substance use chapter questions Flashcards
What is substance abuse?
Substance abuse is maladaptive pattern of recurrent use that extends over a period of 12 months; leads to notable impairment of distress and continues despite social, occupational, psychological, physical or safety problems.
How is substance dependence diagnosed?
DSM-IV-TR criterion for substance dependence
A person exhibits several of the following symptoms over 12 months period:
1. unable to cut down or control use of the substance, despite knowledge of its harmful physical or interpersonal effects
2. Takes increasingly larger amounts of the substance or continues to use it over a long period than he or she intended
3. Devotes considerable time to activities necessary to obtain the substance even though those activities mean that important social occupational and recreational activities must be sacrificed
4. Evidence of tolerance: increasing doses of the substance are necessary to achieve the desired effect, such as ‘high’
5. Evidence of withdrawal: distress or impairment in social occupational, or other areas of functioning or physical or emotional symptoms such as shaking, irritability and inability to concentrate after reducing or ceasing intake of the substance
What does physiological dependence mean?
Physiological dependence is when substance user’s body comes to require steady supply of substance.
What are the three groups of psychoactive substances?
Depressants (sedatives) 镇静剂: alcohol, narcotics, barbiturates, benzodiazepines
Stimulants兴奋剂: amphetamines, Caffeine, Nicotine, Cocaine and crack
Hallucinogens迷幻剂: Marijuana, LSD, PCP
What are the main risk factors for developing alcohol-related problems?
Risk factors are variables related to, or etiologically significant in the development of a disorder. Biological markers involving neurotransmitters in the brain have been found to be related to alcoholism. Another risk factor appears to be sensitivity or responsiveness to alcohol. Individuals who are not sensitive to alcohol may be able to consume large amounts of it before feeling its effects, and they may therefore be more susceptible to alcohols. Being a child of alcoholic and coming from a family with history of alcoholism are also risk factors. Studies have found that high-risk sons of alcoholic fathers were more likely than low-risk sons of social drinking fathers to begin drinking.
What are the main stimulants that people become dependent on?
Amphetamines (Benzedrine, Dexedrine, Methedrine), Nicotine, Cocaine and crack
What are hallucinogens?
Hallucinogens are substance that produces hallucinations, vivid sensory awareness, heightened alertness, or perceptions of increased insight use does not typically lead to dependence, although psychological dependence may occur. E.g. Marijuana, LSD, PCP
What are the major biological explanations for the development of substance dependence?
KEY: Hereditary influences, dopamine reward/ stress pathways, brain activity level
Because alcohol and drugs affect metabolic processes and the central nervous system, investigators have explored the possibility that heredity factors increase susceptibility to addiction. In the case of alcoholism, there is evidence that it ‘runs in families’. Persons with a family history of alcoholism have an increased lifetime risk of 4.5 time or greater of developing alcoholism relative to the general population. Because family members usually share both genetic and environmental influences, many investigators have attempted to isolate genetic and environmental factors through adoption studies and twin studies.
Several studies have indicated that children who have alcoholic biological parents but who were adopted and raised by nonrelatives are more likely to develop drinking problems than are adopted children whose biological parents were not alcoholic. In one study of alcohol abuse among adopted individuals, researchers found clear-cut evidence of a genetic factor operating from biological parent to adopted child. However, they also found evidence of environmental influences: having an alcoholic in the adoptive home also increases the risk of alcohol problems in the adopted person.
Investigators studying the concordance rates for alcoholism among MZ and DZ twins have reported similar findings. MZ twins generally have a higher concordance rate of alcoholism than DZ twins. One study of twins found not only a strong genetic component in alcohol consumption, but also a gender difference in that males are more likely to be influenced by biological factors than are females. Despite the importance of heredity in alcoholism, environmental factors are equally importance, as illustrated in twin studies in which MZ twins are not 100% concordant.
Studies have shown that the A1 allele of the D2 dopamine receptor (DRD2) gene may be a causal mechanism for alcoholism, as well as for nicotine, cocaine and opium dependence. One study assessed alcoholic adolescent boys and found that those with A1+ allele tried and got intoxicated on alcohol more often, tried and used more substances overall, developed a tobacco habit more often, and experienced a marijuana high at an earlier age than boys with the A1- allele.
