Chapter 10 - Notes PDF

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Chapter 10 Substance-related and addictive disorders: Range of problems associated with the use and abuse of drugs such as alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and behave. These are extremely costly in human and financial terms. Impulse-control disorders: A disorder in which a person acts on an irresistible, but potentially harmful, impulse. The cost in lives, money, and emotional turmoil has made the issue of drug abuse a major concern worldwide. Currently, around 9.7% of the general population (12 years or older) are believed to use illegal drugs. Many U.S. presidential administrations have declared various “wars on drugs,” but the problem remains. Alcohol use disorder: A cognitive, biological, behavioral, and social problem associated with alcohol use and abuse. Levels of Involvement 

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Although each drug described in this chapter has unique effects, there are similarities in the ways they are used and how people who abuse them are treated. First, we present some concepts that apply to substance-related disorders in general, noting important terminology and addressing several diagnostic issues. Psychoactive substances: Substances, such as a drug, that alter mood or behavior. o Substance use: The ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning. o Substance intoxication: A physiological reaction, such as impaired judgment and motor ability, as well as mood change, resulting from the ingestion of a psychoactive substance. Substance use disorders: When the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. o Physiological dependence: The use of increasingly greater amounts of the drug to experience the same effect (tolerance) and a negative physical response when the substance is no longer ingested.  Tolerance: The need for increased amounts of a substance to achieve the desired effect, and a diminished effect with continued use of the same amount.  Withdrawal: A severely negative physiological reaction to removal of a psychoactive substance, which can be alleviated by the same or a similar substance. o Other symptoms that make up a substance use disorder include “drug-seeking behaviors.” The repeated use of a drug, a desperate need to ingest more of the substance (stealing money to buy drugs, standing outside in the cold to smoke), and the likelihood that use will resume after a period of abstinence are behaviors that define the extent of substance use disorders. Substance dependence: A maladaptive pattern of substance use characterized by the need for increased amounts to achieve the desired effect, negative physical effects when the substance is withdrawn, unsuccessful efforts to control its use, and substantial effort expended to seek it or recover from its effects. Also known as addiction.

Substance abuse: A pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles and in hazardous situations. Six general categories of substances:     

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Depressants: A psychoactive substance that results in behavioral sedation; such substances include alcohol and the sedative, hypnotic, and anxiolytic drugs. Stimulants: A psychoactive substance that elevates mood, activity, and alertness; such substances include amphetamines, caffeine, cocaine, and nicotine. Opiates: An addictive psychoactive substance such as heroin, opium, or morphine that causes temporary euphoria and analgesia (pain reduction). Hallucinogens: Any psychoactive substance, such as LSD or marijuana, that can produce delusions, hallucinations, paranoia, and altered sensory perception. Other drugs of abuse: Other substances that are abused but do not fit easily into one of the common categories including inhalants, anabolic steroids, and other over-the-counter and prescription medications. Gambling disorder: Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress.

Depressants 

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Depressants primarily decrease central nervous system activity. Their principal effect is to reduce our levels of physiological arousal and help us relax. Included in this group are alcohol and the sedative, hypnotic, and anxiolytic drugs, such as those prescribed for insomnia. These substances are among those most likely to produce symptoms of physical dependence, tolerance, and withdrawal. Alcohol: By-product of the fermentation of yeasts, sugar, and water; the most commonly used and abused depressant substance. Alcohol-related disorders: Cognitive, biological, behavioral, and social problems associated with alcohol use and abuse. o Clinical Description  Apparent stimulation is the initial effect of alcohol, although it is a depressant. We generally experience a feeling of well-being, our inhibitions are reduced, and we become more outgoing. This is because the inhibitory centers in the brain are initially depressed—or slowed. With continued drinking, however, alcohol depresses more areas of the brain, which impedes the ability to function properly. Motor coordination is impaired (staggering, slurred speech), reaction time is slowed, we become confused, our ability to make judgments is reduced, and even vision and hearing can be negatively affected, all of which help explain why driving while intoxicated is clearly dangerous. o Effects  Alcohol affects many parts of the body. After it is ingested, it passes through the esophagus and into the stomach (2), where small amounts are absorbed. From there, most of it travels to the small intestine (3), where it is easily absorbed into the bloodstream. The circulatory system distributes the alcohol throughout the body, where it contacts every major organ, including the heart (4). Some of the alcohol goes to the lungs, where it vaporizes and is exhaled, a phenomenon that is the basis for the breathalyzer test that measures levels of intoxication. As

