Chapter 11 – Substance-Related Disorders

Question 1

Behaviour based on the pathological need for a substance or activity; it may involve the abuse of substances, such as nicotine, alcohol, or cocaine, or gambling

Answer 1

Addictive behaviour

Question 2

Drug that affects mental functioning

Answer 2

Psychoactive substance

Alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana.

Question 3

Poisonous nature of a substance

Answer 3

Toxicity

Question 4

For diagnostic purposes, addictive or substance-related disorders are divided into two major categories:

Answer 4

1. Conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances, for example, and alcohol abuse dementia disorder involving amnesia
2. Substance-induced organic mental disorders and syndromes. These conditions stem from toxicity, the poisonous nature of the substance, or physiological changes in the brain due to vitamin deficiency

Question 5

Maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the abuse of the substance

Answer 5

Substance abuse

Question 6

Severe form of substance use disorder involving physiological dependence on the substance, tolerance, withdrawal, and compulsive drug taking

Answer 6

Substance dependence

Question 7

Need for increased amounts of a substance to achieve the effects

Answer 7

Tolerance

Question 8

Intellectual, emotional, for physical retreat. Physical symptoms such as sweating, tremors, and tension that accompany abstinence from the drug

Answer 8

Withdrawal

Question 9

A term used to characterize a person who is addicted to alcohol

Answer 9

Alcoholic

Question 10

Dependence on alcohol that seriously interferes with life adjustment

Answer 10

Alcoholism

The world health organization no longer recommends the term alcoholism but prefers the term alcohol dependence syndrome, a state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioural and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience it psychic effects, and sometimes to avoid the discomfort of its absence; tolerance may or may not be present

Question 11

Describe the prevalence, comorbidity, and demographics of alcohol abuse and dependence

Answer 11

It is estimated that 50% of adults who are 18 or older our current regular drinkers and only 21% our lifetime abstainers. An estimated 22.2 million persons were classified with substance dependence or abuse in the past year.

Heavy drinking is associated with folder ability to injury, marital discord, and becoming involved in intimate partner violence. The lifespan of the average person with alcohol dependence is about 12 years shorter than that of the average person without this disorder. Alcohol lowers performance on cognitive tasks, and organic impairment including brain shrinkage occurs in a high proportion of people.

Cuts across all age, educational, occupational, and Socio economic boundaries.
The traditional gap between men and women has narrowed when it comes to the development of substance abuse disorders and there do not seem to be important differences in rates of alcohol abuse between black and white Americans, although made of Americans tend to have higher rates of alcohol abuse, and Asian Americans tend to have lower usage.

Problem drinking may develop during any life period from early childhood through old age.

Over 37% suffer from at least one coexisting mental disorder and depression ranks high. Also Haeckel more bitty with eating disorders and many commit suicide. Also with personality disorder.

Question 12

Describe the clinical picture of alcohol abuse, including the biological and psychological effects of chronic consumption of alcohol

Answer 12

Tendency toward decreased sexual inhibition and lower sexual performance. Experience of blackouts or lapses of memory and for heavy drinkers, even moderate drinking can elicit memory lapses. The hangover.

Effects on the brain: at lower levels stimulate certain brain cells and activates the brains pleasure area, which release opium like endogenous opioids that are stored in the body. At higher levels, depresses brain functioning, inhibiting one of the brain excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain. Inhibition of glutamate impairs the organisms ability to learn and affects higher brain centers, impairing judgement and other rational processes and lowering self-control. Some degree of motor on coordination soon become the parent and the drink is discrimination and perception of cold, pain, and other discomforts are dulled. The drinker experiences a sense of warmth, expansiveness, and well-being.

Development of alcohol dependence

The physical effects of chronic alcohol use: alcohol that is taken in must be assimilated by the body, except for about the 5 to 10% that is eliminated through breath, urine, and perspiration, the work of alcohol metabolism is done by the liver. When large amounts are ingested, the liver maybe seriously overworked and eventually irreversible damage such as cirrhosis which involves extensive stiffening of the blood vessels.
Alcohol is also a high calorie dress, so consumption reduce is a drinkers appetite for other food and the drinker can suffer from malnutrition. It also impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins.