Abnormal neurotransmitter transporter and dysfunctional brain also influence the addiction process. An integrated model of drug addiction has developed in which drug addiction causes changes in the brain that in turn alter reward systems and cognitive functioning. Chronic substance abuse alters the normal dopamine reward and stress pathways, thus flooding the brain with far more dopamine than is secreted normally. Feeling of euphoria or pleasure may ensue. Eventually, the drug crowds out other pleasures and turns in to an all-consuming, compulsive难以抑制的desire. As addiction develops, the chronic flooding of dopamine eventually results in the depletion and deregulation of dopamine and other neurotransmitters (e.g., glutamate and GABA) involved in stress and reward. Consequently, by the time an addiction is established, the drug may bring little pleasure and only helps the user to feel temporarily ‘normal’. In other words, the pleasure effects of the substance are dampened, and more and more of the substance are needed.
The brain and neurotransmitter changes may interfere with judgment and decision making. Drug addicts may be unable to make good decisions when facing temptations or urges. This may be particularly true in relapse. Using brain imaging, studies found that it was possible to accurately predict which methamphetamine addicts in a rehabilitation program would relapse and which would be abstinent on the basis of brain activity in brain areas involved in decision making and analytic processes.
In summary, genetics appears to be important in determining dopamine and dopamine receptor levels that are involved in the addiction. However, neurotransmission processes themselves may be influenced by consumption behaviour, and social environment factors are important in the initiation and practice of drug use. In other words, a multipath model is needed to explain substance addiction and abuse.
What psychological explanations have been proposed to account for the development of substance dependence?
Psychological research on alcohol and drug use has largely focused on tension-reducing properties, pleasurable feelings, expectancies from substance use, or the possibility that certain personality types become addicts and abusers
The tension-reducing model assumes that alcohol reduces tension and anxiety and that the relief of the tension reinforces the drinking response. Although it makes intuitive sense and is consistent with the classic ‘experimental neurosis’ on cats, the model has produced conflicting findings. In a study of smokers, smoking after experiencing negative moods did not reduce the negative affect, although smokers increased their puffing. One study found that alcohol can either increase or decrease anxiety, depending on the way alcohol affects perception and thought. When faced with a stressor, subjects who drank alcohol experienced anxiety reduction if allowed to engage in a distracting activity. In contrast, subjects who drank but did not have a distracting activity experienced a rise in anxiety. Without the distraction, drinkers’ attention may have focused on the stressor, which served to magnify their anxiety. The tension-reduction model has difficulty accounting for the two phases of alcohol effects, in which blood alcohol levels initially rise and then fall.
A number of researchers have focused on expectancies that are learned in substance use. Individual who use drugs may come to expect feeling relaxed, confident, high, less anxious, and so on. A survey showed that college students who used marijuana and cocaine showed high expectation on strong positive experience. One experiment provided clear-cut evidence that learned expectations also affect consumption. In this study, participants were led to believe that they would be given alcohol or tonic in mixed drinks. In fact, they were actually given alcohol and tonic regardless of what they were told. Participants who were told that they would receive alcohol drank more than those who were told that they would receive tonic. The participants’ expectancy had a stronger effect than the actual content of their drinks on how much they consumes.
Expectation and cognitive factors may also be important in relapse. Some researchers have found negative emotional states (such as depression, interpersonal conflict, and anxiety) are highly associated with relapse. They account for 53% of relapses among alcoholics trying to quit drinking. Negative emotional states tended to play a role in major relapse (substantial use of the substance), whereas social pressure led to minor relapse. Women were more likely than men to cite interpersonal conflict and less likely to report emotional states such as depression. This suggests that women may be more vulnerable to social influences.
