EXAM 3 - Substance-Related, Addictive & Impulse-control Disorders Flashcards
Substance use
Taking moderate amounts of a substance in a way that doesn’t interfere with functioning
Substance intoxication
Physical reaction to a substance (e.g., being drunk)
Often involves impaired judgment, mood changes, and lowered motor ability
Substance abuse
Use in a way that is dangerous or causes substantial impairment in your life (e.g., affecting job or relationships)
Substance dependence
May be defined by tolerance and withdrawal
Sometimes defined by drug-seeking behavior (e.g., spending too much money on substance)
Tolerance
Needing more of a substance to get the same effect
Reduced effects from the same amount
A need for markedly increased amounts of the substance to achieve intoxication or desired effect
A markedly diminished effect with continued use of the same amount of the substance
Withdrawal
Physical symptom reaction when substance is discontinued after regular use
The characteristic withdrawal syndrome for the substance
Another substance is taken to relieve or to avoid withdrawal symptoms
Substance-Related Disorders in DSM-5: The 11 Criteria associated with substance use
There are no longer separate designations for intoxication, abuse, and dependence
Severity qualifiers are assigned:
Mild (2 or 3 of the 11 criteria are met)
Moderate (4 or 5 of the 11 criteria are met)
Severe (6 or more of the 11 criteria are met)
Taking more of the substance than intended or over a longer period of time than was intended
Persistent desire or unsuccessful efforts to cut down or to control use
Excessive time spent using substance, in activities to acquire substance or in recovering from the effects of the substance
Craving for or strong desire to use the substance
Failure to fulfill major role obligations at work, school, or home
Continued use despite persistent or recurrent social or Interpersonal problems caused by or exacerbated by substance use
Important social, occupational, or recreational activities are given up or reduced due to the substance use
Recurrent substance use in physically hazardous situations (e.g. driving)
Recurrent substance use despite knowing it is causing or exacerbating physical or psychological problems
Depressants
Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)
Stimulants
Increase alertness and elevate mood (e.g., cocaine, nicotine)
Opiates
Produce analgesia and euphoria (e.g., heroin, morphine, codeine)
Hallucinogens
Alter sensory perception (e.g., marijuana, LSD)
Other drugs of abuse
Include inhalants, anabolic steroids, medications
The Brain’s Pleasure Centers - The Limbic System
Hippocampus (memories)
Amygdala (emotions)
The Striatum
Reward Circuits
Ventral Tegmental Area
Nucleus Accumbens
The Locus Coeruleus
The Prefrontal Cortex
How do drugs produce their effects and lead to addiction?
Some Stimulate GABA receptors, major inhibitory neurotransmitters, and causes dopamine to be released
Reduces tension (benzodiapines)
Some Increase levels of dopamine and/or endorphins
Pleasurable feelings
Some reduce levels of serotonin, Others increase serotonin
Some inhibit glutamate receptors
Cognitive effects, such as slurred speech, impaired decisions, and memory loss
Some Stimulate GABA receptors
major inhibitory neurotransmitters, and causes dopamine to be released
Reduces tension
Some Increase levels of dopamine and/or endorphins
Pleasurable feelings
Some reduce levels of serotonin, Others increase serotonin
Some inhibit glutamate receptors
Cognitive effects, such as slurred speech, impaired decisions, and memory loss
Alcoholism
Jellinek’s (1946) sequence of behaviors associated with alcohol dependence: Periodic, excessive drinking Blackouts Sneaking drinks Loss of control over drinking (Key Sign) Remorse and rationalization Changing patterns Morning Drinking Benders Defeat
Incidence rates for Alcohol Dependence
men is over 20% and for women is over 8%
Native American youth have highest rates
Alcohol Use: The Effects - Acts on multiple neurotransmitter systems
Major effects on GABA, an inhibitory neurotransmitter; inhibits firing of other neurons (e.g. anti-anxiety)
Effects glutamate system, excitatory (e.g. learning/memory)
Effects serotonin (e.g., mood, sleep, eating. Cravings)
At low blood alcohol levels (.03 to .06) Disinhibitory Effect (ex., boisterous, aggressive, depressed) Impaired Judgment At higher blood concentrations (.06 up) Psychomotor Incoordination More impaired Judgment
At low blood alcohol levels (.03 to .06)
Disinhibitory Effect (ex., boisterous, aggressive, depressed) Impaired Judgment
At higher blood concentrations (.06 up)
Psychomotor Incoordination
More impaired Judgment
Effects of Alcohol:
Hangovers
From the conginers added to alcohol to enhance the taste; These can be added chemicals or byproducts of the fermentation process.
