PSY110P-Chapter-11-Substance-Related-and-Addictive-Disorders.pptx

CHAPTER 11 SUBSTANCE-RELATED AND ADDICTIVE DISORDERS PERSPECTIVES ON SUBSTANCE-RELATED DISORDERS AND ADDICTIVE DISORDERS  Substance-related disorders     Use and abuse of psychoactive substances Signifi cant impairment Costs Polysubstance use  Impulse-control disorders  Inability to resi...

CHAPTER 11 SUBSTANCE-RELATED AND ADDICTIVE DISORDERS PERSPECTIVES ON SUBSTANCE-RELATED DISORDERS AND ADDICTIVE DISORDERS  Substance-related disorders     Use and abuse of psychoactive substances Signifi cant impairment Costs Polysubstance use  Impulse-control disorders  Inability to resist acting on drives or impulses PERSPECTIVES ON SUBSTANCE-RELATED DISORDERS AND ADDICTIVE DISORDERS  Levels of involvement  Substance use is the ingestion of psychoactive substances in moderate amounts that does not signifi cantly interfere with social, educational, or occupational functioning.  Substance intoxication A cluster of temporary undesirable behavioral or psychological changes that develop during or shortly after the ingestion of a substance.  Psychoactive substances alter mood, behavior, or both  Substance abuse - Pattern of psychoactive substance use leading to signifi cant distress or impairment in social and occupational roles and in hazardous situations.  Substance dependence - Maladaptive pattern of substance use characterized by the need for increased amounts to achieve the desired eff ect, negative physical eff ects when the substance is withdrawn, unsuccessful eff orts to control its use, and substantial eff ort expended to seek it or recover from its eff ects. Also known as addiction.  Tolerance - The brain and body’s need for ever larger doses of a drug to produce earlier eff ects.  Withdrawal Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug.  Withdrawal from many substances can bring on chills, fever, diarrhea, nausea and vomiting, and aches and pains. SUBSTANCE RELATED DISORDER  include 11 symptoms that range from relatively mild (e.g., substance use results in a failure to fulfi ll major role obligations) to more severe (e.g., occupational or recreational activities are given up or reduced because of substance use) Main categories  Depressants - These substances result in behavioral sedation and can induce relaxation.  Stimulants - These substances cause us to be more active and alert and can elevate mood.  Opiates - The major eff ect of these substances is to produce analgesia temporarily (reduce pain) and euphoria.  Hallucinogens - These substances alter sensory perception and can produce delusions, paranoia, and hallucinations.  Other drugs of abuse  Inhalants  Anabolic steroids  Medications  Gambling disorder ALCOHOL-RELATED DISORDERS Clinical description  CNS depressant  Inhibitory centers of the brain are depressed  Global - Motor coordination is impaired (staggering, slurred speech), reaction time is slowed, we become confused, our ability to make judgments is reduced, and even vision and hearing can be negatively affected  Neurotransmitter systems  GABA Alcohol seems to reinforce the movement of chloride ions; as a result, the neurons have diffi culty fi ring.  Glutamate Blackouts, the loss of memory for what happens during intoxication, may result from the interaction of alcohol with the glutamate system.  Serotonin This neurotransmitter system affects mood, sleep, and eating behavior and is thought to be responsible for alcohol cravings ALCOHOL-RELATED DISORDERS EFFECTS OF CHRONIC ALCOHOL USE  Intoxication  Withdrawal  Delirium tremens (DTs) a condition that can produce frightening hallucinations and body tremors.  Dementia - involves the general loss of intellectual abilities and can be a direct result of neurotoxicity or “poisoning of the brain” by excessive amounts of alcohol  Wernicke-Korsakoff disorder - confusion, loss of muscle coordination, and unintelligible speech; believed to be caused by a defi ciency of thiamine, a vitamin metabolized poorly by heavy drinkers. ALCOHOL-RELATED DISORDERS Fetal alcohol syndrome (FAS)  Growth retardation  Cognitive deficits  Behavior problems  Facial abnormalities STATISTICS ON USE AND ABUSE  Use      Most adults: light drinkers or abstainers Current use = ~50% Binge drinking = 22.6% Dependence = 3 million Males > Females PROGRESSION OF ALCOHOL RELATED DISORDERS Spontaneous remission - 20% Jellinek’s four stage model  prealcoholic 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 (the primary daily activities involve getting and drinking alcohol)  Limited empirical support SEDATIVE, HYPNOTIC, OR ANXIOLYTIC RELATED DISORDERS  Barbiturates(which include Amytal, Seconal, and Nembutal) They were prescribed to help people sleep and replaced such drugs as alcohol and opium; highly addictive.  