Task 9 - Why Do I Want It So Bad? PDF

Task 9 - Why do I want it so bad? Introductory chapters (Mostly Hoeksema, I skimmed through Davey) Defining substance use disorders Substance intoxication - behavioral & psychological changes that result from the physiological effects of a substance use on the CNS....

Task 9 - Why do I want it so bad? Introductory chapters (Mostly Hoeksema, I skimmed through Davey) Defining substance use disorders Substance intoxication - behavioral & psychological changes that result from the physiological effects of a substance use on the CNS. Intoxication declines as the amount of substance in blood/tissue declines, but symptoms may last for hours or days after the substance is no longer detectable in the body. Specific intoxication symptoms depend on what substance is taken, how much & when is it taken, the user's tolerance and the context. Acute intoxication may have different symptoms from chronic intoxication (e.g. sociability when first taking cocaine, but isolation when used chronically). People's expectations also influence the types of symptoms they show. People who expect marijuana to make them relaxed may experience relaxation, while people who are afraid of disinhibition may experience anxiety. The diagnosis of substance intoxication is only given when the behavioral & psychological changes are significantly maladaptive (i.e. they disrupt relationships, cause occupational or financial problems, or put the person at risk for adverse effects, such as accidents or medical complications). Substance intoxication is common among individuals with substance use disorder, but also occurs among those without a substance use disorder. Substance withdrawal - behavioral & physiological symptoms that result when people who have been using substances for a long time stop or greatly re duce their intake. Symptoms are typically the opposite of those of intoxication. The diagnosis of substance withdrawal requires significant distress or impairment in a person's everyday functioning. Substance use disorder - a disorder that involves chronic difficulties in resisting the desire to drink alcohol or take drugs. DSM-5 diagnostic criteria are grouped into impaired control, continued use despite negative social, occupational and health consequences, risky use and tolerance or withdrawal. Users must show >=2 symptoms associated with substance use disorder over the course of a year to receive the diagnosis. Clinicians rate the severity of the substance use disorder as mild (2-3 criteria), moderate (4-5 criteria), or severe (>=6 criteria). In the DSM-5, the term addiction is synonymous with the classification of severe substance use disorder. DSM-5 recognizes 10 substance classes around which substance use disorders emerge: alcohol; caffeine; cannabis; hallucinogens (with separate categories for phencyclidine [or similarly acting arylcyclohexylamines] and other hallucinogens); inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants (amphetamine-type substances, cocaine, and other stimulants); tobacco; and other (or unknown) substances. Comorbidity Substance use disorders are highly comorbid with various psychological disorders. 53-76% of people with substance dependence have at least 1 other co-occurring psychiatric disorder. Higher levels of substance use disorders have been found in people with bipolar disorder, major depression, anxiety disorders, schizophrenia, bulimia and personality disorders than in the general population. Usually psychiatric disorders pre-date substance abuse and dependence, which suggests a self-medication effect, in which people with a psychiatric disorder start using substances to alleviate the negative emotional & behavioral effects of the disorder. coping mechanism Classes of drugs There is no one way to classify different drugs into stimulants, depressants and hallucinogens, because many can Psychopathology Page 1  There is no one way to classify different drugs into stimulants, depressants and hallucinogens, because many can overlap across categories. For example, nicotine can act as both a stimulant and a depressant; hallucinogenic drugs (e.g. LSD & MDMA) have both hallucinogenic and stimulant properties; cannabis has a variety of psychological and physical effects. Depressants In low doses, depressants make people relaxed and somewhat sleepy, reduce concentration, and impair thinking, judgment and motor skills. In heavy doses, they can induce stupor or death. Alcohol 8.5 %, higher in men At first, alcohol acts to relax the individual as a GABA agonist. Low doses of alcohol also cause increased self-confidence, relaxation, euphoria and disinhibition. Sexual functioning can be impaired. At increasing doses, symptoms of depression are caused (fatigue & lethargy, decreased motivation, sleep