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    PowerPoint Lecture Notes PresentationChapter 10

    Substance Related Disorders

    Abnormal Psychology, Eleventh Editionby

    Ann M. Kring, Gerald C. Davison, John M. Neale,& Sheri L. Johnson

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    Copyright 2009 John Wiley & Sons, NY 2

    Table 10.1 Percentage of US PopulationReporting Drug Use in Past onth !"00#$

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    Substance Dependence and%buse

    Substance deendence !addiction"# $ccuational or social roble%s, %uch ti%e trying to obtain substance,continued use desite roble%s, etc.

    nvolves either toleranceor withdrawal# 'olerance

    ( Greater a%ounts re)uired to roduce desired e**ect

    # +ithdraal( -hysiological and sychological conse)uences hen individualdiscontinues or reduces substance use estlessness, an/iety, cra%s, death

    Substance abuse# Maladative use o* substance

    # No hysiological deendence n 0112, 00 %illion %et criteria *or deendence or abuse.

    # $* those 34 %illion involved alcohol.

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    %lcohol Dependence and%buse

    Alcohol abuse# Negative social and occuational e**ects# No tolerance, ithdraal, or co%ulsive usage

    Alcohol Deendence

    # More severe sy%to%s such as tolerance and ithdraal# +ithdraal results in5( An/iety( Deression( +ea6ness( estlessness( nso%nia

    ( Muscle tre%ors 7ace, *ingers, eyelids, other s%all %usculature

    ( 8levated 9-, ulse, te%erature

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    %lcohol %buse andDependence

    Deliriu% tre%ens !D's"# Can occur hen blood alcohol levels dro

    suddenly

    # esults in5( Deliriousness( 're%ulousness

    ( :allucinations -ri%arily visual; %ay be tactile

    0.4< o* alcohol abusers develodeendence

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    %lcohol %buse andDependence

    -olydrug abuse# Many users abuse %ultile substances

    ( e.g., cigarettes, cocaine, %ari=uana

    ( >4< o* alcohol are s%o6ers

    Synergistic# So%e co%binations o* drugs roduce stronger

    reaction(Alcohol and barbiturates

    May cause death

    (Alcohol and heroin Alcohol reduces a%ount o* heroin needed to roduce lethal

    dose

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    Pre&alence of %lcohol %buse

    Li*eti%e revalence !Kessler et al., 3??@"# 01< *or %en# >< *or o%en

    Li*eti%e revalence5

    # Abuse 3B

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    Pre&alence of %lcohol %buse

    +hite adolescents and adults %ore li6ely toabuse alcohol than A*rican A%ericans

    9inge & heavy use drin6ing loest a%ong AsianA%ericans

    Alcohol deendence highest a%ong NativeA%ericans and :isanics

    03.< o* those ith alcohol abuse ordeendence also have at least 3 %ental disorder

    # e.g. ersonality, %ood, or an/iety disorders, orschiohrenia

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    Short'ter( )*ects of %lcohol

    8nters the bloodstrea% through s%allintestine# %etabolied by the liver

    8**ects vary by concentration

    # Concentration varies by gender, height, eight,liver e**iciency

    A**ects brain areas associated ith error%onitoring and decision %a6ing.

    9ihasic e**ect

    # nitially sti%ulates# Later deresses( ncrease in negative e%otions

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    Short'ter( )*ects of %lcohol

    8**ect o* ingesting large a%ounts# %aired seech and vision# nter*erence in co%le/ thought rocesses# -oor coordination

    # Loss o* balance# Deression and ithdraal

    nteracts ith several neural syste%s# Sti%ulates GA9A recetors

    # ncreases doa%ine and serotonin# nhibits gluta%ate recetors

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    Long'ter( )*ects of %lcohol

