substance use disorders chapter 11. what is a drug? a drug is a substance that has an action on...
TRANSCRIPT
Substance Use Disorders
Chapter 11
What is a drug?
A drug is a substance that has an action on biological tissues when administered
Some drugs influence mood cognition and behavior Aspirin doesn’t Cocaine does –
Psychoactive/Psychotropic
Psychoactive drugs are used for a variety of purposes Medicinal Spiritiual Recreational
Psychoactive Drugs
Substances active on CNS tissues when administered thereby causing changes in mood, cognition, behavior
Drug Action on the Nervous System
Pharmacokinetics Administration
Oral, IV, Smoke Absorption/Distribution
Metabolization Elimination
Pharmacodynamics Action on NT
systems Agonist Antagonist
Most drugs that are abused have a common effect on a particular NT pathway. They also have unique effects
Drug Action on the Nervous System – Reinforcement
Drug Action on the Nervous System – Reinforcement
Drug Action on the Nervous System – Repaeated Use
Tolerance Decreased response to repeated exposure
Dependence System adapts to presence of drug. Drug
necessary for homeostasis Withdrawal
Response to drug leaving the system Addiction
Compulsive engagement in reinforcing behavior
The Spectrum of Drug Involvement
Everyone has a relationship to drugs. Drugs are used for one simple reason. The effect of that drug for that person is FUNCTIONAL No use
Use
Misuse
Abuse
Dependence
Does Use Mean Abuse?
DSM-IV Abuse
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
B. The symptoms have never met the criteria for Substance Dependence for this class of substance.
DSM-IV Dependence
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
(1) tolerance, as defined by either of the following: (a) a need for markedly increased amounts of
the substance to achieve intoxication or desired effect(b) markedly diminished effect with continued use of the same amount of the substance
DSM-IV Dependence
(2)withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
(3) the substance is often taken in larger amounts or over a longer period than was intended
(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
DSM-IV Dependence
(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or
recover from its effects
(6) important social, occupational, or recreational activities are given up or reduced because of substance use
(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
Causes of Drug Disorders
Causes of Drug Use Disorders - Risks
Genes Moreso for acohol (LR, 5-HT Transporter)
Temperament Negative affectivity Impulsiviity
Psychopathology Bipolar PTSD ASPD
Peer Permissive norms around use
Public Health Model
Agent – Drug Properties
Host – Person Characteristics
Environment
Access, Norms
Media
Treatment - Medication
Agonist Substitution Substitute safer drug with a similar chemical
composition methadone and nicotine gum or patch
Antagonistic Treatment Drugs that block or counteract pleasurable drug
effects naltrexone for opiate and alcohol problems
Other drugs Antidepressants, Acamprosate
Treatment – Psychological Treatments
Motivational Enhancement Increase motivation to change
Behavioral/CBT Approaches Rely on functional analysis Alter structure of reinforcement Skills training Cognitive Restructuring
Treatment??? – The 12 steps
The 12 Steps of Alcoholics Anonymous We admitted we were powerless over alcohol--that our lives had become
unmanageable. Came to believe that a Power greater than ourselves could restore us to sanity. Made a decision to turn our will and our lives over to the care of God as we
understood Him. Made a searching and fearless moral inventory of ourselves. Admitted to God, to ourselves and to another human being the exact nature of
our wrongs. Were entirely ready to have God remove all these defects of character. Humbly asked Him to remove our shortcomings. Made a list of all persons we had harmed, and became willing to make amends
to them all. Made direct amends to such people wherever possible, except when to do so
would injure them or others. Continued to take personal inventory and when we were wrong promptly
admitted it. Sought through prayer and meditation to improve our conscious contact with
God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Evaluating the 12 steps
No data support the 12 step model of causality Very good data to suggest that involvement
increases abstinence Involvement in more than just going
Active ingredient seems to be the strong social support for abstinence that 12 fellowships provide
Many people don’t take to it, but for those who do it’s highly efficacious