Ch 10 Substance Use and Addictive Disorders

Question 1

Depressants

Answer 1

DEPRESSANTS – slow the activity of the central nervous system. They reduce tension and inhibitions and may interfere with a person’s judgment, motor activity, and concentration.

• The three most widely used groups of depressants are alcohol, sedative-hypnotic drugs, and opioids.

Depressants are drugs that lower neurotransmission levels. They depress or reduce arousal and stimulation in various parts of the brain.

Depressants are used worldwide as prescription meds and illicit drugs

Question 2

Stimulants

Answer 2

STIMULANTS – substances that increase the activity of the central nervous system, resulting in increased blood pressure and heart rate, more alertness, and sped-up behavior and thinking.

• Among the most troublesome stimulants are cocaine and amphetamines, whose effects on people are very similar.
• Two other widely used and legal stimulants are caffeine and nicotine.

COCAINE – An addictive stimulant obtained from the coca plant. It is the most powerful natural stimulant known.

• Brings euphoric RUSH, increasing the neurotransmitters Dopamine as well as norepinephrine and Serotonin and eventually leads to a CRASH, which is a deppression-like letdown.
  
  • Some people have hallucinations, delusions, or both, a condition called COCAINE-INDUCED PSYCHOSIS.
• FREEBASING – A technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically separated from processed cocaine, vaporized by heat from a flame, and inhaled with a pipe.
  
  • CRACK – a powerful form of freebase cocaine that has been boiled down into crystalline balls.
• The annual number of cocaine-related emergency room incidents in the United States multiplied by more than 125 times since 1982, from around 4,000 cases to 505,000.
• Overdoses – Excessive doses have a strong effect on the respiratory center of the brain, at first stimulating it and then depressing it to the point where breathing may stop. Cocaine can also create major, even fatal, heart irregularities or brain seizures that bring breathing or heart functioning to a sudden stop.

AMPHETAMINE – A stimulant drug that is manufactured in the laboratory.

• like cocaine, amphetamines stimulate the central nervous system by increasing the release of the neurotransmitters dopamine, norepinephrine, and serotonin throughout the brain.

METHAMPHETAMINE – A powerful amphetamine drug that has surged in popularity in recent years, posing major health and law enforcement problems.

• It can have serious negative effects on a user’s physical, mental, and social life. Of particular concern is that it damages nerve endings, a problem called NEUROTOXICITY.

STIMULANT USE DISORDER – where the stimulant comes to dominate the person’s life in negative ways.

• Withdrawal symptoms can last for weeks or even months after drug use has ended.

Stimulants are drugs that increase the activity of the central nervous system. Similar to depressants, stimulants are also used worldwide with prescriptions and as illicit drugs. Stimulants are also used illegally in sports as performance-enhancing drugs.

Some stimulants are cocaine and amphetamines.

Question 3

Alcohol Use Disorder

Answer 3

ALCOHOL – Any beverage containing ethyl alcohol, including beer, wine, and liquor.

BINGE-DRINKING EPISODE – When people consume five or more drinks on a single occasion.

• 25% of people in the United States over the age of 11, mostly male, binge drink each month.
• 6.5% of people over 11 years old binge drink at least five times each month. (considered heavy drinkers).
  
  • Among heavy drinkers, males outnumber females by at least 2 to 1.

ETHYL ALCOHOL – a chemical that is quickly absorbed into the blood through the lining of the stomach and the intestine.

