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Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale Copyright © 2012 John Wiley.

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Presentation on theme: "Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale Copyright © 2012 John Wiley."— Presentation transcript:

1 Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

2  Chapter 10: Substance Use Disorders I. Clinical Descriptions, Prevalence, and Effects of Substance Use Disorders II. Etiology of Substance Use Disorders III. Treatment of Substance Use Disorders © 2012 John Wiley & Sons, Inc. All rights reserved.

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4  DSM-IV-TR pathological use of substances divided into two categories: Substance abuse Substance abuse Substance dependence Substance dependence  DSM-5 has one category: Substance use disorder Substance use disorder Categorize by specific substance: Categorize by specific substance:  Alcohol  Amphetamine  Cannabis  Cocaine  Hallucinogen  Inhalant  Opioid  Phencyclidine  Sedative/hypnotic/anxiolytic  Tobacco © 2012 John Wiley & Sons, Inc. All rights reserved.

5 Problematic pattern of use that impairs functioning. Two or more symptoms within a 1 year period: Failure to meet obligations Repeated use in situations where it is physically dangerous Repeated relationship problems Continued use despite problems caused by the substance Tolerance Withdrawal Substance taken for a longer time or in greater amounts than intended Efforts to reduce or control use do not work Much time spent trying to obtain the substance Social, hobbies, or work activities given up or reduced Continued use despite knowing problems caused by substance Craving to use the substance is strong © 2012 John Wiley & Sons, Inc. All rights reserved.

6  Severe substance use disorder Having four more severe symptoms, such as: Having four more severe symptoms, such as:  Tolerance  Larger doses needed; lower dosage does not produce typical effect  Withdrawal  Negative physical and psychological effects from stopping usage  Using more than intended amounts  Trying unsuccessfully to stop  Having physical or psychological problems made worse by drug  Experience problematic relationships With physiological dependence: With physiological dependence:  Presence of either tolerance or withdrawal Without physiological dependence: Without physiological dependence:  Absence of either tolerance or withdrawal © 2012 John Wiley & Sons, Inc. All rights reserved.

7  Alcoholic Physiologically dependent or heavy user Physiologically dependent or heavy user  Delirium tremens (DTs) Can occur when blood alcohol levels drop suddenly Can occur when blood alcohol levels drop suddenly Results in: Results in:  Deliriousness  Tremulousness  Hallucinations  Primarily visual; may be tactile  Polydrug abuse Many users abuse multiple substances Many users abuse multiple substances  e.g., cigarettes, cocaine, marijuana  85% of alcohol abusers are smokers © 2012 John Wiley & Sons, Inc. All rights reserved.

8  Lifetime prevalence: Abuse – 17% Abuse – 17% Dependence – 12% Dependence – 12%  Binge drinking 5 drinks in short period (e.g., within an hour) 5 drinks in short period (e.g., within an hour) 43.5% prevalence among college students 43.5% prevalence among college students  Heavy use drinking 5 drinks, 5 or more times in a 30-day period 5 drinks, 5 or more times in a 30-day period  16% prevalence among college students © 2012 John Wiley & Sons, Inc. All rights reserved.

9  White and Hispanic adolescents and adults more likely to binge drink than African Americans  Binge and heavy use drinking lowest among Asian Americans  Alcohol dependence highest among Native Americans and Hispanics  21.3% of those with alcohol abuse or dependence also have at least 1 mental disorder e.g. personality disorders, mood or anxiety disorders, or schizophrenia e.g. personality disorders, mood or anxiety disorders, or schizophrenia © 2012 John Wiley & Sons, Inc. All rights reserved.

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11  Enters the bloodstream quickly through small intestine Metabolized by the liver slowly at 1 ounce of 100 proof per hour Metabolized by the liver slowly at 1 ounce of 100 proof per hour  Effects vary by concentration Concentration varies by gender, height, weight, liver efficiency, food in stomach Concentration varies by gender, height, weight, liver efficiency, food in stomach  Size of drink defined by alcohol content 12 oz. glass of beer, 5 oz. glass of wine, and 1.5 oz. of hard liquor are equal in alcohol content 12 oz. glass of beer, 5 oz. glass of wine, and 1.5 oz. of hard liquor are equal in alcohol content © 2012 John Wiley & Sons, Inc. All rights reserved.

12  Interacts with several neural systems Stimulates GABA receptors Stimulates GABA receptors  Reduces tension Increases dopamine and serotonin Increases dopamine and serotonin  Produces pleasurable effects Inhibits glutamate receptors Inhibits glutamate receptors  Produces cognitive difficulties (e.g., slowed thinking, memory loss)  Effect of ingesting large amounts Significant motor impairment Significant motor impairment Poor decision making Poor decision making Poor awareness of errors made Poor awareness of errors made © 2012 John Wiley & Sons, Inc. All rights reserved.

