Substance Related Disorders
Substance Use Disorders
l Most prevalent in youths and young adults
l Adult lifetime prevalence for controlled substances 6.2%
l Abuse/Dependence greatest for marijuana
l Highest drug use among American Indian population
Substance Abuse
l Maladaptive Pattern of recurrent use that extends over a 12 month period
l Lead to impairment or distress
l Continues despite social, occupational, psychological or physical
problems
l Could cause legal problems
l Could endanger safety of abuser or others
l Could effect social relationships or performance at work
Substance Dependence
l Inability to cut down or stop using
l Increased consumption
l Large amounts of time spent being drunk, high or hung over
l Tolerance
l Withdrawal symptoms
Depressants or Sedatives
l
Cause generalized CNS depression
l
Slow down responses
l
feeling calm and relaxed
l
Lowers interpersonal inhibitions
l
Can become more social
l
Examples:
l
Alcohol
l
Narcotics
l
Barbiturates
l
Benzodiazepines
Alcohol Use Disorders
l Disorder referred to as alcoholism
l Two types of alcoholics
l
Daily users
l
Binge Drinkers
l Both types can result in impairment in vocational, social and behavioral
problems
Alcohol Use Disorders
l Highest prevalence in
White males between the ages of 18 and 35
l
11% of adults drink daily
l
55% drink less than 3 drinks per week
l
35% abstain completely
l 50% of alcohol consumer by 10% of drinking population
l 20% of 12-17 year old had used alcohol in previous month
Alcohol Use Disorders
l Large number of binge drinkers in college
l Found that amount of alcohol consumer over time decreased but frequency
remained the same
l This finding not true in college students with family history of
substance abuse
l Implications?
Effects of Alcohol
l
Short-term (when BAC = 0.1)(5 beers)
l
Coordination impaired
l
Slurred speech
l
Loss of inhibitions
l
Feelings of happiness
l
Poor judgment and concentration
l
Can also become moody, angry
l
Slow reaction time
l
Effects also depend on expectancy
l
At BAC 0.5 – unconscious
Effects of Alcohol
l Long Term Effects
l
Psychological effects
l
Addiction
l
Withdrawal
l
Preoccupation
l
Physiological Effects
l
Brain cell depletion
l
Agitation
l
Cirrhosis of liver
l
Fetal alcohol syndrome
Narcotics
l Opium – heroin, morphine, codeine
l Highly addictive
l Tolerance develops quickly
l Withdrawal symptoms severe
l Give sense of euphoria/well-being
l Usually injected – risk of HIV
Barbiturates
l Downers
l Induce relaxation and sleep
l CNS depressants
l Commonly prescribed
l Often abused and addictive
l Can accidentally overdose – no development of tolerance
Benzodiazepines
l Valium
l Most widely prescribed drug
l CNS depressant
l Great danger of abuse
l People use valium to cope with stress/anxiety
Stimulants
l
Amphetamines
l
“uppers”
l
Speed up CNS
l
\increase alertness, energy
l
Increase levels of dopamine in
synapses
l
Inhibit appetite and sleep
l
Physically addictive
l
Can be snorted, IV or taken orally
l
“ice” –
smoked – high doses cause delusions/hallucinations
Stimulants
l Caffeine
l
Legal stimulant
l
Found in coffee, tea, chocolate, soft
drinks
l
After 250mg (about 2 cups of coffee)
people show signs of caffeine intoxication
l
Restlessness, nervousness, insomnia,
cardiac arrhythmia
l
Physically addictive
Stimulants
l Nicotine
l
Associated with cigarette smoking
l
Associated with 1/6 of death in US
l
1/3 of the US population used nicotine in past
month
l
80-90% of smokers are addicted
l
Approximately 25% of US population
nicotine dependent
l
What are withdrawal symptoms?