disturbances, depress ed mood, confusion. Intoxication leads to people slurring their words, walking unsteadily, having difficulties with attention & memory, and are s low in their physical reactions. They may act inappropriately, becoming aggressive or rude. Extreme intoxication can lead to stupor or coma. Intoxicated people usually deny it. lower dose is more of a stimulant, then a depressant Alcohol's course of effect is biphasic - its initial effects may act as a stimulant (making the drinker reactive & happy), but the later effects as a depressant (maki ng the drinker sluggish and causing negative emotions). Alcohol myopia - when an alcohol-intoxicated individual has less cognitive capacity available to process all ongoing information, and so alcohol acts to narro w attention. This leads to an arousal-dampening effect, where both positive & negative affect are reduced. Therefore, the drinker's behavior is likely to be under the influence of the most salient cues in the environment. In lively,friendly environments, this will result in the drinker processing only these types of cues, and as a consequence will feel happy, sociable, and unable to process worries ornegative emotions. Blackout - the type of amnesia that people sometimes have once sober, about the events that occurred while they were intoxicated with al cohol. An empty stomach quickly delivers alcohol to the small intestine, where it is rapidly absorbed into the body. A person with a full stomach needs to drink many more drinks before reaching a dangerous blood-alcohol level or showing clear signs of intoxication. In countries where alcohol is usually consumed with meals (e.g. France), there are lower rates of alcohol use disorders. Around 50% of all fatal car accidents & deaths due to falls or fires and > 1/3 of drownings are alcohol -related. More than 50% of murderers and their victims are intoxicated with alcohol at the time of the murders, and people who attempt/ commit suicide often do so while drunk. Alcohol withdrawal symptoms manifest themselves in 3 stages: Within a few hours after drinking has been stopped, a person experiences tremulousness (the 'shakes'), weakness, perspiration. Sometimes also anxiety, headache, nausea, abdominal cramps, vomiting. The person is restless and easily startled but alert. The EEG pattern may be mildly abnormal. The person may begin to see/hear things. If alcohol use disorder is moderate, only this first stage of withdrawal may be experienced, and the symptoms may disappear within a few days. After >=12 hours after drinking has stopped (but usually on the second-third day), convulsive seizures may occur. The third stage involves delirium tremens (DTs). These include auditory, visual & tactile hallucinations. They may also include bizarre, terrifying delusions, reduction of sleep, agitation, disorientation, fever, perspiration, and irregular heartbeat. DT is fatal in ~10% of cases. Death may occur from hyperthermia or the collapse of the peripheral vascular system. Only 10% of people with sever alcohol use disorder ever experience seizures or DTs. The symptoms are more common in people with a medical illness who drink large amounts in a single sitting. Binge drinking, a.k.a. heavy episodic drinking (>=5 drinks within a couple of hours for men, >=4 drinks within a couple of hours for women) and heavy drinking (binge drinking on >=5 days a month) are associated with significant health problems. In most countries, men are more likely than women to engage in binge & heavy drinking. Males are also much more likely to develop alcohol use disorders than females. Psychopathology Page 2  Males are also much more likely to develop alcohol use disorders than females. The gender gap is even greater among men and women who subscribe to traditional gender roles, which condone drinking for men but not for women. The earlier the age of onset of drinking and drinking-related problems, the more likely individuals are to develop alcohol use disorders. Alcohol use disorders decline with age, due to the following factors: With age the liver metabolizes alcohol at a slower rate, and the lower % of body water increases the absorption of alcohol =>older people become intoxicated faster and experience the negative effects more severely and more quickly. As people grow older, they may become more mature in their choices regarding drinking alcohol to an excess. Older people have grown up among stronger prohibitions against alcohol use. People who have used alcohol excessively for many years die from alcohol-related diseases before they reach old age. Alcohol-related problems have been related to poverty & unemployment, low levels of education, and a greater sense of helplessness & hopelessness. Heavy alcohol use can have toxic effects on many systems of