Alcohol and Substance Disorders PDF

11/13/24 Alcohol and Substance Disorders 1 Alcohol USE DISORDER Potential Effects Impacts cognition, relationships, work behaviors, physical health Damage to areas of brain contribute to memory impairment, problems with...

11/13/24 Alcohol and Substance Disorders 1 Alcohol USE DISORDER Potential Effects Impacts cognition, relationships, work behaviors, physical health Damage to areas of brain contribute to memory impairment, problems with attention and processing speed and balance difficulties Long term cumulative effects on system overall 2 Alcohol USE DISORDER Potential effects Cirrhosis of the liver (jaundice) Korsakoff’s Syndrome (nutritional problems) Fetal alcohol syndrome Withdrawal symptoms Varied … DT Delirium tremens 3 1  11/13/24 Sedatives/hypnotics Anxiolytics: feelings of relaxation and drowsiness to reduce anxiety and aid sleep Low doses – calming or sedative effect High doses – induced sleep or hynotics *Barbiturates – widely prescribed for decades … not so cool any more phenobarbital, amobarbital 4 Sedatives/hypnotics Benzodiazepines “Safer” with less risk of intoxication, tolerance and withdrawal Long term use can cause cognitive impairment Increases GABA activity (inhibitory) Xanax, Ativan, Valium 5 Natural (opium, heroin, morphine, codeine) Synthetic (methadone) Routes of administration vary by Opiates substance Speed of action and development of tolerance vary but generally – all happens pretty quick! 6 2  11/13/24 Opiates Withdrawal symptoms can be very severe Anxiety, restlessness initially Further into sickness: diarrhea, vomiting, fever, body aches, twitching and dehydration Many ”relapse” in order to avoid the withdrawal Medical detox is helpful in managing symptoms 7 Opiates 25 % of opioid use disorder – heroin Greatly increased over the pandemic – why? Dangers Overdose Impurity of drug (dealers cut it so it is more addictive and they have more product to sell) Lifestyle – high risk situations, cleanliness not a concern 8 Opiates 15,000 + die every year from heroin overdose 37,000 die every year from ”pain relievers” Fentanyl = 20 – 35x stronger than heroin (but it ”seems” cleaner) Even after short term abstinence, chance of overdose increases with relapse as person goes back to using same amount, with less tolerance 9 3  11/13/24 Opiates Often begins with prescription use that becomes problematic Some rationalize their use because “the doctor said so” Other times, it is used for recreation without knowing how quickly dependance can develop Withdrawal sickness keeps people hooked 10 STIMULANTS Opposite of depressants and stimulate the activity of the CNS *heart* Common Cocaine – most powerful known Amphetamines – Caffeine – 90% of world population DAILY 11 STIMULANTS: Cocaine Increases dopamine, serotonin and norepinephrine, producing euphoric feeling Snorted – injected – smoked …. Various forms (freebasing – pure, crack - cheap) Over 40,000,000 have tried it, 2,000,000 currently using Use often followed by depression like crash AND depression of the respiratory system 12 4  11/13/24 STIMULANTS: AMphetamines Lab-created: amphetamine, dextroamphetamine, methamphetamine Prescribed for ADHD and used off-label for depression Usually pill or capsule form but sometimes crushed for faster effect Low dose – increased energy and alertness with decreased appetite High dose – rush, intoxication, psychosis 1 in 10 college students acquire it without a prescription 13 STIMULANTS: AMphetamines Methamphetamine (meth, crank) Made in “stove top labs” Dangers Physical, mental, emotional distress ER visits Neurotoxicity – paranoia, delusions, hallucinations (some don’t come back from it) 14 Hallucinogens “psychedelic drugs” Produces powerful changes in sensory and perceptual processes Some natural, others manufactured – any can be dangerous 15 5  11/13/24 Hallucinogens: LSD Lysergic acid diethylamide State of hallucinogen intoxication (Hallucinosis) @ 6 hours Strong emotions – joy, anxiety, depression, fear Hallucinations Synesthesia 16 Hallucinogens: LSD BUT – long term effects Tolerance and … flashbacks, self-injury, withdrawal are rare bad trips 17 Hallucinogens: MDMA 3, 4-methylenedioxymethamphetamine “Ecstasy” or “Molly” … but … unlikely that recreational versions are pure, thus negating research about it being useful, enhancing or safe Energy boost and feelings of connectedness (to others, to the world) Psychological and cognitive impairment can be immediate 18 6  11/13/24 Hallucinogens: Cannabis Produced from variety of hemp plants Hashish – solidified resin of cannabis plant Marijuana – mixture of buds, crushed leaves, flowers Active ingredient: Tetrahydrocannabinol (THC) Experience varies by potency Mix of hallucinogenic, depressant and stimulant effects 19 Hallucinogens: Cannabis 1970s – THC content in marijuana around 2% 2020s – THC content in marijuana around 15% Higher concentration when used with a vape Withdrawal symptoms evident after regular use (CRANKY!! ) Long term health risks: lungs, reproductive organs, memory 20 COMBINED SUBSTANCES Synergistic effects: the whole is greater than the sum of its parts Sometimes effects are compounded – experience extremes of usual reaction Sometimes effects are antagonistic – use of one makes use of another more problematic OR opposite effect is experienced Polysubstance use can lead to unintended effects – even hospitalization 21 7  11/13/24 Causes of Substance Use disorder: sociocultural Chronic stress (health, discrimination, housing, interpersonal) Families