Stimulants
l Crack and Cocaine
l
Derived from cocoa plant
l
Induces sense of euphoria and self
confidence
l
Snorting cocaine fashionable and used
among celebrities and upper classes
l
In late 1800s cocaine used in
beverages and medicine to alleviate depression (even in Coke)
l
However realized it was addictive so
stopped
Stimulants
l
Crack and Cocaine
l
Cocaine can be consumed, injected but
generally snorted
l
Can cause both psychological and
physical addiction
l
Crack is purer form of cocaine
l
Produced by heating cocaine with
ether “freebasing”
l
Euphoria followed by depression
l
Highly addictive
l
Relatively cheap and available
Hallucinogens
l
Marijuana
l
Mildest of hallucinogens
l
Smoked in “joint” form
l
Can also be consumed
l
1/3 of American have tried marijuana
l
Feeling of euphoria, relaxed,
increased sensory experiences
l
Now small amounts decriminalized for
medicinal purposes
l
Reduces nausea for chemotherapy, pain
for glaucoma
Hallucinogens
l LSD
l
Lysergic Acid Diethylamide
l
Caused psychedelic experiences -
“trips”
l
Popular in the 60s “Lucy in the Sky
with Diamonds”
l
Can have good and bad trips
l
Used for “mind expansion”
l
Doesn’t produce physical dependence
l
Can cause psychotic reactions in some
Hallucinogens
l PCP
l
Phencyclidine
l
Angel dust
l
Initially developed as a pain killer
l
Causes perceptual distortions, euphoria,
nausea, delusions, and violent psychotic behavior
Causes of Substance Use Disorders
l Biological
l
Alcoholism runs in families
l
4 times higher in male offspring of
alcoholics
l
Hard to separate genetics from
environment
l
Adoption studies
l
High concordance among twins (both
fraternal and paternal)
l
Postulated familial and nonfamilial types of alcoholism
Causes of Substance Use Disorders
l Biological Risk Factors
l
Brain neurotransmitters
l
Sensitivity to alcohol
l
Family history of alcohol abuse
Causes of Substance Use Disorders
l Personality Characteristics
l
High activity level
l
Emotionality
l
Sociability
l
Life transitions (i.e. college
students)
l
Depression
l
Antisocial personality disorder
l
Little research supports “alcoholic”
personality
Causes of Substance Use Disorders
l Sociocultural Explanations
l
Male gender
l
Age (young)
l
Religion (catholic)
l
Country of origin (Italy and France)
l
American Indian and Irish
l
Suggest influence of cultural values
l
Peer pressure
Causes of Substance Use Disorders
l Behavioral Explanations
l
Anxiety reduction
l
Learned expectations (alcohol/tonic
experiments)
l
Cognitive influences
(tension-reduction)
l
Supported by relapse in stressful situations
The Relapse Process
Theories of Addiction
l Solomon’s Opponent Process Theory
l
Motivation for drinking changes as addiction
develops
l
Changes from high to relief of
withdrawal symptoms
l Wise’s Two Factor Model
l
Positive reinforcement
(pleasure/euphoria)
l
Negative Reinforcement (alleviates
negative feelings)
Theories of Addiction
l Tiffany’s Theory of Automatic Processes
l
Drug use controlled by automatic
processes
l
Develop automatic skills for drug
acquisition and use
l
Cognitive processes not involved
Treatments
l Detox Programs
l Self Help Groups
l
AA
l
NA
l Pharmacological Approach
l
Antabuse
l
Methadone
Treatments
l Cognitive Behavioral Approaches
l
Aversion Therapy
l
Covert Sensitization
l
Skills Training
l
Reinforcing Abstinence
l
Nicotine Fading
l
Relaxation
l
Systematic Desensitization
l
Relapse Prevention
Controlled Drinking Controversy
l Some researchers believe that being able to control (versus abstain is
more beneficial
l Others argue that total abstinence should be the goal
l Research still underway
l Thoughts?
Prevention Programs
l Targeting children in schools
l Smoking Prevention Programs
l “Just Say “NO” to drugs”
l Teaching Coping Skills
l College intervention successful