Chapter 11 Flashcards
The two diagnoses for Substance-Related Disorders in the DSM-5 are:
Substance-induced disorders and Substance-use disorders
Substance-induced disorders
– Disorders, such as intoxication, that can be induced by using psychoactive substances.
Substance-use disorders
– patterns of maladaptive use of psychoactive substances that lead to significant levels of impaired functioning or personal distress.
Substance intoxication
– A pattern of repeated episodes of intoxication, which is a state of drunkenness or of being “high.”
Reversible and temporary condition
Substance abuse
– Recurrent substance use that results in significant adverse consequences in functioning
Substance dependence
– lack of control over substance use
Two forms of dependence:
Physiological and psychological
Addiction
– Impaired control over the use of a chemical substance, accompanied by physiological dependence.
Physiological dependence
– A condition in which the drug user’s body comes to depend on a steady supply of the substance.
Defined largely in terms of tolerance and withdrawal
Psychological dependence
– Compulsive use of a substance to meet a psychological need.
Also known as habituation
Impairment of control
– exceeding amounts of a substance or time using than intended
Tolerance
– Physical habituation to a drug such that with frequent use:
1) higher doses are needed to achieve the same effects,
or
2) the same amount of substance has a diminished effect.
Withdrawl syndrome
– A characteristic cluster of symptoms following the sudden reduction or cessation of use of a psychoactive substance after physiological dependence has developed.
Substance-use disorders
– Patterns of maladaptive use of psychoactive substances that are identified by the particular drug associated with problematic use (e.g., “alcohol use disorder”).
Characterized by a range of features that include the following:
persistent problems cutting back or controlling use of the substance
developing tolerance or a withdrawal syndrome
spending an excessive amount of time seeking/using the substance
using the substance in situations that pose a risk to the person’s safety or the safety of others (such as repeatedly drinking and driving).
The DSM-5 has included a category for nonchemical forms of addiction, including what 3 disorders?
Gambling disorder
kleptomania (compulsive stealing)
pyromania (compulsive fire-setting).
These disorders were previously classified in the DSM-IV in a diagnostic category called Impulse Control Disorders.
Characterized by difficulties controlling or restraining impulsive behavior.
polysubstance abuse
May be addicted to more than one thing or the substance they are addicted to might be laced with other things that their body is reacting to
depressants
drugs that slows down or curbs the activity of the central nervous system.
It reduces feelings of tension and anxiety, slows movement, and impairs cognitive processes.
In high doses, depressants can arrest vital functions and cause death.
the most widely used substance in the United States and worldwide
Alcohol
Alcoholism
– An alcohol dependence disorder or addiction that results in serious personal, social, occupational, or health problems.
the disease model
- the most widely held view of alcoholism
- the belief that alcoholism is a medical illness or disease.
risk factors for developing alcoholism and alcohol-related problems
- Gender
- Age
- Antisocial personality disorder
- Family history
- Sociodemographic factors
Canadian Consumption Statistics
77% of Canadians reported drinking in the past 12 months
12% former drinkers
11% never drink
90% of youth aged 18-24 drink during the course of a year
Heaviest drinking reported by those with the least education and those out of work
Effects of alcohol
- Alcohol reduces anxiety, produces euphoria, and creates a sense of well-being
- Reduces inhibitions
- Short-term effects are strongly related to expectations of the alcohol
- Alcohol level, aka blood alcohol level (BAL), expressed as a percentage of blood
Physiological Effects of Alcohol
Alcohol appears to work by heightening activity of the neurotransmitter GABA.
GABA is an inhibitory neurotransmitter.
Increasing GABA activity produces feelings of relaxation.
Short-Term Physical Health and Alcohol
Blackouts
Interval for a period of time where the person cannot recall key details or entire events
More common than thought – 51% of university students reported waking and forgetting events after drinking
Hangovers
Largely related to cellular dehydration, diuretic effects, and alcohol being a gastric irritatnt
Heavy alcohol use is linked to increased risk of many serious health concerns, including:
Liver disease
Increased risk of some forms of cancer
Coronary heart disease
Neurological disorders
Two of the major forms of alcohol-related liver disease are
alcoholic hepatitis - a serious and potentially life-threatening inflammation of the liver
cirrhosis - a potentially fatal disease in which healthy liver cells are replaced with scar tissue.