    Malnutrition# Calories *ro% alcohol lac6

    nutrients# Alcohol inter*eres ith digestion

    and absortion o* vita%ins *ro%*ood

    De*iciency o* 9co%le/ vita%ins# A%nestic syndro%e

    ( Severe loss o* %e%ory *or bothlong and short ter% in*or%ation

    Cirrhosis o* the liver# Liver cells engorged ith *at and

    rotein i%eding *unctioning# Cells die triggering scar tissue

    hich obstructs blood *lo

    # Liver disease and cirrhosis ran630thin ES causes o* death.

    Da%age to endocrine glandsand ancreas

    :eart *ailure 8rectile dys*unction :yertension Stro6e Caillary he%orrhages

    # 7acial selling and redness,esecially in nose

    Destruction o* brain cells# 8secially areas i%ortant to

    %e%ory

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    +etal %lcohol S,ndro(e

    :eavy alcohol inta6e during regnancy# 7etal groth sloed

    ( Cranial, *acial and li%b ano%alies occur

    Moderate alcohol inta6e# 3 drin6 er day

    # Learning and %e%ory i%air%ents

    # Groth de*icits

    'otal abstinence reco%%ended by NAAA

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    Nicotine and CigaretteS(o-ing

    Nicotine#Addicting agent o* tobacco

    # -rincial alkaloid

    (Active che%icals that give drugs theirhysiological and sychological alteringroerties

    # Sti%ulates doa%ine neurons in%esoli%bic area( nvolved in rein*orcing e**ect

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    Pre&alence and ealthConse/uences

    About @@1,111 A%ericans die re%aturely eachyear !ESD::S, 011@"

    Cigarettes 6ill 3,311 eole every day# 3 o* 2 deaths related to tobacco use

    Lung cancer is %ost co%%on cancer Cigarettes also cause or e/acerbate5

    # 8%hyse%a, cancers o* laryn/, esohagus,ancreas, bladder, cervi/, sto%ach

    # Sudden in*ant death syndro%e and regnancy

    co%lications# Cardiovascular disease

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    Pre&alence and ealthConse/uences

    -revalence decreased since %id 3?21s although useincreased through the 3??1s, a%ong hite adolescents More revalent a%ong hite & :isanic youth than A*rican

    A%ericans# A*rican A%ericans less li6ely to )uit and %ore li6ely to get lung

    cancer

    ( Metabolie nicotine %ore sloly Chinese A%ericans have loer lung cancer rates

    # Metabolie less nicotine

    More revalent a%ong %en than o%en# 8/cetion5 30 to 3B year olds

    Secondhand s%o6e !8'S, environ%ental tobacco s%o6e"# :igher levels o* a%%onia, carbon %ono/ide nicotine and tar# Causes @1,111 deaths er year in ES

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    ariuana

    Drug derived *ro% dried and groundleaves and ste%s o* the *e%ale he%lant !Cannibis sativa"

    :ashish

    # Stronger than %ari=uana

    # -roduced by drying the resin e/udate o* the

    tos o* lants

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    +igure 10 " Trends in oung %dults2

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    +igure 10." Trends in oung %dults2Use in Pre&ious onth fro( "00" to

    "00#

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    )*ects of ariuana

    Ma=or active ingredient# ':C !delta?

    tetrahydrocannabinol" -sychological

    # 7eelings o* rela/ation andsociability

    # aid shi*ts o* e%otion# nter*eres ith attention,

    %e%ory, and thin6ing( Decline in F over ti%e

    # :eavy doses can inducehallucinations and anic

    # %air%ent o* s6ills needed

    *or driving( %air%ent resent *or

    several hours a*ter highHhas orn o**

    -hysiological# 9loodshot & itchy eyes# Dry %outh and throat# ncreased aetite# educed ressure ithin the

    eye# ncreased 9-# Abnor%al heart rate

    ( May e/acerbate ree/istingcardiovascular roble%s

    # Da%age to lung structureand *unction in long ter%users

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    ariuana and the 3rain

    C93 and C90# 'o cannabinoid brain recetors# :igh concentration in hioca%us

    ( Contributes to S'M de*icits

    ncreased blood *lo to e%otion regions#A%ygdala and anterior cingulate gyrus Decreased blood *lo to te%oral lobe

    #Associated ith auditory attention( -oor er*or%ance on listening tas6s

    :abitual use leads to tolerance# +ithdraal sy%to%s also observed

    Therapeutic )*ects of

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    Therapeutic )*ects ofariuana

    educes nausea and loss o* aetite caused byche%otheray !Salan et al., 3?B4"

    elieves disco%*ort o* ADS !Suss%an et al.,3??2"

    Analgesic e**ects due to ability o* ':C to bloc6ain signals *ro% reaching the brain.

