Ch.11, substance abuse disorders Flashcards
most commonly used substances of abuse
psychoactive substances, which are those that affect mental functioning in the central nervous system (CNS), such as alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these substances, like alcohol and nicotine (and marijuana in some states), can be purchased legally by adults; others, such as barbiturates or pain medications like OxyContin, can be used legally under medical supervision; still others, such as heroin, ecstasy, and methamphetamine, are illegal.
Addictive behavior—
behavior based on the pathological need for a substance—may involve the abuse of substances such as nicotine, alcohol, ecstasy, or cocaine. Addictive behavior is one of the most prevalent and difficult-to-treat mental health problems facing our society today.
substance abuse vs dependence vs tolerance vs withdrawal
Substance abuse generally involves an excessive use of a substance resulting in (1) potentially hazardous behavior such as driving while intoxicated or (2) continued use despite a persistent social, psychological, occupational, or health problem.
Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing amounts of a substance to achieve the desired effects. Dependence in these disorders means that an individual will show a tolerance for a drug and/or experience withdrawal symptoms when the drug is unavailable.
Tolerance—the need for increased amounts of a substance to achieve the desired effects—results from biochemical changes in the body that affect the rate of metabolism and elimination of the substance from the body.
Withdrawal refers to physical symptoms such as sweating, tremors, and tension that accompany abstinence from a drug.
why dont we use the word alcoholic?/ WHO definition of heavy episodic drinking
they are not accepted medical terms and are not defined or used by the medical or psychological communities. The World Health Organization (WHO) instead recommends the more precise term harmful use of alcohol—“drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes” / heavy episodic drinking as the consumption of six or more alcoholic drinks on at least one occasion at least once per month
prevalence of alcohol use disorder
30 percent of people in the United States meet DSM criteria for alcohol use disorder at some point in their lifetime, and nearly 15 percent meet criteria in a given year
risks of execssive alcohol use/ gender difference/ ethnic differences
The potentially detrimental effects of excessive alcohol use are enormous. Heavy drinking is associated with significantly increased risk of death by accident, suicide, homicide, and a host of other leading causes of death (e.g., heart disease, cancer, stroke) (Connor, Haber, & Hall, 2016; Wintemute, 2015). The life span of the average person with alcohol dependence is about 12 years shorter than that of the average person without this disorder. Chronic alcohol consumption has been shown to lead to worse cognitive abilities (e.g., decision-making) in both human and animal studies
he risk of alcohol use disorder is twice as high in men than in women
native Americans tend to have higher rates of alcohol abuse
alcohol vs opiate withdrawal
The physiological symptoms accompanying withdrawal from heroin are no more frightening or traumatic to an individual than alcohol withdrawal. Actually, alcohol withdrawal is potentially more lethal than opiate withdrawal.
alcohol effects on brain in low vs high levels
At lower levels, alcohol activates the brain’s “pleasure areas,” causing the release of dopamine in the mesolimbic dopamine pathway (discussed later in this chapter) (Connor et al., 2016). At higher levels, alcohol depresses brain functioning, inhibiting one of the brain’s excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain (Koob et al., 2002). Inhibition of glutamate in the brain impairs the ability to learn and affects the higher brain centers, impairing judgment and other rational processes and lowering self-control. As behavioral restraints decline, a drinker may indulge in the satisfaction of impulses ordinarily held in check. A lack of motor coordination soon becomes apparent, and the drinker’s discrimination and perception of cold, pain, and other discomforts are dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out and the drinker’s feelings of self-esteem and adequacy rise
what blood alcohol level indicates intoxication?
lcohol content of the bloodstream reaches 0.08 percent, the individual is considered intoxicated, at least with respect to driving a vehicle. Muscular coordination, speech, and vision are impaired and thought processes are confused. Even before this level of intoxication is reached, however, judgment becomes impaired to such an extent that the person misjudges his or her condition. For example, drinkers tend to express confidence in their ability to drive safely long after such actions are in fact quite unsafe. When the blood alcohol level reaches approximately 0.5 percent (the level differs somewhat among individuals), the entire neural balance is upset and the individual passes out
what determines intoxication?
amount of alcohol actually concentrated in the bodily fluids, not the amount consumed, that determines intoxication. The effects of alcohol vary for different drinkers, depending on their physical condition, the amount of food in their stomach, and the duration of their drinking. In addition, alcohol users may gradually build up a tolerance for the drug so that ever-increasing amounts may be needed to produce the desired effects. Women metabolize alcohol less effectively than men and thus become intoxicated on lesser amounts
why do hangovers occur?
leading theories focusing on dehydration along with the buildup of alcohol metabolites, such as acetaldehyde, and the triggering of the body’s immune response (Penning et al., 2010). Another component of hangovers for some people is the experience of jitters or intense anxiety. As mentioned, alcohol consumption leads to the suppression of glutamate, a major excitatory neurotransmitter, which contributes to the feeling of calmness during intoxication. However, after a person stops drinking, the body makes up for lost time by producing a lot of glutamate, which can lead to trouble with sleeping and with increased jitters and anxiety the next day
THE PHYSICAL EFFECTS OF CHRONIC ALCOHOL USE
Alcohol that is taken in must be assimilated by the body, except for the approximately 5 to 10 percent that is eliminated through breath, urine, and perspiration. The work of alcohol metabolism is done by the liver, but when large amounts of alcohol are ingested, the liver may be seriously overworked and eventually suffer irreversible damage (Lucey et al., 2009). In fact, from 15 to 30 percent of heavy drinkers develop cirrhosis of the liver, a disorder that involves extensive stiffening of the blood vessels in the liver.
