Chapter 10Substance-Related Disorders

Perspectives on Substance-RelatedDisorders: An Overview

The Nature of Substance-Related Disorders Problems related to the use and abuse of psychoactive

substances Produce wide-ranging physiological, psychological, and

behavioral effects Some Important Terms and Distinctions

Substance use vs. substance intoxication Substance abuse vs. substance dependence Tolerance vs. withdrawal

Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Five Main Categories of Substances Depressants – Result in behavioral sedation (e.g.,

alcohol, sedative, anxiolytic drugs) Stimulants – Increase alertness and elevate mood (e.g.,

cocaine, nicotine, caffeine) Opiates – Primarily produce analgesia and euphoria (e.g.,

heroin, morphine, codeine) Hallucinogens – Alter sensory perception (e.g.,

marijuana, LSD) Other drugs of abuse – Include inhalants, anabolic

steroids, medications

Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.1

Ice, LSD, chocolate, TV: Is everything addictive?

Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.1 (cont.)

Ice, LSD, chocolate, TV: Is everything addictive?

Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.2

Easy to get hooked on, hard to get off

Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.2 (cont.)

Easy to get hooked on, hard to get off

The Depressants: Alcohol Use Disorders

Psychological and Physiological Effects of Alcohol Central Nervous system depressant Influences several neurotransmitter systems, but mainly

GABA Effects of Chronic Alcohol Use

Alcohol intoxication Alcohol withdrawal Associated brain conditions – Dementia and Wernicke’s

disease Fetal alcohol syndrome

DSM-IV Criteria for Disordered Alcohol Use

The Depressants: Alcohol Use Disorders (cont.)

Figure 11.3

The path traveled by alcohol throughout the body

In the United States Most adults consider themselves light drinkers or

abstainers Most alcohol is consumed by 11% of the U.S. population Alcohol use is highest among Caucasian Americans Males use and abuse alcohol more so than females Violence is associated with alcohol, but alcohol alone

does not cause aggression

Alcohol: Some Facts and Statistics

Facts and Statistics on Problem Drinking 10% of Americans experience problems with alcohol Most persons with alcoholism can moderate or cease

drinking on occassion 20% of those with alcohol problems experience

spontaneous recovery Anhedonia – Lack of pleasure, or indifference to

pleasurable activities Affective flattening – Show little expressed emotion, but

may still feel emotion

Alcohol: Some Facts and Statistics (cont.)

Sedative, Hypnotic, or AnxiolyticSubstance use Disorders: An Overview

The Nature of Drugs in This Class Sedatives – Calming Hypnotic – Sleep inducing (e.g., barbiturates) Anxiolytic – Anxiety reducing (e.g., benzodiazepines)

Effects of Such Drugs Are Similar to Large Doses of Alcohol Combining such drugs with alcohol is synergistic

All Exert Their Influence Via the GABA Neurotransmitter System

DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders

Stimulants: An Overview

Nature of Stimulants Most widely consumed drug in the United States Such drugs increase alertness and increase energy Examples include amphetamines, cocaine, nicotine, and

caffeine

Stimulants: Amphetamine Use Disorders

Effects of Amphetamines Produce elation, vigor, reduce fatigue Enhance the release of dopamine and norepinephrine,

while blocking reuptake Such effects are followed by a “crash” (e.g., feeling

depressed and tired) DSM-IV Criteria for Amphetamine Intoxication

Psychological symptoms Physiological symptoms

Ecstasy and Ice Produces effects similar to speed, but without the crash 2% of college students report using Ecstasy Both drugs can result in dependence

Stimulants: Cocaine Use Disorders

Effects of Cocaine Produce short lived sensations of elation, vigor, reduce

fatigue Effects result from blocking the reuptake of dopamine Cocaine is highly addictive, but addiction develops slowly Cocaine use in the United States has declined over the

last decade DSM-IV Criteria for Cocaine Intoxication and Withdrawal

Psychological symptoms Physiological symptoms Most cocaine users cycle through patterns of tolerance

and withdrawal

Stimulants: Nicotine Use Disorders

Effects of Nicotine Stimulates the central nervous system, specifically

nicotinic acetylcholine receptors Results in sensations of relaxation, wellness, pleasure Nicotine is highly addictive

DSM-IV Criteria for Nicotine Withdrawal Only Psychological symptoms Physiological symptoms Nicotine users dose themselves to maintain a steady

state of nicotine

Stimulants: Nicotine Use Disorders (cont.)

Figure 11.8

Relapse rates for nicotine compared to alcohol and heroin

Stimulants: Caffeine Use Disorders

Effects of Caffeine – The “Gentle” Stimulant Found in tea, coffee, cola drinks, and cocoa products Caffeine blocks the reuptake of the neurotransmitter

adenosine Small doses elevate mood and reduce fatigue Used by over 90% of Americans Regular use can result in tolerance and dependence

DSM-IV Criteria for Caffeine Intoxication Psychological symptoms Physiological symptoms

Opiods: An Overview

The Nature of Opiates and Opiods Opiate – Natural chemical in the opium poppy with

narcotic effects (i.e., pain relief) Opiods – Refers to a class of nature and synthetic

substances with narcotic effects Such drugs are often referred to as analgesics Examples include heroin, opium, codeine, and morphine

Effects of Opiods Activate body’s enkephalins and endorphins Low doses induce euphoria, drowsiness, and slowed

breathing High doses can result in death Withdrawal symptoms can be lasting and severe

DSM-IV Criteria for Opiod Intoxication and Withdrawal Psychological symptoms Physiological symptoms Mortality rates are high for opiod addicts

Opiods: An Overview (cont.)

