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67 Cards in this Set

  • Front
  • Back

Classification of Substance-Related


and Addictive Disorders

-Substance-induced disorders


-Substance-use disorders

Substance-induced disorder

Disorders, such as intoxication, that can be induced by using psychoactive substances.

Substance-use disorder

patterns of maladaptive use of psychoactive substances that lead to significant levels of impaired functioning or personal distress.



Patterns of maladaptive use of psychoactive substances that are identified by the particular


drug associated with problematic use (e.g., “alcohol use disorder”).

Substance-Induced Disorders

Substance intoxication – A pattern of repeated episodes of intoxication, which is a state of drunkenness or of being “high.”



Withdrawal syndrome – A characteristic cluster of symptoms following the sudden reduction or cessation of use of a psychoactive substance after physiological dependence has developed.


– In some cases of chronic alcoholism,withdrawal produces a state of delirium tremens, or DTs.(shakes)

Tolerance

Physical habituation to a drug such that with frequent use:


1) higher doses are needed to achieve the same effects,


or


2) the same amount of substance has a diminished effect.

Substance-Use Disorders characterized by:

– persistent problems cutting back or controlling use of the substance


– developing tolerance or a withdrawal syndrome


– spending an excessive amount of time seeking/using the substance


– using the substance in situations that pose a risk to the person’s safety or the safety of others (such as repeatedly drinking and driving).

Lifetime prevalence of drug dependence in order

Highest: Any drug


-marijuana


-cocaine


-amphetamine


-opioid

Racial and Ethnic Differences in


Substance Use Disorders

• Despite the popular stereotype that drug dependence is more frequent among ethnic minorities, this belief is not supported by evidence.


• To the contrary, African Americans and Latinos have comparable or even lower rates of substance use disorders than do European Americans (non-Hispanic Whites)

Nonchemical Addictions and Other Forms of Compulsive Behavior

• The DSM-5 has included a category for nonchemical forms of addiction, including:


– gambling disorder


– kleptomania (compulsive stealing)


– pyromania (compulsive fire-setting).



• These disorders were previously classified in the DSM-IV in a diagnostic category called Impulse Control Disorders.



• Characterized by difficulties controlling or restraining impulsive behavior.

Addiction



-Impaired control over the use of a chemical substance, accompanied by physiological dependence.

Physiological dependence

A condition in which the drug user’s body comes to depend on a steady supply of the substance.

Psychological dependence

Compulsive use of a substance to meet a psychological need.

Pathways to Drug Dependence

Although the progression to substance dependence varies from person to person, one common pathway involves a progression through the following stages:


1. Experimentation


2. Routine use


3. Addiction or dependence

Drugs of Abuse

Drugs of abuse are generally classified within three major groupings:


-Depressants, such as alcohol and opioids


-Stimulants, such as amphetamines and cocaine


-Hallucinogens (changes perception, such as marijuana, shrooms)

Depressants

• A depressant is a drug that slows down or curbs the activity of the central nervous system.



• It reduces feelings of tension and anxiety, slows movement, and impairs cognitive processes.



• In high doses, depressants can arrest vital functions and cause death.

Alcohol/ Alcoholism

Alcohol is the most widely abused substance in the United States and worldwide.


Alcoholism – An alcohol dependence disorder or addiction that results in serious personal, social, occupational, or health problems.


• The most widely held view of alcoholism is the disease model, the belief that alcoholism is a medical illness or disease.

Risk Factors for Alcoholism

1. Gender (males 2x likely)


2. Age (highest is between 20-40)


3. Antisocial personality disorder


4. Family history


5. Sociodemographic factors

Ethnicity and Alcohol Use and Abuse

• Rates vary among American ethnic and racial groups.



• Some groups—Jews, Italians, Greeks, and Asians—have relatively low rates of alcoholism, largely as the result of tight social controls placed on excessive and underage drinking.



• Asian Americans, in general, drink less heavily than other population groups

Psychological Effects of Alcohol

• The effects of alcohol or other drugs vary from person to person.



• By and large they reflect the interaction of:


(a) The physiological effects of the substances.


