Chapter 8: Substance-Related and Addictive Disorders

Question 1

Substance intoxication

Answer 1

A pattern of repeated episodes of intoxication brought on by a particular drug.

State of drunkenness or being “high”

Question 2

Substance withdrawal

Answer 2

A characteristic cluster of symptoms following the sudden reduction or cessation of use of a psychoactive substance after prolonged use.

Question 3

When a person consumes alcohol, how do they explain and/or rationalize such behaviors.

Answer 3

Alcohol is our most widely used—and abused—drug. Many people use alcohol to celebrate achievements and happy occasions. Unfortunately, some people use alcohol to drown their sorrows, which may only compound their problems. Where exactly does substance use end and abuse begin?

Use becomes abuse when it leads to damaging consequences.

When assessing for alcohol use, it’s important to consider when and how much is being consumed, as well as the patient’s reasons behind their use (e.g., easing social interactions, avoiding anxiety/depression, escaping from situational stressors, etc.).

Question 4

Why is Gambling Disorder classified into the same category as substance use disorders in the DSM-5?

Answer 4

Gambling disorder is considered a nonchemical form of addiction

Many nonchemical compulsive or addictive patterns of behavior share features with patterns of chemical addiction.

Question 5

Addiction

Answer 5

Compulsive use of a drug, accompanied by signs of physiological dependence.

Question 6

Physiological dependence

Answer 6

Repeated use of a substance alters the body’s physiological reactions.

Bodily changes resulting from regular use of a drug, as denoted by the development of tolerance and/or a withdrawal syndrome (also called chemical dependence).

Question 7

Tolerance

Answer 7

With frequent drug use, higher doses are needed to achieve the same effect.

Question 8

Withdrawal syndrome

Answer 8

Specific physiological reaction which will vary depending on the drug.

Question 9

Psychological dependence

Answer 9

Compulsive use of a substance to meet a psychological need.

Relying on a drug to combat daily stress or anxiety

Question 10

Pathways to addiction

Answer 10

Experimentation

Routine use

Addiction or dependence

Question 11

Experimentation

Answer 11

Occasional use, feeling good/euphoric. Belief of the ability to stop use at any time.

Question 12

Routine use

Answer 12

Structuring life around pursuing/using substance. Typically denial of developing an addiction and its impact on overall functioning.

Question 13

Addiction or dependence

Answer 13

Powerless to stop use, ongoing need to experience the drug’s effects of fear of experiencing withdrawal symptoms.

Question 14

What are the three major groupings of substances, and which substances would be examples of each group?

Answer 14

1. Depressants, such as alcohol and opioids
2. Stimulants, such as amphetamines and cocaine
3. Hallucinogens, such as marijuana, PCP, and LSD

Question 15

Depressants

Answer 15

Slows down or curbs the activity of the central nervous system:

Reduces feelings of tension and anxiety
Slows movement
Impairs cognitive processes
Can cause death in high doses

Question 16

The disease model of alcoholism

Answer 16

Widely held view of alcoholism as a medical illness/disease (adopted by Alcoholics Anonymous and medical providers).

Question 17

Risk factors for alcoholism

Answer 17

Male gender

Age between 20 and 40

Antisocial personality disorder

Family history

Lower income and educational level

Question 18

Women and alcohol

Answer 18

Women are less likely to develop alcoholism, in part because of greater cultural constraints on excessive drinking by women, and perhaps because women absorb more pure alcohol into the bloodstream than men, making them more biologically sensitive to the effects of alcohol at the same level of intake as men.

Question 19

Which group has the highest prevalence of alcohol-related cirrhosis?

Answer 19

The prevalence of alcohol-related cirrhosis of the liver is nearly twice as high among African Americans as among White Americans, although African Americans are less likely to develop alcohol abuse or dependence disorders.

Question 20

Which group tends to at a lower risk for alcohol abuse/dependence?

Answer 20

Jewish Americans have relatively low incidences of alcohol-related problems, perhaps because they tend to expose children to the ritual use of wine in childhood and impose strong cultural restraints on excessive drinking.

Question 21

Which group is characterized by having a “flushing” response to alcohol use, and why?

Answer 21

Asian Americans tend to drink less heavily than most other Americans, in part of cultural restraints and possibly because a less biological tolerance for alcohol, as shown by a great flushing response.