FAS
Newborn infants whose mothers drank heavily during pregnancy have been found to have frequent physical and behavioral abnormalities, including growth deficiencies, facial and limb irregularities, damage to the CNS, and impairment in cognitive and motor functioning (Lucas et al., 2014). Neuroimaging research has shown that there is an overall reduction of brain size and prominent brain shape abnormalities, with narrowing in the parietal region along with reduced brain growth in portions of the frontal lobe (Spadoni et al., 2007). Moreover, children with FAS often show significant working memory deficits and altered activation patterns in some brain regions
Psychosocial Effects of Alcohol Abuse and Dependence
heavy drinkers often suffer from chronic fatigue, oversensitivity, and depression. Initially, alcohol may seem to provide a useful crutch for dealing with the stresses of life, especially during periods of acute stress, by helping screen out intolerable realities and enhance the drinker’s feelings of adequacy and worth. The excessive use of alcohol eventually becomes counterproductive, however, and can result in impaired reasoning, poor judgment, and gradual personality deterioration
-excessive drinker may be unable to hold a job and generally becomes unqualified to cope with new demands that arise (Frone, 2003). General personality disorganization and deterioration may be reflected in loss of employment and marital breakup. The drinker’s overall health will eventually deteriorate, and brain and liver damage will occur. For example, there is evidence that the brain of a person with alcohol use disorder is accumulating diffuse organic damage even when no extreme organic symptoms are present
Psychoses Associated with Severe Alcohol Abuse vs alcohol induced psychotic disorders
induced: acute reactions usually last only a short time and generally consist of confusion, excitement, and delirium. These disorders are often called alcohol-induced psychotic disorders because they are marked by a temporary loss of contact with reality
alcohol withdrawal delirium symptoms
Among those who drink excessively for a long time, a reaction called alcohol withdrawal delirium (formerly known as delirium tremens) may occur. This reaction usually happens following a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or suddenly moving objects may cause considerable excitement and agitation. The full-blown symptoms include (1) disorientation for time and place, in which, for example, a person may mistake the hospital for a church or jail, no longer recognize friends, or identify hospital attendants as old acquaintances; (2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches; (3) acute fear, in which these animals may change in form, size, or color in terrifying ways; (4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested; (5) marked tremors of the hands, tongue, and lips; and (6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath.
=The delirium typically lasts from 3 to 6 days and is generally followed by a deep sleep. When a person awakens, few symptoms remain, but frequently the individual is scared and may not resume drinking for several weeks or months. = 30 percent of patients with alcohol withdrawal delirium die within 8 years of onset, though risk of death is significantly decreased with appropriate treatment
alcohol amnestic disorder
first described by the Russian psychiatrist Sergei Korsakoff in 1887 and is one of the most severe alcohol-related disorders (d’Ydewalle & Van Damme, 2007). The primary symptom is a memory defect (particularly with regard to recent events), which is sometimes accompanied by falsification of events (confabulation). People with this disorder may not recognize pictures, faces, rooms, and other objects that they have just seen, although they may feel that these people or objects are familiar. Such people increasingly tend to fill in their memory gaps with confabulations that lead to unconnected and distorted associations. These individuals may appear to be delirious, delusional, and disoriented for time and place, but ordinarily their confusion and disordered actions are closely related to their attempts to fill in memory gaps. The memory disturbance itself seems related to an inability to form new associations in a manner that renders them readily retrievable. Such a reaction usually occurs in long-time alcohol abusers after many years of excessive drinking. These patients have also been observed to show other cognitive impairments such as planning deficits (Brokate et al., 2003), intellectual decline, emotional deficits (Snitz et al., 2002), judgment deficits (Brand et al., 2003), and cortical lesions
Neurobiology of Addiction
mesocorticolimbic dopamine pathway (MCLP) is the center of psychoactive drug activation in the brain. The MCLP is made up of neuronal cells in the middle portion of the brain known as the ventral tegmental area (see Figure 11.2) and connects to other brain centers such as the nucleus accumbens and then to the prefrontal cortex. This neuronal system is involved in functions such as control of emotions, memory, and gratification. Alcohol produces euphoria by stimulating this area in the brain. Research has shown that direct electrical stimulation of the MCLP produces great pleasure and has strong reinforcing properties
genetics and alcohol use disorder
study of children of adults with alcohol use disorder found that for males, having one alcoholic parent increased the rate of alcohol use disorder from 12.4 percent to 29.5 percent and having two such parents increased the rate to 41.2 percent. For females with no parents with alcohol use disorder, the rate was 5.0 percent; for those with one such parent, the rate was 9.5 percent; and for those with two parents with alcohol use disorder, it was 25.0 percent
adoption studies and alcohol use disorder
Adoption studies also provide evidence for a genetic vulnerability for alcohol problems. In these studies, researchers followed up with children of parents with versus without alcohol use disorder who were all adopted by nonalcoholic families. Such studies have shown that the children of parents whose parents had alcohol use disorder were nearly twice as likely to have alcohol problems by their late 20s
alcohol risk personality
described as an individual who has an inherited predisposition toward alcohol abuse and who is impulsive, prefers taking high risks, and is emotionally unstable.
physiological patterns of those at risk for developing alcohol use disorder
Research has shown that those who are genetically predisposed to developing drug or alcohol problems but who have not yet acquired the problem show different physiological patterns than those not at risk. Those at risk tend to experience greater decreases in stress following alcohol ingestion (Finn et al., 1997), show different alpha wave patterns on EEGs (Stewart et al., 1990), and have larger conditioned physiological responses to alcohol cues than individuals who were considered to have a low risk for alcohol use disorder
alcohol flush reaction
Some research suggests that certain ethnic groups, particularly Asians and Native Americans, have abnormal physiological reactions to alcohol—a phenomenon referred to as “alcohol flush reaction.” Asian and Eskimo subjects have shown a tendency to have a hypersensitive reaction including flushing of the skin, a drop in blood pressure, heart palpitations, and nausea following the ingestion of alcohol (Gill et al., 1999). This physiological reaction is found in roughly half of all Asians (Chen & Yeh, 1997) and results from a mutant enzyme that fails to break down alcohol molecules in the liver during the metabolic process
why are alcohol abusing parents bad for their children
They then evaluated several possible mediating factors that can affect whether adolescents start using alcohol. They found that parenting skills or parental behavior was associated with substance use in adolescents. Specifically, alcohol-abusing parents are less likely to keep track of what their children are doing, and this lack of monitoring often leads to the adolescents’ affiliation with drug-using peers. In addition, stress and negative affect (more prevalent in families with a parent with an alcohol use disorder) are associated with alcohol use in adolescents. Extremely stressful childhood experiences such as physical abuse (Douglas et al., 2010; Kaufman et al., 2007) or child sexual abuse might also make a person vulnerable to later problems.
Psychological Vulnerability and comorbidity effect on alcohol use disorder
substantial research has focused on the link between alcohol-related disorders and such other disorders as antisocial personality, depression, and schizophrenia to determine whether some individuals are more vulnerable to substance abuse disorders. About half of those with schizophrenia have either alcohol or drug abuse or dependence as well (Kosten, 1997). In addition, antisocial personality disorder, alcohol, and aggression are strongly associated
trauma and substance abuse disorders/ stress coping
substance abuse treatment have shown high levels of trauma in their prior histories—about 25 to 50 percent of PTSD patients also have substance abuse disorders
-A number of investigators have pointed out that the typical individual who abuses alcohol is discontented with his or her life and is unable or unwilling to tolerate tension and stress- a high degree of association between alcohol consumption and negative affectivity such as anxiety and somatic complaints. In other words, many people with alcohol use disorder drink to relax. In this view, anyone who finds alcohol tension reducing is in danger of abusing alcohol, even without an especially stressful life situation. However, the tension-reduction causal model is difficult to accept as a sole explanatory hypothesis.
reciprocal-influence model and adolescent drinking
According to the reciprocal-influence model, adolescents begin drinking as a result of expectations that using alcohol will increase their popularity and acceptance by their peers.