Korsakoff’s syndrome
Habitual drinkers tend to be malnourished, which can put them at risk of complications arising from nutritional deficiencies
- characterized by glaring confusion, disorientation, and memory loss for recent events.
- associated with cell loss in the hypothalamus and thalamus
Fetal alcohol spectrum disorder
a pattern of physical impairments, neurodevelopmental deficiencies, and birth defects related from exposure to prenatal alcohol use
Common symptoms/impairments/associated disorders include growth retardation, CNS abnormalities, ADHD, learning disabilities, inappropriate behaviors, and substance use disorders.
Moderate drinking health benefits
1 to 2 drinks per day for women, 2 to 4 drinks for men is linked to lower risks of heart attacks and strokes, as well as lower death rates overall.
Health promotion efforts might be better directed toward finding safer ways of achieving the health benefits associated with moderate drinking than by encouraging alcohol consumption, such as by quitting smoking
Barbiturates
– Sedative drugs which are depressants with high addictive potential.
Narcotics
– Drugs that are used medically for pain relief but that have strong addictive potential.
Opioids
include both naturally occurring opiates (morphine, heroin, codeine) derived from the juice of the poppy plant and synthetic drugs (e.g., Demerol, Darvon) that have opiate like effects.
Endorphins
– Natural substances that function as neurotransmitters in the brain and are similar in their effects to opioids.
Morphine
– A strongly addictive narcotic derived from the opium poppy that relieves pain and induces feelings of well-being.
“soldier’s disease” is associated with what drug
Morphine
Heroin
– A narcotic derived from morphine that has strong addictive properties
- a powerful depressant that can create a euphoric rush.
the most widely used opiate
Heroin
Stimulants
are psychoactive substances that increase the activity of the central nervous system, which enhances states of alertness and can produce feelings of pleasure or even euphoric highs.
Amphetamines
– A class of synthetic stimulants that activate the central nervous system, producing heightened states of arousal and feelings of pleasure. Effects similar to adrenaline
Amphetamine psychosis
– A psychotic state characterized by hallucinations and delusions, induced by ingestion of amphetamines.
The drug ecstasy, or MDMA (3,4-methylenedioxymeth-amphetamine)
a designer drug, a chemical knockoff similar in chemical structure to amphetamine.
psychological effects of ecstasy include
depression, anxiety, insomnia, and even paranoia and psychosis.
Cocaine
a natural stimulant extracted from the leaves of the coca plant—the plant from which the soft drink obtained its name
Crack
– The hardened, smokable form of cocaine that may be more than 75% pure.
Overdoses on Cocaine
can produce restlessness, insomnia, headaches, nausea, convulsions, tremors, hallucinations, delusions, and even sudden death due to respiratory or cardiovascular collapse.
Health effects of Cocaine
cocaine directly stimulates the brain’s reward or pleasure circuits.
It also produces a sudden rise in blood pressure and an accelerated heart rate that can cause potentially dangerous, even fatal, irregular heart rhythms.
Regular snorting of cocaine can lead to serious nasal problems, including ulcers in the nostrils.
Causes of Caffeine
Low doses (100-150 mg) can increase attention, improve problem-solving skills, and improve mood
High doses (300-400+ mg range) cause increased jitteriness, nervousness, insomnia, gastrointestinal discomfort
Doses exceeding 1000mg can cause muscle tremors, disorganized thinking, rapid/irregular heartbeat, agitation
psychedelics
a class of drugs that produce sensory distortions or hallucinations, including major alterations in color perception and hearing.
LSD
is the acronym for lysergic acid diethylamide, a synthetic hallucinogenic drug.