13  Malnutrition Calories from alcohol lack nutrients Calories from alcohol lack nutrients Alcohol interferes with digestion and absorption of vitamins from food Alcohol interferes with digestion and absorption of vitamins from food Deficiency of B-complex vitamins causes Amnestic syndrome Deficiency of B-complex vitamins causes Amnestic syndrome  Severe loss of memory for both long-and-short-term information  Cirrhosis of the liver Liver cells engorged with fat and protein, impeding functioning Liver cells engorged with fat and protein, impeding functioning Cells die, triggering scar tissue which obstructs blood flow Cells die, triggering scar tissue which obstructs blood flow Liver disease and cirrhosis rank 12 th in U.S. causes of death. Liver disease and cirrhosis rank 12 th in U.S. causes of death.  Damage to endocrine glands and pancreas  Heart failure  Erectile dysfunction  Hypertension  Stroke  Capillary hemorrhages Facial swelling and redness, especially in nose Facial swelling and redness, especially in nose  Destruction of brain cells Especially areas important to memory Especially areas important to memory © 2012 John Wiley & Sons, Inc. All rights reserved.

14  Heavy alcohol intake during pregnancy Leading cause of mental retardation Leading cause of mental retardation Fetal growth slowed Fetal growth slowed Cranial, facial and limb anomalies occur Cranial, facial and limb anomalies occur  Total abstinence by pregnant women recommended © 2012 John Wiley & Sons, Inc. All rights reserved.

15  Nicotine Addicting agent of tobacco Addicting agent of tobacco Stimulates dopamine neurons in mesolimbic area Stimulates dopamine neurons in mesolimbic area  Involved in reinforcing effect © 2012 John Wiley & Sons, Inc. All rights reserved.

16  About 440,000 Americans die prematurely each year  Cigarettes kill 1,100 people every day 1 of 6 deaths related to tobacco use 1 of 6 deaths related to tobacco use  Lung cancer is most common cancer 87% caused by smoking 87% caused by smoking  Cigarettes also cause or exacerbate: Emphysema, cancers of larynx, esophagus, pancreas, bladder, cervix, stomach, cardiovascular disease Emphysema, cancers of larynx, esophagus, pancreas, bladder, cervix, stomach, cardiovascular disease Sudden infant death syndrome and pregnancy complications Sudden infant death syndrome and pregnancy complications © 2012 John Wiley & Sons, Inc. All rights reserved.

17  More prevalent among White and Hispanic youth than African Americans African Americans less likely to quit and more likely to get lung cancer African Americans less likely to quit and more likely to get lung cancer  Metabolize nicotine more slowly  Smoke more menthol cigarettes, which is inhaled more deeply and longer  More prevalent among men than women Exception: 12-to 17-year-olds Exception: 12-to 17-year-olds  Secondhand smoke (ETS, environmental tobacco smoke) Higher levels of ammonia, carbon monoxide nicotine and tar Higher levels of ammonia, carbon monoxide nicotine and tar Causes 40,000 deaths per year in U.S. Causes 40,000 deaths per year in U.S. © 2012 John Wiley & Sons, Inc. All rights reserved.

18  Drug derived from dried and ground leaves and stems of the female hemp plant (Cannibis sativa)  Hashish Stronger than marijuana Stronger than marijuana Produced by drying the resin exudate of the tops of plants Produced by drying the resin exudate of the tops of plants  In DSM-5, called Cannabis use disorder © 2012 John Wiley & Sons, Inc. All rights reserved.

19  Most frequently used illicit drug in U.S. 17,000,000 reported using it in ,000,000 reported using it in 2010  Greater use by men than women  Use more common in European- and Hispanic Americans than in African- and Asian- Americans, and Hispanics  Heavier use in US than in Europe, Africa, or Canada © 2012 John Wiley & Sons, Inc. All rights reserved.

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21  Major active ingredient THC (delta-9-tetrahydrocannabinol) THC (delta-9-tetrahydrocannabinol)  Psychological Feelings of relaxation and sociability Feelings of relaxation and sociability Rapid shifts of emotion Rapid shifts of emotion Interferes with attention, memory, and thinking Interferes with attention, memory, and thinking  Decline in IQ over time Heavy doses can induce hallucinations and panic Heavy doses can induce hallucinations and panic Difficult to regulate dosage Difficult to regulate dosage  Effects take 30 minutes to appear  Smoke more than intended waiting for effects Interfere with cognitive functioning Interfere with cognitive functioning  Impairs memory, complex motor skills  Physiological Bloodshot and itchy eyes Bloodshot and itchy eyes Dry mouth and throat Dry mouth and throat Increased appetite Increased appetite Reduced pressure within the eye Reduced pressure within the eye Increased BP Increased BP Damage to lung structure and function in long-term users Damage to lung structure and function in long-term users © 2012 John Wiley & Sons, Inc. All rights reserved.