This view gives professionals an important and potentially powerful means of deterring drinking among young people or at least delaying its onset. From this perspective, alcohol use in teenagers can be countered by providing young people with more effective social tools and with ways of altering these expectancies before drinking begins. Some researchers have suggested that prevention efforts should be targeted at children before they begin to drink so that the positive feedback cycle of reciprocal reinforcement between expectancy and drinking will never be established
moderating variable
A moderating variable is a variable that influences the association between two other variables. For example, depression is common after bereavement. However, men who have lost a spouse tend to be more likely to be depressed than women who have lost a spouse. In this case, gender is a key moderating variable for the bereavement–depression relationship.
marital/interpersonal poor relationships and substance abuse
Adults with less supportive relationships tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships
college drinking influences
One study suggests that extensive drinking in college, even among the heaviest drinkers from sororities and fraternities, might be determined to a great extent by situational events, factors that change with graduation. In a follow-up study of drinking behavior a year after graduation, Sher, Bartholow, and Nanda (2001) reported that being a member of a fraternity or sorority did not predict postcollege drinking. Interestingly, a long-term follow-up of over 11 years has shown that the heavy drinking during college did not translate to heavy drinking during later years (Bartholow et al., 2003). These investigators found that heavy drinking that is associated with Greek society involvement does not generally lead to sustained heavy drinking in later life.
most important family relationship factors associated with the development of alcohol use disorder
The most important family variables that were considered to predispose an individual to substance use problems were the presence of a father with alcohol use disorder, acute marital conflict, lax maternal supervision and inconsistent discipline, many moves during the family’s early years, lack of “attachment” to the father, and lack of family cohesiveness.
Rates of alcohol consumption vary around the world,
highest rates in eastern Europe, followed by western Europe and the Americas
“diseases of denail” and treatment for substance abuse
Alcohol abuse and dependence are difficult to treat because many people who abuse alcohol refuse to admit that they have a problem before they “hit bottom,” and many who do go into treatment leave before therapy is completed. Addictions have been described as “diseases of denial” (DiClemente, 1993). Overall, less than one-third of those with alcohol use disorders receive treatment, and available treatments for alcohol-related disorders show modest effects (Hasin et al., 2007; Magill & Ray, 2009). In general, a multidisciplinary approach to the treatment of drinking problems appears to be most effective because the problems are often complex, requiring flexibility and individualization of treatment procedures
Disulfiram and medications blocking desire to drink / benefits and cons
a drug that causes violent vomiting when followed by ingestion of alcohol, may be administered to prevent an immediate return to drinking (Grossman & Ruiz, 2004). However, such deterrent therapy is seldom advocated as the sole approach because an alcohol-dependent person may simply discontinue the use of Antabuse when he or she is released from a hospital or clinic and begins to drink again. In fact, the primary value of drugs of this type seems to be their ability to interrupt the alcohol abuse cycle for a period of time during which therapy may be undertaken. Uncomfortable side effects may accompany the use of Antabuse; for example, alcohol-based aftershave lotion can be absorbed through the skin, resulting in illness. Moreover, the cost of Antabuse treatment, which requires careful medical maintenance, is higher than that for many other, more effective treatments.
naltrexone, and treating alcohol abuse
opiate antagonist that helps reduce the craving for alcohol by blocking the pleasure-producing effects of alcohol, and acamprosate, a drug whose properties are still being studied
primary therapy goals for alcohol abuse
initial focus is on detoxification (the elimination of alcoholic substances from an individual’s body), on treatment of the withdrawal symptoms described earlier, and on a medical regimen for physical rehabilitation. One of the primary goals in treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches are the prevention of heart arrhythmias, seizures, delirium, and death. These steps can usually best be handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome motor excitement, nausea, and vomiting; prevent withdrawal delirium and convulsions; and help alleviate the tension and anxiety associated with withdrawal
use of benzodiazepines/tranquilizers in alcohol addiction
he use of tranquilizers—drugs that depress the CNS, resulting in calmness, relaxation, reduction of anxiety, and sleeping—does not promote long-term recovery and may simply transfer the addiction to another substance. Accordingly, some detoxification clinics are exploring alternative approaches including a gradual weaning from alcohol instead of a sudden cutoff. Maintenance doses of mild tranquilizers are sometimes given to patients withdrawing from alcohol to reduce anxiety and help them sleep. Such use of medications may be less effective than no treatment at all, however. Usually patients must learn to abstain from tranquilizers as well as from alcohol because they tend to misuse both. Further, under the influence of medications, patients may even return to alcohol use.
group therapy alcohol abuse treatment
Group therapy has been shown to be effective for many clinical problems (Galanter et al., 2005), especially substance-related disorders (Velasquez et al., 2001). In the confrontational give-and-take of group therapy, people who abuse alcohol are often forced (perhaps for the first time) to face their problems and their tendencies to deny or minimize them. These group situations can be extremely difficult for those who have been engrossed in denial of their own responsibilities, but such treatment also helps them see new possibilities for coping with circumstances that have led to their difficulties. Often this paves the way for them to learn more effective ways of coping and other positive steps toward dealing with their drinking problem.
family treatment and alcohol abuse disorder
the spouses of people who abuse alcohol and even their children may be invited to join in group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic efforts. Given that alcohol abuse and dependence can cause significant strains on family relationships, family therapy in such cases involves a delicate balance of educating the drinker about the familial consequences of her or his drinking, discussing any role that the family may have played in facilitating the drinking behavior (if any), and making plans for how the family can function most adaptively in the future.
Behavioral therapy for alcohol abuse
-aversive conditioning therapy, which involves the presentation of a wide range of noxious stimuli with alcohol consumption in order to suppress drinking behavior. For example, the ingestion of alcohol might be paired with an electric shock or a drug that produces nausea
-^^One approach involves an intramuscular injection of emetine hydrochloride, an emetic. Before experiencing the nausea that results from the injection, a patient is given alcohol, so that the sight, smell, and taste of the beverage become associated with severe retching and vomiting. That is, a conditioned aversion to the taste and smell of alcohol develops. With repetition, this classical conditioning procedure acts as a strong deterrent to further drinking—probably in part because it adds an immediate and unpleasant physiological consequence to the more general socially aversive consequences of excessive drinking.