In addition to the vivid parade of colors and visual distortions produced by LSD, users have claimed it “expands consciousness” and opens new worlds—as if they were looking into some reality beyond the usual reality.
Sometimes they believe they have achieved great insights during the LSD “trip,” but when it wears off they usually cannot follow through or even summon up these discoveries.
Phencyclidine, or PCP
—which is referred to as “angel dust” on the streets—was developed as an anesthetic in the 1950s but was discontinued as such when its hallucinatory side effects were discovered.
A smokable form of PCP became popular as a street drug in the 1970s.
However, its popularity has since waned, largely because of its unpredictable effects such as paranoya.
Marijuana
– A hallucinogenic drug derived from the leaves and stems of the plant Cannabis sativa.
Marijuana is derived from the Cannabis sativa plant.
Psychoactive effects caused primarily by the chemical delta-9-tetrahydrocannabinol (THC)
Marijuana is generally classified as a hallucinogen because it can produce perceptual distortions or mild hallucinations, especially in high doses or when used by susceptible individuals.
Health effects of Marijuana
Involves mild changes in perception along with enhancement of physical experiences
Experiences differs among individuals
Short-term effects include deficits in complex motor skills, short-term memory, reaction time, attention
Long-term effects include greater lung problems than tobacco smokers, increased depression risk, amotivational syndrome (less of a desire to obtain employment etc.)
Learning theory on substance use
propose that substance-related behaviors are largely learned and can, in principle, be unlearned.
They focus on the roles of operant and classical conditioning and observational learning.
Substance abuse problems are not regarded as symptoms of disease but rather as problem habits.
Operant Conditioning and substance use
People may initially use a drug because of social influences, trial and error, or social observation.
In the case of alcohol, they learn that the drug can produce reinforcing effects, such as feelings of euphoria, and reductions in anxiety and tension.
Alcohol may also reduce behavioural inhibitions.
Alcohol can thus be reinforcing when it is used to combat depression (by producing euphoric feelings, even if short lived), to combat tension (by functioning as a tranquilizer), or to help people sidestep moral conflicts (for example, by dulling awareness of moral prohibitions).
Learning theorists on Alcohol and Tension Reduction
Learning theorists have long maintained that one of the primary reinforcers for using alcohol is relief from states of tension or unpleasant states of arousal.
According to the tension-reduction theory, the more often one drinks to reduce tension or anxiety, the stronger or more habitual the habit becomes.
We can think of some uses of alcohol and other drugs as forms of self-medication—as a means of using the pill or the bottle to ease psychological pain, at least temporarily.
negative reinforcement and substance use
Once people become physiologically dependent, negative reinforcement comes into play in maintaining the drug habit.
In other words, people may resume using drugs to gain relief from unpleasant withdrawal symptoms.
In operant conditioning terms, relief from unpleasant withdrawal symptoms is a negative reinforcer for resuming drug use.
Conditioning model of craving
Classical conditioning may help explain drug cravings.
In this view, cravings reflect the body’s need to restore high blood levels of the addictive substance and thus have a biological basis.
But they also come to be associated with environmental cues associated with prior use of the substance.
Observational Learning
Modeling or observational learning plays an important role in determining risk of substance abuse problems.
Parents who model inappropriate or excessive drinking or use of illicit drugs may set the stage for maladaptive drug use in their children.
Evidence shows that adolescents who have a parent who smokes face a substantially higher risk of smoking than do their peers in families where neither parent smokes.
Cognitive perspectives
Evidence supports the role of cognitive factors in substance abuse and dependence, especially the role of expectancies.
Alcohol or other drug use may also boost self-efficacy expectations—personal expectancies we hold about our ability to successfully perform tasks.
Expectancies may account for the “one-drink effect”—the tendency of chronic alcohol abusers to binge once they have a drink.
Psychodynamic theory
- alcoholism reflects an oral-dependent personality.
- associates excessive alcohol use with other oral traits, such as dependence and depression, and traces the origins of these traits to fixation in the oral stage of psychosexual development.
- Excessive drinking or smoking in adulthood symbolizes an individual’s efforts to attain oral gratification.