that value or tolerate substance use Socioeconomic hardship – can’t pay electricity, they’re shutting if off anyway – may as well have a good time while I can… 22 Causes of Powerful dependency needs in early years Substance Use Parents did not provide for needs disorder: Learned to seek out ways to meet needs elsewhere psychodynamic 23 “Substance Abuse Personality” Causes of Dependent Substance Use Antisocial disorder: Impulsive Novelty seeking psychodynamic Risk-taking Depressed 24 8  11/13/24 Causes of Substance Use disorder: Cognitive Behavioral Substance used to self-medicate when feeling tense or anxious Classical conditioning – seeing cues leads to behavior associated with pleasure Operant conditioning – feel better? Use again 25 Causes of Substance Use disorder: Biological Genetics Neurotransmitters Brain’s reward circuit 26 Causes of Substance Use disorder: Biological Genetics Predisposition shown in animal studies, twin studies, adoptee studies Abnormal dopamine-2 receptor genes in subjects with substance use disorders 27 9  11/13/24 Causes of Substance Use disorder: Biological Neurotransmitters Excessive drug use leads brain to reduce production of particular neurotransmitters Tolerance and withdrawal as evidence of the brain’s shift after repeated exposure to substance Alcohol, benzodiazepines: lower GABA production Cocaine, amphetamines: lower endorphin production Marijuana: lower anandamide production 28 Causes of Substance Use disorder: Biological Brain Reward Circuit Key neurotransmitter: Dopamine Activated with food, hugs, praise, music, etc….. Also activated with alcohol and substances Activation may be direct or indirect … same effect 29 Causes of Substance Use disorder: Biological Brain Reward Circuit Incentive-Sensitization Theory: some neurons fire more readily when stimulated by certain substances, creating a craving for the substance Reward Deficiency Syndrome: reward center is NOT readily activated in daily life … can create same effect with substances 30 10  11/13/24 Treatment of Substance Use disorder: Psychodynamic Therapy to identify and understand unmet needs Work toward resolution of internal conflicts Research: little support when used as sole approach 31 Treatment of Substance Use disorder: cognitive behavioral Aversion Therapy Contingency Management Relapse Prevention Acceptance and Commitment Therapy 32 Treatment of Substance Use disorder: cognitive behavioral Aversion Therapy Most common in treating alcohol use disorders Pair an unpleasant stimulus with the substance – repeatedly – until the substance itself creates the same yucky feeling Not always clear if it is a good choice, therapeutically (risky) 33 11  11/13/24 Treatment of Substance Use disorder: cognitive behavioral Contingency Management Incentives contingent on clean drug tests (operant conditioning) Needs a fairly motivated individual to work … if not, the incentive is meaningless and won’t work 34 Treatment of Substance Use disorder: cognitive behavioral Relapse Prevention Work toward having control over substance-related thoughts and behaviors Track use to understand everything about the experience Develop coping skills to use in risky situations Plan for likely circumstances that may be problematic 35 Treatment of Substance Use disorder: cognitive behavioral Acceptance and Commitment Therapy Used to acknowledge and accept difficult thoughts, cravings, behaviors, situations Reduce urge to “fight off” the urge to use and instead allow it to pass 36 12  11/13/24 Treatment of Substance Use disorder: biological Detoxification Antagonist Drugs Drug Maintenance 37 Treatment of Substance Use disorder: biological Detoxification Systematic and medically supervised withdrawal from a substance Can be outpatient but often inpatient May have person gradually reduce ingestion OR may treat withdrawal symptoms to get them through the worst of it *** Not sufficient “treatment” – just first step 38 Treatment of Substance Use disorder: biological Antagonist Drugs Medications used to block or change the effect of substances Disulfram (Antabuse) used for alcohol – little effect alone but lots of undesirable side effects if alcohol is ingested Naloxone used for opiates – make the drug “ineffective” in terms of creating usual response (high) 39 13  11/13/24 Treatment of Substance Use disorder: biological Drug Maintenance Medically supervised substitute for the drug of choice Meant to provide a safer situation with less tolerance buildup and fewer withdrawal symptoms 40 Gambling disorder Defined by the addictive nature of the behavior Genetic predisposition Heightened dopamine activity and dysfunction when gambling Impulsive, novelty-seeking personality style Repeated cognitive mistakes re: expectancies, risk analysis Treatment Cognitive-behavioral approaches (relapse-prevention training) Biological approaches (opioid antagonists) Self-help programs (Gamblers Anonymous) 41 Gambling Disorder Maladaptive pattern of gambling, featuring at least 4 of the following symptoms over the course of a full year: Gambling often triggered by upset feelings Can achieve excitement only by increasing Frequently returns to gambling to recoup gambling previous losses Feels restless or irritable during gambling Lies to cover up amount of gambling reduction Gambling puts important relationships, job, or Repeated failures at controlling gambling education at risk Consumed with gambling thoughts Seeks money from others to address Gambling often triggered by upset feelings gambling debts 42 14