Substance Use and Impulse Control PDF

Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 1 Psychoactive Drugs Psychoactive substances - alter mood, behaviour, or both; include: Levels of involvement: Substance use - mo...

Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 1 Psychoactive Drugs Psychoactive substances - alter mood, behaviour, or both; include: Levels of involvement: Substance use - moderate amounts - does not significantly interfere with everyday life functioning. Substance intoxication: Our physiological reaction to ingested substances—drunkenness or getting high - Substance use disorder – addiction Copyright © 2024 by Cengage Learning 2 Levels of Involvement Substance Use Disorder Physiological dependence: ◦ Tolerance: greater amounts of drug needed to experience same effect ◦ Withdrawal: negative physical response when the substance is no longer ingested Psychological dependence: behavioural reactions to substance dependence Polysubstance use - using multiple substances. Copyright © 2024 by Cengage Learning 3 1  Substance Use Disorder Diminished Control 1. Uses more substance, or for longer, than intended. 2. Tries unsuccessfully to regulate use of substance. At least 2 3. Spends much time acquiring, using, or recovering from effects of substance. symptoms in the 4. Craves the substance. 12-month period Diminished Social Functioning 5. Use disrupts commitments at work, school, or home. Mild: Two or 6. Continues use despite social problems. three symptoms 7. Causes reduced social, recreational, and work activities. Moderate: Four Hazardous Use or five symptoms 8. Continues use despite hazards. 9. Continues use despite worsening physical or psychological Severe: Six or problems. more symptoms Drug Action 10. Experiences tolerance (needing more substance for the desired effect). 11. Experiences withdrawal when attempting to end use. Copyright © 2024 by Cengage Learning 4 Categories of Psychoactive Drugs Five general categories of substances: ◦ Depressants ◦ Opioids ◦ Stimulants ◦ Hallucinogens ◦ Other drugs Copyright © 2024 by Cengage Learning 5 Depressants Alcohol-Related Disorders Alcohol use marked by tolerance, withdrawal, and a drive to continue problematic use ◦ People who are physically dependent on alcohol tend to have more severe symptoms of the disorder ◦ Reverse Tolerance Often part of polysubstance/polydrug use ◦ Effects of drugs can be synergistic ◦ Potentially fatal overdoses (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons 6 2  Depressants Alcohol-Related Disorders Clinical Description Depressant, inhibitory centres in the brain are depressed, or slowed ◦ Low dose- reduces inhibition ◦ High dose- acts as a potent sedative Copyright © 2024 by Cengage Learning 7 Depressants Alcohol-Related Disorders Clinical Description Continued drinking depresses more areas of the brain ◦ Impaired motor coordination ◦ Vision and hearing affected ◦ Reduces self-awareness and self- control ◦ Slower reaction time ◦ Confused, poor judgments ◦ Memory blackouts Copyright © 2024 by Cengage Learning 8 Depressants Alcohol-Related Disorders Effects Influences several neuroreceptor systems GABA, inhibitory neurotransmitter Glutamate systems – memory blackouts DA systems- pleasurable feelings Serotonin system- alcohol cravings Releases natural analgesics Copyright © 2024 by Cengage Learning 9 3  Depressants Alcohol-Related Disorders Long term effect Chronic drinking causes severe biological damage and psychological deterioration Almost every tissue and organ is adversely affected: ◦ Malnutrition ◦ Cirrhosis of the liver ◦ Damage to the endocrine glands and pancreas ◦ Heart failure, hypertension, stroke, and capillary hemorrhages, which in turn can produce brain damage (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons 10 Depressants Alcohol-Related Disorders Long term effect Two types of brain syndromes Dementia – general loss of intellectual abilities Wernicke-Korsakoff syndrome – confusion, loss of muscle coordination, and incomprehensible speech Copyright © 2024 by Cengage Learning 11 Depressants Alcohol-Related Disorders Fetal alcohol syndrome (FAS): affects child whose mother drank while she was