Question 22

Physiological effects of alcohol

Answer 22

Heightened activity of the inhibitory neurotransmitter GABA producing relaxation

Impaired senses, balance, coordination, motor ability

Impaired judgment

Impaired ability to curb impulses, risk-taking, violence

Impaired sexual performance

Question 23

Psychological effects of alcohol

Answer 23

Reduces tension

Enhance pleasurable experiences

Diminish worries

Enhance social skills

Question 24

Long-term health effects and increased risk of medical diseases/conditions of alcohol

Answer 24

Chronic, heavy alcohol use affects virtually every organ and body system

Increased risk of many serious health concerns, including:

Liver disease

• alcohol hepatitis (inflammation)
• cirrhosis (healthy liver cells replaced with scar tissue)

Some forms of cancer

Coronary heart disease

Korsakoff’s syndrome
- vitamin B deficiency, disorientation, memory loss of recent events, glaring confusion

Question 25

Risks to moderate drinking approach

Why is there generally a lack of evidence that this approach is ineffective?

Answer 25

Better understanding the health benefits of moderate drinking is a challenge. From a research perspective, it’s hard to find/observe safe ways of alcohol use across one’s lifetime.

Question 26

Risks to moderate drinking approach

Answer 26

Correlational evidence shows moderate use of alcohol is linked to lower risks of heart attacks and strokes, as well as lower death rates

Moderate use of alcohol

• 1 drink per day for women
• 2 drinks per day for men

Question 27

Barbiturates

What does an individual typically experience when using this drug

Answer 27

Sedative drugs used to ease anxiety, reduce pain and treat epilepsy and high blood pressure.

Highly addictive

• Relaxing and can produce mild state of euphoria
• Popular as street drugs
• Deadly in high doses, especially when mixed with alcohol

Question 28

Barbiturates

Which substance shares similar features?

Answer 28

In high doses, has similar effects as alcohol, usually lasts three to six hours

Question 29

What type of psychiatric medications are related to barbiturates?

Answer 29

Anti-anxiety medications

Question 30

Opioids

Answer 30

Has pain-relieving and sleep-inducing properties

Produces a rush, an intense feeling of pleasure

Dulls awareness of personal problems (thus it’s attraction when overwhelmed by stress)

Stimulates brain’s pleasure circuit - similar feelings/responses to sexual pleasure or eating a satisfying meal

Question 31

What’s the difference between opioids and endorphins?

Answer 31

Opioids
- Includes naturally occurring opiates derived from the juice of poppy plants and synthetic drugs that have opiate-like effects (e.g., Demerol, Vicodin)

Endorphins
- Brain produces its own opiate-like substance

Question 32

Opioids and endorphins

How are the responses to these substances described, and tend to mimic?

Answer 32

Neurons in the brain have receptor sites in which opiates fit like a key in a lock

Opioids dock at the same receptor sites as endorphins

Opioids mimic the actions of endorphins by docking at receptor sites intended for endorphins, dulling pain and stimulating brain centers that produce pleasurable sensations.

Question 33

What substance creates a “euphoric rush”, involves flu-like withdrawal symptoms, and usually does not result in aggressive/criminal behavior?

Answer 33

Heroin

Question 34

Amphetamines

Answer 34

A class of synthetic stimulants

Used in high doses for euphoric rush

Most potent form in methamphetamine, injected directly into veins

Can cause amphetamine psychosis
- psychotic state characterized by hallucinations and delusions, induced by ingestion of amphetamines

Question 35

Ecstasy/MDMA

Answer 35

Known as “designer drugs”

Produces mild euphoria and hallucinations

Popular on college campuses and in clubs

Can produce adverse psychological effects, including depression, anxiety, insomnia, and even paranoia and psychosis

Question 36

Stimulants

Answer 36

Psychoactive substances that increase the activity of the central nervous system

• Enhance state of alertness
• Produce pleasure or even euphoric highs
• Effects vary with the particular type of stimulant drug

Question 37

Cocaine

Answer 37

A natural stimulant derived from the leaves of the coca plant

Second most widely used illicit drug in the United States (after marijuana)

Directly stimulate’s the brain’s reward or pleasure circuits

Produces sudden rise in blood pressure and accelerated heart rate

Crack
- Hardened form of cocaine, more 75% pure, more intense effects that normally last a few minutes

Question 38

Nicotine

Answer 38

Stimulant found in tobacco products

Claims more than 480,000 lives annually in the United States and more than 3 million worldwide

Smoking rates have declined dramatically in last several decades

Leads to release of endorphins

About 50% who quit show symptoms of withdrawal after two or more days

Question 39

What are its effects, and which mental health disorder is associated with this substance that often involves such medications as Ritalin and Adderall?