22  Two cannabinoid brain receptors CB1 and CB2 CB1 and CB2 High concentration in hippocampus High concentration in hippocampus  Increased blood flow to emotion regions Amygdala and anterior cingulate Amygdala and anterior cingulate  Habitual use leads to tolerance Withdrawal symptoms also observed Withdrawal symptoms also observed © 2012 John Wiley & Sons, Inc. All rights reserved.

23  Reduces nausea and loss of appetite caused by chemotherapy  Relieves discomfort of AIDS, chronic pain  Supreme Court rulings: Federal law prohibits dispensing marijuana for medicinal purposes Federal law prohibits dispensing marijuana for medicinal purposes Medical use can be prohibited by federal government even if states approve Medical use can be prohibited by federal government even if states approve © 2012 John Wiley & Sons, Inc. All rights reserved.

24  Group of addictive sedatives that in moderate doses relieve pain and induce sleep Opium Opium Morphine Morphine Heroin Heroin Codeine Codeine  Synthetic sedatives Separate category from DSM-5 sedative/hypnotic/anxiolytic use disorder Separate category from DSM-5 sedative/hypnotic/anxiolytic use disorder  Opiates legally prescribed as pain medications include: Hydrocodone combined with other substances yields Vicodin, Zydone, and Lortab Hydrocodone combined with other substances yields Vicodin, Zydone, and Lortab Oxycodone the basis for OxyContin, Percodan, and Tylox Oxycodone the basis for OxyContin, Percodan, and Tylox © 2012 John Wiley & Sons, Inc. All rights reserved.

25  Heroin Estimated 1,000,000 individuals addicted to heroin in U.S. Estimated 1,000,000 individuals addicted to heroin in U.S. Accounted for 62 to 82% of drug-related hospital admissions in 2003 Accounted for 62 to 82% of drug-related hospital admissions in 2003  5 million pain meds users OxyContin prescriptions jumped 1800% between 1996 and 2000 OxyContin prescriptions jumped 1800% between 1996 and 2000 Hydrocodone use increased from 4.5 to 5.7 million users Hydrocodone use increased from 4.5 to 5.7 million users Oxycodone abuse increased 43% in just 1 year (1997 to 1998) Oxycodone abuse increased 43% in just 1 year (1997 to 1998) Rates of abuse of pain meds has remained stable since 2002 Rates of abuse of pain meds has remained stable since 2002 © 2012 John Wiley & Sons, Inc. All rights reserved.

26  Produce euphoria, drowsiness, and lack of coordination Loss of inhibition, increased self-confidence Loss of inhibition, increased self-confidence Severe letdown after about 4 to 6 hours Severe letdown after about 4 to 6 hours  Heroin and OxyContin Rush Rush  Intense feelings of warmth and ecstasy following injection  Stimulate receptors of the body’s opioid system Stimulate nucleus accumbens Stimulate nucleus accumbens  Tolerance develops and withdrawal occurs Muscle soreness and twitching, tearfulness, yawning Muscle soreness and twitching, tearfulness, yawning Become more severe and also include cramps, chills/sweating, increase in HR and BP, insomnia, and vomiting Become more severe and also include cramps, chills/sweating, increase in HR and BP, insomnia, and vomiting  Withdrawal lasts about 72 hours © 2012 John Wiley & Sons, Inc. All rights reserved.

27  29 year follow-up of 500 heroin addicts 28% dead by age 40 28% dead by age 40  Half by suicide, homicide, or accident  One-third by overdose  Many users resort to illegal activities to obtain money for drugs Theft, prostitution, dealing drugs Theft, prostitution, dealing drugs  Exposure to infectious diseases via shared needles e.g. HIV e.g. HIV Evidence suggests that free needles reduce infectious diseases associated with IV drug use Evidence suggests that free needles reduce infectious diseases associated with IV drug use © 2012 John Wiley & Sons, Inc. All rights reserved.

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29  Increase alertness and motor activity; reduce fatigue  Amphetamines Synthetic stimulants Synthetic stimulants  Benzedrine, Dexedrine, Methedrine Trigger release of and block reuptake of norepinephrine and dopamine Trigger release of and block reuptake of norepinephrine and dopamine Produce high levels of energy, sleeplessness Produce high levels of energy, sleeplessness Reduce appetite, increase HR, constrict blood vessels in skin and mucous membranes Reduce appetite, increase HR, constrict blood vessels in skin and mucous membranes High doses can lead to: High doses can lead to:  Nervousness, agitation, irritability, confusion, paranoia, hostility Tolerance can develop after only 6 days’ use Tolerance can develop after only 6 days’ use © 2012 John Wiley & Sons, Inc. All rights reserved.