pregnant Copyright © 2024 by Cengage Learning 12 4  Depressants Alcohol-Related Disorders Withdrawal Chronic use – hand tremors, nausea or vomiting, anxiety, hallucinations, agitation, insomnia Delirium Tremens (DTs): frightening hallucinations and body tremors Copyright © 2024 by Cengage Learning 13 Depressants Alcohol-Related Disorders Statistics on Use and Abuse Canada – alcohol use disorder; 2022 12-month prevalence 2.2% Binge consumption frequent among college students Binge drinking- Males; 18-29 years Copyright © 2024 by Cengage Learning 14 Depressants Alcohol-Related Disorders Statistics on Use and Abuse Men drink more than women Single males most likely to be heavy drinkers Women absorb and metabolize alcohol differently Copyright © 2024 by Cengage Learning 15 5  Depressants Alcohol-Related Disorders Statistics on Use and Abuse Cultural differences exist Highest rates in Europe and Americas regions Attitudes, availability, family norms, physiological reactions Copyright © 2024 by Cengage Learning 16 Depressants Alcohol-Related Disorders Progression Early consumption can predict dependence/abuse in later years Linked with violent behaviour; may reduce the fear of punishment Copyright © 2024 by Cengage Learning 17 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Sedative (calming) Hypnotic (sleep-inducing) Anxiolytic (anxiety-reducing) Include ◦ Barbiturates: synthesized sedatives ◦ Benzodiazepines: anxiety-reducing (Valium, Xanax) ◦ Act on GABA NT system Copyright © 2024 by Cengage Learning 18 6  Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Clinical Description Barbiturates - relax muscles, induce sleep ◦ Low doses produce mild feeling of well-being ◦ Large doses- effects similar to heaving drinking ◦ Overdosing is common means of suicide Benzodiazepines: calming, induce sleep ◦ Tolerance and dependence with repeated use Copyright © 2024 by Cengage Learning 19 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Clinical Description DSM-5 TR Criteria Similar to alcohol-related disorders Maladaptive behaviours, variable moods, impaired judgement, impaired social or occupational functioning, impaired motor functioning, slurred speech. Copyright © 2024 by Cengage Learning 20 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Statistics Benzodiazepine use declined by 6% between 2016– 2017 (CIHI, 2018) CTADS, 2019: 12% of Canadians reported using sedatives in the past year ◦ 9% of men and 14% of women Copyright © 2024 by Cengage Learning 21 7  Opioids Opiate: natural chemicals in opium poppy having a narcotic effect (Heroin, morphine, oxycodone) ◦ Temporarily lessen pain and anxiety; high doses overwhelming sense of euphoria ◦ Slow breathing, and cause lethargy Copyright © 2024 by Cengage Learning 22 Opioids Sleep-inducing, pain-relieving (analgesic) ◦ Canada in grip of opioid crisis: prescription and illegal ◦ 21.3 million prescriptions for opioids were dispensed in 2017 ◦ Withdrawal is unpleasant (nausea and vomiting, chills, muscle aches, diarrhea, and insomnia) continued use ◦ Intravenously taken: risks of HIV ◦ High mortality rates Copyright © 2024 by Cengage Learning 23 Stimulants Stimulant-Related Disorders Amphetamines “Uppers” leading to a “down” and crash Reduce appetite, weight Reduce fatigue Initially used to control mild depression and appetite Today used to treat children with hyperactivity Enhance the activity of NE and DA (attention, impulse control) The high produced by these drugs is less intense but generally lasts longer. Copyright © 2024 by Cengage Learning 24 8  Stimulants Stimulant-Related Disorders Amphetamines ◦ Behavioural symptoms - euphoria or affective blunting anxiety, tension, anger, stereotyped behaviours, impaired judgment, and impaired social or occupational functioning. ◦ Physiological symptoms - heart rate or blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, muscular weakness, respiratory depression, chest pain, seizures, or coma Copyright © 2024 by Cengage Learning 25 Stimulants Stimulant-Related Disorders Methamphetamine ◦ The most abused form of amphetamine ◦ Intense exhilaration  followed by euphoria that can lasts for 6-12 hours ◦ Powerfully addictive ◦ Carries a high risk of overdose and dependence ◦ Tolerance builds quickly; Withdrawal - prolonged periods of sleep, irritability, depression. 