the body, including the stomach, esophagus and liver. Low-grade hypertension (one of the most common medical conditions associated with alcohol misuse), combined with increases in thelevels of triglycerides and low- density lipoprotein (a.k.a. "bad") cholesterol, increases alcohol users' risk for heart disease. Heavy alcohol use increases cancer risk, particularly breast cancer in women. Alcohol use can lead to malnourishment because chronic alcohol ingestion decreases the absorption of critical nutrients from the gastrointestinal system and because alcoholics often skip meals and drink alcohol instead. A chronic thiamine (vitamin B1) deficiency sometimes occurs, which can lead to several CNS disorders: numbness & pain in extremities, muscle deterioration, loss of visual acuity. Heavy alcohol use increases the risk of dementia and substance-induced mild neurocognitive disorder. Heavy and prolonged use of alcohol during adolescence and early adulthood may have permanent negative effects on the brain, which is undergoing massive developmental changes during these periods of life. Longitudinal studies suggest that these effects of alcohol may persist even after people stop drinking. Fetal alcohol syndrome - physiological risks associated with heavy drinking in women, in which heavy drinking during pregnancy can cause a variety of physical & psychological abnormalities in the child. Benzodiazepines and barbiturates Intoxication with and withdrawal from other depressants (e.g. benzodiazepines & barbiturates) are similar to alcohol intoxica tion and withdrawal. Benzodiazepines & barbiturates are legally manufactured and sold by prescription, usually as sedatives or for the treatment o f anxiety and insomnia, as muscle relaxants or antiseizure medications. However, large quantities of these substances end up on the black market and are abused in combination with other drugs to pr oduce greater euphoria or to relieve the agitation caused by other substances. 9% of adults, 9.6% of college students, and 5% of teenagers report using prescription sedatives or tranquillizers in the lastyear for nonmedical purposes. DSM-5 classifies problematic misuse of these drugs as sedative, hypnotic or anxiolytic use disorders. In overdose, benzodiazepines & barbiturates can be extremely dangerous or even cause death from respiratory arrest or cardiov ascular collapse. Overdose is especially likely when these substances are combined with alcohol. Stimulants Stimulants activate the CNS, causing feelings of energy, happiness and power; a decreased desire Psychopathology Page 3  Stimulants activate the CNS, causing feelings of energy, happiness and power; a decreased desire for sleep; and a diminished appetite. Cocaine and amphetamines (including related methamphetamines) are the stimulants associated with severe substance use disorders. They cause dangerous increases in blood pressure & heart rate, alter the rhythm & electrical activity of the heart, constrict the blood vessels, which can lead to heart attacks, respiratory arrest, and seizures. The use of prescription stimulants (e.g. Ritalin & Dexedrine) for nonmedical purposes has sharply increased in the recent decades and they can also have long-term negative effects. Cocaine 0.3% Cocaine - a white powder extracted from the coca plant, which is one of the most addictive substances known. Initially, it produces intense euphoria, followed by heightened self-esteem, alertness, energy, and feelings of competence and creativity. Users crave increasing amounts due to cocaine's physiological & psychological effects. In high doses or when taken repeatedly, it leads to grandiosity, impulsiveness, hypersexuality, compulsive behavior, agitation, and anxiety reaching the point of panic & paranoia. Stopping cocaine use can induce exhaustion and depression. Cocaine blocks transporters for the reuptake of dopamine, resulting in excess dopamine in the synapses. These rapid & strong effects on the brain's reward centers make cocaine more likely to lead to a stimulant use disorder. People with cocaine-related stimulant use disorder spend huge amounts of money on cocaine and may engage in theft, prostitution, or drug dealing to obtain enough money to purchase it. Desperation can lead frequent users to participate in extremely dangerous behaviors. Many users contract HIV by sharing needles with infected users or by having unprotected sex in exchange for money or cocaine. Amphetamines Amphetamines (& related methamphetamines) are stimulants prescribed for the treatment of attention problems, narcolepsy & chronic fatigue. Amphetamines cause dopamine & norepinephrine release & block their reuptake. Intoxication symptoms are similar to those of cocaine. Like cocaine, they can also induce perceptual illusions & persecutory delusions