1. Copyright © Houghton Mifflin Company. All rights reserved.9 - 1 Substance-Related Disorders Psychoactive substances –Affecting the central nervous system –Causing significant social, occupational, psychological, or physical problems –Can result in abuse or dependence User may –Become a danger to others –Engage in criminal activities Gateway Theory

2. Copyright © Houghton Mifflin Company. All rights reserved.9 - 2 Percentage of Persons Who Reported Using Specific Substances at Any Time During Their Lives (Age 12 and Over)

3. Copyright © Houghton Mifflin Company. All rights reserved.9 - 3 Substance-Related Disorders DSM-IV-TR –Substance-use disorders Dependence and abuse –Substance-induced disorders Withdrawal Substance-induced delirium

4. Copyright © Houghton Mifflin Company. All rights reserved.9 - 4 Substance-Related Disorders Substance abuse –Maladaptive pattern of recurrent use that Extends over a period of 12 months Leads to notable impairment or distress Continues despite social, occupational, psychological, physical or safety problems Substance dependence –Maladaptive pattern of use over 12-month period Unsuccessful efforts to control use Takes more of substance than intended Devotes considerable time to activities necessary to obtain the substance

5. Copyright © Houghton Mifflin Company. All rights reserved.9 - 5 Substance-Related Disorders –Tolerance Increasing doses are necessary to achieve desired effect –Withdrawal Distress/impairment in social, occupational, other areas of functioning or physical/emotional symptoms persist after reducing/ceasing intake –shaking, irritability, inability to not think about the drug –Tolerance or withdrawal indicates physiological dependence

6. Copyright © Houghton Mifflin Company. All rights reserved.9 - 6 Depressants or Sedatives Caused generalized depression of the central nervous system and a slowing down of responses Alcoholic –Person who abuses/ is dependent on alcohol Alcoholism –Characterized by abuse of, or dependency on, alcohol, which is a depressant Binge drinking –Person abstains for a while, but is unable to control/moderate intake when drinking resumes

7. Copyright © Houghton Mifflin Company. All rights reserved.9 - 7 Alcohol-Use Disorders Pattern of problem drinking –Finds taste unpleasant –Swears never to drink again –Heavy drinking serves a purpose –Use continues despite negative consequences –Preoccupation with alcohol consumption –Deterioration of social and occupational functioning

8. Copyright © Houghton Mifflin Company. All rights reserved.9 - 8 The Effects of Alcohol Physiological and psychological effects –Depends on such factors as a person’s weight, amount of food in stomach, stress, etc. –Depresses CNS functioning –Affects mood and behavior –Long-term Blackouts, tolerance, destruction of brain cells, cirrhosis of liver and other lethal diseases –Fetal Alcohol Syndrome (FAS) Can result in mentally retarded, physically deformed children

9. Copyright © Houghton Mifflin Company. All rights reserved.9 - 9 Other Depressants or Sedatives Narcotics –Opiates – opium, morphine, heroin, methadone –Relieves pain, anxiety, tension –Tolerance builds rapidly –Withdrawal Syndrome Barbiturates –“downers” –Depresses the CNS –Commonly used to induce relaxation/sleep –Accidental overdose when combined with alcohol Benzodiazepines (e.g., Valium) –Rohypnol “Roofies” “date-rape” drug

10. Copyright © Houghton Mifflin Company. All rights reserved.9 - 10 “Club Drugs” Used by 70% of attendees at dance clubs/raves –Stimulants Ecstasy/MDMA LSD GHB Ketamine methamphetamine –Cardiovascular failure High heart rate and blood pressure Heart wall stress –Cognitive deficits

11. Copyright © Houghton Mifflin Company. All rights reserved.9 - 11 Stimulants Stimulant –Central nervous system energizer elation, grandiosity, hyperactivity, agitation, and appetite suppression –Amphetamines Increased CNS activity Increased alertness, energy Feelings of euphoria and confidence “uppers” –Caffeine

12. Copyright © Houghton Mifflin Company. All rights reserved.9 - 12 Stimulants Nicotine –Cannot stop or reduce use –Cold turkey can cause withdrawal symptoms –Continued use despite serious physical disorder Cocaine –From the coca plant –Feelings of euphoria and self-confidence –Followed by depression –Chronic abuse Changes in CNS Premature ventricular heartbeats and death –Crack Purified, potent form of cocaine produced by heating cocaine with ether

13. Copyright © Houghton Mifflin Company. All rights reserved.9 - 13 Hallucinogens Hallucinogen –Produces hallucinations –Vivid sensory awareness –Heightened alertness –Perceptions of increased insight –Marijuana The mildest and most commonly used –Lysergic Acid Diethylamide (LSD) –Phencyclidine (PCP)

14. Copyright © Houghton Mifflin Company. All rights reserved.9 - 14 Causes of Substance-Use Disorders Biological –Heredity and Congenital factors –Two types of alcoholism Familial –Family history of alcoholism –Genetic predisposition »Identified for certain traits in alcoholism. »Neurotransmitters sensitivity/responsiveness to alcohol »Changes in CNS functioning Non-familial –Suggesting environmental factors

15. Copyright © Houghton Mifflin Company. All rights reserved.9 - 15 Causes of Substance-Use Disorders Psychodynamic –Childhood trauma Especially in oral stage Leads to repression of painful conflicts involving dependency needs –Alcohol allows repressed conflicts to be expressed and offers oral gratification to satisfy dependency needs. Personality characteristics –High activity level –Emotionality –Goal impersistence –Sociability –Life transitions/maturational events –No evidence for “alcoholic personality,” Antisocial behavior Depression

16. Copyright © Houghton Mifflin Company. All rights reserved.9 - 16 Causes of Substance-Use Disorders Sociocultural factors –More males than females –More young adults than older adults –More Catholics than Protestants or Jews –Parents –Peers Two-way street regarding peers: –Users seek out other users –Users influence their friends to use –Cultural values

17. Copyright © Houghton Mifflin Company. All rights reserved.9 - 17 Causes of Substance-Use Disorders Behavioral –Anxiety reduction Approach-avoidance conflict –Learned expectations –Cognitive influences Tension-reducing model –Alcohol reduces tension and anxiety –Relief of tension reinforces drinking behavior Coping responses plus expectancy

18. Copyright © Houghton Mifflin Company. All rights reserved.9 - 18 Causes of Substance-Use Disorders –Relapse Resume drinking after voluntary abstinence –Negative emotional states –Negative physical states –Gender differences (women: interpersonal conflict) –Social pressure –Coping responses Abstinence violation effect –Loss of personal control after drinking begins Biological –Physical dependence –Avoid withdrawal symptoms

19. Copyright © Houghton Mifflin Company. All rights reserved.9 - 19 Figure 9.5: The Relapse Process

20. Copyright © Houghton Mifflin Company. All rights reserved.9 - 20 Theories of the Addiction Process Solomon’s opponent process theory –Conditions that cause drug experimentation have not been identified. –Best predictor Availability –Addiction An acquired motivation Opponent process theory of acquired motivation Motivation changes with repeated consumption

21. Copyright © Houghton Mifflin Company. All rights reserved.9 - 21 Theories of the Addiction Process (cont’d) Wise’s two-factor model –Positive and negative reinforcement Tiffany’s theory of automatic processes –Drug-use behaviors are controlled by “automatic” processes –Once activated, drug-use behaviors are resistant to change.