PSY240 5. Substance Abuse Flashcards
Externalizing Disorders
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Externalizing Disorders
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Externalizing Disorders
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Substance use
• Substance: Any product with psychoactive effects • ~50% have tried an illegal substance (U.S.) – 15% in the past year • Problematic use differs • Across the lifespan • Across different cultures
Substance use
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Substance use
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Substance use
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Categories of Substances
- CNS Depressants
- CNS Stimulants
- Opioids
- Hallucinogens and phencyclidine (PCP) 5. Cannabis
Categories of Substances
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Categories of Substances
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Categories of Substances
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Substances Used
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Substances Used
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Substances Used
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Frequency of DSM-IV Disorders
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Frequency of DSM-IV Disorders
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Frequency of DSM-IV Disorders
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Frequency of DSM-IV Disorders
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Substance-Related Conditions (DSM-IV)
• Substance intoxication: – Maladaptive symptoms due to effect of substance on CNS • Substance withdrawal: – Distress/impairment in function due to cessation/reduction of use
Substance-Related Conditions (DSM-IV)
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Substance-Related Conditions (DSM-IV)
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Substance-Related Conditions (DSM-IV)
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Substance-Related Conditions (DSM-IV)
• Substanceabuse: – Recurrent substance useharmful consequences • Substancedependence: – Recurrent substance use • physiological dependence • Significant impairment • Significant distress
Substance-Related Conditions (DSM-IV)
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Substance-Related Conditions (DSM-IV)
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Substance-Related Conditions (DSM-IV)
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Substance Abuse (DSM-IV)
1+ symptoms occurs during a 12-month period:
1. Failure to fulfill important obligations
2. Repeated use in hazardous situations
3. Repeated legal problems
4. Use despite social problems
• Causes significant impairment or distress
Substance Abuse (DSM-IV)
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Substance Abuse (DSM-IV)
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Substance Abuse (DSM-IV)
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Substance Abuse (DSM-IV)
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Substance Dependence (DSM-IV-TR)
Maladaptive pattern of substance use (3+):
- Tolerance
- Withdrawal
- Substance taken in more/longer than intended
- Persistent desire/unsuccessful efforts to cut back/control
- Substance use is time-consuming
- Important activities are reduced because of substance use
- Use continued despite persistent problems
Substance Dependence (DSM-IV-TR)
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Substance Dependence (DSM-IV-TR)
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Substance Dependence (DSM-IV-TR)
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Substance Dependence (DSM-IV-TR)
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Substance Dependence (DSM-IV-TR)
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Substance Dependence (DSM-IV-TR)
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CHANGES IN DSM-5: Criteria and Terminology
Diagnostic Thresholds
CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
• Severity is based on the number of criteria endorsed: – Mild disorder: 2–3 criteria
– Moderate disorder: 4–5 criteria
– Severe disorder: 6+ criteria
CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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CHANGES IN DSM-5: Criteria and Terminology
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Changes in DSM-5
DSM-IV
DSM-5
Changes in DSM-5
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Changes in DSM-5
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Changes in DSM-5
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Changes in DSM-5
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Remission Status
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Remission Status
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Remission Status
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Alcohol Use
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Alcohol Use
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Alcohol Use
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Alcohol Use
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Alcohol Intoxication
- Mood
* Behaviour • Physiology • Cognition
Alcohol Intoxication
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Alcohol Intoxication
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Alcohol Intoxication
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Alcohol Intoxication
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Common Problems in Alcohol Use Disorder
- 80% Engaged in daily or weekly heavily drinking • 70% Consumed 1/5 (26er) of liquor in one day • 62% Family objects
- 59% Perceives self as an “excessive drinker”
- 31% Was arrested while drinking
- 21% Wanted to stop drinking but couldn’t • 14% Continued to drink with serious illness
Common Problems in Alcohol Use Disorder
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Common Problems in Alcohol Use Disorder
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Common Problems in Alcohol Use Disorder
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Common Problems in Alcohol Use Disorder
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Long-term Effects of Alcohol Abuse
- Low-grade hypertension
- Paranoia
- Deficits in memory and cognition
- Wernicke-Korsakoff ’s syndrome
- Alcohol-induced dementia
- Alcohol-induced persisting amnesic disorder
- Fetal alcohol syndrome