• GABA – a neurotransmitter that carries an inhibitory message – a message to stop firing – when it is received at certain neurons. When alcohol binds to receptors on those neurons, it apparently helps GABA to shut down the neurons, thus helping to relax the drinker.
• When more alcohol is absorbed, it slows down additional areas in the central nervous system, leaving drinkers less able to make sound judgments, their speech less careful and less coherent, and their memory weaker. Many people become highly emotional and perhaps loud and aggressive.
• Women have less of the stomach enzyme alcohol dehydrogenase, which breaks down alcohol in the stomach before it enters the blood. So women become more intoxicated than men on equal doses of alcohol, and women may be at greater risk for physical and psychological damage.
• Levels of impairment are closely related to the concentration of ethyl alcohol in the blood. When the alcohol concentration reaches 0.06 percent of the blood volume, a person usually feels relaxed and comfortable. By the time it reaches 0.09 percent, however, the drinker crosses the line into intoxication. If the level goes as high as 0.55 percent, the drinker will likely die.
• More than 1,000 people in the United States die each year from too high a blood alcohol level
• The average rate of this metabolism is ¼ of an ounce per hour
• Though legal, alcohol is actually one of the most dangerous of recreational drugs, and its reach extends across the life span.

ALCOHOL USE DISORDER** – (**ALCOHOLISM)

• 5.9% of all people in the US are alcoholics
• For teenagers specifically, the rate is 2.5%
• Men with this disorder outnumber women by 2 to 1.
• American Indians, particularly men, have the highest rate of alcohol use disorder at 9.7%
• 3.2% of Asian Americans are alcoholics.
  
  • Half of them have a deficiency of alcohol dehydrogenase, the chemical responsible for breaking down alcohol, so they react quite negatively to even a modest intake of alcohol. Such reactions in turn help prevent extended use.
• Educators to describe binge drinking as “the number one public health hazard” for full-time college students.
• Students who are binge drinkers in high school are more likely to binge drink in college.
• People with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious.
• DELERIUM TREMIN (The “DT’s”) – A dramatic alcohol withdrawal reaction that consists of confusion, clouded consciousness, and visual hallucinations.
• Like most other alcohol withdrawal symptoms, the DTs usually run their course in 2 to 3 days. However, people who have severe withdrawal reactions such as this may also have seizures, lose consciousness, suffer a stroke, or even die.
• Deaths from alcoholism cost society many billions of dollars annually.
• The disorder also plays a role in more than one third of all suicides, homicides, assaults, rapes, and accidental deaths
• Also has a role in 29% of all fatal automobile accidents in the United States
• Altogether, intoxicated drivers are responsible for more than 10,000 deaths each year.
• 30 million children of Alcoholics likely to be abused and are, in turn, more likely to have psychological problems.
• Physical damage includes:
  
  • CIRRHOSIS – in which the liver becomes scarred and dysfunctional.
  • KORSAKOFF’S SYNDROM – An alcohol-related deficiency of vitamin B1 (thiamine) may lead to this disease marked by extreme confusion, memory loss, and other neurological symptoms.
• FETAL ALCOHOL SYNDROM – A cluster of problems in a child, including irregularities in the head and face and intellectual deficits, caused by excessive alcohol intake during pregnancy.
  
  • Affects 1/1,000 babies

Eventhough alcohol is legal, it is arguably the most dangerous drug legal or otherwise

23% of middle schoolers admit to some alcohol use

33% of high schoolers drink each month and 1.3% drink daily

Alcoholics drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious. Drinking will eventually interfere with their social lives and may spark a downward spiral.

MRI scans of chronic heavy drinkers shows damage in different parts of the brain that effect memory, quick thinking, attention skills and balance.

One of the worst things about alcohol abuse is how difficult it is to stop. Alcoholics start to build a tolerance for alcohol so they have to drink larger quantities to feel the effects. Alcoholics also have withdrawal symptoms when they stop drinking.

Within hours their hands, tongue, and eyelids begin to shake; they feel weak and nauseated; they sweat and vomit; their heart beats rapidly; and their blood pressure rises. They may also become anxious, depressed, unable to sleep, or irritable

In the US, 5.9 % of all people over the age of 11 display alcohol use disorder. For teens it’s 2.5%

Men with this disorder out number women 2 to 1

Question 4

Sedative-Hypnotic Drugs

Answer 4

SEDATIVE-HYPNOTIC DRUGS (ANXIOLYTIC – Meaning “Anxiety reducing”) – A drug used in low doses to reduce anxiety and in higher doses to help people sleep.