Sociocultural Perspectives
Drinking is determined, in part, by where we live, whom we worship with, and the social or cultural norms that regulate our behavior.
Cultural attitudes can encourage or discourage problem drinking.
Peer pressure and exposure to a drug subculture are important influences in determining substance use among adolescents and young adults.
Detoxification
– The process of ridding the system of alcohol or other drugs under supervised conditions.
Detoxification is often more safely carried out in a hospital setting.
Disulfiram (Antabuse)
- discourages alcohol consumption because the combination of the two produces a violent response consisting of nausea, headache, heart palpitations, and vomiting
- In some extreme cases, combining disulfiram and alcohol can produce such a dramatic drop in blood pressure that the individual goes into shock or even dies
- Although disulfiram has been used widely in alcoholism treatment, its effectiveness is limited because many patients who want to continue drinking simply stop using the drug
Treatment of Antidepressants
may help reduce cravings for cocaine following withdrawal.
These drugs stimulate neural processes that promote feelings of pleasure derived from everyday experiences.
However, antidepressants have yet to produce consistent results in reducing relapse rates for cocaine dependence, so it is best to withhold judgment concerning their efficacy.
Nicotine Replacement Therapy
The use of nicotine replacements in the form of prescription gum (brand name Nicorette), transdermal (skin) patches, and nasal sprays can help smokers avoid unpleasant withdrawal symptoms and cravings for cigarettes.
After quitting smoking, ex-smokers can gradually wean themselves from the nicotine replacement.
Methadone
– A synthetic opiate that is used to help people who are addicted to heroin to abstain from it without a withdrawal syndrome. However, it is highly addictive
Naltrexone
– A drug that blocks the high from alcohol as well as from opiates.
- doesn’t prevent the person from taking a drink or using heroin, but seems to blunt cravings for these drugs.
- useful in treating alcohol, opiate, and amphetamine dependence.
A residential approach to treatment
requires a stay in a hospital or therapeutic residence. Most people with alcohol-use disorders do not require hospitalization.
Psychodynamic Approaches
Psychoanalysts view substance abuse and dependence as symptoms of conflicts rooted in childhood experiences.
The therapist attempts to resolve the underlying conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of gratification.
Although there are many successful psychodynamic case studies of people with substance abuse problems, there is a dearth of controlled and replicable research studies.
The effectiveness of psychodynamic methods for treating substance abuse and dependence thus remains unsubstantiated.
Behavioral Approaches
focus on modifying abusive and dependent behavior patterns.
key question is whether abusers can learn to change their behavior when they are faced with temptation.
Self-control training used by behavioural therapists focus on three components—the “ABCs”— of substance abuse:
- The antecedent cues or stimuli (As) that prompt or trigger abuse.
- The abusive behaviours (Bs) themselves.
- The reinforcing or punishing consequences (Cs) that maintain or discourage abuse.
Contingency management (CM) programs
provide reinforcements (rewards) contingent on performing desirable behaviors such as producing drug-negative urine samples. On average, the CM (reward) group achieved longer periods of continual abstinence than the standard methadone treatment group.
aversive conditioning
painful or aversive stimuli are paired with substance abuse or abuse-related stimuli to condition negative emotional responses to drug-related stimuli.
In the case of problem drinking, tasting alcoholic beverages is usually paired with drugs that cause nausea and vomiting, or with electric shock.
Unfortunately, aversive conditioning effects are often temporary and fail.
Social skills training
- helps people develop effective interpersonal responses.
- Assertiveness training used to train alcohol abusers to fend off social pressures to drink
- Behavioral marital therapy seeks to improve marital communication and problem solving that may trigger abuse
Learning theory on substance use
propose that substance-related behaviors are largely learned and can, in principle, be unlearned.
They focus on the roles of operant and classical conditioning and observational learning.
Substance abuse problems are not regarded as symptoms of disease but rather as problem habits.
Operant Conditioning and substance use
People may initially use a drug because of social influences, trial and error, or social observation.