that act users to lead violently. Some users know that these experiences are not real, but others develop amphetamine-induced psychotic disorders. Tolerance & physical dependence develops quickly for amphetamines. Chronic users may experience mood instability, memory loss, confusion, paranoia, and perceptual abnormalities for weeks, mont hs or even years. With extended use, people become irritable & hostile and need more stimulants to avoid withdrawal symptoms. Their personal relationships & health decline. Abuse of (meth)amphetamines can lead to many medical issues, particularly cardiovascular problems. Nicotine Nicotine is an alkaloid found in tobacco. Over 2/3 of people who begin smoking become dependent on nicotine, which is much higher than found with most other psychoactive substances. Tobacco use is increasing in developing countries but decreasing in industrialized countries due to high taxes, restricting l aws and limited advertisement. Nicotine operates on both the central & peripheral nervous systems: In the brain, it helps release dopamine (in the mesolimbic pathway, it acts through nicotinic receptors which increase the firing rate of midbrain dopaminergic neurons), norepinephrine, serotonin and the endogenous opioids. Its physiological effects resemble the fight-or-flight response - several body systems are aroused, including the cardiovascular & respiratory systems. The subjective sense that smoking reduces stress may reflect the reversal of the tension and irritability that signal nicotine withdrawal (=> nicotine addicts need nicotine to feel normal to counteract its effects on the body and the brain). However, it is still possible that regular smokers come to associate smoking with tension relief and become conditioned to having a cigarette during or after any stressful experience. Longitudinal studies show that increases in negative affect and stressful life events are associated with increases in smokin g. In the DSM-5, nicotine dependence is recognized as a tobacco use disorder. Cigarette smoking causes lung cancer, bronchitis and probably coronary heart disease. Women who smoke while pregnant give bir th to smaller babies. When chronic heavy users try to quit smoking or are forbidden from smoking for an extended period, they show severe withdrawa l symptoms: they become depressed, irritable, angry, anxious, frustrated, restless, hungry; they have trouble concentrating, and desperately crave a cigarette. These symptoms are relieved immediately by smoking. Psychopathology Page 4  These symptoms are relieved immediately by smoking. 70% of people who smoke say they want to quit. However, quitting is difficult, partly because the withdrawal syndrome is diff icult to withstand. dopamine spikes -> cause craving In this way, environmental stimuli previously paired with drug use start eliciting conditioned spikes of dopamine that trigger the craving for the drug, motivate drug- seeking behaviors and lead to heavy "binge" use of the drug. While dopaminergic neurons stop firing after repeated consumption of a natural reward (e.g. food, sex) and satiate the drive to further pursue it, addictive drugs go around this natural satiation and continue to directly increase dopamine levels, which helps explain why compulsive behaviorsare more likely to emerge when people use drugs than when they pursue a natural reward.natural rewards like food or sex: dopamine release eventually decreases after repeated consumption, leading to satiation (the feeling of being satisfied addictive drugs: Withdrawal and negative affect bypass this natural mechanism: directly increase dopamine levels without decreasing over time. This explains why compulsive behaviors (e.g., addiction) are more likely to develop with drugs compared to natural re As a result of the conditioning involved in drug addiction, ordinary & healthy rewards lose their former motivational power. This is partly because in addicts, the reward & motivational systems become reoriented to focus on the more potent release ofdopamine produced by the drug and its cues. drug use triggers smaller dopamine increases, making the brain less sensitive to rewards: tolerance develops, meaning the addict no longer feels the same level of euphoria from the drug. everyday rewards (e.g., eating or socializing) feel unimportant or unfulfilling compared to the drug. In addicts, drug consumption triggers less and less dopamine increases, which makes the reward system less sensitive to stimu lation by both drug-related and non-drug- related rewards. As a result, addicts no longer experience the same degree of euphoria from the drug and it is often the case that they becomeless motivated by everyday stimuli that they previously found to be motivating & rewarding. These changes become deeply ingrained