• BARBITURATES – Addictive sedative-hypnotic drugs that reduce anxiety and help people sleep.
• BENZODIAZAPINES – The most common group of antianxiety drugs; includes Xanax.
  • These have largely replaced barbiturates as they are safer with fewer side-effects. Benzodiazepines relieve anxiety without making people as drowsy as other kinds of sedative-hypnotics. They are also less likely to slow a person’s breathing, so they are less likely to cause death in the event of an overdose.

Sedative-hypnotic drugs when used in lower doses reduce anxiety and in higher doses it helps people sleep.

For the first half of the 20th century physicians often prescribed barbiturates, a group of sed-hyp drugs which people now know are highly addictive.

For the most part barbiturates have been replaced by a new group of drugs called benzodiazepines which are generally safer and less likely to lead to intoxication, tolerance, and withdrawal. Some of these drugs are, xanax, valium, and ativan.

130 million prescriptions are written anually for benzodiazepines.

At first benzos seemed so safe and effective that physicians prescribed them very generously. It soon became apparent that in high enough doses it can lead to intoxication and sedative-hypnotic disorder.

0.4% of all adults in america have this disorder.

Question 5

Opioids

Answer 5

OPIOID – include opium, which is taken from the sap of the opium poppy; drugs derived from opium, such as heroin, morphine, and codeine; and similar synthetic (laboratory-blended) drugs.

OPIUM – A highly addictive substance made from the sap of the opium poppy.

MORPHINE – A highly addictive substance derived from opium that is particularly effective in relieving pain.

• In 1898, morphine was converted into yet another new pain reliever, HEROIN, One of the most addictive substances derived from opium.

RUSH – a spasm of warmth and ecstasy followed by several hours of a pleasant feeling called a high or nod.

• Opioids create these effects by depressing the central nervous system.

ENDORPHINS – Neurotransmitters that help relieve pain and reduce emotional tension. They are sometimes referred to as the body’s own opioids.

• When neurons at these receptor sites receive opioids, they produce pleasurable and calming feelings just as they would do if they were receiving endorphins

OPIOID USE DISORDER – when an opioid, such as heroin, interferes significantly with the individual’s social and occupational functioning, and their lives center around the drug. They may also build a tolerance for the drug and experience a withdrawal reaction when they stop taking it

• Heroin use exemplifies the kinds of problems posed by opioids. After taking heroin repeatedly for just a few weeks, users may develop opioid use disorder.
• Such people soon need heroin just to avoid going into withdrawal, and they must continually increase their doses in order to achieve even that relief.
• 1% of adults in the United States, a total of 2.6 million people, display an opioid use disorder within a given year.

OVERDOSE – closes down the respiratory center in the brain, almost paralyzing breathing and in many cases causing death.

• Death is particularly likely during sleep, when a person is unable to fight this effect by consciously working to breathe.
• 20,000 people in the United States die from pain reliever overdoses each year.
• 15,000 from heroin overdoses
• 8,000 from overdoses of other opioids
• These numbers represent two-thirds of all drug overdose deaths.
• In some areas of the United States, the HIV infection rate among active heroin users is reported to be as high as 60%.

RISE OF THE OPIOID CRISIS:

• 1990s saw the rise of prescription painkillers being overprescribed.
• Many patients developed a Painkiller Use Disorder.
• As their use was increasing, so was their potency.
• FENTANYL was invented – one of the most powerful pain relief drugs.
  
  • Fentanyl is by far the painkiller most commonly linked to overdose deaths.
• Rising availability and decreased cost of heroin

Opioids include opium which is a highly addictive substance made from the sap of opium poppies

Other opioids are drugs that are derived from opium such as, heroin, codeine, and morphine as well as similar synthetic drugs.