Long-term Effects of Alcohol Abuse
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Long-term Effects of Alcohol Abuse
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Long-term Effects of Alcohol Abuse
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Long-term Effects of Alcohol Abuse
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Benzodiazepines and Barbiturates
• Benzodiazepines: Xanax, Valium, Halcion, Librium • Barbiturates: Quaaludes
– Legally manufactured – Sold by prescription
Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
Signs of use/intoxication
• Mild euphoria
• Relief of tension, anxiety • Slurred speech
• Poor motor coordination • Impaired judgment
• Poor concentration
• Sleepiness
Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
Long-term effects
• Chronic tiredness
• Breathing disorders • Vision Problems
Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
Patterns of problematic use:
1. Adolescents’ recreational use 2. Increasing prescription dosage
Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Benzodiazepines and Barbiturates
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Inhalants
- Solvents
* Anesthetic gases and nitrates
Inhalants
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Inhalants
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Inhalants
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Inhalants
Signs of use/intoxication
• paintorstainsonbodyorclothing • spotsorsoresaroundthemouth
• redorrunnyeyesornose
• chemicalbreathodor
• drunk,dazedordizzyappearance • nausea, loss of appetite
• anxiety,excitability,irritability
Inhalants
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Inhalants
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Inhalants
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Inhalants
Harmful Effects • Brain damage, memory loss • Hearing loss, Slurred speech • Nose bleeds, loss of smell • Suffocation, sudden death • Irregular heart beat, heart attack • Nausea, vomiting • Liver damage, kidney damage • Etc…
Inhalants
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Inhalants
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Inhalants
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Inhalants
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Inhalants
Chronic use • Respiratory irritations, rashes • Permanent CNS damage, organ failure, death At-risk populations • Prepubescent and early teen boys • Aboriginal youth
Inhalants
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Inhalants
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Inhalants
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Stimulants: Cocaine
Affective/Cognitive symptoms: • Euphoria • Affective blunting • Impaired judgment Somatic Symptoms: • Fight-or-flight response • GI symptoms • Seizures, coma
Stimulants: Cocaine
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Stimulants: Cocaine
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Stimulants: Cocaine
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Stimulants: Cocaine
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Stimulants: Amphetamines
Uses: • Combat depression, fatigue • Boost energy and self-confidence • Appetite suppressant • Symptoms similar to cocaine intoxication
Stimulants: Amphetamines
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Stimulants: Amphetamines
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Stimulants: Amphetamines
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Stimulants: Amphetamines
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Amphetamines and Neurotransmitters
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Amphetamines and Neurotransmitters
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Amphetamines and Neurotransmitters
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Stimulants: Nicotine
• Affects CNS & PNS
• Releases DA, NE, 5-HT, endogenous opioids
• Withdrawal symptoms:
– https://www.youtube.com/watch?v=a7MIpyUpEcE
• No DSM-IV-TR diagnosis Æ new to DSM-5
Stimulants: Nicotine
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Stimulants: Nicotine
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Stimulants: Nicotine
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Stimulants: Nicotine
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Stimulants: Caffeine
• Most heavily used stimulant – ~2 cups / day (U.S.) – 1 cup = 100 mg caffeine • Affects CNS • Increases DA, NE, & 5-HT
Stimulants: Caffeine
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Stimulants: Caffeine
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Stimulants: Caffeine
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Stimulants: Caffeine
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Stimulants: Caffeine
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Opioids
Derived from the opiate poppy: – Morphine – Heroin – Codeine – Methadone • Derived naturally from the body: – Endorphins – Enkaphalins
Opioids
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Opioids
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Opioids
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Opioids
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Opioids
Intoxication
• Mood
• Cognition
• Physiology
Withdrawal
• Mood
• Physiology
Opioids
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Opioids
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Opioids
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Opioids
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Hallucinogens and PCP
Hallucinogens • e.g., LSD, MDMA (ecstasy), and peyote. PCP (angel dust) • Snorted or smoked • Not technically a hallucinogen, but has similar effects
Hallucinogens and PCP
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Hallucinogens and PCP
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Hallucinogens and PCP
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Hallucinogens and PCP
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Cannabis
- Intoxication
- Mood
- Cognition
- Physiology
- Moderate to high dose may cause
- hallucinations
- depersonalization
- paranoia
Cannabis
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Cannabis
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Cannabis
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Cannabis
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Non-Substance-Related Addictions
Examples: gambling, sex, exercise,
video games, work, shopping, etc.