Answer 39

Stimulants

They enhance state of alertness

Used to treat ADHD

Question 40

Which populations have the highest rates of tobacco/nicotine use?

Answer 40

Smoking rates are highest among American Indians/Alaska Natives, and are higher among men than women in all ethnic/racial groups except for American Indians/Alaska Natives

Question 41

Hallucinogens

Answer 41

A class of drugs that produce sensory distortions or hallucinations

May also have additional effects, such as relaxation and euphoria or, in some cases, panic

Some may have unpleasant experiences (“bad trips”)

Question 42

Which hallucinogen is thought to influence states of delirium?

Answer 42

Phencyclidine, or PCP (“angel dust”)

Classified as a deliriant - a drug capable of producing states of delirium

Question 43

What might be some of the factors that contribute to marijuana having a psychological dependence?

Answer 43

People may turn to marijuana to help them cope with life problems or to help them function when they are under stress

Question 44

Marijuana

Answer 44

In low doses, produces relaxed feelings

Use is on the rise among high school students and adults

Can produce perceptual distortions or mild hallucinations

Associated with psychological rather than physiological dependence

Question 45

Which neurotransmitters are associated with developing substance dependence

Answer 45

Many drugs of abuse alter levels of neurotransmitters

increased levels of the neurotransmitter dopamine in the brain’s reward or pleasure circuits produce feelings of pleasure
- Regular use may sap the brain’s own production of dopamine, leading to dependence on drug to produce feelings of pleasure

Other neurotransmitters such as serotonin and endorphins may play a role in drug abuse and dependence

Question 46

Nicotine replacement therapy

Answer 46

Nicotine replacements in the form of prescription gum, transdermal patches, lozenges, and nasal sprays can help smokers reduce cravings and unpleasant withdrawals.

Not very good success rates, 20% or lower

Question 47

Methadone maintenance programs

Answer 47

The synthetic opiate methadone is used to blunt cravings for heroin and curb unpleasant withdrawal.

Controversy over replacing “one drug over another”.

Criticism over treatment being “permanent” or long-term, ends up being costly and further influences dependence.

Question 48

Naltrexone

Answer 48

A drug used to help block the feelings of pleasure produced by alcohol, opioids, and amphetamines.

Concerns over effectiveness, especially with alcohol, as well as not offering other combined treatments (i.e. counseling/psychotherapy).

Question 49

Nonprofessional support groups

Answer 49

Promote abstinence and provide an opportunity to discuss feelings and experiences in a supportive group setting.

Examples:

• Alcoholics Anonymous
• Narcotics Anonymous
• Cocaine Anonymous

AA is in part spiritual. The spiritual component may be helpful to some participants but distasteful to others.

Question 50

Residential approaches

Answer 50

Requires a stay in a hospital or therapeutic residence

Hospitalization recommended when substance abusers:

• Are not able to exercise self-control in usual environments
• Cannot tolerate withdrawal symptoms
• Behave self-destructively or dangerously

Most inpatient programs use an extended 28-day detoxification period, which includes:

• Treatment for withdrawal symptoms
• Counseling

Research has suggested that effectiveness is about the same between outpatient and inpatient treatment programs. This has fueled concerns over effectiveness and quality of such programs, and costs.

Question 51

Gambling Disorder

Answer 51

Classified by DSM-5 as a nonchemical addictive disorder

• Loss of control over behavior
• State of high arousal or pleasurable excitement when behavior is performed
• Withdrawal symptoms

Personality characteristics overlap with chemical abusers (e.g., borderline and obsessive-compulsive).

Cognitive errors (impulsivity, beliefs they can stop, beliefs they will likely win if continuing to gamble).

Many suffer low self-esteem and childhood rejection or abuse.

Question 52

What are some of the reasons that treatment for Gambling Disorder is challenging and marginally effective?

Answer 52

Treatment is challenging because:

• Have little insight into the causes of their problems
• Are reluctant to enter treatment

Question 53

Alcohol

Answer 53

Most widely abused substance in the United States and worldwide.

Contains depressant drug called ethyl alcohol.

Three in ten American adults develop an alcohol use disorder in their lifetime.