Benzodiazepines (which today include Valium, Xanax, and Ativan) primarily to reduce anxiety. These drugs were originally touted as a miracle cure for the anxieties of living in our highly pressured technological society.  Eff ects = similar to alcohol  GABA  Synergistic in combination SEDATIVE, HYPNOTIC, OR ANXIOLYTIC RELATED DISORDERS SEDATIVE, HYPNOTIC, OR ANXIOLYTIC RELATED DISORDERS  DSM criteria The DSM-5 criteria for sedative-, hypnotic-, and anxiolytic related disorders do not diff er substantially from those for alcohol disorders. Maladaptive behavior changes Sexual Aggressive Variable moods Impaired judgment Impaired function Physiological effects Speech Coordination Gait SEDATIVE, HYPNOTIC, OR ANXIOLYTIC RELATED DISORDERS  Statistics     1% of people with substance problems Female Caucasian Over the age of 35 STIMULANT-RELATED DISORDERS  Of all the psychoactive drugs used in the United States, the most commonly consumed are stimulants.  Nature of stimulants  Most widely consumed drug (U.S.)  Increase alertness and energy  Examples:  Amphetamines  MDMA  Cocaine  Nicotine  Caff eine STIMULANT-RELATED DISORDERS AMPHETAMINE  Eff ects of amphetamines  “Up”  Elation  Vigor  Reduced fatigue  “Crash”  Extreme fatigue  Depression AMPHETAMINE  DSM criteria         Behavioral symptoms (euphoria or aff ective blunting) Changes in sociability Interpersonal sensitivity Anxiety, tension, anger Stereotyped behaviors Impaired judgment Impaired function Physiological symptoms AMPHETAMINE Designer drugs – used to mimic other drugs MDMA methylenedioxymethamphetamine (Ecstasy)  Effects similar to amphetamines (“speed”) Methamphetamine (“crystal meth” or “ice”)  Purified, crystallized form of speed  Longer half-life  Incredible potential for dependence AMPHETAMINE CNS effects of amphetamines Significant agonist and reuptake blocking effects  Norepinephrine  Dopamine Link with hallucinations and delusions COCAINE Effects of cocaine  Blocks dopamine reuptake  Euphoria  Feelings of power and confidence (short term)  Increased blood pressure/pulse  Insomnia  Decreases appetite  Paranoia COCAINE Statistics  Worldwide, almost 5% of adults  ER admissions for cocaine  23%  29%  18%  12% Caucasian males African American males Caucasian females African American females  17% also used crack cocaine COCAINE Dependence Highly addictive Develops slowly Tolerance Atypical withdrawal Cyclical pattern TOBACCORELATED DISORDERS TOBACCO-RELATED DISORDERS Effects of nicotine  Stimulates nicotinic acetylcholine receptors, the site of the brain’s pleasure pathway (the dopamine system responsible for feelings of euphoria) Highly addictive  Relapse rates = alcohol and heroin TOBACCO-RELATED DISORDERS Psychological symptoms Depressed mood Irritability Anxiety Diffi culty concentrating Physiological symptoms Restlessness Increased appetite Weight gain CAFFEINE USE DISORDERS Effects of caffeine  Used by over 90% of Americans  Tea, coffee, cola, and cocoa products  Small doses  Elevate mood  Reduce fatigue  Regular use  Tolerance  Dependence CAFFEINE USE DISORDERS CAFFEINE USE DISORDERS Withdrawal symptoms Psychological  Irritability  Unpleasant mood Physiological  Drowsiness  Headaches OPIOIDS Opioid-related disorders Nature of opiates and opioids  Opiates  Opioids  Referred to as analgesics  Examples: heroin, opium, codeine, and morphine OPIOIDS Effects of opioids  Activate enkephalins, beta-endorphins, and dynorphins  Low doses  Euphoria  Drowsiness  Slow breathing  High doses = fatal OPIOIDS OPIOIDS Withdrawal symptoms (6 to 12 hours)  Excessive yawning  Nausea and vomiting  Chills  Muscle aches  Diarrhea  Insomnia High mortality rates Increased HIV risk (due to injection) CANNABIS-RELATED DISORDERS Marijuana  Most frequently used drug  Tetrahydrocannabinol (THC)  Variable, individual reactions  Euphoria  Mood swings  Paranoia  Hallucinations  Tolerance = questionable  Withdrawal and dependence = uncommon HALLUCINOGEN-RELATED DISORDERS Nature of hallucinogens  Alter sensory perception  Can produce delusions, paranoia, hallucinations  Examples: marijuana, psilocybin, LSD  Hallucinogens use disorder HALLUCINOGEN-RELATED DISORDERS LSD and other hallucinogens  LSD = most common hallucinogenic drug  Tolerance = rapid  Withdrawal symptoms = uncommon  Intoxication  Altered sensory perceptions  Depersonalization  Hallucinations  Mystical experiences?  