Chapter 11 Flashcards
Substance-related disorders
- using substances in excessive amounts that result in impairment
Addictive behaviour
- behaviour based on pathological need for a substance
Psychoactive substances
- substances that affect mental functioning in central nervous system
Substance abuse vs. substance dependence
- abuse: excessive use of substance resulting in potentially hazardous behavior; continued use despite problems
- dependence: more severe forms of substance use disorders
Tolerance
- need for increased amounts of substance to achieve desired effects
Withdrawal
- physical symptoms (like sweating) that accompany abstinence from a drug
Alcohol use disorder
- use of alcohol even though there are detrimental effects associated with it
- brain shrinkage leads to worsening cognitive abilities
- found across all age, educational, occupational, and SES backgrounds
- high comorbidity between alcohol use and mental illness/other substance abuse disorders
- avg. lifespan is 12y shorter
U.S. Prevalence - Alcohol Use Disorder
- 30% meet diagnostic criteria at least once in their life (nearly 15% in a given year)
- > 50% 18+ drink alcohol; 27% report binge drinking
- 2x as common in men
- Native Americans > Black/whites > Asian Americans
Is alcohol a stimulant or a depressant?
- alcohol is both a nervous system stimulant (low doses) and depressant (high doses)
Rates of alcohol abstainers in US
- 28% of men
- 50% of women
Alcohol vs heroin withdrawal
- alcohol withdrawal potentially more lethal than opiate withdrawal!
BAC
- 0.08%: no driving
- 0.5%: pass out
- 0.55%+: usually lethal
Effects of alcohol on the brain
- low levels stimulate release of dopamine from pleasure centers
- high levels depress brain function/inhibit glutamate (impairments in judgement, motor coordination, etc)
Development of alcohol dependence
- early-to middle-to late-stage
- often starts with slight problem drinking behavior, increases in frequency and intensity over time
Physical effects of chronic alcohol use
- 15-30% of heavy drinkers develop cirrhosis of the liver
- excessive use may lead to malnutrition (may choose substance over food)
Psychosocial effects of alcohol abuse and dependence
- chronic fatigue
- oversensitivity
- depression
- impaired reasoning
- personality deterioration
Hangovers!
- peaks when BAC approaches 0
- ppl with these disorders may drink again to avoid hangover
Alcohol withdrawal delirium
- alcohol abuse related psychosis
- follows prolonged drinking spree when person enters state of withdrawal for 3-6 days
- hallucinations, acute fear, fever, rapid/weak heartbeat
- followed by deep sleep
- increased risk of death
Alcohol amnesiac disorder
- memory defect sometimes accompanied by falsification of events
- delusions connected to trying to fill in memory gaps
- symptoms result from malnutrition (lack of vitamin B–treated with thiamine)
- reversible if treated within the first few days
Biological causes of alcohol use disorder
- addictive drugs activate mesocorticolimbic dopamine pathway (“pleasure pathway”); drugs that activate this are a potential candidate for abuse
- genetics play a role in vulnerability, not sure exactly how, might be bc of dysfunction in reward pathway
- 2x risk in late 20s if biological parent has alcohol use disorder
Psychosocial causes of alcohol use disorder
- family dysfunction (lack of stable relationships)
- exposure to negative models
- these two might have bidirectional effect
- often correlated w mental disorders
- exposure to trauma correlated w alcohol use; ppl might use to reduce stress
- teens begin drinking bc they think alcohol will increase popularity
- might begin during crisis periods of relationship; excessive drinking can also contribute to divorce
- cultural attitudes influence incidence
Medications in Treating Alcohol Abuse and Dependency
Meds to block desire to drink:
- Disulfiram (Antabuse) causes vomiting when followed by alcohol
- Naltrexone helps reduce cravings for alcohol
- Acamprosate
Meds to reduce withdrawal side-effects:
- tranquilizers have been used
- Valium in hospitals
- concern this does not promote long-term recovery
Behavioral and Cognitive-Behavioral Therapy (alcohol use disorders)
Tools to change behavior
- aversive conditioning methods (condition noxious stimuli with drinking)
- provide life and coping skills to reduce use in future
- self-control techniques aimed at reducing intake
“Controlled drinking”
- highly controversial
- more successful in people with less severe alcohol problems
- abstinence associated w greater success (after you’ve had one drink your judgment is impaired, harder to resist another)
Alcoholics Anonymous
- self-help group; spiritual element to it
- basic belief that one is an alcoholic for life
- rehabilitation lifts burden of personal responsibility
Treatment outcomes in alcohol abuse
- not super great outcomes
- more severe condition = lower impact of interventions
- relapse prevention treatment is important (teach clients to recognize early warning signs of relapse)
____% of US population 12+ used at least one illicit drug in the past year
approx. 10%
7 psychoactive drugs most commonly associated with abuse (in order)
- Alcohol
- Opiates (opium, heroin)
- Stimulants (cocaine/amphetamines/caffeine/nicotine)
- Sedatives (barbiturates)
- Hallucinogens (LSD)
- Antianxiety drugs (benzodiazepines)
- Pain medications (OxyContin)
Sedatives
Alcohol (ethanol)
- reduces tension
- facilitates social interaction
- “blots out” feelings or events
Barbiturates
- nembutal, seconal, veronal, tuinal
- reduce tension
Stimulants
Ampthetamines
- Benzedrine, Dexedrine, Methodine, Cocaine
- increase feelings of alertness
- decrease feelings of fatigue
- increase endurants
- stimulate sex drive
Opiates
Opium and its derivatives
- Morphine, Codeine, Heroin
- alleviate physical pain
- alleviate anxiety and tension
Mathadone (synthetic narcotic)
- used to treat heroin dependence (less addictive than natural opiates)