Psychosocial effects of alcohol abuse and dependence: chronic city, oversensitivity, and depression. Excessive use can result in impaired reasoning, poor judgment, and gradual personality deterioration and behaviour typically becomes coarse and inappropriate and assumes increasingly less responsibility, loses pride in personal appearance, neglect spouse and family, and becomes generally touchy, irritable, and unwilling to discuss the problem. Maybe unable to hold a job and generally becomes unqualified to cope with new demands that arise

Psychoses: Acute reactions usually last only a short time and generally consist of confusion, excitement, and delirium. For those who drink excessively for a long time, a reaction called alcohol withdrawal delirium formally known as delirium tremens may occur where slight noises or suddenly moving objects may cause considerable excitement and agitation. Usually happens following a prolonged drinking spree when the person enters a state of withdrawal. Symptoms include disorientation for time and place; vivid hallucinations particularly of small fast-moving animals like snakes rats and roaches; acute fear, in which these animals may change in form, size, or colour in terrifying ways; extreme suggestibility in which a person can be made to see almost any animal if its presence is merely suggested; marked tremors of the hands, tongue, and lips; and other symptoms including perspiration, fever, a rapid and weak heartbeat, a costed tongue, and foul breath. Last from 3 to 6 days and is generally followed by a deep sleep and upon awakening, few symptoms remain.
A second related psychosis is persisting alcohol disorder or alcohol annestic disorder (formerly known as Korsakoff’s syndrome). The outstanding symptom is a memory defect particularly with regard to recent events, which is sometimes accompanied by falsification of events. The person may not recognize pictures, faces, rooms, and other objects that they had just seen, although they may feel that these people or objects are familiar. Increasingly tend to fill in their memory gaps with reminiscences and fanciful tales. The memory disturbance itself seems related to an inability to form new associations in a manner that renders them readily retrievable. Thought to be due to vitamin B deficiency and other dietary inadequacies.

Question 13

Acute delirium associated with withdrawal from alcohol after prolonged heavy consumption; characterized by intense anxiety, tremors, fever and sweating, and hallucinations

Answer 13

Alcohol withdrawal delirium or delirium tremens

Question 14

Centre of psychoactive drug activation in the brain. This area is involved in the release of dopamine and in mediating the rewarding properties of drugs

Answer 14

Mesocorticolimbic dopamine pathway or MCLP

Question 15

Describe the biological causal factors in the abuse and dependence on alcohol

Answer 15

Biological causal factors:

The neurobiology of addiction – central to the neurochemical process underline addiction is the role the drug place in activating the pleasure pathway. The mesocorticolimbic dopamine pathway is the centre of psychoactive drug activation in the brain. Alcohol produces euphoria by stimulating this area in the brain. Drug ingestion or behaviours that lead to activation of the brain reward system are reinforced, so further use is promoted.

Genetic vulnerability – heredity probably plays an important role in a persons developing sensitivity to the addictive power of drugs like alcohol. Almost 1/3 of alcoholics had at least one parent with an alcohol problem. For males, having one alcohol parents increase the rate of alcoholism from 12.4% to 29.5% and having two alcoholic parents increase the rate 241.2%. For females with no alcoholic parents the rate was 5%, one alcoholic parent 9.5%, and two parents 25%.
And alcohol-based personality has been described as an individual who is usually an alcoholic’s child, who has an inherited predisposition toward alcohol abuse and who is impulsive, prefers taking high risks, and is emotionally unstable.
Free alcoholic men tend to experience a greater lessening of feelings of stress with alcohol ingestion then do nonalcoholic men and also show different Alpha wave patterns on EEGs and have been found to have larger condition physiological responses to alcohol cues.

Genetic influences and learning – a person must be exposed to the substance to a sufficient degree for the addictive behaviour to appear. The development of alcohol related problems involve living in an environment that promotes initial as well as continuing use of the substance. People become conditioned to stimuli and tend to respond in particular ways as a result of learning.