Many other plant hallucinogens Occurring naturally in a variety of plants:  Psilocybin (found in certain species of mushrooms)  Lysergic acid amide (found in the seeds of the morning glory plant)  Dimethyltryptamine (DMT) (found in the bark of the Virola tree, which grows in South and Central America)  Mescaline (found in the peyote cactus plant) Phencyclidine (or PCP) OTHER DRUGS OF ABUSE Nature of inhalants  Found in volatile solvents  Breathed into the lungs directly  Rapid absorption  Examples: spray paint, hair spray, paint thinner, gasoline, nitrous oxide  Effects similar to alcohol intoxication  Produce tolerance and prolonged withdrawal symptoms  Several negative physiological effects OTHER DRUGS OF ABUSE ANABOLIC–ANDROGENIC STEROIDS Nature of anabolic-androgenic steroids  Derived or synthesized from testosterone  Used medicinally or to increase body mass  No associated high  “Cycling” or “stacking” patterns of use  Long-term mood disturbances  Physical problems DESIGNER DRUGS Dissociative anesthetics and designer drugs  “Club drugs”  Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”), Heightened sensory perception  Popular in nightclubs, raves, or large gatherings  All can produce tolerance and dependence BIOLOGICAL DIMENSIONS Familial and genetic influences Twin, family, and adoption studies Use = environmental influences Abuse and dependence = polygenetic vulnerability NEUROBIOLOGICAL INFLUENCES Pleasure or reward centers  Dopaminergic system  Midbrain - ventral tegmental area  Frontal cortex – nucleus accumbens  GABA  Inhibition yields more dopamine activation  Rewards system  Serotonin and norepinephrine NEUROBIOLOGICAL INFLUENCES PSYCHOLOGICAL DIMENSIONS Positive reinforcement  Repeated pairings with rewards Negative reinforcement  Escape from unpleasantness  Self-medication  Tension reduction  Coping mechanism for negative affect PSYCHOLOGICAL DIMENSIONS  Opponent-process theory  Increase in positive  Increase in negative  Remedy is to use more of same drug PSYCHOLOGICAL DIMENSIONS Opponent-process theory Explanation of drug tolerance and dependence suggesting that when a person experiences positive feelings these will be followed shortly by negative feelings, and vice versa. Eventually, the motivation for drug taking shifts from a desire for the euphoric high to a need to relieve the increasingly unpleasant feelings that follow drug use. A vicious cycle develops: the drug that makes a person feel terrible is the one thing that can eliminate the pain. COGNITIVE FACTORS Expectancy effects  Beliefs about drugs and effects Cravings  Cues  Environmental triggers SOCIAL DIMENSIONS Exposure to drugs  Prerequisite for use  Media  Peers  Family  Monitoring  Peer groups Societal views  Moral weakness  Disease model TREATMENT OF SUBSTANCERELATED DISORDERS BIOLOGICAL Agonist substitution  Safer drug  Similar chemical composition  Methadone and nicotine gum or patch Antagonistic treatment  Block or counteract pleasurable eff ects  Naltrexone for opiate and alcohol Aversive treatment  Make use of drugs extremely unpleasant  Antabuse for alcoholism TREATMENT OF SUBSTANCERELATED DISORDERS PSYCHOSOCIAL Inpatient facilities  Expensive  Effi cacy is equal to outpatient Alcoholics anonymous (12 step)  Most popular  Social support  Limited research  Effective for highly motivated GAMBLING DISORDER Pathological gambling  1.9% of adult Americans  Biological influences  Poor impulse regulation  Dopamine  Serotonin  Treatment  Similar to substance dependence GAMBLING DISORDER IMPULSE-CONTROL DISORDERS DSM-5  Intermittent explosive disorder  Kleptomania  Pyromania Commonalities  Increased tension/anxiety before  Relief after  Social and occupational impairment IMPULSE-CONTROL DISORDERS Intermittent explosive disorder  Frequent aggressive outbursts  Injury and/or destruction of property  Biological  Serotonin, norepinephrine, testosterone  Psychosocial  Stress, disrupted family life, parenting  CBT is most promising treatment IMPULSE-CONTROL DISORDERS Kleptomania  Failure to resist urge to steal unnecessary items  High comorbidities  Mood disorders  Substance abuse & dependence  Treatments  Behavioral interventions?  Antidepressants? IMPULSE-CONTROL DISORDERS Pyromania  Irresistible urge to set fires  3% of arsonists  Little etiological and treatment research  CBT