alcohol passes through the liver (5), it is broken down or metabolized into carbon

dioxide and water by enzymes. Withdrawal delirium: The frightening hallucinations and body tremors that result when a heavy drinker withdraws from alcohol. Also known as delirium tremens (DT).  Delirium Tremens: The frightening hallucinations and body tremors that result when a heavy drinker withdraws from alcohol. Also known as delirium tremens (DT). o Consequences of long-term excessive drinking include liver disease, pancreatitis, cardiovascular disorders, and brain damage. o Wernicke-Korsakoff syndrome: Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers. o Fetal alcohol syndrome (FAS): A pattern of problems, including learning difficulties, behavior deficits, and characteristic physical flaws, resulting from heavy drinking by the victim’s mother when she was pregnant with the victim. o We know that not everyone who drinks develops an alcohol use disorder. Researchers estimate, however, that more than 16.6 million adults ages 18 and older meet criteria for an alcohol use disorder and the same is true of 697,000 adolescents ages 12 to 17. Lifetime prevalence rates for alcohol use disorders, meaning a person met criteria for an alcohol use disorder at some point in his or her life, are more than 29% Sedative-, Hypnotic-, or Anxiolytic-Related Disorders o The general group of depressants also includes sedative (calming), hypnotic (sleepinducing), and anxiolytic (anxiety-reducing)  Barbiturates: A sedative (and addictive) drug such as Amytal, Seconal, or Nembutal that is used as a sleep aid.  Benzodiazepines: An antianxiety drug such as Valium, Xanax, Dalmane, or Halcion also used to treat insomnia. Effective against anxiety (and, at high potency, panic disorder), benzodiazepines show some side effects, such as some cognitive and motor impairment, and may result in substance dependence. Relapse rates are extremely high when such a drug is discontinued. o The DSM-5 criteria for sedative-, hypnotic-, and anxiolytic-related disorders do not differ substantially from those for alcohol disorders. Both include maladaptive behavioral changes such as inappropriate sexual or aggressive behavior, variable moods, impaired judgment, impaired social or occupational functioning, slurred speech, motor coordination problems, and unsteady gait. o

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Stimulants 

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Of all the psychoactive drugs used in the United States, the most commonly consumed are stimulants. Included in this group are caffeine (in coffee, chocolate, and many soft drinks), nicotine (in tobacco products such as cigarettes), amphetamines, and cocaine. In contrast to the depressant drugs, stimulants make you more alert and energetic. Amphetamine use disorders: Psychological, biological, behavioral, and social problems associated with amphetamine use and abuse. o Amphetamines: Stimulant medication used to treat hypersomnia by keeping the person awake during the day, and to treat narcolepsy, including sudden onset episodes, by suppressing rapid eye movement sleep. Cocaine use disorders: Cognitive, biological, behavioral, and social problems associated with the use and abuse of cocaine. Tobacco-related disorders: Cognitive, biological, behavioral, and social problems associated with the use and abuse of nicotine. o Nicotine: Toxic and addictive substance found in tobacco leaves. o DSM-5 does not describe an intoxication pattern for tobacco-related disorders. Rather, it lists withdrawal symptoms, which include depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, and increased appetite and weight gain. Nicotine in small doses stimulates the central nervous system; it can relieve stress and improve mood. But it can also cause high blood pressure and increase the risk of heart disease and cancer. High doses can blur your vision, cause confusion, lead to convulsions, and sometimes even cause death. Caffeine-Related Disorders o Caffeine is the most common of the psychoactive substances; upwards of 85% of the U.S. population has at least one caffeinated beverage per day o DSM-5 includes caffeine use disorder—defined problematic caffeine use that causes significant impairment and distress—as a condition for further study

