Chapter 12 Substance-Related Disorders

Ch 12

Perspectives on Substance-RelatedDisorders: An Overview

• 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

Definitions of Substance-Related Disorders

• Substance dependence is characterized by– Tolerance to drug action occurs (greater doses,

diminished drug action)– Withdrawal symptoms occur with drug cessation– Person recognizes excessive use of the drug– Much of the person’s time is spent getting the drug or

recovering from its effects– Substance use continues despite physical or

psychological problems caused by the drug

Ch 12.1

• Substance abuse is characterized by– Failure to fulfill major obligations (e.g. work or child

care)– Exposure to physical dangers (e.g. driving while

intoxicated)– Legal problems brought on by drug use– Persistent social or interpersonal problems (e.g.

arguments with spouse)

Definitions of Substance-Related Disorders

Ch 12.2

Perspectives on Substance-RelatedDisorders: An Overview

Figure 11.1 Barlow/Durand, 3rd Edition

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

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

Figure 11.1 (cont.)

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

Figure 11.2 Barlow/Durand, 3rd. Edition

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

• 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 occasion– 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.)

Alcohol Abuse and Dependence

• Alcohol dependence can include tolerance and withdrawal reactions – Abrupt cessation can lead to anxiety, depression,

weakness, and an inability to sleep– Delirium tremens (DTs) is a severe alcohol withdrawal

reaction that includes hallucinations– Alcohol tolerance is common in alcoholism

• Alcohol abuse can be part of polydrug abuse (80-85% of alcohol abusers smoke)

Ch 12.3

Short-term Actions of Alcohol

• Alcohol is absorbed from the stomach into the blood – Alcohol is metabolized by the liver (1 oz/hr)

• Alcohol is a drug, a CNS depressant• Alcohol acts within brain to

– Stimulate GABA receptors (reduces tension)– Increases dopamine/serotonin levels (pleasurable

aspects of intoxication)– Inhibits glutamate receptors (cognitive actions)

Ch 12.4

• Alcoholics reduce their food intake when consuming alcohol – Alcohol has no nutrient value– Alcohol impairs food digestion– Result is vitamin deficiency (B-complex)

• Can lead to brain damage and amnesia

• Alcohol kills brain cells, leading to loss of gray matter from the temporal lobes

• Alcohol suppresses the immune system• Fetal alcohol syndrome risk in offspring

Long-term Actions of Alcohol

Ch 12.5

Nicotine and Tobacco Smoking

• Smoking tobacco results in absorption of nicotine into the blood – Nicotine reaches brain receptors that control dopamine

release– Dopamine action of nicotine mediate its addictive

properties

• Cigarette smoking is responsible for 1 of every 6 deaths in the US– Smoking is THE SINGLE MOST PREVENTABLE cause

of early death

Ch 12.6

Prevalence of Smoking

• Rates of smoking among American adults have dropped since 1965, but 57 million smoke.– Smoking rates higher in Asia and South America

• Rates for white adolescents have been increasing since 1992.– Rates of smoking are higher for Hispanic and white

adolescents than for African American teens.• Rates for African American teens have been increasing since 1992.

• Lowest prevalence rates for college graduates and people over 75.

• Highest prevalence rates for blue-collar workers, Native Americans, and individuals with less education.

• Prevalence has declined more for men than for women.

Race, Ethnicity, & Smoking

• African Americans – Retain nicotine in their blood longer than whites.– Because of a greater preference for mentholated

cigarettes than whites, African Americans may take more puffs & inhale more deeply

• May explain lower rates of quitting and increased likelihood of developing lung cancer.

• Chinese Americans metabolize less nicotine than whites or Hispanics– May explain lower rates of lung cancer among Asians

• Marijuana consists of the dried and crushed leaves of the hemp plant Cannabis sativa

• Smoking marijuana results in– Relaxation– Shifts in attention– Impaired memory

• Marijuana effects depend on dose and potency

Marijuana

Ch 12.7

• Marijuana– Interferes with cognitive function including loss of short-

term memory – Interferes with the operation of complex equipment

(e.g. an automobile)– Contributes to psychological problems in adulthood– Elevates heart rate– Impairs lung structure and function– Can produce reverse tolerance

Adverse Actions of Marijuana

Ch 12.8

• Marijuana– Reduces the nausea and loss of appetite

associated with chemotherapy– Can reduce pain signaling (via THC)– Can be used to treat the discomfort of AIDS– Can reduce the pressure increases in the eye

associated with glaucoma

Therapeutic Actions of Marijuana

Ch 12.9

Sedatives

• Sedatives slow the activities of the body and reduce its responsiveness – Opiates relieve pain and induce sleep

• Include opium, morphine, heroin • Opiates are physiologically addictive

– Barbiturates induce relaxation and sleep• Act by stimulating GABA receptors• Can result in tolerance and severe withdrawal reactions

Ch 12.10

Stimulants• Stimulants act on the brain to increase alertness and

motor activity – Amphetamines release norepinephrine and dopamine in brain

to produce alertness and to reduce appetite• Tolerance quickly develops to amphetamine use

– Ephedrine is a variant of amphetamine that induces alertness and reduces appetite (found in herbal weight loss preparations)

– Cocaine blocks the reuptake of dopamine to produce alertness and produce euphoria

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

Ch 12.11

• Hallucinogenic drugs alter sensory perception and create sensory experiences

• Hallucinogenic drugs include– LSD, mescaline, ecstasy and phencyclidine

• General effects of LSD include– Synesthesia: blending of sensory information– Subjective time is altered (slowed)– Rapid shifts in mood– Effects depend on set and setting

Hallucinogens

Ch 12.12

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

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

Development of Substance Abuse

Ch 12.13

Fig 12.3

Etiology of Substance Use• Biological / Genetic factors (alcoholism is heritable, twin & adoptee

studies)• Sociocultural variables include family, friends, media (television,

billboards)

• Psychological variables include – Mood alteration (enhance positive, reduce negative moods)– Beliefs/expectancies about prevalence and risks (harmful actions

of drug)– Personality variables include

• High levels of negative affect• Enduring desire for arousal, increased positive affect

Ch 12.14

• 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

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 ingestion 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 covert sensitization– Contingency management– Community reinforcement– Relapse prevention– Preventative efforts via education– NIAA“Project Match” comparative study

Fig 12a

Therapy for Cigarette Smoking• The long-term efficacy of psychological treatments for

smoking are not good– Making smoking unpleasant– Scheduled smoking involves gradual reduction of number of

cigarettes smoked and controls when smoking will happen

– Advice from a physician • Biological treatments for smoking involve substitution of

nicotine for smoking– Use of a nicotine patch or gum

Ch 12.16