Task 1 Flashcards
Cotman and McGaugh – 4 very general classes of drugs subject to abuse:
Narcotics,
General depressants
Stimulants
Hallucinogens
Wakefield
Wakefield: mental disorder is a “harmful dysfunction”- the failure of an internal mechanism to perform its naturally selected evolutionary function, causing harm to an individual
The onset of alcoholism was ordered into 4 specific phases (Jellinek, 1943):
The onset of alcoholism was ordered into 4 specific phases (Jellinek, 1943):
1. pre-alcoholic phase: drinking mostly socially motivates and involves the experiences of “relief drinking”
- prodromal phase: drinking becomes the principal means of escape from tensions and problems; consumption of large amounts, blackouts, sneaking drinks, shame, chronic hangovers etc.
- crucial phase: individual moves into addictive drinking, involving loss-of control, morning drinking, development of alibis, rule to (unsuccessfully) limit drinking, antisocial behavior, losses of family, friend, or workplace relationships
- chronic phase: self-control is utterly destroyed, and the sufferer can only move toward further deterioration
Subtypes of alcoholism, Jellinek, 1960:
Subtypes of alcoholism, Jellinek, 1960:
– Alpha alcoholism (problem drinking)
– Beta alcoholism (pathophysiological effects of drinking in the absence of strong psychological or physical dependence)
– Gamma alcoholism (classic variety of alcoholism as described above)
– Delta alcoholism (similar to gamma but without the loss-of-control)
– Epsilon alcoholism (periodic binge-drinking)
The Alcohol Dependence Syndrome, ADS, 1976
compulsive use patterns and the incentive salience of alcohol use
- Seven dimensions: tolerance, withdrawal, use to avoid withdrawal, subjective compulsion to use, salience of use in the person’s life, stereotyped use patterns, and rapid reinstatement of frank addiction upon return to use after a period of abstinence
- Can also be used for other substances
Seven dimensions
Seven dimensions: tolerance, withdrawal, use to avoid withdrawal, subjective compulsion to use, salience of use in the person’s life, stereotyped use patterns, and rapid reinstatement of frank addiction upon return to use after a period of abstinence
- Can also be used for other substances
substance abuse
substance abuse = hazardous use or continued use despite social consequences (broader criterion array than DSM III)
- Type I:
Type I:
- Usually described by no more than moderate heritability, gradual onset in maturity, absence of gross character pathology, relatively contained consequences in the context of a moderately abusive drinking pattern, and is about as common in females as in males
- Less likely to have genetic influence, generally milder course, and consequences
Type II:
Type II:
- typically described as having high heritability, early onset, association with antisocial traits, severely uncontrolled drinking, severe psychosocial consequences, and male gender dominance
Type II:
Type II:
- typically described as having high heritability, early onset, association with antisocial traits, severely uncontrolled drinking, severe psychosocial consequences, and male gender dominance
Cultural Perspectives on Substance Use Disorders
- universalistic:
- focuses on common elements across cultures and is exemplified by descriptions of ADS
- permits cross-cultural comparisons, culture specific manifestations of illness may be ignored
- relativistic:
- emphasizes the influence of culture on the manifestation and content of illness and asserts that the impact of culture in defining and shaping illness can lead to culturally specific or culture-bound syndromes
Current Diagnostic System for Substance Use Disorders
- ICD-10:
ICD-10:
- Substance dependence (require presence of 3 or more criteria) and harmful use (one criterion enough)
- 6 criteria: tolerance; withdrawal; craving; difficulties in controlling the onset, termination or levels of use; much time spent using or reduced activities in favor of drinking; and the harmful use symptom
DSM 5 includes categorical dimensional approach
DSM 5 includes categorical dimensional approach
- The dimensional approaches utilize the concepts of “spectrum nosology”, which emphasizes the subthreshold manifestations of disorder, the importance of scaling severity among those who are above a diagnostic threshold, and non-criterion signs and symptoms associated with a disorder
DSM 5
DSM 5 includes categorical dimensional approach
- The dimensional approaches utilize the concepts of “spectrum nosology”, which emphasizes the subthreshold manifestations of disorder, the importance of scaling severity among those who are above a diagnostic threshold, and non-criterion signs and symptoms associated with a disorder
- DSM-5 describes symptom count ranges that correspond to “mild,” “moderate,” and “severe” SUD
- Level of severity can be used to make clinical decisions about the appropriate level of care
heavy episodic drinking
heavy episodic drinking – drinking five or more drinks on the same occasion
heavy alcohol use
drinking five or more drinks on the same occasion on 5 or more days in the past 30 days
Tabaco Use
Usually starts in adolescence, escalates soon thereafter, and then stabilizes during young adulthood, with a gradual decline into later adulthood
- Peak around age 24
- Stable usage after age 30 for daily smokers
Cannabis Use
Cannabis Use
- Lifetime consumption reported by about 50%
- Peak initiation age is 17
- DSM-IV dependence criteria are met by 10-18% of cannabis users
- Higher probability for dependence if initiation at younger age
Summary - Jackson & Sartor
- data indicate that use of alcohol, tobacco, and illicit drugs increases over adoles¬cence, with young adulthood comprising the period of peak prevalence
- Smoking exhibits a more gradual decline and a slightly later peak than alcohol and drug use.
Heavy smoking tends to show greater stability than non-heavy smoking, attesting to the addictive nature of smoking - males show greater prevalence of alcohol and drug use than females, the literature has failed to identify gender differences in smoking over the lifespan.
-Substance use rates in adolescence tend to be greatest in whites and lowest in blacks, although for smoking and, to a lesser extent, for drinking, rates for blacks approach and even surpass rates for whites by young adulthood.
Onset & Alcohol
- Early drinking onset is associated with an increase in the likelihood of numerous short- and long-term adverse outcomes
- Likelihood of developing alcohol dependence reduce by 5-9% for each year that drinking onset is delayed
- Youth with later onset (>14) progress faster to heavier drinking but are less likely than early onsetters to develop alcohol dependence
- Decline in alcohol use in adulthood primarily has been attributed to major changes in social role status (work, marriage, parenthood)
Onset & Alcohol
- Early drinking onset is associated with an increase in the likelihood of numerous short- and long-term adverse outcomes
- Likelihood of developing alcohol dependence reduce by 5-9% for each year that drinking onset is delayed
- Youth with later onset (>14) progress faster to heavier drinking but are less likely than early onsetters to develop alcohol dependence
- Decline in alcohol use in adulthood primarily has been attributed to major changes in social role status (work, marriage, parenthood)
Onset & tabacco
- Likelihood of daily smoking and dependence are higher for those with an early onset
- Early onset smoking is associated with illicit drug use
- 3 stages: nonsmoking, experimentation, and regular/daily smoking
Transtheoretical Model of smoking
Transtheoretical Model
- 3 classifications for smokers: pre-contemplation, contemplation, and preparation
- 2 classifications for former smokers: action, maintenance
- strategies to bring about change, including both experiential processes (e.g., self-reevaluation) and behavioral processes (e.g., self-liberation)
Risk factors tabaccco use
Risk factors:
- most robust predictors of onset and progression are peer smoking and peer approval
- accessibility is large risk factor (e.g. by being offered cigs from friends)
- parent smoking also influences onset and progression
- onset and transition is more prominent in whites
- lower SES increases likelihood
- girls probably more susceptible to peer influence