Opioid-related disorders: Cognitive, biological, behavioral, and social problems associated with the use and abuse of opiates and their synthetic variants. Cannabis use disorders: A problematic pattern of cannabis use leading to clinically significant impairment or distress. Hallucinogen-Related Disorders  

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LSD (d-lysergic acid diethylamide): The most common hallucinogenic drug; a synthetic version of the grain fungus ergot. The DSM-5 diagnostic criteria for hallucinogen intoxication are similar to those for cannabis: perceptual changes such as the subjective intensification of perceptions, depersonalization, and hallucinations. Physical symptoms include pupillary dilation, rapid heartbeat, sweating, and blurred vision Hallucinogen use disorders: Cognitive, biological, behavioral, and social problems associated with the use and abuse of hallucinogenic substances.

Other drugs of abuse 

A number of other substances are used by individuals to alter sensory experiences. These drugs do not fit neatly into the classes of substances just described but are of concern because they can

be physically damaging to those who ingest them. We describe inhalants, steroids, and a group of drugs referred to as designer drugs. o Inhalants include substances found in volatile solvents—making them available to breathe into the lungs directly.  Common inhalants used abusively include spray paint, hair spray, paint thinner, gasoline, amyl nitrate, nitrous oxide (“laughing gas”), nail polish remover, felttipped markers, airplane glue, contact cement, dry-cleaning fluid, and spot remover o Another class of drugs—dissociative anesthetics—causes drowsiness, pain relief, and the feeling of being out of one’s body. Sometimes referred to as designer drugs, this growing group of drugs was originally developed by pharmaceutical companies to target specific diseases and disorders. Causes of Substance-Related Disorders 

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Biological Dimensions o Familial and Genetic Influences o Neurobiological Influences Psychological Dimensions o Positive reinforcement  The feelings that result from using psychoactive substances are pleasurable in some way, and people will continue to take the drugs to recapture the pleasure. o Negative reinforcement  Most researchers have looked at how drugs help reduce unpleasant feelings through negative reinforcement. In addition to the initial euphoria, many drugs provide escape from physical pain (opiates), from stress (alcohol), or from panic and anxiety (benzodiazepines). This phenomenon has been explored under a number of different names, including tension reduction, negative affect, and selfmedication, each of which has a somewhat different focus Cognitive dimensions o What people expect to experience when they use drugs influences how they react to them. A person who expects to be less inhibited when she drinks alcohol will act less inhibited whether she actually drinks alcohol or a placebo she thinks is alcohol.  This observation about the influence of how we think about drug use has been labeled an expectancy effect and has received considerable research attention.  Expectancies develop before people actually use drugs, perhaps as a result of parents’ and peers’ drug use, advertising, and media figures who model drug use Social dimensions o Research suggests that drug-addicted parents spend less time monitoring their children than parents without drug problems and that this is an important contribution to early adolescent substance use o How does our society view people who are dependent on drugs? This issue is of tremendous importance because it affects efforts to legislate the sale, manufacture, possession, and use of these substances. It also dictates how drug-dependent individuals are treated.

Two views of substance-related disorders characterize contemporary thought: the moral weakness and the disease models of dependence.  According to the moral weakness model of chemical dependence, drug use is seen as a failure of self-control in the face of temptation; this is a psychosocial perspective. Proponents of this model see drug users as lacking the character or moral fiber to resist the lure of drugs.  The disease model of physiological dependence, in contrast, assumes that drug use disorders are caused by an underlying physiological cause; this is a biological perspective. Cultural dimensions o Cultural factors not only influence the rates of substance abuse but also determine how it is manifested. 