and cannot be immediately reversed through termination of drug use. lasting brain changes Moreover, repeated exposure to dopamine-enhancing drugs leads to adaptations in the circuitry of the extended amygdala, which result in increased reactivity to stres s and emergence of negative emotions. This "antireward" system is facilitated by corticotrophin-releasing factor & dynorphin, which normally help maintain homeostasis. However, in the addicted brain, this antireward system becomes overactive, causing the dysphoric phase of drug addiction during withdrawal and reducing reactivity of dopaminergic neurons. Therefore, the conditioned pull towards the rewards of drug use is accompanied by a motivational push to escape the discomfort associated with withdrawal. As a result, a person no longer takes drugs for pleasure, but to escape dysphoria. This leads to a vicious cycle where people take the drug to only temporarily relieve distress and eventually deepen the dysph oria during withdrawal. Preoccupation and anticipation Addiction also results in changes in the PFC. The down-regulation of dopamine signaling also occurs in PFC & its associated circuits, impairing executive processes (e.g. self-regulation, decision making, flexibility in Psychopathology Page 13  The down-regulation of dopamine signaling also occurs in PFC & its associated circuits, impairing executive processes (e.g. self-regulation, decision making, flexibility in the selection and initiation of action, attribution of salience (the assignment of relative value), and the monitoring of error). Impaired signaling of dopamine & glutamate in PFC weakens addicts' ability to resist strong urges or to follow through on decisions to stop taking the drug. Classic psychedelics in the treatment of substance use disorder: potential synergies with 12-step programs - Yaden (2021) ! „accepted treatments“ = treatments that are legal, approved, and accessible to patients -so psychedelics are not included, only in MC Classic psychedelics for substance use disorders Classic psychedelics primarily act on the serotonin system as agonists of the serotonin 2A receptor. These include psilocybin , LSD, mescaline, DMT and the DMT-containing ayahuasca. These compounds are extremely low in toxicity, are non-addictive and usually cause only mild, transient physiological changes (e.g. modest increases in blood pressure & heart rate). Physiological and psychological risks are strongly mitigated in a clinical setting. Preliminary studies have shown that classical psychedelics could be beneficial in treating various psychiatric disorders, inc luding substance use disorders across a wide variety of substances, including tobacco, alcohol, opioids and cocaine. There are also naturalistic classic psychedelic uses that led to addiction recovery across a wide variety of substances (e.g. the AA founder Bill Wilson recovered completely after using a classical psychedelic). There seems to be a link between treatment outcomes and the level of 'mystical' experience a participant reports. Twelve-step Facilitation (TSF) 12-step programs advocate an abstinence-only policy. Despite evidence supporting the efficacy of medication-assisted treatments, these programs state that these treatments are philosophically incompatible with their emphasis on abstinence. However, 12-step programs have been described as a 'spiritual recovery movement', and their participants are looking to a higher power for guidance. The ultimate goal of such programs is to elicit a spiritual awakening that will help the individual out of their addiction. Therefore, some of the properties of classic psychedelics' subjective effects suggest an ideological overlap with aspects of these programs, warranting a consideration of combining classical psychedelic administration with such treatments. For example, psychedelics can be included in step 2 of the 12-step programs (surrendering oneself to recovery), where many people tend to drop out, or at step 12, where a spiritual awakening leads to recovery. 1. acceptance 2. surrender 3. involvement emphasis is on a guiding force, not necessarily a religious deity, believe that this higher one can restore sanity While it might be seen as controversial in some quarters to suggest that classic psychedelic treatments for substance use dis order are compatible with 12-step programs, evidence indicates that Bill Wilson, the very founder of AA, supported this view and that classic psychedelic treatments seem largely compatible with the overall philosophy of AA programs. why? group-based, peer-support mode, personal guidance controversial: referencing to „higher power“, accepting powerlessness, one size fits all approach - doesn’t address individual differences or co-occuring mental disorders, Psychopathology Page 14