Question 16

Describe the psychosocial causal factors in alcohol abuse and dependence

Answer 16

Failures in parental guidance: stability is often lacking in families of substance abuse or’s. Children who have parents who are extensive alcohol or drug abusers are vulnerable to developing substance abuse and related problems and who are exposed to negative role models and family disfunction or experience other negative circumstances because the adults around them provide limited guidance and often falter on the difficult steps they must take in life.

Psychological vulnerability: personality factors related to having a family history of alcoholism are associated with the development of alcohol use disorders. Many potential alcohol abusers tends to be emotionally immature, expect a great deal of the world, require an inordinate amount of praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to for fill expected male or female roles. Also more impulsive and aggressive than those at low risk for abusing alcohol.

Stress, tension reduction, and reinforcement: patients undergoing substance abuse and treatment have shown high levels of trauma in their prior history. High exposure to threatening situations and atrocities, such as Iraq war veterans, was associated with a positive screen for alcohol abuse.
The typical alcohol abuser is discontented with their lives and is unable or unwilling to tolerate tension and stress. High degree of association between alcohol consumption and negative affectivity such as anxiety and somatic complaints. In other words, alcoholics drink to relax.

Expectations of social success: many people especially young adolescents, expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life. According to the reciprocal-influence model, adolescence begin drinking as a result of expectations that using alcohol will increase their popularity and acceptance by their peers. Time and experience have moderating influences on these alcohol expectancies, there was a significant decrease in outcome expectancy overtime.

Marital and other intimate relationships: adults with less intimate and supportive relationships tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking often begins during crisis. In marital or other intimate personal relationships, particularly those that we do hurt and self-evaluation. Excessive use of alcohol is one of the most frequent cause of divorce in the US and is often a hidden factor in the two most common causes, financial and sexual problems.

Question 17

Describe socio-cultural causal factors related to alcohol abuse and dependence

Answer 17

Alcohol is often seen as a “social lubricant” or tension reducer that enhances social events.

The effect of cultural attitude toward drinking is well illustrated by Mahometans and Mormons, who’s religious values prohibit the use of alcohol and the incidence of alcoholism among these groups is minimal.

Question 18

Describe the treatment for alcohol-related disorders

Answer 18

Difficult to treat because many abusers refuse to admit that they have a problem before they hit bottom, and many who do you go into treatment leave before therapy is completed.

Use of medications include medications to block the desire to drink (Antabuse causes violent vomiting when followed by ingestion of alcohol). Primary value seems to be their ability to interrupt the alcohol-abuse cycle for a period of time during which therapy maybe undertaken. Naltrexone blocks the pleasure-producing affects of alcohol.

Medications to reduce the side effects of acute withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness.

Psychological treatment approaches:

Group therapy – in the confrontational give-and-take of group therapy, alcohol abusers are often forced to face their problems and their tendencies to deny or minimize them.

Environmental intervention – alleviate a patient’s aversive life situation such as estrangement from family and friends.

Behavioural and cognitive-behavioral therapy – one type is aversive conditioning therapy which involves the presentation of a wide range of noxious stimuli with alcohol consumption in order to suppress drinking behavior.
One of the most effective contemporary procedures has been the cognitive-behavioral approach which combines cognitive-behavioral strategies of intervention with social learning theory and modelling of behavior. Often referred to as a “skills training procedure” and relies on such techniques as imparting specific knowledge about alcohol, developing coping skills and situations associated with increased risk of alcohol abuse, modifying cognitions and expectancies, acquiring stress management skills, and providing training in life skills.
Brief motivational intervention – goal is to get alcoholics to reduce alcohol intake without necessarily abstaining all together

Controlled drinking versus abstinence: some alcoholics can learn to control their alcohol intake. Controlled drinking was more likely to be successful in persons with less severe alcohol problems.

Alcoholics Anonymous – operates primarily as a self-help counselling program in which both person-to-person and group relationships are emphasized. In the AAA view, one is an alcoholic for life and is never cured of alcoholism but is instead in recovery. And important aspect is to lift the burden of personal ability by helping them accept that alcoholism, like many other problems, is bigger than they are.

