chapter 8 Flashcards
Substance Use and Abuse
The line between substance use and substance abuse is the point at which a pattern of substance use significantly impairs the person’s occupational, social, or daily functioning or causes significant personal distress
Substance induced disorders
Repeated episodes of drug intoxication or development of withdrawal syndrome
Abnormal behavior patterns that are directly induced by psychoactive substances
Two types: Substance intoxication and substance withdrawal
Substance intoxication
- A substance induced disorder involving a pattern of repeated episodes of intoxication, which is a state of drunkenness or being “high,” brought about by use of a particular drug
- Features depend on which drug is ingested, the dose, the user’s biological reactivity, and the user’s expectations
- Signs of intoxication: confusion belligerent, impaired judgment, inattention, and impaired motor and spatial skills
Accidental overdose are the second leading cause of accidental death (after motor vehicle accidents) in the US
Substance withdrawal
A substance induced disorder involving a cluster of symptoms that occur when a person abruptly stops using a particular substance following a period of prolonged and heavy use of the substance
Cessation of (or reduction in) use of a substance that has been heavy and prolonged
The development of a substance-specific syndrome shortly after the cessation of (or reduction in) substance use
Substance use disorders
Maladaptive use of a substance leading to psychological distress or impaired functioning
tolerance
State of physical habituation to a drug, resulting from frequent use, so that higher doses are needed to achieve the same effect
alcoholism
Alcohol dependence
A pattern of impaired control over the use of alcohol in someone who has been physiologically dependent on the drug
Peer support group - AA (alcoholics anonymous)
risk groups - alcoholism
Gender
- Men
Age
- 20-40
Antisocial personality disorder
Family history
Sociodemographic
- Lower income and educational levels
Alcohol withdrawal criteria
A) Cessation of (or reduction in) alcohol use that has been heavy and prolonged
B) Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A:
- Autonomic hyperactivity
- Increased hand tremor
- Insomnia
- Nausea or vomiting
- Transient visual, tactile, or auditory hallucinations or illusions
- Psychomotor agitation
- Anxiety
- Generalized tonic-clonic seizures
C) The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) The signs or symptoms are not attributable to another medical condition are not better explained by another mental disorder, including intoxication or withdrawal from another substance
Separate diagnostics, the overall criteria are almost identical for the following disorders
Alcohol use disorder
Cannabis use disorder
Inhalant use disorder
Opioid use disorder
Sedative, hypnotics, anxiolytic use disorder
Phencyclidine use disorder
Tobacco use disorder
Hallucination use disorder
Stimulant use disorder
substance use disorder criteria
A) A problematic pattern of X use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period
- X is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control X use
- A great deal of time is spent in activities necessary to obtain X, use X, or recover from its effects
- Craving, or a strong desire or urge to use X
- Recurrent X use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued X use despite having persistent or recurrent social or interpersonal problems causes or exacerbated by the effects of X
- Important social, occupational, or recreational activities are given up or reduced because of X use
- Recurrenet X use in situations in which it is physically hazardous
- X use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by X
- Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of X to achieve intoxication or desired effect
b. A markedly diminished effect with continued use of the same amount of X - Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for X (refer to substance specific withdrawal diagnosis)
b. X (or closely related substance) is taken to relieve or avoid withdrawal symptoms
Specifiers for Use Disorders
Mild: 2-3 sx (symptoms)
Moderate: 4-5 sx
Severe: 6+ sx
in early remission
in sustained remission
In early remission
After full criteria for X use disorder were previously met, none of the criteria for X use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use X,” may be met).
In sustained remission
After full criteria for X use disorder were previously met, none of the criteria for X use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use X,” may be met).