Opium has been used for thosands of years. It used to be used medically because of it’s ability to reduce both physical and emotional pain.

In 1804 a new substance, morphine, was derived from opium. Named after Morpheus, the Greek god of sleep, morphine could relieve pain better than opium could and was thought to be safe at first.

In 1898, morphine was converted into another drug, perhaps the worst, heroin. heroin was initially viewed as a ‘wonder drug’ and it was used for cough medicine as well as other medical uses. Eventually it was discovered that heroin was even more addictive than other opioids.

1917, congress concluded that all drugs derived from opium is addictive and passed a law making all opioids illeagal except for medical uses.

Question 6

Hallucinogens

Answer 6

HALLUCINOGENS – A substance that causes powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations. Also called a psychedelic drug. They produce sensations so out of the ordinary that they are sometimes called “trips.”

• Includes LSD, mescaline, psilocybin, MDMA (Ecstasy)
• LSD (lysergic acid diethylamide) – A hallucinogenic drug derived from ergot alkaloids.
  
  • All of the effects take place while the user is fully awake and alert, and they wear off in about 6 hours.
  • Although people do not usually develop tolerance to LSD or have withdrawal symptoms when they stop taking it, the drug poses dangers for both one-time and long-term users. It is so powerful that any dose, no matter how small, is likely to produce enormous perceptual, emotional, and behavioral reactions. Sometimes the reactions are extremely unpleasant—a so-called BAD TRIP.
  • Another danger is the long-term effect that LSD may have. Some users eventually develop psychosis or a mood or anxiety disorder.

Hallusinogens are substances that cause powerful changes in sensory perception, from strengthening their normal perceptions or inducing illusions or hallucinations.

Some of these drugs are, LSD, MDMA, shrooms. Most psychadelics come from plants, animals or lab manufactured.

LSD puts people in a hallucinogen intoxication, also called hallucinosis, and may enhance colors, change shapes of objects, and enhance tiny details. Sometimes people react very differently and have what people call a ‘bad trip’ which can be a very frightening and traumatic experience for the user

Sometimes, people have flashbacks of tripping even if the drug is out of their system

Question 7

Cannabis

Answer 7

• CANNABIS – Drugs produced from the varieties of the hemp plant Cannabis sativa. They cause a mixture of hallucinogenic, depressant, and stimulant effects.
  
  • MARIJUANA – One of the cannabis drugs, derived from the buds, leaves, and flowering tops of the hemp plant Cannabis sativa.
  • TETRAHYDROCANNIBINOL (THC) – The main active ingredient of cannabis substances.
  • Most of the effects of cannabis last 2 to 6 hours. The changes in mood, however, may continue longer.

CANNABIS USE DISORDER – when use adversely affects lives.

• The marijuana widely available in the United States today is at least four times more powerful than that used in the early 1970s. The average THC content of today’s marijuana is 8 percent, compared with 2 percent in the late 1960s. Marijuana is now grown in places with a hot, dry climate, which increases the THC content.
• Occasionally causes panic reactions similar to the ones caused by hallucinogens.
• Interferes with the performance of complex sensorimotor tasks and with cognitive functioning,
• Legalization – Currently, 30 states (plus Washington, D.C., Guam, and Puerto Rico) have laws allowing marijuana to be used for medical purposes, and several more have such laws pending. Medical marijuana is now legal in about a dozen countries.
  
  • Since 2012, residents in eight states have voted to legalize marijuana for use of any kind.

Cannabis is any drug produced from the hemp plant Cannabis sativa.

Cannabis is found in various strengths depending on, the climate where it grows, the way it is prepared, and the manner and duration that it is stored. The highest strength is hashish, the weakest and most popular worldwide is marijuana.

More than 22 million people over the age of 11 currently smoke marijuana monthly.

Marijuana interferes with the performance of complex sensorimotor tasks and with cognitive functioning. It has caused many automobile accidents

Question 8

Drug Interactions

Answer 8

POLYSUBSTANCE USE – taking more than one drug at a time – VERY DANGEROUS!