26 Stimulants Stimulant-Related Disorders Methylenedioxymethamphetamine (MDMA), “ecstasy”: recreational drug Stimulate central nervous system ◦ Synthetic stimulant and mild hallucinogen ◦ Produces euphoria ◦ Lead to hallucinations and delusions Copyright © 2024 by Cengage Learning 27 9  Stimulants Stimulant-Related Disorders Cocaine Derived from leaves of the coca plant Coca-Cola contained 60 milligrams of cocaine per 240 mL until 1903 Clinical Description: increases alertness, blood pressure; causes insomnia Produces a quick rush of euphoria, indifference to pain and sense of well-being A crash of agitated depression occurs within 15 to 30 minutes after neurotransmitter levels drop. Copyright © 2024 by Cengage Learning 28 Stimulants Tobacco-Related Disorders Single most preventable cause of premature death (1 in every 5 deaths) Nicotine in tobacco is a psychoactive substance ◦ Produces dependence, tolerance, withdrawal 12% of Canadians smoke (CCHS, 2022) Inhaled nicotine enters blood in 7–19 seconds ◦ Low doses  acetylcholine and glutamate improves attention and memory ◦ Elevates dopamine levels  feelings of pleasure and reward Copyright © 2024 by Cengage Learning 29 Stimulants Tobacco-Related Disorders Nicotine and depression interrelated Genetic vulnerability and life stresses combine to lead to vulnerability to nicotine use and depression Second hand smoke Copyright © 2024 by Cengage Learning 30 10  Stimulants Tobacco-Related Disorders Many people have turned to the use of battery- powered electronic cigarettes (e-cigarettes); e- cigarette: inhale vaporized liquid of varying flavours: o motivated by restrictions on public smoking in public o presumed to be a healthier alternative (Flett et al., 2017) Copyright © 20217 By John Wiley and Sons 31 Hallucinogens Hallucinogens alter perception, mood, and various cognitive processes, often resulting in visual and auditory hallucinations. Increase in 12-month prevalence rate from 3.5% in 2018-2019 to 4% in 2021-22 (CTADS). Copyright © 2024 by Cengage Learning 32 Hallucinogens LSD (acid; d-lysergic acid diethylamide) ◦ Psilocybin (mushrooms), lysergic acid amide, dimethyltryptamine (DMT), mescaline (peyote), phencyclidine (PCP) Perceptual changes: subjective intensification of perceptions, depersonalization, and hallucinations Physical symptoms: pupillary dilation, rapid heartbeat, sweating, blurred vision (American Psychiatric Association, 2022) Copyright © 2024 by Cengage Learning 33 11  Hallucinogen LSD Two long-term effects of LSD: o Persistent psychosis. o Hallucinogen persisting perception disorder (HPPD) or Flashbacks (Liliendfeld et al., 2020) Copyright © 2020 Pearson Canada Inc. 34 Hallucinogens Cannabis - dried and crushed leaves and flowering tops of Cannabis sativa Major active chemical is delta-9- tetrahydrocannabinol (THC) Cannabis (marijuana) most routinely used drug in Canada; 12-month prevalence of Cannabis use disorder 1.4% (2022) Reverse tolerance with repeated use Copyright © 2024 by Cengage Learning 35 Hallucinogens Psychological Effects of Marijuana ◦ Feel more relaxed and sociable ◦ Can dull attention, fragment thoughts, and impair memory ◦ Extremely heavy doses can induce hallucinations Somatic Effects ◦ Specific cannabinoid receptors in brain have been located in various brain regions Therapeutic Effects ◦ Reduce nausea and appetite loss that accompanies chemotherapy (Flett et al., 2017) Copyright © 20217 By John Wiley and Sons 36 12  Other Drugs Inhalants ◦ Inhalant use disorder - Key symptoms include recurrent use and constant craving of inhalants ◦ Spray paint, paint thinner, amyl nitrate Anabolic-androgenic steroids Designer drugs Copyright © 2024 by Cengage Learning 37 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2024). Psychopathology: An integrative approach (7th Canadian ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Canadian ed.). Wiley Liliendfeld, S. O., Lynn, S. J., Namy, L.L., Woolf, N. J., Cramer, K. M., & Schmaltz, R. (2020). Psychology: From inquiry to understanding (4th Canadian ed.). Pearson Canada. 38 13