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An integrative model

Treatment 

Biological treatment o Agonist substitution: A replacement of a drug on which a person is dependent with one that has a similar chemical makeup, an agonist. Used as a treatment for substance dependence.  Nicotine patch: Patch placed on the skin that delivers nicotine to smokers without the carcinogens in cigarette smoke. Somewhat more successful than nicotine gum because it requires less effort by the wearer and delivers the drug more consistently; should be coupled with counseling to stop smoking and avoid relapse o Antagonist drugs: The medication that blocks or counteracts the effects of a psychoactive drug.

Medication is often prescribed to help people deal with the often-disturbing symptoms of withdrawal. Psychosocial treatment o Impatient facilities, AA o Controlled drinking: An extremely controversial treatment approach to alcohol dependence, in which severe abusers are taught to drink in moderation. o Relapse prevention: The extending therapeutic progress by teaching the client how to cope with future troubling situations. o

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Impulse control disorders   

Intermittent explosive disorder: The episodes during which a person acts on aggressive impulses that result in serious assaults or destruction of property. Kleptomania: A recurrent failure to resist urges to steal things not needed for personal use or their monetary value. Pyromania: An impulse-control disorder that involves having an irresistible urge to set fires.

Summary Perspectives on Substance-Related and Addictive Disorders 

What are substance-related and addictive disorders? o In DSM-5, substance-related and addictive disorders include problems with the use of depressants (alcohol, barbiturates, and benzodiazepines), stimulants (amphetamines, cocaine, nicotine, and caffeine), opiates (heroin, codeine, and morphine), and hallucinogens (cannabis and LSD) as well as gambling.

Depressants, Stimulants, and Opioids 

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What are the physiological and psychological effects of depressants? o Depressants are a group of drugs that decrease central nervous system activity. The primary effect is to reduce our levels of physiological arousal and help us relax. Included in this group are alcohol and sedative, hypnotic, and anxiolytic drugs, such as those prescribed for insomnia. What are the physiological and psychological effects of stimulants? o Stimulants, the most commonly consumed psychoactive drugs, include caffeine (in coffee, chocolate, and many soft drinks), nicotine (in tobacco products such as cigarettes), amphetamines, and cocaine. In contrast to the depressant drugs, stimulants make us more alert and energetic. What are the physiological and psychological effects of opiates o Opiates include opium, morphine, codeine, and heroin; they have a narcotic effect— relieving pain and inducing sleep. The broader term opioids is used to refer to the family of substances that includes these opiates and synthetic variations created by chemists (e.g., methadone) and the similarly acting substances that occur naturally in our brains (enkephalins, beta-endorphins, and dynorphins).

Cannabis-Related Disorders 

What are the physiological and psychological effects of cannabis?

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Cannabis (marijuana) is the most routinely used illegal substance, with 5%–15% of people in western countries reporting regular use. Perhaps more than any other drug, however, cannabis can produce different reactions in people, including a sense of wellbeing, mood swings, and paranoia.

Hallucinogen-Related Disorders 

What are the physiological and psychological effects of hallucinogenics? o Hallucinogens essentially change the way the user perceives the world. Sight, sound, feelings, and even smell are distorted, sometimes in dramatic ways, in a person under the influence of drugs such as cannabis and LSD.

Other Drugs of Abuse 

What are the physiological and psychological effects ofother drugs, including inhalants, steroids, and designer drugs? o A number of other substances are used by individuals to alter sensory experiences. The high associated with the use of inhalants resembles that of alcohol intoxication and usually includes dizziness, slurred speech, incoordination, euphoria, and lethargy. Steroid use differs from other drug use because the substance does not produce a desirable high but instead is used to enhance performance and body size. Designer drugs heighten a person’s auditory and visual perception, as well as the senses of taste and touch.

Causes and Treatment of Substance-Related Disorders 

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What physiological and psychological processes lead to substance dependence? o Most psychotrop...