    Sure%e Court rulings5# 7ederal la rohibits disensing %ari=uana *or

    %edicinal uroses

    # Medical use can be rohibited by *ederalgovern%ent even i* states arove

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    4piates

    Grou o* addictive sedativesthat in %oderate dosesrelieve ain and induce slee# $iu%

    # Morhine

    # :eroin

    # Codeine Synthetic sedatives

    # Seconal and valiu%

    $iates legally rescribed as ain %edicationsinclude5

    # Hydrocodoneco%bined ith other substances yields Iicodin,ydone, and Lortab

    # Oxycodonethe basis *or $/yContin, -ercodan, & 'ylo/.

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    Pre&alence of 4piate Use

    :erion# 8sti%ated3,111,111 individuals addicted to heroin in ES( 11,111 in 0112 alone

    # 7ro% 3??4 to 0110, rates o* use a%ong adults 3> to 04increased *ro% 1.>< to 3.20< o* drugrelated hosital ad%issionsin 9alti%ore, 9oston, & Near6.

    :eroin is %ore ure !04 to 41 %illion users !SAMS:A, 011@"

    ( Can be dissolved *or in=ection or snorting( Street rice *ro% 04 to @1 er ill

    P h l i l d Ph i l

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    Ps,chological and Ph,sical)*ects of 4piates

    8uhoria, drosiness, reverie, and lac6 o* coordination# Loss o* inhibition, increased sel*con*idence# Severe letdon a*ter about @ to 2 hours

    :eroin and $/yContin# Rush

    ( ntense *eelings o* ar%th and ecstasy *olloing in=ection

    Sti%ulate recetors o* the bodyHs oioid syste%# 8ndorhins and en6ehalins

    'olerance develos and ithdraal occurs# Muscle soreness and titching, tear*ulness, yaning

    # 9eco%e %ore severe and also include cra%s,

    chillsseating, increase in : and 9-, inso%nia, & vo%iting( +ithdraal lasts about B0 hours

    P h l i l d Ph i l

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    Ps,chological and Ph,sical)*ects of 4piates

    0? year *ollo u o* 411 heroin addicts !:ser,et al., 3??"# 0>< dead by age @1

    ( :al* by suicide, ho%icide, or accident( $nethird by overdose

    Many users resort to illegal activities to obtain%oney *or drugs# 'he*t, rostitution, dealing drugs

    8/osure to in*ectious diseases via sharedneedles

    # e.g. :I# 8vidence suggests that *ree needles reducesin*ectious diseases associated ith I drug use

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    +igure 10.5 )R 6isits for,drocodone and 47,codone 4Ds

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    S,nthetic Sedati&es

    9arbituates# nduce %uscle rela/ation,

    reduce an/iety, roduce %ildeuhoria

    # n 3?@1s rescribed to aidslee

    # Esage declined *ro% 3?B4thru 3??1s but increasedrecently

    $ther synthetic sedatives# 9enodiaeines

    ( e.g., Ialiu%, Keta%ine

    Sti%ulate GA9A syste%

    :eavy dosages# Slurred seech

    # Ensteady gait

    # %aired =udg%ent &concentration

    # rritability & co%bativeness# Accidental su**ocation due to

    e/cessive rela/ation o*diahrag% %uscles

    Alcohol %agni*iesderessant e**ects

    'olerance & ithdraal# Deliriu%, convulsions & othersy%to%s

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    Sti(ulants8 %(pheta(ines

    ncrease alertness and %otor activity educe *atigue A%heta%ines

    # Synthetic sti%ulants( 9enedrine, De/edrine, Methedrine

    # 'rigger release o* and bloc6 reuta6e o* noreinehrine anddoa%ine

    # -roduce high levels o* energy, sleelessness

    # educe aetite, increase :, constrict blood vessels in s6inand %ucous %e%branes

    # :igh doses can lead to5

    ( Nervousness, agitation, irritability con*usion, aranoia, hostility# 'olerance can develo a*ter only 2 days use !Co%er et al.,