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CBT for alcohol abuse
Cognitive-behavioral therapy (CBT) is commonly used to treat alcohol-related problems (Marlatt, 1985; Witkiewitz & Marlatt, 2004). This approach combines cognitive-behavioral strategies of intervention with social-learning theory and modeling of behavior. Often referred to as a “skills training procedure,” the approach is usually aimed at younger problem drinkers who are considered to be at risk for developing more severe drinking problems because of an alcohol abuse history in their family or their current heavy consumption. CBT relies on such techniques as imparting specific knowledge about alcohol, developing coping skills in situations associated with increased risk of alcohol use, modifying cognitions and expectancies, acquiring stress management skills, and providing training in life skills
= only modest effects in the treatment of alcohol problems
Self-control training techniques, and alcohol abuse
such as the BMI procedure noted earlier, in which the goal of therapy is to get the person to reduce alcohol intake without necessarily abstaining altogether, have a great deal of appeal for some drinkers. For example, one approach to improve drinking outcomes by altering the drinker’s social networks was found to be successful (Litt et al., 2007), and motivational interviewing with adolescents was found to be promising in decreasing substance use (Macgowan & Engle, 2010). There is now even a computer-based self-control training program available that has been shown to reduce problem drinking in a controlled study
controlled drinking treatment vs abistinence
Alcoholics Anonymous
A practical approach to alcohol use disorder that has become very popular around the world is that of Alcoholics Anonymous (AA). This organization was started in 1935 by two men, Dr. Bob and Bill W., in Akron, Ohio. Bill W. recovered from alcohol use disorder through a “fundamental spiritual change” and immediately sought out Dr. Bob, who, with Bill’s assistance, also achieved recovery.
-Alcoholics Anonymous operates primarily as a self-help counseling program in which both person-to-person and group relationships are emphasized. AA accepts both teenagers and adults with drinking problems, has no dues or fees, does not keep records or case histories, does not participate in political causes, and is not affiliated with any religious sect, although spiritual development is a key aspect of its treatment approach.
-An important aspect of AA’s rehabilitation program is that it appears to lift the burden of personal responsibility by helping alcoholics accept that alcohol use disorder, like many other problems, is bigger than they are. Henceforth, they can see themselves not as weak willed or lacking in moral strength but rather simply as having an affliction—they cannot drink—just as other people may not be able to tolerate certain types of medication.
effectiveness of alcoholics anonymous treatment
The reported success of Alcoholics Anonymous is based primarily on anecdotal information rather than on objective study of treatment outcomes because AA does not directly participate in external comparative research efforts. There have been studies focused on testing the effectiveness of AA, but these have been largely inconclusive due to methodological concerns.
motivational interviewing treatment
Motivational interviewing (MI) is a brief intervention that was designed to be a major departure from earlier confrontational approaches in which a clinician suggested that the drinker stop consuming so much alcohol. Instead, in MI the clinician guides the patient through a collaborative conversation in which the patient articulates the pros and cons of drinking and ultimately makes a decision about whether she or he is motivated to change
- A great strength of MI is that it can be administered in one brief (35-minute) session and still have positive effects. For instance, a recent study found that adolescents visiting an emergency department (ED) with alcohol problems and aggression who were randomly assigned to receive a brief MI-focused intervention via a clinician or computer (compared to those who received no such intervention) showed significant reductions in their drinking and aggression up to 6 months after this brief intervention
project match and therapy for alcohol use
maintained that treatment for alcohol use and abuse disorders would be more effective if important patient characteristics (e.g., personality characteristics, degrees of severity) were considered. This view was evaluated in a study of patient–treatment matching (referred to as “Project MATCH”) that was sponsored by the NIAAA (1997). This extensive study, initiated in 1989, involved 1,726 patients who were treated in 26 alcohol treatment programs in the United States by 80 different therapists representing three treatment approaches. The research design included both inpatient and outpatient treatment components. The results of this study were unexpected: Matching the patients to particular treatments did not appear to be important to having an effective outcome because the treatments studied all had equal outcomes
when does relapse prevention treatment work the best?:
found that relapse prevention treatment worked most effectively when family members were involved in the treatment.
indulgent behaviours and relapses
The behaviors underlying relapse are seen as “indulgent behaviors” that are based on an individual’s learning history. When an individual is abstinent or has an addiction under control, she or he gains a sense of personal control over the indulgent behavior. The longer the person is able to maintain this control, the greater the sense of achievement—the self-efficacy or confidence—and the greater the chance that she or he will be able to cope with the addiction and maintain control. However, a person may violate this rule of abstinence through a gradual, perhaps unconscious, process rather than through the sudden “falling off the wagon” that constitutes the traditional view of craving and relaps
cognitive behavioural view of relapse
In the cognitive-behavioral view, a person may, even while maintaining abstinence, inadvertently make a series of mini-decisions that begin a chain of behaviors that render relapse inevitable. For example, an abstinent alcohol abuser who buys a quart of bourbon just in case his friends drop by is unconsciously preparing the way for relapse.
“abstinence violation effect,”
Another type of relapse behavior involves the “abstinence violation effect,” in which even minor transgressions are seen by the abstainer as having drastic significance. The effect works this way: An abstinent person may hold that she or he should not, under any circumstance, transgress or give in to the old habit. Abstinence-oriented treatment programs are particularly guided by this prohibitive rule. What happens, then, when an abstinent person becomes somewhat self-indulgent and takes a drink offered by an old friend or joins in a wedding toast? He or she may lose some of the sense of self-efficacy—confidence—needed to control his or her drinking. Feeling guilty about having technically violated the vow of abstinence, the person may rationalize that he or she “has blown it and become a drunk again, so why not go all the way?”
relapse prevention treatment, c
clients are taught to recognize the apparently irrelevant decisions that serve as early warning signals of the possibility of relapse. High-risk situations such as parties or sports events are targeted, and the individuals learn to assess their own vulnerability to relapse. Clients are also trained not to become so discouraged that, if they do relapse, they lose their confidence. Some cognitive-behavioral therapists have even incorporated a “planned relapse” phase into the treatment. Research with relapse prevention strategies has shown them to be effective in providing continuing improvement over time
psychoactive drugs most commonly associated with abuse and dependence in our society
appear to be (1) opiates, including opium and heroin; (2) stimulants such as cocaine and amphetamines as well as caffeine and nicotine (disorders associated with tobacco withdrawal and caffeine intoxication are included in the DSM-5 diagnostic classification system); (3) sedatives such as barbiturates; (4) hallucinogens such as LSD; (5) antianxiety drugs such as benzodiazepines; and (6) pain medications such as OxyContin
opium derivatives
-Opium is a mixture of about 18 chemical substances known as alkaloids. In 1805, the alkaloid present in the largest amount (10–15 percent) was found to be a bitter-tasting powder that could serve as a powerful sedative and pain reliever; it was named morphine after Morpheus, the god of sleep in Greek mythology.
anagelsic properties
(that is, its ability to eliminate pain without a loss of consciousness)
acetic anhydride and morphine
, it would be converted into another powerful analgesic called heroin. Heroin was hailed enthusiastically by its discoverer, Heinrich Dreser (Boehm, 1968). Leading scientists of his time agreed on the merits of heroin, and the drug came to be widely prescribed in place of morphine for pain relief and related medicinal purposes. However, heroin proved to be an even more dangerous drug than morphine, acting more rapidly and more intensely and being equally, if not more, addictive. Eventually, heroin was removed from use in medical practice.