• SYNERGISTIC EFFECT – In pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time.
  
  • Ex: One kind of synergistic effect occurs when two or more drugs have similar actions. For instance, alcohol, benzodiazepines, barbiturates, and opioids—all depressants—may severely depress the central nervous system when mixed. Combining them, even in small doses, can lead to extreme intoxication, coma, and even death.
  • Ex: A different kind of synergistic effect results when drugs have opposite, or antagonistic, actions. Stimulant drugs, for example, interfere with the liver’s usual disposal of barbiturates and alcohol. Thus, people who combine barbiturates or alcohol with cocaine or amphetamines may build up toxic, even lethal, levels of the depressant drugs in their systems.
• 90% of those who use one illegal drug are also using another to some extent.
• 18% of unemployed people use illegal drugs compared with 11% of those full-time employed and 13% of those part-time employed.

When different drugs are in the body at the same time they can multiply or amplify each other’s effects. This is called a synergistic effect.

One kind of synergistic effect is when 2 or more drugs have similar effects. For example, alcohol mixed with another depressant like Xanax may severely depress the central nervous system and even a small dose can lead to extreme intoxication, coma, or even death.

Another kind is when there are 2 or more drugs with opposite effects. Stimulants interfere with the liver’s ability to dispose of alcohol and barbiturates. People who mix barbs or alc with stimulants like cocaine may build up toxic, even lethal levels of depressants in their system.

Thousands of people each year are admitted to a hospital with a multiple-drug emergency.

As many as 90% of people who use an illegal drug also use another to some extent.

Question 9

What Causes Substance Use Disorders

Answer 9

What Causes Substance Use Disorders?

Sociocultural Views

• People are most likely to develop substance use disorders when they live under stressful socioeconomic conditions.
• Intense discrimination environments also have a large percentage with substance abuse disorders.
• People are more likely to develop substance use disorders if they are part of a family or social environment in which substance use is valued or at least accepted.
• lower rates of alcoholism are found among Jews and Protestants, groups in which drinking is typically acceptable only as long as it remains within clear limits, whereas alcoholism rates are higher among the Irish and Eastern Europeans, who do not, in general, draw as clear a line

Psychodynamic Views

• People with substance use disorders have powerful dependency needs that can be traced to their early years.
• They suggest that when parents fail to satisfy a young child’s need for nurturance, the child is likely to grow up depending excessively on others for help and comfort, trying to find the nurturance that was lacking during the early years. If this search for outside support includes experimentation with a drug, the person may well develop a dependent relationship with the substance.
• Impulsive men are indeed more prone to develop alcohol problems.
• Researchers cannot presently conclude that any one personality trait or group of traits stands out in the development of the disorders.

Cognitive-Behavioral Views

• Operant conditioning may play a key role in substance use disorders. They argue that the temporary reduction of tension or raising of spirits produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again.
• Similarly, the rewarding effects may eventually lead users to try higher dosages or more powerful methods of ingestion.
• They further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation helps motivate people to increase drug use at times of tension.
  
  • Essentially, they’re saying that many people take drugs to “medicate” themselves when they feel tense. If so, one would expect higher rates of substance use disorders among people who suffer from anxiety, depression, and other such problems.
• Classical conditioning may also play a role in these disorders.
  
  • Cues or objects present in the environment at the time a person takes a drug may act as classically conditioned stimuli and come to produce some of the same pleasure brought on by the drugs themselves.
  • In a similar manner, cues or objects that are present during withdrawal distress may produce withdrawal-like symptoms.