In a controlled environment: This additional specifier is used if the individual is in an environment where access to x is restricted
Gambling disorder
An addictive disorder characterized by a pattern of habitual gambling and impaired control over the behavior
Compulsivity
- Repeatedly engaging in behavior that has negative consequences
Gambler’s fallacy
Illusion of control bias
Non Chemical Addictions and Other Forms of Compulsive Behavior criteria
A) Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12 month period:
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement
- Is restless or irritable when attempting to cut down to stop gambling
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling
- Is often preoccupied with gambling
- Often gambles when feeling distressed
- After losing money gambling, often returns another day to get even
- Lies to conceal the extent of involvement with gambling
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- Relies on others to provide money to relieve desperate financial situations caused by gambling
B) gambling behavior is not better explained by a manic episode
physiological dependence
Repeated use of a substance alters the body’s physiological reactions, leading to tolerance and/or withdrawal syndrome
psychological dependence
Dependence occurs when compulsive use of a substance meets a psychological need
addiction
Compulsive use of a durg and by signs of physiological dependence
pathways to addiction
- Experimentation
- Routine use
- Addiction/dependence
depressants
Slows down or curbs the CNS activity
Reduction of feelings of anxiety, slowing movement, and impairs cognitive processes
major types of depressants
Alcohol
Barbiturates
Opioids
barbiturates
Sedatives drugs that are depressants with high addictive potential
Popular street drugs
Euphoric high
stimulants
Increase the CNS activity
Enhances states of alertness, and can produce pleasure or highs
major types of stimulants
amphetamines
ecstasy
cocaine
nicotine
amphetamines
A class of synthetic stimulants
Used in high doses for their euphoric rush
Meth can cause brain damage
cocaine
A stimulant derived from the leaves of a coca plant
Snorted in powder form or smoked in the form of crack
crack
A hardened form of cocaine that may be more than 75% pure
Freebasing - heating it; intensifies the effects
nicotine
Drug found in tobacco products like cigarettes, cigars, etc
Hallucinogens
Produce sensory distortions or hallucinations, including color perception and hearing alterations
major types of hallucinogens
LSD
phencyclidine
marijuana
LSD
Synthetic hallucinogenic drug
Effects are unpredictable
Flashbacks
Phencyclidine
Angel dust
Smokeable form of PCP
Classified as a deliriant
Drug capable of producing states of delirium
Biological Perspectives
Neurotransmitters
- Focus on the role of neurotransmitter imbalance and the biological pathways
- Re: physiological dependence
Genetics
- Focus on the role of genetic vulnerability
- MZ twins have higher rates of alcoholism
Learning theorists
Substance use disorders as learned patterns of behavior that, in principle, can be unlearned (classical, operant conditioning and observational learning)
- Reinforcement of tension reduction/negative emotion repression (negative reinforcement)
- Conditioning to stimuli of cravings
- Parental and social modeling of use
cognitive
Roles of attitudes, beliefs, and expectancies in accounting for substance use and abuse
- Increase of self efficacy “getting out of the shell”
- Positive expectancies increase likelihood of use
Psychoanalytic theorists
Signs of oral fixation in alcohol or smoking use. Psychodynamic views of function of the substance and role as a defense against difficult unconscious content
Sociocultural perspectives
Focused on the adoption of culturally sanctioned prohibitions against excessive drinking in explaining differences among various ethnic and religious groups in rates of alcoholism
Stages of Change Model
Precontemplation————-contemplation———-preparation——–action——-
–maintenance
Relapse is normal!
Detoxification
Helping through withdrawal from substances
Drug intervention
- disulfiram
- smoking cessation (bupropion, varenicline), nicotine replacement
- methadone
- naltrexone
disulfiram
A drug that discourages alcohol consumption because the combination of the two produces a strongly unpleasant, even violent, response consisting of nausea, headache, heart palpitations, and vomiting
methadone
Synthetic opiate that blunts cravings for heroin and helps curb the unpleasant symptom that accompany withdrawal
naltrexone
A drug that helps block the high or feeling of pleasure produced by alcohol, opioids, and amphetamines
Psychological / Therapeutic Approaches
Individual therapy, often in conjunction with drug counseling
Group therapy, professional (substance recovery groups) or non-professional led (AA, NA, etc)
Hospital settings, such as inpatient for withdrawal or residential settings (‘rehab’)
Different settings require different relationships too drugs (harm reduction vs abstinence vs active use)
Psychodynamic approach
Uncovering and working through inter conflicts originating in childhood.
Increased awareness of + resolution of conflict = lessened need for use or “escape”
behavioral approach
self control training
aversive conditioning
skills training
self control training
Helps abusers develop skills they can use to change their abusive behavior
ABCS
1. The antecedent cues or stimuli that prompt or trigger abuse
2. The abusive behaviors themselves
3. The reinforcing or punishing consequences that maintain or discourage abuse
aversive conditioning
Pairing painful stimuli with substance of choice
harm reduction
A set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs
