SubstanceRelated Disorders Chapter 10 Perspectives on SubstanceRelated Disorders

Substance-Related Disorders Chapter 10

Perspectives on Substance-Related Disorders • The Nature of Substance-Related Disorders – Kills 500 000 Americans annually – Problems related to the use and abuse of psychoactive substances – Produce wide-ranging physiological, psychological, and behavioral effects related to use and abuse of drugs • Some Important Terms and Distinctions – Substance – alter mood and behavior – Substance use (moderate amount that does not interfere with functioning) vs. substance intoxication (physiological reactions to ingestion to psychoactive substances) – Substance abuse (leads to significant distress or impairment in functioning) vs. substance dependence (need for increasing amounts to achieve the desired effects) – Tolerance (diminished effect with continuous use) vs. withdrawal (negative physiological reaction to removal of a psychoactive substance)

Perspectives on Substance-Related Disorders (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

• **Ice, LSD, chocolate, TV: Is everything addictive? Figure 10. 1

Easy to get hooked on, hard to get off Figure 10. 2

The Depressants: Alcohol Use Disorders • Psychological and Physiological Effects of Alcohol – Central Nervous system depressant – Influences several neurotransmitter systems, mainly GABA (inhibition of behavior) but also glutamate system and serotonin system • Effects of Chronic Alcohol Use – Alcohol intoxication – Alcohol withdrawal (withdrawal delirium – delirium tremens) – Associated brain conditions – Dementia and Wernicke’s disease – Fetal alcohol syndrome

The path traveled by alcohol throughout the body Figure 10. 3

Alcohol: Some Facts and Statistics • 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 • Statistics on Abuse and Dependence – 10% of Americans experience problems with alcohol – Most persons with alcoholism can moderate or cease drinking – 20% of those with alcohol problems experience spontaneous recovery

Sedative, Hypnotic, or Anxiolytic Substance 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 – Such effects are followed by a “crash” (e. g. , feeling depressed and tired) – Enhance the release of dopamine and norepinephrine, while blocking reuptake • 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 • DSM-IV Criteria for Cocaine Intoxication and Withdrawal – Psychological symptoms – Physiological symptoms – Most cocaine users cycle through patterns of tolerance and withdrawal • Effects of Cocaine – Produce short lived sensations of elation, vigor, reduce fatigue – Cocaine use in the United States has declined over the last decade – Effects result from blocking the reuptake of dopamine – Cocaine is highly addictive, but addiction develops slowly

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: Caffeine Use Disorders • Effects of Caffeine – The “Gentle” Stimulant – Used by over 90% of Americans – Found in tea, coffee, cola drinks, and cocoa products – Small doses elevate mood and reduce fatigue – Regular use can result in tolerance and dependence – Caffeine blocks the reuptake of the neurotransmitter adenosine • 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 natural and synthetic substances with narcotic effects – Such drugs are often referred to as analgesics – Examples include heroin, opium, codeine, and morphine • Effects of Opiods – Low doses induce euphoria, drowsiness, and slowed breathing – High doses can result in death – Withdrawal symptoms can be lasting and severe – Activate body’s enkephalins and endorphins • DSM-IV Criteria for Opiod Intoxication and Withdrawal – Psychological symptoms – Physiological symptoms – Mortality rates are high for opiod addicts

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 systems (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: 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 – Most see substance abuse as a means to cope with negative affect – The self-medication and the tension reduction hypotheses • 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 in 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

An integrative model of substance related disorders Figure 10. 7

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 • 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 not generally very effective when used alone

Psychosocial Treatment of Substance-Related Disorders • 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 • Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

Psychosocial Treatment of Substance-Related Disorders • 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