Biological Views

• Genetic predisposition, neurotransmitters, and brain circuits have all pointed in this direction.
• GENETIC PREDISPOSITION – Genetic linkage strategies and molecular biology techniques provide more direct evidence in support of a genetic explanation
  
  • Research has found an abnormal form of the so-called dopamine-2 (D2) receptor gene in a majority of research participants with substance use disorders but in less than 20% of participants who do not have such disorders.
  • If one identical twin displays alcoholism, the other twin also does in 50% of the cases.
  • Comparing adoptees whose biological parents abuse alcohol with adoptees whose biological parents do not. By adulthood, the individuals whose biological parents abuse alcohol typically show higher rates of alcoholism than those with nonalcoholic biological parents.
• NEUROTRANSMITTERS –
  
  • When a particular drug is ingested, it increases the activity of certain neurotransmitters whose normal purpose is to calm, reduce pain, lift mood, or increase alertness.
    
    • When a person keeps on taking the drug, the brain apparently makes an adjustment and reduces its own production of the neurotransmitters. As drug intake increases, the body’s production of the neurotransmitters continues to decrease, leaving the person in need of progressively more of the drug to achieve its effects. In this way, drug takers build TOLERANCE for a drug, becoming more and more reliant on it rather than on their own biological processes to feel comfortable, happy, or alert.
    • If they suddenly stop taking the drug, their natural supply of neurotransmitters will be low for a time, producing the symptoms of withdrawal. Withdrawal continues until the brain resumes its normal production of the neurotransmitters.
      
      • Repeated and excessive use of alcohol or benzodiazepines may lower the brain’s production of the neurotransmitter GABA.
      • Regular use of opioids may reduce the brain’s production of endorphins.
      • Regular use of cocaine or amphetamines may lower the brain’s production of dopamine
      • Excessive use of marijuana may reduce the production of anandamide.
• BRAIN REWARD CIRCUIT – A dopamine-rich circuit in the brain that produces feelings of pleasure when activated. Also called the reward center and the pleasure pathway.
  
  • The neurotransmitter-focused explanation of substance abuse helps explain why people who regularly take substances have tolerance and withdrawal reactions.
  • Whenever a person ingests a substance (from foods to drugs), the substance eventually activates the brain’s reward circuit.
  • The key neurotransmitter in this circuit is dopamine. When dopamine is activated throughout this circuit, a person feels pleasure.
  • As substances repeatedly stimulate this reward circuit, the circuit develops a hypersensitivity to the substances. That is, neurons in the circuit fire more readily when stimulated by the substances, contributing to future desires for them (addiction).
  • People who chronically use drugs may suffer from a REWARD DEFICIENCY SYNDROM: their reward circuit is not readily activated by the usual events in their lives, so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress.
  • Abnormal genes, such as the abnormal D2 receptor gene, have been cited as possible contributors to this syndrome. In short, the chronic intake of certain substances helps to produce a dysfunctional reward circuit in the brain and, along with that, the symptoms of a substance use disorder.

The Developmental Psychopathology View

• The Developmental psychopathology perspective provides a framework for understanding why the factors discussed in this chapter sometimes lead to substance use disorders and sometimes do not.
  
  • it offers an explanation for seeming contradictions in the substance abuse research literature.
  • – the principle that different developmental pathways can lead to the same psychological disorder.
• The road to substance use disorders begins with genetically inherited predispositions characterized by a less-than-optimal reward circuit in the brain and by a problematic temperament.
• These predispositions will eventually result in a substance use disorder if the individual further experiences numerous significant stressors throughout childhood.
• PROTECTIVE FACTORS – individuals who experience manageable adversities throughout childhood and adolescence can develop a level of resilience that help counter such unfavorable predispositions, stressors, and negative influences.
• Either of two different temperaments may set the stage for later substance abuse:

1. EXTERNALIZING TEMPERAMENT – featuring impulsivity, aggressiveness, overactivity, limited persistence, low frustration tolerance These individuals have great difficulty controlling their behaviors.
2. INTERNALIZING TEMPERAMENT – a temperament of inhibition and negative affectivity, characterized by multiple fears, depression, negative thinking, and dependence.