(b)Our interpretations of those effects.

Physiological Effects of Alcohol

– Alcohol appears to work by heightening activity of the neurotransmitter GABA.


– GABA is an inhibitory neurotransmitter.


– Increasing GABA activity produces feelings of


relaxation.

Physical Health concerns from Alcohol

• Chronic, heavy alcohol use affects virtually every organ and body system, either directly or indirectly.


• Heavy alcohol use is linked to increased risk of many serious health concerns, including:


1. Liver disease


2. Increased risk of some forms of cancer


3. Coronary heart disease


4. Neurological disorders

Physical Health and Alcohol

Two of the major forms of alcohol-related liver disease are alcoholic hepatitis, a serious and potentially life-threatening inflammation of the liver, and cirrhosis of the liver, a potentially fatal disease in which healthy liver cells are replaced with scar tissue.



• Habitual drinkers tend to be malnourished, which can put them at risk of complications arising from nutritional deficiencies.



• This condition, also known as Korsakoff’s syndrome, is characterized by glaring confusion, disorientation, and memory loss for recent events.

Moderate Drinking:


Is There a Health Benefit?

-moderate use of alcohol (1 to 2 drinks per day for women, 2 to 4 drinks for men) is linked to lower risks of heart attacks and strokes, as well as lower death rates overall



-Higher doses of alcohol are associated with higher mortality (death) rates.

Barbiturates

Sedative drugs which are depressants with high addictive potential.



• About 1% of adult Americans develop a substance abuse/ dependence disorder of


barbiturates, sleep medication (hypnotics), or


antianxiety agents at some point in their lives.



• Barbiturates such as amobarbital, pentobarbital, phenobarbital, and secobarbital are depressants, or sedatives.

Opioids

• Are Narcotics – Drugs that are used medically for pain relief but that have strong addictive potential.


• Opioids include both naturally occurring opiates (morphine, heroin, codeine) derived from the juice of the poppy plant and synthetic drugs (e.g., Demerol, Darvon) that have opiate like effects.



• The ancient Sumerians named the poppy plant opium, meaning “plant of joy.”

Opioids continued

• Two discoveries made in the 1970s show that the brain produces chemicals of its own that have opiate-like effects.


• One was that neurons in the brain have receptor sites that opiates fit like a key in a lock.


• The second was that the human body produces its own opiate-like substances that dock at the same receptor sites as opiates do.


Endorphins – Natural substances that function as neurotransmitters in the brain and are similar in their effects to opioids.

Morphine

A strongly addictive narcotic derived from the opium poppy that relieves pain and induces feelings of well-being.

history of morphine


• Morphine—which receives its name from Morpheus, the Greek god of dreams—was introduced at about the time of the U.S. Civil War.


• Morphine, a powerful opium derivative, was used liberally to deaden pain from wounds.


• Physiological dependence on morphine became known as the “soldier’s disease.”


• There was little stigma attached to dependence until morphine became a restricted substance.


Heroin

A narcotic derived from morphine that has strong addictive properties.


• Heroin, the most widely used opiate, is a powerful depressant that can create a euphoric rush.




Users of heroin claim that it is so pleasurable it can eradicate any thought of food or sex.

Stimulants

are psychoactive substances that increase


the activity of the central nervous system, which enhances states of alertness and can produce feelings of pleasure or even euphoric highs.


• The effects vary with the particular drug.

Amphetamines

Amphetamines – A class of synthetic stimulants that activate the central nervous system, producing heightened states of arousal and feelings of pleasure.



Amphetamine psychosis – A psychotic state


characterized by hallucinations and delusions, induced by ingestion of amphetamines.



Cocaine – A stimulant derived from the leaves of the coca plant.

Ecstasy

• The drug ecstasy, or MDMA (3,4-methylenedioxymethamphetamine) is a designer drug, a chemical knockoff similar in chemical structure to amphetamine.



• It produces mild euphoria and hallucinations and has become especially popular on college campuses and in clubs and “raves” in many cities.



• Ecstasy can produce adverse psychological effects, including depression, anxiety, insomnia, and even paranoia and psychosis.