Hallucinogens
Cannabis
- Marijuana, Hashish
- induce changes in mood, thoughts, behavior
Mescaline (peyote)
- Psilocybin (shrooms), LSD, PCP
- “expand” one’s mind
induce stupor
Antianxiety drugs (minor tranquilizers)
- Librium, Miltown, Valium (diazepam), Xanax
- alleviate tension and anxiety
- induce relaxation and sleep
Opium and its derivatives
- Opium: mix of about 18 alkaloids, comes from opium poppy, couldn’t control potency
- Morphine: synthesized from opium, introduced around 1856, used to treat wounded in Civil War
- Heroin: more potent, acts more rapidly, more addictive (used to be used to treat pain)
Biological effects of morphine and heroin
- rush followed by high during which addict is typically in lethargic state (4-6 hours)
- withdrawal symptoms: tearing eyes, perspiration, restlessness, increased respiration rate, intensified desire for drug
- continued use >30days leads to physiological craving
- withdrawal symptoms usually gone within a week
Causal factors in Opiate abuse and dependence
- genes and environments play a role
- ppl start using heroin for many reasons (cheap/easy to obtain, desire to escape life stress, personal maladjustment, sociocultural conditions)
Neural bases for physiological addiction
- Endorphins: opium-like substances in brain, thought to be involved in pain responses
- Dopamine theory of addiction: addiction is result of dysfunction of dopamine reward pathway
- Reward deficiency syndrome: addiction more likely in those who have deficient reward pathways (are less satisfied by natural rewards)
Opioids and comorbidity
- opioid use is associated w dramatically increased risk of other forms of psychopathology
Treatments and outcomes of opioid use
- meds like methadone/buprenorphine help substitute for heroin
- meds and therapy combo leads to best results
- large relapse rates
Cocaine
- plant product discovered in ancient times
- more affordable now, “crack” cocaine even cheaper
Effects of cocaine use
- increases availability of dopamine creates 4-6 hour euphoric state
- feelings of contentment and confidence
- high use can lead to psychotic symptoms
- acute toxic psychotic symptoms may result from chronic abuse
Treatments and outcomes of cocaine abuse
- methadone and naltrexone reduce cravings
- CBT and contingency management approaches effective for dependence
- psychological treatments associates w decreases in use and other problems
Ampthetamines
- psychologically and physiologically addictive
- can be used to suppress appetite, treat narcolepsy or ADHS
- chronic use leads to tolerance
- methadrine (speed) is very potent, can be lethal
Effects of amphetamine use
- not energy source
- activates pathways to make you more alert/active (feel like you have more energy)
-can cause hazardous fatigue - side effects: excitability, sweating, rapid/unclear speech, sleeplessness, tremors, loss of appetite, confusion
Treatments and outcomes of amphetamine abuse
- little research
- slow withdrawal encouraged
Methamphetamine
- form of amphetamine (“crystal meth”)
- one of most dangerous illegal drugs
- produces immediate and long-lasting high
- raises levels of dopamine in brain
- prolonged use changes brain structure (can cause permanent damage)
- highly resistant to treatment, relapse is common
Caffeine
- addictive and commonly available
- caffeine-related disorder: restlessness, nervousness, insomnia, and muscle twitching
Nicotine
- mostly in tobacco, widely used
- can lead to nicotine-dependence syndrome
- often used to self-medicate anxiety disorders
- withdrawal symptoms last several days-weeks
Barbiturates
- depressants, slow down actions of CNS
- high risk of tolerance, overdose, addiction
- can lead to brain damage and personality deterioration
Causal factors in barbiturate abuse and dependence
- middle-aged/older ppl suscepible to dependency when using these as sleeping pills
- “silent abusers”
- often combine w alcohol, can be fatal
Treatments and outcomes of barbiturate abuse
- should withdraw slowly to minimize anxiety, tremors
- withdrawal symptoms more severe than opiates
LSD
- most potent hallucinogen
- usually causes 8 hours of changes in sensory perception, mood swings, feelings of depersonalizations/detachment
- esp for those w preexisting mental health condition, hallucinations can be traumatic/terrifying
- flashback: involuntary recurrence of perceptual distortions/hallucinations weeks or months later
Mescaline
- derived from small growths at top of peyote cactus
- milder LSD-like effects
- distorted reality, altered perceptions
Psilocybin
- from “sacred” Mexican mushrooms known as Psilocybe mexicana
- milder LSD-like symptoms
- distorted reality, altered perceptions
Ecstasy (MDMA)
- hallucinogen and stimulant
- chemically similar to methamphetamine and mescaline
- effects last several hours
- releases serotonin+blocks reuptake, causes feelings of euphoria, energy, well-being
- short and long term negative psychological and neurocognitive consequences
- increased % of ecstasy pills don’t have MDMA, but substitutes that affect CNS
Marijuana
- comes from hemp plant cannabis sativa
- mild hallucinogen, mild euphoria
- related to hashish (stringer drug)
- effects vary greatly depending on person and context
Treatment of marijuana dependence
- some users report withdrawal-like symptoms when abstaining (nervousness, tension, sleep problems)
- psychological treatments effective in reducing use
- pharmacotherapy treatments largely ineffective
Synthetic cannabinoids
- mimic effects of THC
- can cause serious side-effects (anxiety, heart palpitations, seizures)
Synthetic cathinones
- mimic effects of amphetamines and cocaine
- “bath salts”
- produce motor activity agitation, violence, psychosis-like effects, heart problems
Gambling disorder
- Pathological gambling: addictive disorder, behavior maintained by short-term gains despite long-term disruption of person’s life
- treatment methods include CBT and Gamblers Anonymous
- 1-2% prevalence (men and women)
