coma and death are possible Process of Becoming a Drug Abuser  Etiology of Substance-Related Disorders: Genetic Factors Relatives and children of problem drinkers have higher-than-expected rates of alcohol abuse or dependence Greater concordance in MZ than DZ twins Genetic and shared environmental risk factors for illicit drug abuse and dependence appear to be nonspeci c Ability to tolerate large quantities of alcohol may be an inherited diathesis  Etiology of Substance-Related Disorders: Neurobiological Factors Nearly all drugs, including alcohol, stimulate the dopamine system in the brain, pa icularly the mesolimbic pathway – Produce rewarding or pleasurable feelings – Some evidence that people dependent on drugs or alcohol have a de ciency in the dopamine receptor DRD2 – Vulnerability model vs. Toxic e ect model Vulnerability in the dopamine system leads to substance use or substance use leads to dopamine system problems People take drugs to avoid the bad feelings associated with withdrawal – Explains frequency of relapse Incentive-sensitization theo – Distinguish Wanting (craving for drug) from Liking (pleasure obtained by taking the drug) – Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.) – Sensitivity to cues induces and strengthens wanting Brain imaging studies show that cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use  Etiology of Substance-Use Disorders: Psychological factors Mood becausealteration: it drug enhances use is positive reinforced feelings or diminishes negative ones Tension reduction for alcohol «alcohol myopia» E ect similar for smoking- reduces negative emotion – However, alcohol and nicotine may when no distractions are present increase tension increase positive emotion when they are bored Expectancies about drug e ects – People who expect alcohol to reduce stress and anxiety are most likely to drink – Drinking positivelyand positive expectancies in uence each other  Etiology of Substance-Use Disorders: Personality Personality factors that predict onset of substance- related disorders: – Neuroticism/Negative emotionality or negative a ect – Desire for increased arousal and positive a ect – Low constraint Harm avoidance, conse ative moral values, and cautious behavior Kinderga en children who were rated high in anxiety and novelty seeking more likely to get drunk, smoke, and use drugs in adolescence  Etiology of Substance-Use Disorders: Sociocultural Factors Alcohol is the most common abused substance worldwide Men consume va by count more alcohol than women but di erences Availability – Usage is higher when alcohol and drugs are easily available Family factors – Parental alcohol use – Marital discord, psychiatric or legal problems in the family linked to substance use – Lack of emotional suppo from parents increases use of cigarettes, marijuana, and alcohol – Lack of parental monitoring linked to higher drug usage  Etiology of Substance-Use Disorders: Sociocultural Factors Social network – Social in uence or social selection? – Bullers et al. (2001) found evidence for both Having peers who drink in uences drinking behavior (social in uence) but individuals also choose friends with drinking patterns similar to their own (social selection) Adve ising and media – Countries that ban ads have 16% less consumption than those that don’t  Treatment of Substance Use Disorders:
Alcohol Use Disorders Inpatient hospital treatment – Detoxi cation Withdrawal from alcohol under medical supe ision e therapeutic results of hospital treatment are not superior to those of outpatient treatment May be necessa for those without social suppo or with other serious psychological problems Alcoholics Anonymous (AA) – Largest self-help group for problem drinkers – Regular meetings provide suppo , understanding, and acceptance – Promotes complete abstinence – Although some studies have shown AA pa icipation predicts better outcome, recent studies suggest AA no more e ective than other forms of therapy  Treatment of Substance Use Disorders:
Alcohol Use Disorders Cognitive and Behavioral Treatments – Contingency-Management erapy Patient and family reinforce behaviors inconsistent with drinking – e.g., avoiding places associated with drinking Teach problem drinker how to deal with uncomfo able situations – e.g., refusing the o er of a drink – Relapse prevention Strategies to prevent relapse Motivational inte entions – Designed to curb heavy drinking in college Individualized relation feedback on person’s drinking to community and national averages in Education about e ects of alcohol Tips for harm reduction  Treatment of Substance Use Disorders:
Alcohol Controlled drinkingUse Disorders – Belief that moderation problem drinkers can consume alcohol in – Avoid total abstinence and inebriation – Guided taking self-change second drink,E.g., delay allowing 20 minutes person to re before ect on costs/bene ts of drinking to excess Medications – Antabuse (disul ram) Produces nausea and vomiting if alcohol is consumed High drop out rate – Other medications acamprosate include naltrexone and Most e ective when combined with CBT  Treatment of Substance Use Disorders:
Nicotine Dependence Laws prohibiting smoking in most public places – Social context that provides incentive to stop smoking Peer behavior impo ant – Ifthat others in social network stop individual will also stop smoking, increases likelihood Physician’s advice – By age 65, most smokers have quit Scheduled smoking – Reduce nicotine intake gradually over a few weeks Nicotine replacement treatments – Gum, patches, or inhalers – Reduce craving for nicotine – Combining success ratepatch with antidepressants (Wellbutrin) improved Treatment of Drug Use Disorders 90% of people who need treatment for substance use disorder do not get it Substance use disorders are typically chronic, and relapse occurs often Detoxi cation central to treatment Drug Replacement Treatments – Opiate antagonists Naltrexone: Prevents feeling high Treatment of Drug Use Disorders Psychological treatments – CBT Learn how to avoid high-risk situations, recognize triggers, and develop alternatives to use – Desipramine and CBT showed e ectiveness for cocaine use CBT especially helpful for users with high dependence levels – Contingency management Vouchers that can be traded for desirable goods are given to users who abstain – Motivational inte iewing or enhancement therapy CBT plus solution focus therapy e ective for alcohol and drug use – Self-help residential homes Non-drug environment Group therapy Guidance and suppo from former users  Prevention of Substance-Use Disorders Often aimed at adolescents Utilize some or all of the following elements: – Enhancing self-esteem – Social skills training – Peer pressure resistance training – Parental involvement in school programs – Warning labels on alcohol bottles – Education regarding alcohol impairment – Testing for drugs and alcohol at school or work – Correction of beliefs and expectations – Inoculation against mass media messages – Peer leadership