U.S. Congress enacted the Harrison Act in 1914.
under this and later legislation, the unauthorized sale and distribution of certain drugs became a federal offense; physicians and pharmacists were held accountable for each dose they dispensed. Thus, overnight, the role of a chronic narcotic user changed from that of addict—whose addiction was considered a vice, but was tolerated—to that of criminal
how are morphine and heroin introduced into the body?
smoking, snorting (inhaling the powder), eating, “skin popping,” or “mainlining,” the last two being methods of introducing the drug via hypodermic injection. Skin popping is injecting the liquefied drug just beneath the skin, while mainlining is injecting the drug directly into the bloodstream.
immediate effects of heroin
Among the immediate effects of mainlined or snorted heroin is an intense feeling of euphoria (the rush) lasting 60 seconds or so, which many addicts compare to a sexual orgasm. However, vomiting and nausea have also been known to be part of the immediate effects of heroin and morphine use. This rush is followed by a high, during which an addict typically is in a lethargic, withdrawn state in which bodily needs, including needs for food and sex, are markedly diminished; pleasant feelings of relaxation and euphoria tend to dominate. These effects last from 4 to 6 hours and are followed—in addicts—by a negative phase that produces a desire for more of the drug.
=use of opiates over a period of time generally results in a physiological craving for the drug. The time required to establish the drug habit varies, but it has been estimated that continual use over a period of 30 days is sufficient.
when do withdrawal symptoms onset for opiates?
When people addicted to opiates do not get another dose of the drug within approximately 8 hours of their last dose, they start to experience withdrawal symptoms. The character and severity of these reactions depend on many factors including the amount of the narcotic habitually used, the intervals between doses, the duration of the addiction, and especially the addict’s health and personality.
withdrawal from heroin
Withdrawal from heroin is not always dangerous or even very painful. Many addicted people withdraw without assistance. Withdrawal can, however, be an agonizing experience for some people, with symptoms including runny nose, tearing eyes, perspiration, restlessness, increased respiration rate, and an intensified desire for the drug. As time passes, the symptoms may become more severe. Typically, a feeling of chilliness alternates with flushing and excessive sweating, vomiting, diarrhea, abdominal cramps, pains in the back and extremities, severe headache, marked tremors, and varying degrees of insomnia. Beset by these discomforts, an individual refuses food and water, and this, coupled with the vomiting, sweating, and diarrhea, results in dehydration and weight loss. Occasionally, symptoms include delirium, hallucinations, and manic activity. Cardiovascular collapse may also occur and can result in death. If morphine is administered, the subjective distress experienced by an addict temporarily ends and physiological balance is quickly restored.
how long do withdrawal symptoms last?
Withdrawal symptoms usually decline by the third or fourth day and by the seventh or eighth day have disappeared. As the symptoms subside, the person resumes normal eating and drinking and rapidly regains lost weight. After withdrawal symptoms have ceased, the individual’s former tolerance for the drug is reduced; as a result, there is a risk that taking the former large dosage might result in overdose.
effects of morphine and heroin use
Lifestyle factors can lead to further problems; an inadequate diet, for example, may lead to ill health and increased susceptibility to a variety of physical ailments. The use of unsterile equipment may also lead to various problems including liver damage from hepatitis (Lucey et al., 2009) and transmission of the AIDS virus. In addition, the use of such a potent drug without medical supervision and government controls to ensure its strength and purity can result in fatal overdose. Injection of too much heroin can cause coma and death. Women who use heroin during pregnancy subject their unborn children to the risk of dire consequences. One tragic outcome is premature babies who are themselves addicted to heroin and vulnerable to a number of diseases.
Causal Factors in Opiate Abuse and Dependence
The most frequently cited reasons that people give for beginning to use heroin are because of its very pleasurable “high” and because it is cheaper and often easier to obtain than other opioids (Cicero et al., 2014). Other reasons such as a desire to escape life stress, personal maladjustment, and sociocultural conditions also play a part. In addition, it has been suggested that various forms of substance abuse such as smoking, drinking, and the use of drugs are all related to a personality characteristic referred to as “sensation seeking,” which is itself thought to be mediated through genetic and biological mechanisms as well as through peer influences
endorphins and how opiates operate
The human body produces its own opium-like substances, called endorphins, in the central nervous system and pituitary gland. Heroin plugs into opiate receptors (taking the place of endorphins), but works much more quickly and intensely, producing the extreme euphoria previously described.
dopamine theory of addiction in early research
suggests that addiction is the result of a dysfunction of the dopamine reward pathway (Diana, 2011). This pathway, also called the “pleasure pathway,” as mentioned earlier in our discussion of alcohol addiction, was first discovered in seminal work by Olds and Milner (1954), who found that rats would repeatedly press a lever to self- stimulate certain areas of their brain (via electrodes placed there) instead of engaging in any other activity. Researchers later realized that what Olds and Milner had stumbled upon was the dopamine reward pathway, which stretches from the ventral tegmental area to the nucleus accumbens (refer back to Figure 11.2), which in turn connects with other parts of the brain such as the amygdala and prefrontal cortex. Early versions of the dopamine theory of addiction suggested that all addictive drugs (e.g., alcohol, opiates, cocaine) and behaviors (e.g., gambling) activate the dopamine reward pathway, thus causing pleasure and increasing the likelihood of drug use and engagement in addictive behavior.
inacuracies of the dopamine theory
Several decades of research, however, have demonstrated that the picture appears to be much more complex than that, and the pleasure experienced in response to drug use is not simply the result of elevated levels of dopamine
- First, if substances and experiences that lead to pleasurable internal states were the whole story, then exposure to these things would explain addiction. However, it is clear that people differ in their vulnerability to addiction—some of us can have one drink and then stop, whereas others of us have a strong urge to keep drinking over and over again
modern reward deficiency syndrome theory
reward deficiency syndrome hypothesis suggests that addiction is much more likely to occur in individuals who have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards (e.g., from food, sex, drugs, and other pleasurable activities), which in turn leads them to overuse drugs and related experiences as a way to adequately stimulate their reward pathway
opiod vs dopamine systems of reward
e is not a simple, single “pleasure pathway” in the brain. For instance, although dopaminergic pathways play a primary role in the “wanting” or anticipation of reward, it is the opioid system that seems to play a primary role in the “liking” or consumption of rewarding stimuli (Smith & Berridge, 2007). Findings such as these highlight that dopamine plays an important role in the neural understanding of addiction, but that other neurotransmitters, and other explanations altogether, may be needed to fully understand how and why people become addicted to substance use and other behaviors.