Relapse prevention: many treatment programs do not pay enough attention to maintaining effective behaviour and preventing relapse into previous maladaptive patterns. Relapse prevention treatment worked most effectively when family members were involved in the treatment.
In relapse prevention treatment, clients are taught to recognize the apparently a relevant decisions that serve as early warning signals of the possibility of relapse. High-risk situations 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.

Question 19

Aside from alcohol, the psychoactive drugs most commonly associated with abuse and dependence in our society appear to be:

Answer 19

1. Narcotics such as opiates or opioids, including opium and heroin
2. Sedatives such as barbiturates
3. Stimulants such as cocaine and amphetamines
4. Anti-anxiety drugs such as benzodiazepines
5. Pain medications such as OxyContin
6. Hallucinogens such as LSD
7. Caffeine and nicotine

Question 20

Narcotic drug that leads to physiological dependence and the development of tolerance; derivatives are morphine, heroin, and codeine.

A mixture of about 18 chemical substances known as alkaloids; it was named morphine after Morpheus, the god of sleep in Greek mythology

Answer 20

Opium

Question 21

Addictive drug derived from opium that can serve as a powerful sedative and pain reliever

Answer 21

Morphine

It was discovered that if morphine was treated with an inexpensive and readily available chemical called acetic anhydride, it would be converted into another powerful analgesic called heroin

Question 22

Powerful psychoactive drug, chemically derived from morphine, that relieves pain but is even more intense and addictive than morphine

Answer 22

Heroin

Question 23

What are the biological effects of morphine and heroin?

Answer 23

A euphoric spasm is the immediate effect, the rush that last 60 seconds or so, which many addicts compared to a sexual orgasm. Vomiting and nausea have also been known to be part of the immediate effects. 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. These effects last from 4 to 6 hours and are followed by a negative phase that produces a desire for more of the drug.

Withdrawal from heroin is not always dangerous or even very painful. But candy and a conniving experience for some with symptoms including runny nose, tearing eyes, perspiration, restlessness, increased respiration rate, and an intense desire for the drug. Typically a feeling of chilliness alternates with flashing and excessive sweating, vomiting, diarrhea, abdominal cramps, pains in the back and extremities, severe headache, marked tremors, and varying degrees of insomnia. The symptoms are usually on the decline by the third or fourth day and have disappeared by the seventh or eighth day.

Question 24

Opiates produced in the brain and throughout the body that function like neurotransmitters to dampen pain sensations. They also play a role in the body’s building up a tolerance to certain drugs

Answer 24

Endorphins

Question 25

Synthetic narcotic related to heroin; used in treatment of heroin addiction because it satisfies the grading for hair went without producing serious psychological impairment

Answer 25

Methadone

Question 26

Stimulating and pain-reducing psychoactive drug.

Answer 26

Cocaine

Precipitates a euphoric state of 4 to 6 hours duration, during which a user experiences feelings of confidence and contentment. The blissful state may be preceded by headache, dizziness, and restlessness. When cocaine is chronically abused, acute toxic psychotic symptoms may occur, including frightening visual, auditory, and tactual hallucinations similar to those in acute schizophrenia.

Question 27

Drug that produces a psychologically stimulating and energizing effect. First became available in drugstores as an inhalant to relieve stuffy noses.

Answer 27

Amphetamine

In the late 1930s, two new are amphetamines were introduced – Dexedrine or dextroamphetamine and methedrine or methamphetamine hydrochloride also known as speed.

Initially was considered to be wonder pills that help people stay alert and awake and function temporarily at a level beyond normal. During World War II, military interest was aroused in the stimulating effects of these drugs, and they were used by both Allied and German soldiers to ward off fatigue. They tend to suppress appetite and so became popular with people trying to lose weight.

Often push users toward greater expenditures of their own resources – often to the point of hazardous fatigue.