Only ¼ to 1/3 of alcohol is metabolized in 1 hour
Negative Physiological Effects of Alcohol Dependence
Hepatitis (Inflammation of the Liver)
Treatable
Cirrhosis of the Liver (Fat buildup along with fibrous tissue replacing liver cells)
Nonreversable; eventually toxins destroy the liver
Wernicke-Korsakoff’s Syndrome (Dementia)
Memory impairment
Flat Affect
Blackouts
Delirium Tremens
After sudden cessation of drinking, when dependent for many years
Can be fatal (Seizures, Hallucinations)
Social Factors of Alcoholism
The more available, the higher the rates of alcoholism (ex., bartenders, liquor store owners)
Alcohol use by parents increases risk of drinking in children
Risk increases with Psychiatric problems, marital problems, lack of emotional support from parents, lack of parental monitoring of children’s behavior, or legal problems
Media influences problems (Countries that ban alcohol ads had 16% less consumption)
Cost of alcohol
Psychological Factors
of Alcoholism
Alcohol abuse can be reinforced by altering mood states
Alcohol-> Stress->Alcohol
While alcohol is reported to reduce stress, it is not really a very potent stress reducer for most people
The Exception: People with Anxiety Problems may find it more tension reducing
Biological Factors
of Alcoholism
Concordance rates are higher in identical than fraternal twins
The diathesis may be an inherited higher tolerance for alcohol
Risk is low among Asians
3/4 of Asians have an inherited deficiency in an enzyme that metabolizes alcohol and drinking causes noxious effects
Schuckit (1994, 1996) found 2 variables that predicted the development of alcohol abuse in a 10 year follow-up study of men
1)Self-report of low level of intoxication after a dose of alcohol
2)Less body sway after drinking
Women with these indicators tend to have a positive family history of alcoholism (but not men)
Swedish Adoption Studies
Offspring of alcoholic parents reared by nonalcoholic adoptive parents are more likely to develop alcoholism than people in general
Treatment of Alcoholism
Alcoholics Anonymous 12 Step Program Abstinence Inpatient Treatment Detox (just the first step in treatment) Doesn’t appear superior to outpatient treatment, unless they have few sources of social support or if they have comorbid psychiatric disorders
Treatment of Alcoholism: Controlled Drinking (Sobell & Sobell, 1993) (Now called “Guided Self-Change”)
Cognitive-Behavioral Approach
Emphasizes personal responsibility & control
Identify negative aspects of drinking (cost, behavior)
Narrowing where drinking occurs
Sipping instead of gulping
Reinforce resisting the urge to drink
Alternative coping skills developed
Medications for Alcoholism
Disulfiram (Antabuse):
Causes violent vomiting if ingested with alcohol
Blocks the metabolism of alcohol
Very high drop out rates
Opiate Antagonists:
Naltrexone (Revia)
Blocks activity of endorphins stimulated by alcohol, reducing cravings
Reduced relapse compared to placebo when combined with counseling
Acamprosate (Campral) is the most recent medication approved by the FDA
Used by individuals who are already abstaining from alcohol use to maintain sobriety
People are 3 times more likely to abstain from alcohol use compared to a placebo
Acts on the glutamate system to reduce withdrawal symptoms
SSRI anti-depressants
Improve treatment when depression is a comorbid diagnosis
Narcotics
Sedative and analgesic-painreducing effects
Barbiturates
Powerful sedatives and anticonvulsants
Tranquilizers
Benodiazepines: Valium, Xanex; Rohypnol (“Roofies”)
Can die of withdrawal
Extremely addictive
Effects of Narcotics:
Similar to the effects of alcohol (so very dangerous to take with alcohol
Act on GABA, inhibitory neurotransmitter
CNS depressants
Stimulant Drugs
Amphetamines
Nicotine
Caffeine
Cocaine
Stimulant Drugs
Effect dopamine by blocking its reuptake in the synapse by binding to their sites on the dendrites; thus, stimulating the dopamine sites in the pleasure pathways of the brain
Can be very addictive
Opiates
Opium
Morphine
Heroin
Oxycodone (other pain killers)
The Opiates
Effects natural opioids in the brain: enkephalins and endorphins that produce narcotic effects
Can be very addictive
Hallucinogens
Distortions in Sensory Perception
Hallucinogens
LSD Psilocybin (mushrooms) Mescoline (from peyote) PCP (Angel Dust) Ecstasy (also has properties of amphetamines)
LSD
Seeds of the morning glory plant)and psilocybin certain mushrooms likely effect serotonin
Mescoline
found in the peyote cactus plant) likely affects norepinephrine
Ecstasy
likely affects serotonin and dopamine mixed hallucinogen/amphetamine
Some may affect acetylcholine
Cannabis (from the hemp plant)
Marijuana (leaves)
Hashish (dried resin)
Active ingredient is THC
THC activates the same cannaboid receptors in the brain as the neurotransmitter, Anadamide, and has a pain relieving effect (in the limbic system, cortex, and cerebellum), but interferes with their normal functioning
THC also effects dopamine
Long-term use reduces hippocampal activity (Memory)
Rarely can trigger psychosis that may be irreversible
About 10% of people who use marijuana become dependent on it.
It is the most commonly abused drug, except for alcohol and nicotine
Principles of Effective Treatment for Substance Use Disorders (NIH, 2009)
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Gambling Disorder
New disorder in
DSM-5
Classified under “Addictive Disorders”
Recurrent gambling leading to clinically significant distress or impairment
DSM 5 Gambling Disorder Criteria
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Gambling Disorder: Treatment
Psychosocial treatment similar to substance abuse
Treatment is often ineffective
Motivation to get better is critical; dropout is high
Research is limited, but multipart CBT interventions are under investigation
Scheduling alternative activities, setting financial limits, relapse prevention