addiction and other forms of pathology
Opioid abuse is associated with a dramatically increased risk of other forms of psychopathology, as well as a range of other negative outcomes. More specifically, approximately 70 percent of people who abuse opioids have other psychological diagnoses, 50 percent have other forms of substance abuse, and 36 percent have a history of trauma
treatment for opiate addiction
Treatment for opiate addiction is initially similar to that for alcohol use disorder in that it involves restoring physical and psychological health and providing help through the withdrawal period. Addicts often dread the discomfort of withdrawal, but in a hospital setting it is less abrupt and usually involves the administration of medication that eases the distress.
After physical withdrawal has been completed, treatment focuses on helping the person make an adequate adjustment to his or her community and abstain from the further use of opiates. Traditionally, however, the prognosis has been unfavorable, with many clients dropping out of treatment
methadone for opiod addiction treatment
methadone in conjunction with a rehabilitation program (counseling, group therapy, and other procedures) directed toward the “total resocialization” of addicts. Methadone hydrochloride is a synthetic narcotic that is related to heroin and is equally addictive physiologically. Its usefulness in treatment lies in the fact that it satisfies an addict’s craving for heroin without producing serious psychological impairment, if only because it is administered as a “treatment” in a formal clinical context and can result in reduced drug use and improved cognitive performance
buprenorphine and opiod addiction treatment
Buprenorphine promises to be as effective a substitute for heroin as methadone but with fewer side effects (Ling et al., 2010). It operates as a partial antagonist to heroin and produces the feelings of contentment associated with heroin use (Mendelson & Mello, 1992). Yet the drug does not produce the physical dependence that is characteristic of heroin (Grant & Sonti, 1994) and can be discontinued without severe withdrawal symptoms. Like methadone, buprenorphine appears to work best at maintaining abstinence if it is provided along with behavior therapy
“Crack”
is the street name that is applied to cocaine that has been processed from cocaine hydrochloride to a free base for smoking. The name refers to the crackling sound emitted when the mixture is heated. Cocaine is still illegal; however, approximately 0.7 percent of those 12 years or older report having used cocaine in the past month
how does cocaine have its main effects?
. Cocaine has its primary effect by blocking the presynaptic dopamine transporter (whose job it is to retrieve excess dopamine from the synapse), thus increasing the availability of dopamine in the synapse and increasing the activation of the receiving cells. The increase of dopamine activity in the nucleus accumbens is believed to be especially important in cocaine addiction because specific parts of this brain region have been suggested to be “hedonic hot spots” that have been consistently associated with the experience of reward and pleasure
Chronic abuse of cocaine and acute psychotic symp;toms
When cocaine is chronically abused, acute toxic psychotic symptoms may occur, including frightening visual, auditory, and tactile hallucinations similar to those in acute schizophrenia.
treatment for cocaine dependence
Treatment for cocaine dependence is similar in many ways to that for other drugs that involve physiological dependence (Schmitz et al., 2004). To reduce cravings as part of psychological therapy and to ensure treatment compliance, drugs such as naltrexone and methadone have been used to reduce cocaine use (Carroll et al., 2004; Weinstock et al., 2010). The feelings of tension and depression that accompany absence of the drug have to be dealt with during the immediate withdrawal period.
cbt for cocaine dependence
CBT for cocaine dependence focuses on teaching patients cognitive and behavioral skills intended to help them navigate daily life and difficult situations without engaging in drug use. It has proven to be an effective method of decreasing cocaine use in those meeting the criteria for cocaine dependence, even when administered in a fully computerized form
CM thgerapy for cocaine dependence
contigency management
CM is based on the principles of operant conditioning and offers rewards or financial incentives for meeting agreed-on treatment targets (e.g., drug-free urine). CM has been shown to be slightly more effective than CBT for cocaine dependence
benefits of psychological treatment for cocaine dependers
Recent research has shown that CM is just as effective when it uses relatively low-cost reinforcers (Petry et al., 2014). Importantly, recent research has shown that psychological treatments for cocaine dependence are associated with decreases not just in cocaine use but in a range of other problems (Kiluk et al., 2014), are effective in both men and women (DeVito et al., 2014), and are no less effective in patients who are referred for treatment by the criminal justice system (Kiluk et al., 2015).
how do amphetamines work for ADHD?
. Curiously enough, amphetamines have a calming rather than a stimulating effect on those with ADHD
effects of amphetamine use
Despite their legitimate medical uses, amphetamines are not a source of extra mental or physical energy. Instead, they push users toward greater expenditures of their own resources—often to the point of hazardous fatigue. Amphetamines are psychologically and physically addictive, and the body rapidly builds up tolerance to them (Wise, 1996). Thus, habituated abusers may use the drugs in amounts that would be lethal to nonusers. In some instances, users inject the drug to get faster and more intense results.
-For a person who exceeds prescribed dosages, amphetamine consumption results in heightened blood pressure, enlarged pupils, unclear or rapid speech, profuse sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, Methedrine can raise blood pressure enough to cause immediate death
amphetamine psycosis
which appears similar to paranoid schizophrenia
meth and why its dangerous
Methamphetamine, referred to on the streets as “crystal meth” or “ice” because of its appearance, is a highly addictive stimulant drug that can provide an immediate and long-lasting “high.” However, it is one of the most dangerous illegal drugs (Covey, 2007). Methamphetamine is a form of amphetamine that can be “cooked” in large quantities in makeshift laboratories (e.g., within people’s own homes). It can be manufactured, for example, in a portable cooler with ingredients that can be legally obtained from any drugstore. This drug is relatively cheap to make and is sometimes referred to as “poor people’s cocaine.” Like cocaine and heroin, it can be ingested in a variety of ways, through smoking, snorting, swallowing, or injecting.
methlyphenidates and ADHD
One of the most popular treatments for ADHD in children and adolescents is the drug methylphenidate (Morton et al., 2000), which is classified as a CNS stimulant. Methylphenidate, when used intranasally, has receptor effects similar to those of cocaine. The various brands of methylphenidate that are frequently prescribed in the United States (Ritalin, Adderall, and Quillivant) are also FDA approved for treatment of adults. The side effects of these medications can result in long-term problems such as sleep problems, headaches, decreased appetite, and jitteriness. Moreover, methylphenidate drugs are addicting and can result in long-term use.
how does meth work in the brain?