Sociocultural Views: People are most likely to develop substance use disorders when they live under stressful socioeconomic conditions. 18% of unemployed adults currently use an illegal drug, compared with 11% of full-time employed workers and 13% of part-time employees.

Psychodynamic Views: People with substance use disorders have powerful dependency needs that can be traced to their early years. Theorists also believe that certain people respond to their early deprivations by developing a substance abuse personality that leaves them particularly prone to drug abuse.

Biological Views: Many theorists believe that people can be predisposed to being addicted to drugs

Question 10

Substance Use Disorder

Answer 10

SUBSTANCE INTOXICATION – A cluster of temporary undesirable behavioral or psychological changes that develop during or shortly after the ingestion of a substance.

• LSD may produce hallucinogen intoxication, sometimes called HALLUCINOSIS, which consists largely of perceptual distortions and hallucinations.

SUBSTANCE USE DISORDER – A pattern of long-term maladaptive behaviors and reactions brought about by repeated use of a substance.

• TOLERANCE – The brain and body’s need for ever-larger doses of a drug to produce earlier effects.
• WITHDRAWAL – Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly
• 7.8 percent of all teens and adults in the United States, around 21 million people, have a substance use disorder
• American Indians have the highest rate of substance use disorders in the United States (11.6 percent)
• while Asian Americans have the lowest (3.8 percent).
• 18% of all those with substance use disorders receive treatment from a mental health professional.

Question 11

Treatments for Substance Abuse Disorders

Answer 11

How Are Substance Use Disorders Treated?

• The approaches that follow are often combined with MOTIVATIONAL INTERVIEWING in which therapists help motivate the clients to make constructive choices and behavioral changes.

Psychodynamic Therapies

• Help clients to uncover and work through the underlying needs and conflicts that they believe have led to the substance use disorder. The therapists
• Then try to help the clients change their substance-related styles of living –
• NOT particularly effective.
• It may be that substance use disorders, regardless of their causes, eventually become stubborn independent problems that must be the direct target of treatment if people are to become drug-free.

Cognitive-Behavioral Therapies

• Help clients identify and change the behaviors and cognitions that keep contributing to their patterns of substance misuse.
• The leading cognitive-behavioral interventions for these disorders are:
  
  • Aversion therapy – (Classical Conditioning) A treatment in which clients are repeatedly presented with unpleasant stimuli while they are performing undesirable behaviors such as taking a drug.
    
    • A major problem is that the approach can be effective only if people are motivated to subject themselves to multiple sessions of this unpleasant procedure, and many people are not.
  • Contingency management – (Operant Conditioning) Offers clients incentives (such as vouchers, prizes, cash, or privileges) that are contingent on the submission of drug-free urine specimens.
    
    1. As with aversion therapy, a major limitation is that the approach can be effective only when people are motivated to endure its unpleasantness.
  • Relapse prevention training – clients are taught to identify high-risk situations, appreciate the range of decisions that confront them in such situations, change their dysfunctional lifestyles, and learn from mistakes and lapses.
    
    • Relapse-prevention training for alcohol use disorder:
      
      1. Therapists have clients keep track of their drinking – making them more aware of the situations that place them at risk for excessive drinking.
      2. Therapists teach clients coping strategies to use when such situations arise.
         
         • Ex: Clients learn to recognize when they are approaching their drinking limits; to control their rate of drinking (perhaps by spacing their drinks or by sipping them rather than gulping); and to practice relaxation techniques, assertiveness skills, and other coping behaviors in situations in which they would otherwise be drinking.
      3. Therapists teach clients to plan ahead of time.
         
         • Ex: Clients may determine beforehand how many drinks are appropriate, what to drink, and under which circumstances to drink.
  • Acceptance and commitment therapy (ACT) – use a mindfulness-based approach to help clients become aware of their streams of thoughts as they are occurring and to accept such thoughts as mere events of the mind. For people with substance use disorders, that means increasing their awareness and acceptance of their drug cravings, worries, and depressive thoughts.
    