Question 28

Referred to on the streets as Crystal or ice because of its appearance. A highly addictive stimulant drug that can provide a quick and long-lasting high. It is one of the most dangerous illegal drugs because of it’s treacherous properties and it’s unwelcome results. A form of amphetamine that can be cooked in large quantities in makeshift laboratories been out of the way places that defy and frustrate detection. Relatively cheap to manufacture and is often referred to as poor peoples cocaine.

Answer 28

Methamphetamine

Operates by increasing the level of dopamine in the brain, and prolonged use of the drug produces structural changes in the brain. Metabolized more slowly than other drugs such as cocaine and produces a high for a longer period of time. When coming down from the high, users are likely to feel extremely weak, lethargic, sleepy, and depressed.

Question 29

Synthetic drugs that act as depressants to calm the individual and induce sleep

Answer 29

Barbiturates

They act as depressants to slow down the action of the central nervous system and significantly reduce performance on cognitive tasks. 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.

Question 30

Drugs known to induce hallucinations; often referred to as psychedelics. 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.

Answer 30

Hallucinogens

Question 31

The most potent of the hallucinogens. It is odorless, colorless, and tasteless, and an amount smaller than a grain of salt can produce intoxication

Answer 31

LSD or lysergic acid diethylamide

After taking LSD, a person typically go through about eight hours of changes in sensory perception, mood swings, and feelings of depersonalization and detachment. The experience is not always pleasant and can be extremely traumatic, and the distorted objects and sounds, the illusory colors, and the new thoughts can be menacing and terrifying.

Question 32

Involuntary recurrence of perceptual distortions or hallucinations weeks or months after taking a drug; in post-traumatic stress disorder, A dissociative state in which the person briefly relives the traumatic experience

Answer 32

Flashback

Question 33

Hallucinogenic drug derived from the peyote cactus

Answer 33

Mescaline

Question 34

Hallucinogenic drug derived from a variety of mushrooms

Answer 34

Psilocybin

Question 35

A human manufactured drug that is taken orally and acts as both a stimulant and a hallucinogen. The drug effects include feelings of mental stimulation, emotional warmth, enhanced sensory perception, and increased physical energy

Answer 35

Ecstasy or MDMA

Question 36

Mild hallucinogenic drug derived from the hemp plant, often smoked in cigarettes called reefers or joints

Answer 36

Marijuana

The specific effects of marijuana very greatly, depending on the quality and dosage of the drug, the personality and mood of the user, the users past experiences with the drug, the social setting, and the users expectations. When smoked and inhaled, a state of slight intoxication results. This state is one of mild euphoria distinguished by increased feelings of well-being, heightened perceptual acuity, and pleasant relaxation, often accompanied Buy a sensation of drifting or floating away. Sensory inputs are intensified. Alters ones internal clock where in a person sense of time is stretched or distorted so that at event that lasts only a few seconds may seem to cover a much longer spend. Short-term memory may also be affected. Pleasurable experiences are reportedly enhanced.
May also lead to unpleasant as well as pleasant experiences. Can produce extreme euphoria, hilarity, Andover talkativeness, but can also produce intense anxiety and depression as well as delusions, hallucinations, and other psychotic like experiences.

Short range physiological effects include a moderate increase in heart rate, a slowing of reaction time, a slight contraction of pupil size, bloodshot and itchy eyes, a dry mouth, and increased appetite. Induces memory disfunction and slowing of information processing. Continued use of high dosages overtime tends to produce lethargy and passivity along with reduced life success.

Question 37

Strongest drug derived from the hemp plant; a relative of marijuana that is usually smoked

Answer 37

Hashish

Question 38

A drug dependence found in many commonly available drinks and food

Answer 38

Caffeine

Question 39

Addictive alkaloid that is the chief active in gradient in tobacco and a drug of dependence

Answer 39

Nicotine

Question 40

Progressive disorder characterized by loss of control over gambling, preoccupation with gambling and obtaining money for gambling, and irrational gambling behaviour in spite of adverse consequences

Answer 40

Pathological gambling

Question 41

Patterns of maladaptive behaviour centred on the regular use of a substance, such as a drug or alcohol

Answer 41

Substance-related disorders