    0113"

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    Sti(ulants8 etha(pheta(ine

    A%heta%ine derivative!a6a crystal %eth"# Can be ta6en orally,

    intravenously, orintranasally !snorting"

    # n 0112, over B11,111eole used%etha%heta%ine!SAM:SA, 011B".

    Chronic use da%agesbrain# eduction in hioca%us

    volu%e !see *igure 31.@;abusers reresented byyello bars"

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    Sti(ulants8 Cocaine Al6aloid obtained *ro% coca leaves

    # educes ain# -roduces euhoria# :eightens se/ual desire# ncreases sel*con*idence and inde*atigability

    9loc6s reuta6e o* doa%ine in %esoli%bic areas o* brain $verdose

    # Chills, nausea, inso%nia, aranoia, hallucinations; ossibly heartattac6 & death

    Not all users develo tolerance# So%e beco%e %ore sensitive

    ( May increase ris6 o* $D

    n 0112, 0.@ %illion eole over the age o* 30 reorted usingcocaine, and B11,111 reorted using crac6 !SAM:SA, 011B".

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    Sti(ulants8 Cocaine

    Crac6

    # 7or% o* cocaine that )uic6ly beco%eoular in the >1s

    # oc6 crystal that is heated, %elted, &s%o6ed

    # Cheaer than cocaine

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    allucinogens9 )cstas,9 and PCP

    :allucinogene**ects include:# Color*ul visual hallucinations

    # Synestesias( $ver*lo *ro% one sensory

    %odality to another

    # Alterations in ti%eercetion

    # Lability o* %ood

    # An/iety & aranoia LSD

    # dlysergic acid diethyla%ide

    n 0112, there ere about311,111 users, don *ro% 3

    %illion in 0110# A*rican A%ericans less li6ely to use

    than others

    $ther hallucinogens -silocybin# 8/tracted *ro% %ushroo%

    psilocybe mexicana Mescaline

    # Active ingredient o* eyote 8cstasy

    # ncrease *eelings o* inti%acy

    and enhances %ood# Che%ically si%ilar to %escalineand a%heta%ines

    # Acts on serotonin

    # ts use ea6ed in 0113, ith 3.>%illion users.

    -C- !hencyclidine"# Angel dust#

    Ani%al tran)uilier# Causes severe aranoia andviolence

    +igure 10 : Process of 3eco(ing

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    +igure 10.: Process of 3eco(inga Drug %buser

    )tiolog, of Substance Related

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    )tiolog, of Substance'RelatedDisorders8 De&elop(ental approach

    Li et al. !0113" 'o aths to alcohol abuse3. 7irst grou began drin6ing in early adolescence,

    increased drin6ing throughout high school0. Second grou dran6 lesser a%ounts in early

    adolescence, increased drin6ing in %iddle schooland again in high school.( 9oys %ore li6ely to be in the *irst grou, girls in the

    second grou

    Develo%ental studies do not account *or allcases

    # Not an inevitable rogression through stages

    ) i l f S b R l d Di d

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    )tiolog, of Substance'Related Disorders8;enetic +actors

    elatives and children o* roble% drin6ers have higherthan

    e/ected rates o* alcohol abuse or deendence Greater concordance in M than D tins

    # n %en( Alcohol, ca**eine, s%o6ing, %ari=uana, & drug abuse in general

    # n o%en( ole o* genetics less clear( 7eer available studies( 7indings are %i/ed

    Genetic and shared environ%ental ris6 *actors *or illicit drug abuseand deendence aear to be nonseci*ic

    Ability to tolerate large )uantities o* alcohol %ay be an inheriteddiathesis# Asians have lo rates o* alcohol abuse