In the case of alcohol, they learn that the drug can produce reinforcing effects, such as feelings of euphoria, and reductions in anxiety and tension.
Alcohol may also reduce behavioural inhibitions.
Alcohol can thus be reinforcing when it is used to combat depression (by producing euphoric feelings, even if short lived), to combat tension (by functioning as a tranquilizer), or to help people sidestep moral conflicts (for example, by dulling awareness of moral prohibitions).
Learning theorists on Alcohol and Tension Reduction
Learning theorists have long maintained that one of the primary reinforcers for using alcohol is relief from states of tension or unpleasant states of arousal.
According to the tension-reduction theory, the more often one drinks to reduce tension or anxiety, the stronger or more habitual the habit becomes.
We can think of some uses of alcohol and other drugs as forms of self-medication—as a means of using the pill or the bottle to ease psychological pain, at least temporarily.
negative reinforcement and substance use
Once people become physiologically dependent, negative reinforcement comes into play in maintaining the drug habit.
In other words, people may resume using drugs to gain relief from unpleasant withdrawal symptoms.
In operant conditioning terms, relief from unpleasant withdrawal symptoms is a negative reinforcer for resuming drug use.
Conditioning model of craving
Classical conditioning may help explain drug cravings.
In this view, cravings reflect the body’s need to restore high blood levels of the addictive substance and thus have a biological basis.
But they also come to be associated with environmental cues associated with prior use of the substance.
Observational Learning
Modeling or observational learning plays an important role in determining risk of substance abuse problems.
Parents who model inappropriate or excessive drinking or use of illicit drugs may set the stage for maladaptive drug use in their children.
Evidence shows that adolescents who have a parent who smokes face a substantially higher risk of smoking than do their peers in families where neither parent smokes.
Cognitive perspectives
Evidence supports the role of cognitive factors in substance abuse and dependence, especially the role of expectancies.
Alcohol or other drug use may also boost self-efficacy expectations—personal expectancies we hold about our ability to successfully perform tasks.
Expectancies may account for the “one-drink effect”—the tendency of chronic alcohol abusers to binge once they have a drink.
Psychodynamic theory
- alcoholism reflects an oral-dependent personality.
- associates excessive alcohol use with other oral traits, such as dependence and depression, and traces the origins of these traits to fixation in the oral stage of psychosexual development.
- Excessive drinking or smoking in adulthood symbolizes an individual’s efforts to attain oral gratification.
Sociocultural Perspectives
Drinking is determined, in part, by where we live, whom we worship with, and the social or cultural norms that regulate our behavior.
Cultural attitudes can encourage or discourage problem drinking.
Peer pressure and exposure to a drug subculture are important influences in determining substance use among adolescents and young adults.
Detoxification
– The process of ridding the system of alcohol or other drugs under supervised conditions.
Detoxification is often more safely carried out in a hospital setting.
Disulfiram (Antabuse)
- discourages alcohol consumption because the combination of the two produces a violent response consisting of nausea, headache, heart palpitations, and vomiting
- In some extreme cases, combining disulfiram and alcohol can produce such a dramatic drop in blood pressure that the individual goes into shock or even dies
- Although disulfiram has been used widely in alcoholism treatment, its effectiveness is limited because many patients who want to continue drinking simply stop using the drug
Treatment of Antidepressants
may help reduce cravings for cocaine following withdrawal.
These drugs stimulate neural processes that promote feelings of pleasure derived from everyday experiences.
However, antidepressants have yet to produce consistent results in reducing relapse rates for cocaine dependence, so it is best to withhold judgment concerning their efficacy.
Nicotine Replacement Therapy
The use of nicotine replacements in the form of prescription gum (brand name Nicorette), transdermal (skin) patches, and nasal sprays can help smokers avoid unpleasant withdrawal symptoms and cravings for cigarettes.
After quitting smoking, ex-smokers can gradually wean themselves from the nicotine replacement.