Abstinence violation effect was proposed to explain the full-blown resumption of drinking. Once drinking begins, the person senses a loss of personal control. He or she feels weak-willed and guilty and gives up trying to abstain. The abstinence violation effect may also apply to other relapse behaviours, such as overeating, masturbating, and smoking. In a test of abstinence violation effect, researchers ask participants in a smoking-cessation program to record any instances of relapse and their reactions. The investigators then followed the participants’ progress for three months to assess their subsequent smoking after an instance of relapse. They found that psychological demoralization after an initial instance of relapse played a role in progression to another relapse
Past review concluded that there is no single alcoholic personality. Researchers found only two personality characteristics –antisocial behaviour (especially during youth) and depression –associated with drinking problems. However, many alcohol abusers do not show antisocial behaviours and depression might be a consequence rather than cause.
What are the main biological treatments for substance dependence?
Antabuse, naltrexone, and Campral, each with different effects on alcoholics, have been tried. Antabuse produces an aversion to alcohol. A person who consumes alcohol one to two days after taking Antabuse suffers a severe reaction, including nausea, vomiting and discomfort. Antabuse has the effect of blocking the progressive breakdown of alcohol so that excessive acetaldehyde accumulates in the body; acetaldehyde causes dysphoria (depression or distress). The problem with Antabuse treatment is that alcoholic patients may stop taking the drug once they a monitored. And some may drink anyway believing the effects of Antabuse have dissipated, because they have forgotten when they last took it, or because they are tempted to drink in spite of the Antabuse. Naltrexone has been used to reduce craving or the reinforcing effects of alcohol. Campral is also found to be effective on reducing addiction in alcoholics
Medications such as clonidine and naltrexone have allowed some heroin addicts to be detoxified as outpatients. The drug methadone is prescribed to decrease the intensity of withdrawal symptoms. Methadone is a synthetic narcotic chemical that reduces the craving for heroin without producing euphoria (the high’). Nevertheless, methadone itself can become addicting.
In smoking cessation programs, one tactic has been the use of Nicotine replacement therapy (NRT). This therapy provides an alternate way of ingesting nicotine, for example, by transdermal nicotine patch, inhaler, nasal spray, gum, sublingual tablet or lozenge. This helps reducing withdrawal symptoms associated with smoking cessation, thus helping resist the urge to smoke cigarettes. NRT has been found to be fairly effective in smoking cessation. People on treatment are 3 to 5 times less likely to move from a smoking lapse to a full-blown relapse than people not having NRT. That is, it helps to prevent further smoking even after one who wants to quit has succumbed to smoking.
What are the main psychological approaches to treatment of substance dependence?
Aversion therapy is a conditioning procedure in which the response to a stimulus is decreased by pairing the stimulus with an aversive stimulus. For example, alcoholics may be given electric shocks or emetics while drinking or smelling alcohol. After several sessions, alcoholics may vomit or feel nausea when they smell, taste, or think about alcohol. Another aversive conditioning strategy is to have smokers rapidly puff and inhale cigarette smoke, which may make them sick. Imagery has been used as part of covert sensitization, an aversive conditioning technique in which the individual imagines a noxious stimulus in the presence of behaviour. One difficulty with this technique is the inability of some patients to generalize the treatments
Skills training has also been used in drug-cessation programs. Coping strategies or skills have been found to be helpful in reducing temptations and urges in smoking. These skills may involve techniques for refusing to give in to peer pressures or temptations, for resolving emotional conflicts or problems, and for more effective communications. Reinforcing abstinence, or contingency management, was effective for opioid-dependent individuals. The individuals received either reinforcement (such as vouchers for cash) for being abstinent, as measured by urinalysis, or standard forms of counselling used in methadone clinics. Results indicated that the behavioural method was more effective than the counselling methods in promoting abstinence.
Nicotine fading is a effective technique for smokers. Smokers withdraw gradually from nicotine by progressively smoking cigarettes that contain less and less nicotine. When clients reach the stage at which they are soking cigarettes that contain only 0.1mg nicotine, their reduced dependence should enable them to stop altogether. However, some individuals who smoke low-nicotine cigarettes may simply inhale more deeply or smoke more rapidly, thus defeating the purpose of smoking low-nicotine cigarettes. A more superior method is to increase time interval between cigarettes.
CBT place addicts in situations which are strongly associated with substance use and attempts to extinguish their response of consumption.
Virtual-reality therapy;
Self-help groups;
Multimodal treatment;
Prevention programs