    • By accepting such thoughts rather than trying to eliminate them, the clients are expected to be less upset by them and less likely to act on them by seeking out drugs.

Biological Treatments

• Help people withdraw from substances, abstain from them, or simply maintain their level of use without increasing it further.
• DETOXIFICATION – Systematic and medically supervised withdrawal from a drug.
  
  • Detoxification programs seem to help motivated people withdraw from drugs. However, relapse rates tend to be high for those who do not receive a follow-up form of treatment—psychological, biological, or sociocultural—after successfully detoxifying.
• ANTAGONIST DRUGS – Drugs that block or change the effects of an addictive drug.
  
  • Ex: Disulfiram (Antabuse), for example, is often given to people who are trying to stay away from alcohol. By itself, a low dose of disulfiram seems to have few negative effects, but a person who drinks alcohol while taking it will have intense nausea, vomiting, etc. People taking disulfiram are less likely to drink alcohol because they know the terrible reaction that awaits them should they have even one drink. But they have to be willing participants.
  • Ex: For substance use disorders centered on opioids, several opioid antagonist drugs, such as naloxone, are used. These antagonists attach to endorphin receptor sites throughout the brain and make it impossible for the opioids to have their usual effect.
• DRUG MAINTENANCE THERAPY – usually provided as a bridge to stopping use of the illegal drug, mitigating the illegal drug’s withdrawal symptoms or at least moderating the abuser’s drug use.
  
  • METHADONE MAINTENANCE PROGRAM – A treatment in which clients are given legally and medically supervised doses of methadone – a heroin substitute – to treat various opioid use disorders.
    
    • Maintenance treatment with methadone has again sparked interest among clinicians in recent years, partly because of new research support and partly because of the rapid spread of the HIV and hepatitis C viruses among intravenous drug abusers and their sex partners and children.
    • Also, methadone treatment is safer than street opioid use.
    • BUPRENORPHINE – a less potent substitute drug than methadone and produces less tolerance and fewer withdrawal reactions. For these reasons, buprenorphine is permitted by law to be prescribed by physicians in their offices rather than as part of a highly structured clinic program.

Sociocultural Therapies

1. SELF-HELP PROGRAMS

• Alcoholics Anonymous (AA) – A self-help organization that provides support and guidance for people with alcohol use disorder.
  
  • The abstinence goal of AA is in direct opposition to the controlled-drinking goal of relapse-prevention training and several other interventions for substance misuse.
  • Research indicates, however, that both controlled drinking and abstinence may be useful treatment goals, depending on the nature of the particular drinking problem.
    
    • Abstinence may be a more appropriate goal for people who have a long-standing alcohol use disorder.
    • Controlled drinking can be helpful to younger drinkers whose pattern does not include tolerance and withdrawal reactions.
• RESIDENTIAL TREATMENT CENTERS** – A place where people who were formerly addicted to drugs live, work, and socialize in a drug-free environment. Also called a **therapeutic community.

1. CULTURE and GENDER-SENSITIVE PROGRAMS
   
   • Therapists who are sensitive to their clients’ life challenges can do more to address the stresses that often lead to relapse.
   • Aware that women often require treatment methods different from those designed for men.
   • Women’s Issues – In addition, treatment of women with substance use disorders may be complicated by the impact of sexual abuse, the possibility that they may be or may become pregnant while taking drugs, the stresses of raising children, and the fear of criminal prosecution for abusing drugs during pregnancy
2. COMMUNITY PREVENTION PROGRAMS
   
   • The most effective approach to substance use disorders is to prevent them.
   • Some prevention programs are based on a total abstinence model, while others teach responsible use.
   • Some seek to interrupt drug use;
   • Delay the age at which people first experiment with drugs.
   • Offer drug education
   • Teach alternatives to drug use
   • Try to change the psychological state of the potential user
   • Help people change their peer relationships