Cocaine


Crack

Cocaine is a natural stimulant extracted from the leaves of the coca plant—the plant from which the soft drink obtained its name.


Crack – The hardened, smokable form of cocaine that may be more than 75% pure.

Effects of Cocaine

• Like heroin, cocaine directly stimulates the brain’s reward or pleasure circuits.


• It also produces a sudden rise in blood pressure and an accelerated heart rate that can cause potentially dangerous, even fatal, irregular heart rhythms.


• Overdoses can produce restlessness, insomnia, headaches, nausea, convulsions, tremors, hallucinations, delusions, and even sudden


death due to respiratory or cardiovascular collapse.


• Regular snorting of cocaine can lead to serious nasal problems, including ulcers in the nostrils.

Nicotine

Habitual smoking is not merely a bad habit; it is also a physical addiction to a stimulant drug, nicotine, found in tobacco products including cigarettes, cigars, and smokeless tobacco.



Smoking is also deadly, claiming more than 443,000 lives in the United States alone



The World Health Organization estimates that 1 billion people worldwide smoke and more than 3 million die each year from smoking-related causes.

Hallucinogens

– Substances that cause


hallucinations.


• Hallucinogens, also known as psychedelics, are a class of drugs that produce sensory distortions or hallucinations, including major alterations in color perception and hearing.



• Hallucinogens may also have additional effects, such as relaxation and euphoria or, in some cases, panic.

LSD

aka: lysergic acid diethylamide,: a


synthetic hallucinogenic drug.


• In addition to the vivid parade of colors and visual distortions produced by LSD, users have claimed it “expands consciousness” and opens new worlds—as if they were looking into some reality beyond the usual reality.


• Sometimes they believe they have achieved great insights during the LSD “trip,” but when it wears off they usually cannot follow through or even summon up these discoveries.

Phencyclidine (PCP)

• Phencyclidine, or PCP—which is referred to as “angel dust” on the streets—was developed as an anesthetic in the 1950s but was discontinued as such when its hallucinatory side effects were discovered.


• A smokable form of PCP became popular as a street drug in the 1970s.


• However, its popularity has since waned, largely because of its unpredictable effects.

Marijuana

A hallucinogenic drug derived from the leaves and stems of the plant Cannabis sativa.


• Marijuana is derived from the Cannabis sativa


plant.


• Marijuana is generally classified as hallucinogen because it can produce perceptual distortions or mild hallucinations, especially in

Neurotransmitters

Many drugs of abuse,(nicotine, alcohol, heroin,


marijuana, & esp. cocaine & amphetamines) increase levels of the neurotransmitter dopamine in the brain’s pleasure or reward circuits—the networks of neurons responsible for producing feelings of pleasure or states of euphoria.


• Over time, regular use of these drugs may sap the brain’s own production of dopamine.


• Consequently, the brain’s natural reward system—the “feel good” circuitry that produces states of pleasure associated with the ordinarily rewarding activities of life, such as consuming a satisfying meal and engaging in pleasant activities—becomes blunted.

Genetic Factors

Evidence links genetic factors to various forms of


substance use and abuse, including alcohol abuse and dependence, heroin dependence, and even cigarette smoking (nicotine dependence).



• Alcoholism tends to run in families



• Familial patterns provide only suggestive evidence of genetic factors, because families share a common environment as well as common genes.

Learning Perspectives

• Learning theorists propose that substance-related behaviors are largely learned and can, in principle, be unlearned.



• They focus on the roles of operant and classical


conditioning and observational learning.



• Substance abuse problems are not regarded as


symptoms of disease but rather as problem habits.

Operant Conditioning

• People may initially use a drug because of social influence, trial and error, or social observation.


• In the case of alcohol, they learn that the drug can produce reinforcing effects, such as feelings of euphoria, and reductions in anxiety and tension.


• Alcohol may also reduce behavioral inhibitions.


• Alcohol can thus be reinforcing when it is used to combat depression (by producing euphoric feelings, even if short lived), to combat tension (by functioning as a tranquilizer), or to help people sidestep moral conflicts


(for example, by dulling awareness of


moral prohibitions).