    ( 8vidence *or hysiological intolerance in this grou C-0A2

    # Gene associated ith %etabolis% o* nicotine# S%o6ers ith de*ect in this gene less li6ely to beco%e deendent !aoet al., 0111"

    )tiolog, of Substance Related

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    )tiolog, of Substance'RelatedDisorders8 Neurobiological +actors

    Nearly all drugs, including alcohol, sti%ulate the doa%ine

    syste% in the brain So%e evidence that eole deendent on drugs or alcohol have

    a de*iciency in the doa%ine recetor DD0 -eole ta6e drugs to avoid the bad *eelings associated ith ithdraal

    # 8/lains *re)uency o* relase ncentivesensitiation theory !obinson & 9erridge, 3??>,

    011"# Distinguish

    ( Wanting!craving *or drug"( Liking!leasure obtained by ta6ing the drug"

    # Doa%ine syste% beco%es sensitive to the drug andthe cuesassociated ith drug !e.g., needles, rolling aers, etc."

    # Sensitivity to cues induces & strengthens wanting 9rain i%aging studies sho that cues *or a drug !needle or a

    cigarette" activate the reard and leasure areas o* the braininvolved in drug use.

    +i 10 # R d P th i 3 i

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    +igure 10.# Reward Pathwa,s in 3raina*ected b, Di*erent Drugs

    )tiolog, of Substance'Related

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    )tiolog, of Substance RelatedDisorders8 Ps,chological factors

    Mood alteration# 'ension reduction %ay be due to alcohol %yoiaO!Steele & Joseh, 3??1"( Eser *ocuses reduced cognitive caacity on i%%ediate

    distractions( Less attention *ocused on tensionroducing thoughts

    # 8**ect si%ilar *or s%o6ing# Cognitive distraction also reduces aggressive behavior

    in into/icated individuals :oever, alcohol and nicotine %ay increase tension hen

    no distractions are resent.# Crying in ones beer

    8/ectancies about drugs e**ects in*luencebehavior

    # -eole ho e/ect alcohol to reduce stress & an/iety are %ostli6ely to drin6# 'he greater erceived ris6, the less li6ely it is to be used

    )tiolog, of Substance Related Disorders8

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    )tiolog, of Substance'Related Disorders8Ps,chopatholog, and Personalit,

    -ersonality *actors that redict onset o* substancerelated disorders5# Negative e%otionality# Desire *or increased arousal and ositive a**ect# Constraint

    ( :ar% avoidance, conservative %oral values, & cautious behavior Kindergarten children ho ere rated high in an/iety

    and novelty see6ing %ore li6ely to get drun6, s%o6e,and use drugs in adolescence.

    )tiolog, of Substance'Related

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    )tiolog, of Substance RelatedDisorders8 Sociocultural factors

    Alcohol is the %ost co%%on abused substance orldide!S%art & $gborne, 0111"# :ighest consu%tion in 7rance, Sain, & taly here

    consu%tion is idely acceted !deLint et al., 3?B>" Men consu%e %ore alcohol than o%en but di**erences

    vary by country

    # srael( Men dran6 / as %uch as o%en# Netherlands

    ( Men dran6 3P/ as %uch as o%en Availability

    # Esage is higher hen alcohol and drugs are easily available( n 011, drug use a%ong youths ho had been aroached by drug

    dealers as 4 ercent, co%ared to =ust under B ercent a%ong youthsho had not been aroached

    )tiolog, of Substance'Related

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    )tiolog, of Substance RelatedDisorders8 Sociocultural factors

    7a%ily *actors# -arental alcohol use !:a6ins et al., 3??B"

    # -sychiatric, %arital, or legal roble%s in the *a%ilylin6ed to drug abuse

    # Lac6 o* e%otional suort *ro% arents increasesuse o* cigarettes, %ari=uana, and alcohol !Cadoretet la., 3??4a"

    # Lac6 o* arental %onitoring lin6ed to higher drug

    usage !Chassin et al., 3??2; 'ho%as et al., 0111"

    )tiolog, of Substance'Related

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    g,Disorders8 Sociocultural factors