Non-Substance-Related Addictions
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Non-Substance-Related Addictions
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Non-Substance-Related Addictions
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Non-Substance-Related Addictions
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Gambling Disorder
- A pattern of gambling behaviour that causes harm
- 12 month Canadian prevalence = ~ 2% (Cox et al., 2005)
- DSM Classification
- DSM-IV-TR: “Impulse-control disorders NOS”
- DSM-5: Non-substance-related disorder
Gambling Disorder
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Gambling Disorder
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Gambling Disorder
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Gambling Disorder
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DSM-5 Section III Conditions
Hypersexual Disorder:
• A pattern of sexual behaviour that is initially pleasurable
but that becomes unfulfilling and self-destructive
Internet Gaming Disorder:
• Persistent and recurrent use of the Internet to engage in
games, often with other players
DSM-5 Section III Conditions
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DSM-5 Section III Conditions
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DSM-5 Section III Conditions
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DSM-5 Section III Conditions
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DSM-5 Section III Conditions
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Concurrent Disorders
Comorbid mental health and substance use problems
• Complex and difficult to treat
Substance Use Treatment Seekers
Psychiatric Treatment Seekers
Concurrent Disorders
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Concurrent Disorders
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Concurrent Disorders
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Concurrent Disorders: Stress & Trauma
Impact influenced by • Stressor • Individual differences • Gender • Age • Genes
Concurrent Disorders: Stress & Trauma
Stress/Trauma => Negative Affect / Somatic Symptoms => Poor Coping Skills => Substance Use =>Stress Proliferation =>
Concurrent Disorders: Stress & Trauma
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Concurrent Disorders: Stress & Trauma
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Concurrent Disorders: Stress & Trauma
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Concurrent Disorders: Stress & Trauma
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Concurrent Disorders: Stress & Trauma
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Concurrent Disorders: Anxiety & Mood Disorders
Anxiety • Risk of substance problems 2-5X higher • In 75% of cases, anxiety came first Bipolar Disorder • Possible overlapping predispositions • A “disorder-inducing disorder”
Concurrent Disorders: Anxiety & Mood Disorders
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Concurrent Disorders: Anxiety & Mood Disorders
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Concurrent Disorders: Anxiety & Mood Disorders
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Concurrent Disorders: Anxiety & Mood Disorders
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Concurrent Disorders: Anxiety & Mood Disorders
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Concurrent Disorders: Psychosis
• Substance use can:
– Hasten onset of psychotic disorders
– Worsen symptoms and the course of illness
– Exacerbate negative consequences
Concurrent Disorders: Psychosis
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Concurrent Disorders: Psychosis
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Concurrent Disorders: Psychosis
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Cultural Specificity
- Some cultures impose strict sanctions on all drugs
- Some cultures view it as a medical problem
- Some distinguish soft vs. hard drugs
- Some cultures normalize it
Cultural Specificity
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Cultural Specificity
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Cultural Specificity
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Cultural Specificity
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Societal Costs
• Costs ~$14 billion CAD / year
Societal Costs
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Motivational Models
• Desire for Mood Alteration
– Negative Affect Reduction (Emotionally vulnerable)
– Euphoria/Excitement Induction (Antisocial/Impulsive)
Motivational Models
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Major Dopamine Pathways
AKA “the reward pathway,” “the pleasure centre”
Manufactured in • Ventral Tegmental Area (VTA) Released to • Nucleus Accumbens • Prefrontal Cortex
Major Dopamine Pathways
AKA “the reward pathway,” “the pleasure centre”
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Major Dopamine Pathways
AKA “the reward pathway,” “the pleasure centre”
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Major Dopamine Pathways
AKA “the reward pathway,” “the pleasure centre”
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Septal-Hippocampal Area
• Connected via GABA-sensitive neurons • ↑ GABA reduces anxiety • ↓ GABA – increases anxiety – increased sensitivity to pain – panic attacks, seizures • Self-medicate with substances
Septal-Hippocampal Area
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Septal-Hippocampal Area
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Septal-Hippocampal Area
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Genetic Factors
Behavioural Genetics Studies
• Moderate-to-high heritability
• Phenotypes (e.g., impulsivity) also heritable
Molecular Genetics Studies
• The role of specific genes is unclear
• Implicates gene variants linked to DA deficiency
Genetic Factors
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Genetic Factors
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Genetic Factors
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Genetic Factors
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Psychological Theories
Behavioural
• Positive & Negative Reinforcement (self-medication)
• Modelling (parents, peers, culture, media)
• Maladaptive coping (comorbid social phobia)
Psychological Theories
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Psychological Theories
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Psychological Theories
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Psychological Theories
Dispositional • Trait vulnerabilities • Impulsivity • Tendency to act without planning or restraint • Strongest predictor of substance use • Diathesis for substance use disorders
Psychological Theories
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Psychological Theories
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Sociocultural Theories
Adolescent Alcohol Use • Experimentation • Adolescents with alcoholic parents • Stress in family home • Opposite-sex friends
Sociocultural Theories
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Sociocultural Theories
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Sociocultural Theories
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Sociocultural Approaches
- Chronic stress + support/promotion of use
- Advertising and media
- Gender differences
Sociocultural Approaches
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Sociocultural Approaches
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Sociocultural Approaches
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Integrative Model
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Integrative Model
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Integrative Model
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Integrative Model
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Treatments
Alcoholics/Narcotics Anonymous
• “12-step” programs
• Total abstinence
• 27% AA members sober after 1 year
Treatments
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Treatments
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Treatments
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Treatments
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Treatments
Biological Treatments:
• Antidepressants & Antianxiety agents
• Antagonists (block reinforcing effects)
• Agonists (e.g., Methadone)
Treatments
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Treatments
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Treatments
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Treatments
Behavioural • Aversive classical conditioning • Covert sensitization therapy • Cue exposure and response prevention • Controlled Drinking (controversial)
Treatments
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Treatments
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Treatments
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Treatments
Cognitive
• Identify and gain control in risk situations
Motivational Interviewing (MI)
• Therapists express empathy, support self-efficacy
• Help clients explore and resolve ambivalence
Treatments
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Treatments
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Treatments
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