Alcohol and Tension Reduction

• Learning theorists have long maintained that one of the primary reinforcers for using alcohol is relief from states of tension or unpleasant states of arousal.


• According to the tension-reduction theory, the more often one drinks to reduce tension or anxiety, the stronger or more habitual the habit becomes.


• We can think of some uses of alcohol and other drugs as forms of self-medication—as a means of using the pill or the bottle to ease psychological pain, at least temporarily

Negative Reinforcement


and Withdrawal

• Once people become physiologically dependent, negative reinforcement comes into play in maintaining the drug habit.


• In other words, people may resume using drugs to gain relief from unpleasant withdrawal symptoms.


• In operant conditioning terms, relief from unpleasant withdrawal symptoms is a negative reinforcer for resuming drug use

Conditioning Model of Craving

• Classical conditioning may help explain drug cravings.


• cravings reflect the body’s need to restore high blood levels of the addictive substance and thus have a biological basis.


• But they also come to be associated with environmental cues associated with prior use of the substance

Observational Learning

Modeling or observational learning plays an important role in determining risk of substance abuse problems.


• Parents who model inappropriate or excessive


drinking or use of illicit drugs may set the stage for maladaptive drug use in their children


• Evidence shows that adolescents who have a parent who smokes face a substantially higher risk of smoking than do their peers in families where neither parent smokes

Cognitive Perspectives

• Evidence supports the role of cognitive factors in substance abuse and dependence, especially the role of expectancies.


• Alcohol or other drug use may also boost self efficacy expectations—personal expectancies we


hold about our ability to successfully perform tasks.


• Expectancies may account for the “one-drink


effect”—the tendency of chronic alcohol abusers to binge once they have a drink.

Psychodynamic Perspectives

According to traditional psychodynamic theory,


alcoholism reflects an oral-dependent personality.


• Psychodynamic theory also associates excessive alcohol use with other oral traits, such as dependence and depression, and traces the origins of these traits to fixation in the oral stage of psychosexual development.


• Excessive drinking or smoking in adulthood symbolizes an individual’s efforts to attain oral gratification.

Sociocultural Perspectives

• Drinking is determined, in part, by where we live, whom we worship with, and the social or cultural norms that regulate our behavior.


• Cultural attitudes can encourage or discourage problem drinking.


• Peer pressure and exposure to a drug subculture are important influences in determining substance use among adolescents and young adults

Detoxification

process of ridding the system of alcohol or other drugs under supervised conditions.


• Detoxification is often more safely carried out in a hospital setting.


• In the case of addiction to alcohol or barbiturates, hospitalization allows medical personnel to monitor and treat potentially dangerous withdrawal symptoms such as convulsions.

Disulfiram

The drug disulfiram (brand name Antabuse) discourages alcohol consumption because the combination of the two produces a violent response consisting of nausea, headache, heart palpitations, and vomiting.


• In some extreme cases, combining disulfiram and alcohol can produce such a dramatic drop in blood pressure that the individual goes into shock or even dies.


• Although disulfiram has been used widely in alcoholism treatment, its effectiveness is limited because many patients who want to continue drinking simply stop using the drug.

Antidepressants

• Antidepressants may help reduce cravings for cocaine following withdrawal.


• These drugs stimulate neural processes that promote feelings of pleasure derived from everyday experiences.


• However, antidepressants have yet to produce consistent results in reducing relapse rates for cocaine dependence, so it is best to withhold judgment concerning their efficacy.

Nicotine Replacement Therapy

• Most regular smokers, perhaps the great majority, are nicotine dependent.


• The use of nicotine replacements in the form of


prescription gum (brand name Nicorette), transdermal (skin) patches, and nasal sprays can help smokers avoid unpleasant withdrawal symptoms and cravings for cigarettes.


• After quitting smoking, ex-smokers can gradually wean themselves from the nicotine replacement.

Methadone Maintenance Programs

A synthetic opiate that is used to help


people who are addicted to heroin to abstain from it without a withdrawal syndrome.


• Because methadone in normal doses does not produce a high or leave the user feeling drugged, it can help heroin addicts hold jobs and get their lives back on track.