Methamphetamine operates by increasing the level of dopamine in the brain, but it is metabolized more slowly than other drugs, such as cocaine, and produces a high for a longer period of time. Prolonged use of methamphetamine causes structural changes in the brain (Chang, Alicata, et al., 2007), and the severity of psychiatric symptoms associated with the drug is related to the duration of use (Yoshimoto et al., 2002). Moreover, discontinuing the drug after the person has become habituated can result in problems with learning, memory, and cognitive dysfunction (Cretzmeyer et al., 2003; Rothman et al., 2000) and severe mental health problems, such as paranoid thinking and hallucinations (Brecht et al., 2004; Srisurapanont et al., 2003). When the drug wears off or when users “come down from the high,” they are likely to feel extremely weak, lethargic, sleepy, and depressed.
caffeine related disorder
caffeine-related disorder involves symptoms of restlessness, nervousness, excitement, insomnia, muscle twitching, and gastrointestinal complaints. It follows the ingestion of caffeine-containing substances such as coffee, tea, cola, and chocolate. The amount of caffeine that results in intoxication differs among individuals.
nicotine-dependence syndrome/ insula
Strong evidence exists for a nicotine-dependence syndrome (Malin, 2001; Watkins et al., 2000), which nearly always begins during the adolescent years and may continue into adult life as a difficult-to-break and health-endangering habit. Supporting the finding that nicotine may have an antianxiety property, nicotine use has been observed as being highly prevalent among those with anxiety disorders (Morissette et al., 2007). Recent evidence from stroke-related brain injury suggests that nicotine addiction might be controlled by a portion of the brain near the ear called the insula (Naqvi et al., 2007). A stroke patient with damage to that area of the brain reported that his craving for cigarettes vanished. This result suggests that the insula might be an important center for addiction to smoking, but more research is needed to support this conclusion.
“tobacco withdrawal disorder,”
results from ceasing or reducing the intake of nicotine-containing substances after an individual has developed physical dependence on them. The diagnostic criteria for nicotine withdrawal include (1) the daily use of nicotine for at least several weeks, and (2) the presence of the following symptoms after nicotine ingestion is stopped or reduced: craving for nicotine; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain. Several other physical concomitants are associated with withdrawal from nicotine including decreased metabolic rate, headaches, insomnia, tremors, increased coughing, and impairment of performance on tasks requiring attention.
nicotine replacement therapy (NRT).
high-dose NRT reduces withdrawal symptoms. Treatment with active patches reduced withdrawal and craving during cessation and completely eliminated deprivation-related changes in affect or concentration.
barbituates
powerful sedatives called barbiturates have been available as an aid to falling asleep
-Barbiturates were once widely used by physicians to calm patients and induce sleep. They act as depressants—somewhat like alcohol—to slow down the action of the CNS (Nemeroff, 2003). Shortly after taking a barbiturate, or “downer,” an individual experiences a feeling of relaxation in which tensions seem to disappear, followed by a physical and intellectual lassitude and a tendency toward drowsiness and sleep—the intensity of such feelings depends on the type and amount of barbiturate taken. Strong doses produce sleep almost immediately; excessive doses are lethal because they result in paralysis of the brain’s respiratory centers. Impaired decision making and problem solving, sluggishness, slow speech, and sudden mood shifts are also common effects of barbiturates
silent abusers and barbituates
Although many young people experiment with barbiturates, most do not become dependent. In fact, the individuals who do become dependent on barbiturates tend to be middle-aged and older people who often rely on them as “sleeping pills” and who do not commonly use other classes of drugs (except possibly alcohol and minor tranquilizers). These people have been referred to as “silent abusers” because they take the drugs in the privacy of their homes and ordinarily do not become public nuisances. Barbiturates are often used with alcohol. Some users claim they can achieve an intense high by combining barbiturates, amphetamines, and alcohol. However, one possible effect of combining barbiturates and alcohol is death because each drug potentiates (increases the action of) the other.
treatment for barbituate dependence
As with many other drugs, it is often essential in treatment to distinguish between barbiturate intoxication, which results from the toxic effects of overdose, and the symptoms associated with drug withdrawal, because different procedures are required. With barbiturates, withdrawal symptoms are more dangerous, severe, and long lasting than in opiate withdrawal. A patient going through barbiturate withdrawal becomes anxious and apprehensive and manifests coarse tremors of the hands and face; additional symptoms commonly include insomnia, weakness, nausea, vomiting, abdominal cramps, rapid heart rate, elevated blood pressure, and loss of weight. An acute delirious psychosis may develop.
For persons accustomed to taking large dosages, withdrawal symptoms may last for as long as a month, but usually they tend to abate by the end of the first week. Fortunately, the withdrawal symptoms in barbiturate addiction can be minimized by administering increasingly smaller doses of the barbiturate itself or another drug that produces similar effects.
hallucinogens
Hallucinogens are drugs that are thought to induce hallucinations. However, these preparations usually do not in fact “create” sensory images but distort them so that an individual sees or hears things in different and unusual ways. Hallucinogens are often referred to as psychedelics. The major drugs in this category are LSD (lysergic acid diethylamide) or “acid,” mescaline, psilocybin, ecstasy, and marijuana.
LSD
The most potent of the hallucinogens, the odorless, colorless, and tasteless drug LSD, can produce intoxication with an amount smaller than a grain of salt. It is most often sold and consumed via tiny sheets of blotter paper containing a few micrograms of the drug, which is ingested by letting the paper dissolve on the tongue. LSD is a chemically synthesized substance first discovered by the Swiss chemist Albert Hofmann in 1938.
immediate effects of LSD
After taking LSD, a person typically goes through about 8 hours of changes in sensory perception, mood swings, and feelings of depersonalization and detachment. The LSD experience is not always pleasant. It can be extremely traumatic, and the distorted objects and sounds, the illusory colors, and the new thoughts can be menacing and terrifying.
flashbakcs and LSD
An interesting and unusual phenomenon that may occur sometime following the use of LSD is the flashback, an involuntary recurrence of perceptual distortions or hallucinations weeks or even months after an individual has taken the drug. Flashbacks appear to be relatively rare among people who have taken LSD only once—although they do sometimes occur. Even if no flashbacks occur, one study found that continued effects on visual function were apparent at least 2 years after LSD use. In this study, Abraham and Wolf (1988) reported that individuals who had used LSD for a week had reduced visual sensitivity to light during dark adaptation and showed other visual problems compared with controls.
mescaline and psilocybin origins and effects
which is derived from the small, disk-like growths (mescal buttons) at the top of the peyote cactus
psilocybin, which is obtained from a variety of “sacred” Mexican mushrooms known as Psilocybe Mexicana
hese drugs have been used for centuries in the ceremonial rites of Native peoples living in Mexico, the American Southwest, and Central and South America. In fact, they were used by the Aztecs for such purposes long before the Spanish invasion. Both drugs have mind-altering and hallucinogenic properties, but their principal effect appears to enable an individual to see, hear, and otherwise experience events in unaccustomed ways—transporting him or her into a realm of “nonordinary reality.”
ecstasy/ MDMA (3,4-methylenedioxymethylamphetamine)
- both a hallucinogen and a stimulant that is popular as a party drug among young adults.
