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Chapter Eleven SUBSTANCE USE DISORDERS. Substance Use Disorders  Definition of psychoactive substance  Substance abuse and substance dependence definitions.

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Presentation on theme: "Chapter Eleven SUBSTANCE USE DISORDERS. Substance Use Disorders  Definition of psychoactive substance  Substance abuse and substance dependence definitions."— Presentation transcript:

1 Chapter Eleven SUBSTANCE USE DISORDERS

2 Substance Use Disorders  Definition of psychoactive substance  Substance abuse and substance dependence definitions  Course  Epidemiology  Etiology  Treatment

3 Drugs of Abuse (Psychoactive Substance)  A chemical substance that alters mood, changes perception, or changes brain functioning  These substances can range from legal (Nicotine) to prescription (Valium) to illegal (LSD) drugs  It is not unusual for people with substance abuse to use more than one drug (polysubstance abuse)

4 Substance Use Disorders

5  DSM-IV differentiates between two substance use disorders:  Substance dependence  Substance abuse

6 Substance Abuse  A person’s ability to function becomes impaired  Harmful results appear, without signs of tolerance, withdrawal, or compulsive drug use (i.e., not meet criteria for dependence)

7 DSM-IV Definition of Substance Abuse During a 12 month period, 1 or more of the following 4 criteria caused clinically significant impairment or distress:  Recurrent substance use:  Resulting in failure to fulfill role obligations  In situations in which it is hazardous  That result in substance-related legal problems  Despite continued social or occupational problems caused by the drug

8 Substance Dependence  Repeated use of a drug that often results in tolerance, withdrawal, or compulsive drug taking behavior  Commonly called addiction

9 Psychological Dependence  The urge to take a psychoactive substance for reasons such as alleviating negative moods, avoiding withdrawal symptoms, and preparing for public speaking or writing

10 Physiological Dependence  Tolerance and withdrawal are seen as indicators of a physiological dependence on a psychoactive substance

11 Tolerance  Through the ongoing use of any drug of abuse the nervous system becomes less sensitive to the physiological effects of that chemical over time For example: You now need to drink 4 beers to get the same ‘high’ you used to get from drinking 2 beers

12 Withdrawal  Physiological symptoms a person experiences when drug use is stopped (specific symptoms depend on substance)  Withdrawal symptoms for nicotine include: drowsiness, muscle tremors and nausea  Withdrawal symptoms for alcohol in the most severe cases include: convulsions, hallucinations, and possibly alcohol withdrawal delirium

13 DSM-IV Substance Dependence Criteria During a 12 month period, 3 or more of the following caused clinically significant impairment or distress:  Tolerance  Withdrawal  Substance taken in larger amounts or for longer periods of time than intended  Persistent desire or failed efforts to reduce drug use  Great deal of time spent trying to obtain, use, or recover from effects of the drug  Important social or occupational activities are given up or reduced because of drug use  Continuous substance use despite knowledge of consequences of drug use

14 Substance Dependence vs. Substance Abuse  The level of impairment or distress caused by the use of psychoactive substances differentiates dependence from abuse  Substance dependence is the more severe disorder

15 Substance Use Disorders

16 Course  For both dependence and abuse: the course as well as the age of onset vary from one person to the next  Alcoholism research indicates that individuals alternate between periods of heavy use and periods of relative abstinence  Lifetime prevalence rate of alcohol abuse or dependence is 14%  Young adults have highest prevalence rate for alcohol dependence

17 Substance Use Disorders

18 Lifetime Prevalence: Drug Use and Dependence (NCS data)  Tobacco75.624.131.9  Alcohol91.5 14.115.4  Cannabis 46.304.209.1  Cocaine16.202.716.7  Amphetamines15.301.711.2  Sedatives12.701.209.2  Hallucinogens10.6 00.504.9  Heroin01.5 00.423.1 Proportion with Proportion with Dependence History of Use History of Among Users Dependence

19 Substance Use Among College Students (Shinew, 2002)  83% drink alcohol  67% started in high school  24% use drugs  Marijuana (98%) and ecstasy (28%)  80% indicated drinking as a leisure activity

20 Prevalence of Alcohol Dependence and Abuse  Gender differences  Men five times more likely to chronically abuse alcohol than women  Age differences  Rates higher among young adults (18-29) and lowest among elderly (65 and over)

21 Substance Use Disorders

22 Etiology of Substance Abuse/Dependence Three generations of the Barrymore family

23 Etiological Considerations  Not everyone who uses drugs will move to the level of abuse or dependence  The role of biological factors in substance addictions  Social and psychological factors play a role in substance use The etiological factors that will be presented for the rest of the lecture will be those that influence alcoholism