    Social netor6#ocial in!luenceor social selectionQ

    # 9ullers et al.!0113" *ound evidence *or both( :aving eers ho drin6 in*luences drin6ing behavior

    !social in!luence"but individuals also choose *riends ithdrin6ing atterns si%ilar to their on !social selection"

    Advertising and Media# Countries that ban ads have 32< less

    consu%tion than those that donHt !Sa**er, 3??3"

    Treat(ent of Substance Related Disorders8

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    Treat(ent of Substance Related Disorders8%lcohol %buse and Dependence

    n 0112, @ %illion eole over the age o* 30 received treat%ent*or alcohol abuse or deendence# $ver 03 %illion eole over the age o* 30 ere in need o* treat%ent

    *or alcohol or drug roble%s natient hosital treat%ent

    # Deto/i*ication

    ( +ithdraal *ro% alcohol under %edical suervision( 'he theraeutic results o* hosital treat%ent are not suerior to those o*outatient treat%ent

    Alcoholics Anony%ous !AA"# Largest sel*hel grou *or roble% drin6ers# egular %eetings rovide suort, understanding, and accetance# -ro%otes co%lete abstinence# Although so%e studies have shon AA articiation redicts better

    outco%e, recent studies suggest AA no %ore e**ective than other*or%s o* theray.

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    Table 10." The1" Steps of %%

    Treat(ent of Substance Related Disorders8

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    Treat(ent of Substance Related Disorders8%lcohol %buse and Dependence

    Coules and 7a%ily 'heray

    # 8%hasies suort *ro% roble% drin6erHsartner

    # educed roble% drin6ing %aintained3year a*ter theray ended

    #Also reduced coulesH overall level o*distress

    Treat(ent of Substance Related Disorders8

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    Treat(ent of Substance Related Disorders8%lcohol %buse and Dependence

    Cognitive and 9ehavioral 'reat%ents#Contingency#$anagement %herapy

    ( -atient and *a%ily rein*orce behaviors inconsistent ithdrin6ing e.g., avoiding laces associated ith drin6ing

    ( 'each roble% drin6er ho to deal ith unco%*ortablesituations e.g., re*using the o**er o* a drin6

    (AKA Co%%unityrein*orce%ent aroach

    # elase -revention( Strategies to revent relase

    # 9rie* %otivational interventions( Designed to curb heavy drin6ing in college

    Treat(ent of Substance Related Disorders8

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    Treat(ent of Substance Related Disorders8%lcohol %buse and Dependence

    Controlled drin6ing# 9elie* that roble% drin6ers can consu%e alcohol

    in %oderation#Avoid total abstinence and inebriation

    #&uided sel!#change Medications

    #Antabuse !disul*ira%"( -roduces nausea and vo%iting i* alcohol is consu%ed

    # $ther %edications include naltre/one, nalo/one, &

    aca%rosate( Most e**ective hen co%bined ith C9'

    Treat(ent of Substance Related Disorders8

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    Treat(ent of Substance Related Disorders8Nicotine Dependence

    -eer behavior i%ortant# * others in social netor6 sto s%o6ing, increases li6elihood that

    individual ill also sto aid s%o6ing treat%ent

    # aid u**ing, *ocused s%o6ing, & s%o6e holding

    Scheduled s%o6ing# educe nicotine inta6e gradually over a *e ee6s -hysicianHs advice

    # 9y age 24, %ost s%o6ers have )uit !ESD::S, 3??>b" Nicotine relace%ent treat%ents

    # Gu%, atches, or inhalers

    # educe craving *or nicotine# Co%bining atch ith antideressants i%roved success rate

    Treat(ent of Substance Related Disorders8

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    Copyright 2009 John Wiley & Sons, NY 51

    Disorders

    $*ten ai%ed at adolescents

    Etilie so%e or all o* the *olloing ele%ents5# 8nhancing sel*estee%

    #Social s6ills training# -eer ressure resistance training

    # -arental involve%ent in school rogra%s

    # +arning labels on alcohol bottles

    # 8ducation regarding alcohol i%air%ent

    # 'esting *or drugs and alcohol at school or or6

    C4PR

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    C4PR