Hallucinogens: An Overview

Nature of Hallucinogens Substances that change the way the user perceives the

world May produce delusions, paranoia, hallucinations, and altered

sensory perception Examples include marijuana, LSD

Marijuana Active chemical is tetrahydrocannabinol (THC) May produce several symptoms (e.g., mood swings,

paranoia, hallucinations) Impairment in motivation is not uncommon (i.e.,

amotivational syndrome) Major signs of withdrawal and dependence do not typically

occur

Hallucinogens: An Overview (cont.)

LSD and Other Hallucinogens LSD is most common form of hallucinogenic drug Tolerance tends to be rapid, and withdrawal symptoms

are uncommon Psychotic delusional and hallucinatory symptoms can be

problematic DSM-IV Criteria for Marijuana and Hallucinogen Intoxication

Psychological and physiological symptoms are similar

Other Drugs of Abuse: Inhalants

Nature of Inhalants Substances found in volatile solvents that are breathed

into the lungs directly Examples include spray paint, hair spray, paint thinner,

gasoline, nitrous oxide Such drugs are rapidly absorbed with effects similar to

alcohol intoxication Tolerance and prolonged symptoms of withdrawal are

common DSM-IV criteria for inhalant intoxication

Other Drugs of Abuse: Anabolic Steroids

Nature of Anabolic-Androgenic Steroids Steroids are derived or synthesized from testosterone Used medicinally or to increase body mass Users may engage in cycling or stacking Steroids do not produce a high Steroids can result in long-term mood disturbances and

physical problems

Other Drugs of Abuse: Designer Drugs

Designer Drugs Drugs produced by pharmaceutical companies for

diseases Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine

(“special K”) are examples Such drugs heighten auditory and visual perception,

sense of taste/touch Becoming popular in nightclubs, raves, or large social

gatherings All designer drugs can produce tolerance and

dependence

Causes of Substance-Related Disorders: Family and Genetic Influences

Results of Family, Twin, and Adoption Studies Substance abuse has a genetic component Much of the focus has been on alcoholism Genetic differences in alcohol metabolism Multiple genes are involved in substance abuse

Causes of Substance-Related Disorders:Neurobiological Influences

Results of Neurobiological Research Drugs affect the pleasure or reward centers in the brain The pleasure center – Dopamine, midbrain, frontal cortex GABA turns off reward-pleasure system Neurotransmitters responsible for anxiety/negative affect

may be inhibited

Causes of Substance-Related Disorders:Psychological Dimensions

Role of Positive and Negative Reinforcement The self-medication and the tension reduction hypotheses Most see substance abuse as a means to cope with

negative affect Opponent-Process Theory

Explains why the crash after drug use fails to keep people from using

Role of Expectancy Effects Expectancies influence drug use and relapse

Causes of Substance-Related Disorders:Social and Cultural Dimensions

Exposure to Drugs is a Prerequisite for Use of Drugs Media, family, peers Parents and the family appear critical

Societal Views About Drug Abuse Sign of moral weakness – Drug abuse is a failure of self-

control Sign of a disease – Drug abuse is caused by some

underlying process The Role of Cultural Factors

Influence the manifestation of substance abuse

Exposure or Access to a Drug Is Necessary, but not Sufficient

Drug Use Depends on Social and Cultural Expectations Drugs Are Used Because of Their Pleasurable Effects Drugs Are Abused for Reasons That Are More Complex

The premise of equifinality Stress may interact with psychological, genetic, social,

and learning factors

An Integrative Model of Substance-Related Disorders

An Integrative Model ofSubstance-Related Disorders (cont.)

Figure 11.11

An integrative model of substance related disorders

Biological Treatment of Substance-Related Disorders

Agonist Substitution Safe drug with a similar chemical composition as the

abused drug Examples include methadone for heroin addiction, and

nicotine gum or patch Antagonistic Treatment

Drugs that block or counteract the positive effects of substances

Examples include naltrexone for opiate and alcohol problems

Biological Treatment ofSubstance-Related Disorders (cont.)

Aversive Treatment Drugs that make the injection of abused substances

extremely unpleasant Examples include antabuse for alcoholism and silver

nitrate for nicotine addiction Efficacy of Biological Treatment

Such treatments are generally not effective when used alone

Psychosocial Treatment of Substance-Related Disorders

Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

Inpatient vs. Outpatient Care Data suggest little difference in terms of overall

effectiveness Community Support Programs

Alcoholics Anonymous and related groups Seem helpful and are strongly encouraged

Psychosocial Treatment ofSubstance-Related Disorders (cont.)

Components of Comprehensive Treatment and Prevention Programs Individual and group therapy Aversion therapy and convert sensitization Contingency management Community reinforcement Relapse prevention Preventative efforts via education

Summary of Substance-Related Disorders

DSM-IV and DSM-IV TR Substance Related Disorders Cover Four Classes Depressants, stimulants, opiates, and hallucinogens Specific diagnoses include dependence, abuse,

intoxication, or withdrawal Most Psychotropic Drugs Activate the Dopaminergic Pleasure

Pathway in the Brain Psychosocial Factors Interact with Biological Influences to

Produce Substance Disorders Treatment of Substance Dependence Is Largely Unsuccessful

Highly motivated persons do best when part of combined treatment programs

Substance-Related Disorders Are 100% Preventable

Summary of Substance-Related Disorders (cont.)

Figure 11.x1

Exploring substance-related disorders

Summary of Substance-Related Disorders (cont.)

Figure 11.x1 (cont.)

Exploring substance-related disorders

Summary of Substance-Related Disorders (cont.)

Figure 11.x2

Exploring substance-related disorders, treatment

Summary of Substance-Related Disorders (cont.)

Figure 11.x2 (cont.)

Exploring substance-related disorders, treatment