• However, like other opioids, methadone is highly addictive.

Naltrexone

A drug that blocks the high from alcohol


as well as from opiates.


• The drug doesn’t prevent the person from taking a drink or using heroin, but seems to blunt cravings for these drugs.


• Evidence shows that naltrexone and similar drugs are useful in treating alcohol, opiate, and amphetamine dependence.

Culturally Sensitive


Treatment of Alcoholism

• Members of ethnic minority groups may resist traditional treatment approaches because they feel excluded from full participation in society.


• Native American women, for example, tend to respond less favorably to traditional alcoholism counseling than White women



• Hurlburt and Gade attribute this difference to the resistance of Native American women to “White man’s” authority.


• They suggest that Native American counselors might be more successful in overcoming this resistance.

Nonprofessional Support Groups

• Despite the complexity of the factors contributing to substance abuse and dependence, these problems are frequently handled by lay people or nonprofessionals.


• The most widely used nonprofessional program, Alcoholics Anonymous (AA), is based on the belief that alcoholism is a disease, not a sin.


• The AA philosophy holds that that people suffering from alcoholism will never be cured, regardless of how long they abstain from alcohol; rather, people with alcoholism who remain “clean and sober” are seen as “recovering alcoholics.”

Residential Approaches

• A residential approach to treatment requires a stay in a hospital or therapeutic residence.


• Most inpatient programs use an extended 28-day detoxification period.


• Most people with alcohol-use disorders do not require hospitalization.

Psychodynamic Approaches

• Psychoanalysts view substance abuse and dependence as symptoms of conflicts rooted in childhood experiences.


• The therapist attempts to resolve the underlying conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of gratification.


• Although there are many successful psychodynamic case studies of people with substance abuse problems, there is a dearth of


controlled and replicable research studies.


• The effectiveness of psychodynamic methods for treating substance abuse and dependence thus remains unsubstantiated.

Behavioral Approaches

These approaches to treating substance abuse and dependence focus on modifying abusive and dependent behavior patterns.


• According to behaviorally oriented therapists the key question is whether abusers can learn to change their behavior when they are faced with temptation.

Self Control Strategies

Self-control training helps abusers develop skills they can use to change their abusive behavior. Behavior therapists focus on three components—the “ABCs”—of substance abuse:


– 1. The antecedent cues or stimuli (As) that prompt or trigger abuse.


– 2. The abusive behaviors (Bs) themselves.


– 3. The reinforcing or punishing consequences (Cs) that maintain or discourage abuse.

Contingency Management Programs

• Learning theorists believe that our behavior is shaped by rewards and punishments.


• Contingency management (CM) programs provide reinforcements (rewards) contingent on performing desirable behaviors such as producing drug-negative urine samples



• On average, the CM (reward) group achieved longer periods of continual abstinence than the standard methadone treatment group.

Aversive Conditioning

• In aversive conditioning, painful or aversive stimuli are paired with substance abuse or abuse-related stimuli to condition negative emotional responses to drug-related stimuli.


• In the case of problem drinking, tasting alcoholic beverages is usually paired with drugs that cause nausea and vomiting, or with electric shock.


• Unfortunately, aversive conditioning effects are often temporary and fail.

Social Skills Training (SST)

• Social skills training helps people develop effective interpersonal responses.


• Assertiveness training, for example, may be used to train alcohol abusers to fend off social pressures to drink.


• Behavioral marital therapy seeks to improve marital communication and problem solving that may trigger abuse.

Controlled Drinking: A Viable Goal?

• According to the disease model of alcoholism, having even one drink causes people with alcoholism to lose control and go on a binge.


• Some argue that many people with alcohol abuse or dependence can develop self-control techniques that allow them to engage in controlled drinking.


• This contention remains controversial.

Relapse-Prevention Training

• The word relapse derives from Latin roots meaning “to slide back.”


• This training is designed to help substance abusers to identify high-risk situations and learn effective coping skills for handling these situations.


• Relapse-prevention training also focuses on preventing lapses from turning into full-blown relapse.