24 Etiology: Genes  Males:MZ = 56% DZ = 33%  Females: MZ = 30% DZ = 17%  MZ concordances are higher than DZ concordances  Higher concordance rates in male twins reflect higher rates of alcoholism among men  Gender difference in alcoholism for MZ and DZ twins could be attributed to:  Women have lower physical tolerance  Negative social attitudes towards public intoxication (for women)

25 Cloninger Adoption Study  Examined alcohol abuse in adoptees in Sweden (males born out of wedlock and adopted at an early age)  Collected data from official records of hospitals, insurance companies and national criminal register

26 Cloninger’s System of Alcoholism  TYPE 1:  Biological parents had later onset (after age 25) of drinking problems with absence of criminal behavior  TYPE 2:  Biological parents had early onset (before age 25) of drinking problems, and had undergone treatment or presence of criminal behavior

27 Comparison Groups  Type 1 and Type 2 children of alcoholic parents were adopted into two kinds of homes:  Heavy drinking  Absence of heavy drinking  Control group

28 Rate of Alcoholism in Adult Children Adoptive Father

29 Rate of Alcoholism in Adult Children (cont.) Adoptive Father

30 Etiology: Social Factors  Culture or religion could influence how early someone is exposed to alcohol, as well as their attitudes toward drinking  Initial experimentation more likely among those who are rebellious, extraverted, and if parents or peers model/encourage use  Unpleasant emotional environment and low parental monitoring increase risk that children will affiliate with peers who use drugs

31 Substance Use Disorders

32 Treatment Considerations  Most people do not seek treatment in part because they refuse to acknowledge they have a problem  When treatment is initiated compliance is low and dropout rates are high  High comorbidity rate of alcoholism with other mental disorders makes treatment more challenging

33 Treatment Goals  Abstinence versus moderation  Some treatment programs’ goal may be abstinence (e.g., AA), whereas the goal of others may be drinking in moderation  Scope of treatment  Should treatment address areas such as occupational, social, or medical problems

34 Treatment Outcomes  Consistent findings across studies  Although improvement usually persists after treatment, relapse is not uncommon  Research evidence suggests that no one treatment is clearly superior to others. However, 12 step programs, such as AA, are usually more successful at achieving abstinence

35 Treatment Outcomes  Improvements in general health, social, and occupational functioning usually accompany reduction in drug use  Positive long-term outcomes are most favorable for individuals who have a high degree of coping resources, available social support, and low stress situations

36 Optional Slides

37 Substance Dependence  Tolerance and withdrawal are not required for diagnosis  Not requiring tolerance or withdrawal for diagnosis broadens the number of people who may meet the criteria for substance dependence  Not all psychoactive substances result in withdrawal symptoms after drug has been stopped (e.g., cannabis, LSD typically do not lead to withdrawal symptoms)

38 Diagnosing Substance Use Disorders  Although different drugs produce different physiological and psychological effects, the same criteria list is used to diagnose both substance dependence and substance abuse  What are the implications for diagnosing cannabis dependence (no withdrawal symptoms) and alcohol dependence, which does lead to withdrawal symptoms?

39 City Men/College Men Study  Longitudinal study examined 456 inner-city adolescents from Boston and 268 former undergrads from Harvard  Begun in 1940 and followed both groups past the age of 60  35% of city men and 21% of college men met diagnosis for alcohol abuse at some point in their life  Men who abused alcohol died earlier than those who did not  Most alcoholic men went through repeated cycles of abstinence followed by relapse

40 Alcohol Dependence Video: Educational Objectives  Highlights symptoms of alcohol dependence  Shows the effects of alcohol dependence on individual functioning  Considers the issue of comorbid conditions (e.g., depression)

41 Current, Binge, and Heavy Alcohol Use Among Persons Aged 12 or Older, by Race/Ethnicity: 2003

42 Etiology: Psychological Factors (Expectations)  Alcohol Expectancies  Alcohol enhances social and physical pleasure  Alcohol enhances sexual performance  Alcohol improves mood  Alcohol reduces tension  Alcohol increases social assertiveness

43 Etiology: Psychological Factors (Expectations)  Positive expectations have stronger influence on increased drinking than negative expectations have on decreased drinking  Parents, peers, and media may influence adolescents’ expectations of alcohol  Adolescents who experiment with alcohol and have more positive expectations consume greater amounts of alcohol


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