1. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Substance Use and Addictive Disorders Chapter 12

2. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Substance Use Disorders What is a drug? –Any substance other than food that affects our bodies or minds –Current language uses the term “substance” rather than “drug” to overtly include alcohol, tobacco, and caffeine –About 9% of all teens and adults in the U.S. display substance abuse or dependence

3. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Substance Use Disorders Some substances can also lead to long-term problems People who regularly ingest them may develop substance use disorders Also called “addiction”

4. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Substance Use Disorders Tolerance: The adjustment that the brain and the body make to the regular use of certain drugs so that ever larger doses are needed to achieve the earlier effects Withdrawal: Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug

5. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Substance Use Disorders There are several categories of substances used and studied: –Depressants –Stimulants –Hallucinogens –Cannabis

6. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants Depressants slow the activity of the central nervous system (CNS) –Reduce tension and inhibitions –May interfere with judgment, motor activity, and concentration Three most widely used depressants: –Alcohol –Sedative-hypnotic drugs –Opioids

7. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol All alcoholic beverages contain ethyl alcohol It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS –Short-term: alcohol blocks messages between neurons –Alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker

8. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood –A given amount of alcohol has a lesser effect on a large person than on a small one Gender also affects blood alcohol concentration –Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood –Women become more intoxicated than men on equal doses of alcohol

9. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood: –BAC = 0.06: Relaxation and comfort –BAC = 0.09: Intoxication –BAC > 0.55: Death Most people lose consciousness before they can drink this much

10. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol The effects of alcohol subside only after alcohol is metabolized by the liver –The average rate of this metabolism is 25% of an ounce per hour –You can't increase the speed of this process!

11. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol In any given year, 6.6% of the world's population will fall into a pattern of abuse or dependence –13.2% experience one of the patterns sometime during their life 7.4% of all adults in the U.S. display an alcohol use disorder over a one-year period while over 13% display it at some point in their lives –Men outnumber women 2:1

12. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Is All Drug Misuse the Same? DSM-5 has combined two past disorders, substance abuse (excessive and chronic reliance on drugs) and substance dependence (excessive reliance accompanied by tolerance and withdrawal symptoms) into a single category—substance use disorder. Critics worry that clinicians may now fail to recognize and address the different prognoses and treatment needs of individuals who abuse substances and those who depend on substances.

13. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol Alcohol use disorder –In general, people who abuse alcohol drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious Eventually the drinking interferes with social behavior and the ability to think and work –Individual patterns of alcohol abuse vary

14. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Alcohol Alcohol dependence –For many people, the pattern of alcohol misuse includes dependence They build up a physiological tolerance and need to drink greater amounts to feel its effects They may experience withdrawal, including nausea and vomiting, when they stop drinking A small percentage of alcohol-dependent people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”) –Alcohol withdrawal can be fatal

15. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What is the personal and social impact of alcoholism? Alcoholism destroys families, social relationships, and careers –Plays a role in suicides, homicides, assaults, rapes, and accidents –Long-term excessive drinking can seriously damage physical health –Long-term excessive drinking can cause major nutritional problems –Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) and increased risk of miscarriage

16. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Neknomination Goes Viral In the past few years, a popular new “game”—made possible by the internet and social media— has taken alcohol-related behaviors and the impact of peer pressure to new heights. Online drinking game called neknominate (or neknomination) in this game, a person records a video of him or herself drinking an entire bottle of hard liquor and then challenges (“nominates”) a friend by name to post his or her own drinking video, one that will top the level and danger of the initial drinking act, and to then pass the challenge on to another person What psychological factors, besides peer pressure, might induce a person to participate in an activity as risky as Neknominate?

17. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Sedative-Hypnotic Drugs Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness –At low doses, they have a calming or sedative effect –At high doses, they function as sleep inducers or hypnotics Sedative-hypnotic drugs include barbiturates and benzodiazepines

18. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Barbiturates Widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep –They can cause many problems such as abuse, dependence, and overdose At low doses, they reduce excitement in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death

19. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Barbiturates Repeated use of barbiturates can quickly result in a pattern of abuse and/or dependence –A great danger of barbiturate dependence is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects –Barbiturate withdrawal is particularly dangerous because it can cause convulsions

20. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Benzodiazepines  Benzodiazepines are often prescribed to relieve anxiety  Most popular sedative-hypnotics available Class includes Xanax, Ativan, and Valium  Benzodiazepines have a depressant effect on the CNS by binding to GABA receptors and increasing GABA activity  Benzodiazepines relieve anxiety without causing drowsiness Less likely to slow breathing and lead to death by overdose

21. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Opioids This class of drug includes both natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds and is known collectively as “narcotics” –Each drug has a different strength, speed of action, and tolerance level

22. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Opioids Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”) –Injection seems to be the most common method of use, although other techniques have been increasing in recent years –An injection quickly brings on a “rush” – a spasm of warmth and ecstasy that is sometimes compared with orgasm –This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”)

23. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Opioids Opioids create these effects by depressing the CNS –Opioids bind to the receptors in the brain that ordinarily receive endorphins (NTs that naturally help relieve pain and decrease emotional tension) –When these sites receive opioids, they produce pleasurable and calming feelings, just as endorphins do –In addition to reducing pain and tension, opioids can cause nausea, narrowing of the pupils, and constipation

24. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Opioids Heroin use exemplifies the problems posed by opioids: –After just a few weeks, users may become caught in a pattern of abuse (and often dependence) –Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it –Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration

25. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Depressants: Opioids What are the dangers of heroin abuse? –The most immediate danger is overdose The drug closes down the respiratory center in the brain, paralyzing breathing and causing death –Death is particularly likely during sleep –Ignorance of tolerance is also a problem About 2% of those dependent on heroin and other opioids die under the influence of the drug each year –Users run the risk of getting impure drugs Opioids are often “cut” with noxious chemicals –Dirty needles and other equipment can spread infection

26. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants Stimulants are substances that increase the activity of the central nervous system (CNS) –Cause increases in blood pressure, heart rate, and alertness –Cause rapid behavior and thinking The four most common stimulants are: –Cocaine –Amphetamines –Caffeine –Nicotine

27. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Cocaine Most powerful natural stimulant known Cocaine produces a euphoric rush of well-being Produces this effect largely by increasing supplies of dopamine at key neurons throughout the brain Also appears to increase norepinephrine and serotonin

28. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Cocaine High doses of cocaine can produce cocaine intoxication, whose symptoms include mania, paranoia, and impaired judgment –Some people also experience hallucinations and/or delusions, a condition known as cocaine-induced psychotic disorder As the stimulant effects of the drug subside, the user experiences a depression-like letdown, popularly called “crashing”

29. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Cocaine Cocaine abuse and dependence –Regular use may lead to a pattern of abuse in which the person remains under the effect of cocaine for much of each day and functions poorly in social relationships and at work –Dependence on the drug may also develop

30. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Cocaine Cocaine abuse and dependence –Cocaine use in the past was limited by the drug's high cost –Since 1984, cheaper, more powerful versions of the drug have become available, including: A “freebase” form where the drug is heated and inhaled with a pipe “Crack,” a powerful form of freebase that has been boiled down for smoking in a pipe –Currently, 0.5% of all people over the age of 11 in the U.S. manifest cocaine abuse or dependence in a given year

31. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Cocaine What are the dangers of cocaine? –Aside from its behavioral effects, cocaine poses significant physical danger –The greatest danger of use is the risk of overdose Excessive doses depress the brain's respiratory function, and stop breathing Cocaine use can also cause heart failure Pregnant women who use cocaine have an increased likelihood of miscarriage and of having children with abnormalities

32. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Amphetamines Amphetamines: stimulant drugs manufactured in the laboratory –Most often taken in pill or capsule form Some people inject the drugs intravenously or smoke them for a quicker, more powerful effect Like cocaine, amphetamines: –Increase energy and alertness and reduce appetite when taken in small doses –Produce a rush, intoxication, and psychosis in high doses –Cause an emotional letdown as they leave the body

33. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Amphetamines One kind of amphetamine, methamphetamine, has had a major surge in popularity in recent years –Almost 6% of all persons over the age of 11 in the US have used this stimulant at least once Most of the nonmedical meth is made in “stovetop laboratories”

34. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulant Use Disorder Regular use of either cocaine or amphetamines may lead to stimulant use disorder The stimulant dominates the individual’s life Leads to poor function in social relationships and at work

35. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Caffeine  World’s most widely used stimulant  80% of the world's population consumes it daily Most is in the form of coffee; the rest is in the form of tea, cola, energy drinks, chocolate, and over-the-counter medications 99% of ingested caffeine is absorbed by the body and reaches its peak concentration within an hour  Caffeine acts as a stimulant in the CNS, producing a release of dopamine, serotonin, and norepinephrine in the brain  More than 2 to 3 cups of brewed coffee can lead to caffeine intoxication  Seizures and respiratory failure can occur at doses greater than 10 grams of caffeine (about 100 cups of coffee)

36. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Stimulants: Caffeine Many people who suddenly stop or cut back their usual intake experience withdrawal symptoms, including headaches, depression, anxiety, and fatigue –Studies suggest correlations between high doses of caffeine and heart rhythm irregularities, high cholesterol levels, and risk of heart attacks High doses during pregnancy also increase the risk of miscarriage

37. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Hallucinogens, Cannabis, and Combinations of Substances Hallucinogens –Produce delusions, hallucinations, and other sensory changes Cannabis substances –Produce sensory changes, but have both depressant and stimulant effects Combinations of substances

38. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Hallucinogens Hallucinogens produce powerful changes in sensory perceptions (sometimes called “trips”) –Natural hallucinogens Mescaline Psilocybin –Laboratory-produced hallucinogens Lysergic acid diethylamide (LSD) MDMA (Ecstasy)

39. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Hallucinogens  LSD is one of the most powerful hallucinogens  Brings on a state of hallucinogen intoxication (hallucinosis) Increased and altered sensory perception Hallucinations and/or synesthisia  Effects wear off in about six hours  LSD produces these symptoms by binding to serotonin receptors  These neurons help control visual information and emotions, thereby causing the various effects of the drug on the user

40. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Hallucinogens More than 14% of Americans have used hallucinogens at some point in their lives Tolerance and withdrawal are rare –But the drugs do pose dangers Users may experience a “bad trip” – the experience of enormous unpleasant perceptual, emotional, and behavioral reactions –Another danger is the risk of “flashbacks” Can occur days or months after last drug use

41. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Cannabis The drugs produced from varieties of the hemp plant are, as a group, called cannabis –They include: Hashish, the solidified resin of the cannabis plant Marijuana, a mixture of buds, crushed leaves, and flowering tops The major active ingredient in cannabis is tetrahydrocannabinol (THC) –The greater the THC content, the more powerful the drug

42. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Cannabis When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects –At low doses, the user feels joy and relaxation May become anxious, suspicious, or irritated This overall “high” is technically called cannabis intoxication –At high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations Most of the effects of cannabis last 2 to 6 hours –Mood changes may continue longer

43. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Cannabis abuse and Dependence Marijuana was once thought not to cause abuse or dependence One theory about the increase in abuse and dependence is the change in the drug itself –The marijuana available today is significantly more potent than the drug used in the early 1970s

44. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Is Marijuana Dangerous? –As the strength and use of the drug has increased, so have the risks of using it May cause panic reactions similar to those caused by hallucinogens Because of its sensorimotor effects, marijuana has been implicated in accidents Marijuana use has been linked to poor concentration and impaired memory –Long-term use poses additional dangers May cause respiratory problems and lung cancer May affect reproduction –In males, it may lower sperm count –In women, abnormal ovulation has been found

45. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Cannabis  Cannabis and Society: A Rocky Relationship  For centuries, cannabis played a respected role in medicine, but its use fell out of favor and was criminalized  In the late 1980s, several interest groups campaigned for the medical legalization of marijuana  The U.S. Federal Government has continued to fight and punish the production and distribution of marijuana for medical purposes However, in 2009, the US Attorney General directed federal prosecutors to not pursue cases against medical marijuana users complying with state laws Both the Netherlands and Canada permit its use

46. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Combinations of Substances People often take more than one drug at a time, a pattern called polysubstance use –Researchers have studied the ways in which drugs interact with one another, focusing on cross-tolerance and synergistic effects

47. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Combinations of Substances Cross-tolerance –Sometimes two or more drugs are so similar in their actions on the brain and body that as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other (even if they have never taken it) –Users who display this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other Example: alcohol and benzodiazepines

48. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Combinations of Substances Synergistic effects –When different drugs are in the body at the same time, they may multiply, or potentiate, each other's effects –This combined impact is called a synergistic effect, and is often greater than the sum of the effects of each drug taken alone

49. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Combinations of Substances Synergistic effects –One kind of synergistic effect occurs when two or more drugs have similar actions Example: alcohol, barbiturates, benzodiazepines, and opioids All depressants, these drugs may severely depress the CNS when mixed, leading to death –A different kind of synergistic effect results when drugs have opposite (antagonistic) effects Example: stimulants or cocaine with barbiturates or alcohol –May build up lethal levels of the drugs because of metabolic issues (stimulants impede the liver's processing of barbiturates and alcohol)

50. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Combinations of Substances Each year tens of thousands of people are admitted to hospitals because of polysubstance use –May be accidental or intentional As many as 90% of people who use one illegal drug are also using another to some extent

51. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved What Causes Substance Use Disorders? Clinical theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence –No single explanation has gained broad support –Best explanation: a COMBINATION of factors

52. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Sociocultural Views Some theorists propose that people are more likely to develop patterns of substance abuse or dependence when living in stressful socioeconomic conditions Others propose that substance abuse and dependence are more likely to appear in families and social environments where substance use is valued or accepted

53. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Psychodynamic Views Psychodynamic theorists believe that people who abuse substances have powerful dependency needs that can be traced to their early years –Caused by a lack of parental nurturing Some people may develop a “substance abuse personality” as a result –Limited research does link early impulsivity to later substance use, but the findings are correlational and researchers cannot presently conclude that any one personality trait or group of traits stands out in substance use disorders

54. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Cognitive-Behavioral Views According to behaviorists, operant conditioning may play a key role in substance abuse –They argue that the temporary reduction of tension produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again –Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion

55. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Cognitive-Behavioral Views Other behaviorists have proposed that classical conditioning may play a role in substance abuse and dependence –Objects present at the time drugs are taken may act as classically conditioned stimuli and come to produce some of the pleasure brought on by the drugs themselves –Although classical conditioning may be at work, it has not received widespread research support as the key factor in such patterns

56. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Biological Views In recent years, researchers have come to suspect that drug misuse may have biological causes Studies on genetic predisposition and specific biochemical processes have provided some support for this model

57. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Biological Views Genetic predisposition –Research with “alcohol-preferring” animals has demonstrated that their offspring have similar alcohol preferences –Research with human twins has suggested that people may inherit a predisposition to abuse substances –Clearer support for a genetic model may come from adoption studies Studies compared adoptees whose biological parents were dependent on alcohol with adoptees whose biological parents were not dependent –By adulthood, those whose biological parents were dependent showed higher rates of alcohol use themselves

58. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Biological Views Biochemical factors –Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a reward center or “pleasure pathway” in the brain –The reward center apparently extends from the ventral tegmental area of the brain to the nucleus accumbens and on to the frontal cortex

59. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Causes of Substance Use Disorders: Biological Views Biochemical factors –A number of theorists believe that when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances This theory, called the incentive-sensitization theory – has received considerable support in animal studies –Other theorists believe that people who abuse substances suffer from a reward-deficiency syndrome Their reward center is not readily activated by “normal” life events so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress –Defects in D2 receptors have been cited as a possible cause

60. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved How Are Substance Use Disorders Treated? Many approaches have been used to treat substance use disorders, including psychodynamic, behavioral, cognitive- behavioral, and biological, along with sociocultural therapies Although these treatments sometimes meet with great success, more often they are only moderately helpful Today treatments are typically used in combination on both an outpatient and inpatient basis

61. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved How Are Substance Use Disorders Treated? The value of treatment for substance abuse or dependence can be difficult to determine –Different substance use disorders pose different problems –Many people with substance abuse patterns drop out of treatment early –Some people recover without any intervention at all –Different criteria are used by different clinical researchers

62. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Psychodynamic Therapies Psychodynamic therapists first guide clients to uncover and work through the underlying needs and conflicts that they believe led to the disorder then try to help them change their styles of living Research has not found this model to be very effective –Tends to be of greater help when combined with other approaches in a multidimensional treatment program

63. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Behavioral Therapies A widely used behavioral treatment is aversion therapy, an approach based on classical conditioning principles –Individuals are repeatedly presented with an unpleasant stimulus at the very moment they are taking a drug –After repeated pairings, they are expected to react negatively to the substance itself and to lose their craving for it

64. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Behavioral Therapies Aversion therapy is most commonly applied to alcohol abuse/dependence –In one version, drinking behavior is paired with drug- induced nausea and vomiting –Another version of this approach requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking A behavioral approach that has been successful in the short-term is contingency management –This procedure makes incentives contingent on the submission of drug-free urine specimens

65. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Cognitive-Behavioral Therapies These treatments help clients identify and change the patterns and cognitions contributing to their patterns of use Relapse-prevention training –The overall goal is for clients to gain control over their substance-related behaviors Clients are taught to identify and plan ahead for high-risk situations and to learn from mistakes and lapses –This approach is used particularly to treat alcohol use; also used to treat cocaine and marijuana abuse

66. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Biological Treatments Biological approaches may be used to help people withdraw from substances, abstain from them, or simply maintain their level of use without further increases –These approaches have limited long-term success when used alone, but can be helpful when combined with other approaches

67. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Biological Treatments  Detoxification  Systematic and medically supervised withdrawal from a drug Can be outpatient or inpatient  Two strategies: Gradual withdrawal by tapering doses of the substance Induce withdrawal but give additional medication to block symptoms  Detoxification programs seem to help motivated people withdraw from drugs For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high

68. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Biological Treatments Antagonist drugs –As an aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance Example: disulfiram (Antabuse) for alcohol Example: naloxone for narcotics, naltrexone for alcohol

69. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Biological Treatments Drug maintenance therapy –A drug-related lifestyle may be a greater problem than the drug's direct effects Example: heroin addiction –Methadone maintenance programs are designed to provide a safe substitute for heroin Methadone is a laboratory opioid with a long half-life, taken orally once a day Programs were roundly criticized as “substituting addictions” but are regaining popularity, partly because of the spread of HIV/AIDS

70. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Sociocultural Therapies Three sociocultural approaches have been applied to substance use disorders: –Self-help programs –Culture- and gender-sensitive programs –Community prevention programs

71. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Sociocultural Therapies Self-help and residential treatment programs –Most common: Alcoholics Anonymous (AA) Offers peer support along with moral and spiritual guidelines to help people overcome alcoholism It is worth noting that the abstinence goal of AA directly opposes the controlled-drinking goal of relapse prevention training and several other interventions for substance misuse – this issue has been debated for years –Many self-help programs have expanded into residential treatment centers or therapeutic communities People formerly dependent on drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies

72. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Sociocultural Therapies Culture- and gender-sensitive programs –A growing number of treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of ethnic minority groups –Similarly, therapists have become more aware that women often require treatment methods different from those designed for men

73. Abnormal Psychology | Ronald J. Comer | Ninth Edition Copyright © 2015 by Worth Publishers. All rights reserved Sociocultural Therapies Community prevention programs –Perhaps the most effective approach to substance use disorders is to prevent them –Some prevention programs argue for total abstinence from drugs, while others teach responsible use –Prevention programs may focus on the individual, the family, the peer group, the school, or the community at large The most effective of these prevention efforts focuses on multiple areas to provide a consistent message about drug use in all areas of life