-Ecstasy works primarily by triggering the release of large amounts of the neurotransmitter serotonin and blocking its reuptake, leading to feelings of euphoria, energy, and well-being - People who take the drug often report an intense experience of color and sound and mild hallucinations (de la Torre et al., 2004; Lieb et al., 2002; Soar et al., 2001) in addition to the high levels of energy and excitement that are produced.
-The drug MDMA is an addictive substance, but it is not thought to be as addictive as cocaine
ectasy and immediate bad effects
-ecstasy consumption increases the risk of hyperthermia shortly after administration (i.e., while still “high” on the drug), and the serotonin depletion that results from ecstasy consumption leads to feelings of depression, irritability, and anxiety in the days following administration in approximately 80 to 90 percent of users
-ecstasy consumption has been linked with various neurocognitive problems including difficulties with memory and a range of psychiatric concerns (Parrott, 2013). A complicating factor in more recent research in this area is that, whereas prior to 2005, most ecstasy pills (>80 percent of those confiscated by authorities) were shown to actually contain MDMA, since that time that percentage has dropped substantially. An increased percentage of “ecstasy” pills do not actually contain MDMA, but do contain substitutes that have an effect on the CNS; these substitutes, such as amphetamines or ketamine, do not produce the same feeling of euphoria
Marijuana and origin
comes from the leaves and flowering tops of the hemp plant, Cannabis sativa, which grows in mild climates throughout the world. In its prepared state, marijuana consists chiefly of dried green leaves—hence, the colloquial name “grass.” It is ordinarily smoked in the form of cigarettes (variously referred to as “pot,” “reefers,” “joints,” “weed,” etc.) or in pipes. In some cultures the leaves are steeped in hot water and the liquid is drunk, much as one might drink tea.
-lthough marijuana can be considered a mild hallucinogen, there are significant differences between the nature, intensity, and duration of its effects and those induced by drugs like LSD, mescaline, and other major hallucinogens.
Hashish
Marijuana is related to a stronger drug, hashish, which is derived from the resin exuded by the cannabis plant and made into a gummy powder. Hashish, like marijuana, is usually smoked
most frequently used illicit drug
marijuana
marijauna immediate effects
This state is one of mild euphoria distinguished by increased feelings of well-being, heightened perceptual acuity, and pleasant relaxation, often accompanied by a sensation of drifting or floating away. Sensory inputs are intensified. Marijuana has the effect on the brain of altering one’s internal clock (O’Leary et al., 2003). Often a person’s sense of time is stretched or distorted so that an event that lasts only a few seconds may seem to cover a much longer span. Short-term memory may also be affected, as when one notices that a bite has been taken out of a sandwich but does not remember having taken it. For most users, pleasurable experiences, including sexual intercourse, are reportedly enhanced
Treatment for marijuana abuse
When abstaining from marijuana use, some users report having uncomfortable withdrawal-like symptoms such as nervousness, tension, sleep problems, and appetite change
Psychological treatment methods have been shown to be effective in reducing marijuana use in adults who are dependent on the drug
no pharmacotherapy treatment for cannabis dependency has been shown to be very effective
Synthetic cannabinoids
substances that mimic the effects of tetrahydrocannabinol (THC), the active plant-derived substance in marijuana, and activate the human endocannabinoid system (Baumann et al., 2014). Synthetic cannabinoids, sold under the names “Spice,” “K2,” “Blaze,” and others, do contain some actual plants/herbs, but it is the synthetic chemical additive that causes the marijuana-like effects. Specifically, synthetic cannabinoids bind with CB1 receptors and produce marijuana-like intoxication. However, synthetic cannabinoids are much more likely than marijuana to have serious adverse side effects such as anxiety, tachycardia, hypertension, heart palpitations, seizures, and psychosis-like effects
Synthetic cathinones
-substances that mimic the effects of amphetamines and cocaine by activating the body’s monoamine system
-Synthetic cathinones, sold under the name “bath salts,” first appeared on the illegal drug scene in 2010. Since then they have been examined in human epidemiologic and laboratory animal studies, and have been found to produce increased motor activity, agitation, violence, psychosis-like effects, and heart problems
pathological gambling
does not involve a chemically addictive substance, it is considered by many to be an addictive disorder because of the personality factors that tend to characterize compulsive gamblers
-Pathological gambling, also known as “compulsive gambling” or disordered gambling, is a progressive disorder characterized by continuous loss of control over gambling, a preoccupation with gambling and with obtaining money for gambling, and continuation of the gambling behavior in spite of adverse consequences-Both men and women appear to be vulnerable to pathological gambling
cultures that accept gambling
Pathological gambling is a particular problem among some cultural groups (e.g., Chinese, Jewish) and among ethnic minorities and indigenous groups (e.g., Native Americans), perhaps due to the availability and acceptability of gambling behavior
intermittent reinforcement— and gambling
the most potent reinforcement schedule for operant conditioning—could explain an addict’s continued gambling despite excessive losses.
causes of gambling
Although learning undoubtedly plays an important part in the development of personality factors underlying the “compulsive” gambler, recent research on brain mechanisms that are involved in motivation, reward, and decision making indicates that these mechanisms could influence the underlying impulsivity in personality (Chambers & Potenza, 2003). These investigators have suggested that important neurodevelopmental events during adolescence occur in brain regions associated with motivation and impulsive behavior. Recent research has also suggested that genetic factors might play a part in developing pathological gambling habits
treatment for gambling disorders
problems with methadone use treating heroine withdrawal
However, negative consequences are sometimes associated with the use of methadone (Miller & Lyon, 2003). Methadone patients are at increased risk for health problems such as hepatitis (McCarthy & Flynn, 2001) and cognitive impairment (Scheurich, 2005; Verdejo et al., 2005). In addition, many social problems, such as trading sex for drugs, persist (El-Bassel et al., 2001); some addicts get involved with other drugs such as cocaine (Avants et al., 1998; Silverman et al., 1996); suicide attempts are common (Darke & Ross, 2001); and violent deaths and drug overdoses are common among methadone patients (Sunjic & Zabor, 1999)
