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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.



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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



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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"



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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 %%



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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



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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



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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'



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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



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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

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