Methadone
– A synthetic opiate that is used to help people who are addicted to heroin to abstain from it without a withdrawal syndrome. However, it is highly addictive
Naltrexone
– A drug that blocks the high from alcohol as well as from opiates.
- doesn’t prevent the person from taking a drink or using heroin, but seems to blunt cravings for these drugs.
- useful in treating alcohol, opiate, and amphetamine dependence.
A residential approach to treatment
requires a stay in a hospital or therapeutic residence. Most people with alcohol-use disorders do not require hospitalization.
Psychodynamic Approaches
Psychoanalysts view substance abuse and dependence as symptoms of conflicts rooted in childhood experiences.
The therapist attempts to resolve the underlying conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of gratification.
Although there are many successful psychodynamic case studies of people with substance abuse problems, there is a dearth of controlled and replicable research studies.
The effectiveness of psychodynamic methods for treating substance abuse and dependence thus remains unsubstantiated.
Behavioral Approaches
focus on modifying abusive and dependent behavior patterns.
key question is whether abusers can learn to change their behavior when they are faced with temptation.
Self-control training used by behavioural therapists focus on three components—the “ABCs”— of substance abuse:
- The antecedent cues or stimuli (As) that prompt or trigger abuse.
- The abusive behaviours (Bs) themselves.
- The reinforcing or punishing consequences (Cs) that maintain or discourage abuse.
Contingency management (CM) programs
provide reinforcements (rewards) contingent on performing desirable behaviors such as producing drug-negative urine samples. On average, the CM (reward) group achieved longer periods of continual abstinence than the standard methadone treatment group.
aversive conditioning
painful or aversive stimuli are paired with substance abuse or abuse-related stimuli to condition negative emotional responses to drug-related stimuli.
In the case of problem drinking, tasting alcoholic beverages is usually paired with drugs that cause nausea and vomiting, or with electric shock.
Unfortunately, aversive conditioning effects are often temporary and fail.
Social skills training
- helps people develop effective interpersonal responses.
- Assertiveness training used to train alcohol abusers to fend off social pressures to drink
- Behavioral marital therapy seeks to improve marital communication and problem solving that may trigger abuse
What drug has the highest lifetime prevalence rate for dependence?
Tobacco
What hallucinogen is primarily a dissociative anaesthetic?
PCP
The factor linked most closely to alcoholism, alcohol abuse, or problem drinking in adulthood is
Family History of Alcohol Abuse
When alcohol abusers refuse to commit to abstinence as a treatment goal, they are offered an alternative method. What is it?
Harm Reduction
During detoxification from alcohol what are sometimes used to reduce the unpleasant experiences associated with alcohol withdrawal?
benzodiazepines
Naltrexone
is a drug that targets the neurotransmitters that mediate alcohol’s effects on the brain and block the pleasurable effects of alcohol.
AA
Alcoholics Anonymous - 12 step program for alcoholics
Passive smoking
breathing in the smoke of another person.
abstinence syndrome
some individuals experience this when withdrawing from barbiturates and benzodiazepines.
LA’s
Discuss the DSM-IV-TR distinction between drug dependence and drug abuse.
Discuss the common features of treatments for addiction to several drugs.
Discuss the concept of harm reduction and an example of a Canadian program with this as its goal.
Describe the difference between substance abuse and substance dependence according to the DSM-IV-TR and discuss the diagnostic criteria for each.
Discuss the controversy surrounding the use of controlled drinking in the treatment of alcohol abuse.
List the different classifications of drugs
Depressants - Alcohol - Barbiturates (blues, yellow jackets, red birds) and Benzodiazepines (Valium, Xanax) - Opioids (Heroine, and Morphine) Stimulants - Tobacco/Nicotine - Amphetamines (MDMA) - Cocaine - Caffeine Hallucinogens - LSD - PCP - Psilocyben (Mushrooms) - Cannabis (THC, Hashish, Marijuana)
Effects of Barbiturates and Benzodiazepines
low doses cause mild euphoria. Larger doses cause slurred speech, poor motor coordination, and impairment of judgment and concentration and sleep