30  Methamphetamine (aka crystal meth) Amphetamine derivative Amphetamine derivative Can be taken orally, intravenously, or intranasally (snorting) Can be taken orally, intravenously, or intranasally (snorting)  Chronic use damages brain Impacts dopamine and serotonin systems Impacts dopamine and serotonin systems Reduction in hippocampus volume (yellow bars vs. non- users (blue bars) in figure 10.5, at right) Reduction in hippocampus volume (yellow bars vs. non- users (blue bars) in figure 10.5, at right) © 2012 John Wiley & Sons, Inc. All rights reserved.

31  Crack Form of cocaine that quickly become popular in the ’80s Form of cocaine that quickly become popular in the ’80s Rock crystal that is heated, melted, and smoked Rock crystal that is heated, melted, and smoked Cheaper than cocaine Cheaper than cocaine  Alkaloid obtained from coca leaves Reduces pain Reduces pain Produces euphoria Produces euphoria Heightens sexual desire Heightens sexual desire Increases self-confidence and indefatigability Increases self-confidence and indefatigability  Blocks reuptake of dopamine in mesolimbic areas of brain  Overdose: Chills, nausea, insomnia, paranoia, hallucinations; possibly heart attack and death Chills, nausea, insomnia, paranoia, hallucinations; possibly heart attack and death  Not all users develop tolerance Some become more sensitive Some become more sensitive  May increase risk of OD   Cocaine use declined between 2002 and 2009, dropping to 1.4% from 2% Crack use is also declining © 2012 John Wiley & Sons, Inc. All rights reserved.

32  LSD d-lysergic acid diethylamide d-lysergic acid diethylamide  Hallucinogen effects include: Colorful visual hallucinations Colorful visual hallucinations Psychedelic trip: expansion of consciousness Psychedelic trip: expansion of consciousness  Only 1-2% regular users African Americans less likely to use than others African Americans less likely to use than others  Flashbacks Hallucinogen persisting perception disorder (HPPD) Hallucinogen persisting perception disorder (HPPD)  Most common during stress  Other hallucinogens:  Mescaline Active ingredient of peyote Active ingredient of peyote  Psilocybin Extracted from mushroom psilocybe mexicana Extracted from mushroom psilocybe mexicana  Ecstasy (MDMA) Methylenedioxymethamphetamine Increase feelings of intimacy and enhances mood Increase feelings of intimacy and enhances mood Chemically similar to mescaline and amphetamines Chemically similar to mescaline and amphetamines Acts on serotonin Acts on serotonin Improves interpersonal relations Improves interpersonal relations Its use peaked in 2001, with 1.8 million users; may be rising again Its use peaked in 2001, with 1.8 million users; may be rising again  PCP (phencyclidine) Angel dust Angel dust Animal tranquilizer Animal tranquilizer Causes severe paranoia and violence Causes severe paranoia and violence © 2012 John Wiley & Sons, Inc. All rights reserved.

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34  Two paths to alcohol abuse ( Boys more likely to be in the first group, girls in the second group) 1. First group began drinking in early adolescence, increased drinking throughout high school 2. Second group drank lesser amounts in early adolescence, increased drinking in middle school and again in high school  Developmental studies do not account for all cases Not an inevitable progression through stages Not an inevitable progression through stages © 2012 John Wiley & Sons, Inc. All rights reserved.

35  Relatives and children of problem drinkers have higher-than- expected rates of alcohol abuse or dependence  Greater concordance in MZ than DZ twins  Genetic and shared environmental risk factors for illicit drug abuse and dependence appear to be nonspecific  Ability to tolerate large quantities of alcohol may be an inherited diathesis Asians have low rates of alcohol abuse Asians have low rates of alcohol abuse  Deficient enzymes (ADH or alcohol dehydrogenases)  Genes and smoking People with SLC6AS less likely to smoke and more likely to quit People with SLC6AS less likely to smoke and more likely to quit Smokers with defect in CYP2A6 gene less likely to become dependent Smokers with defect in CYP2A6 gene less likely to become dependent © 2012 John Wiley & Sons, Inc. All rights reserved.

36  Nearly all drugs, including alcohol, stimulate the dopamine system in the brain, particularly the mesolimbic pathway Produce rewarding or pleasurable feelings Produce rewarding or pleasurable feelings Some evidence that people dependent on drugs or alcohol have a deficiency in the dopamine receptor DRD2 Some evidence that people dependent on drugs or alcohol have a deficiency in the dopamine receptor DRD2 Vulnerability model vs. Toxic effect model Vulnerability model vs. Toxic effect model  Vulnerability in the dopamine system leads to substance use or substance use leads to dopamine system problems  People take drugs to avoid the bad feelings associated with withdrawal Explains frequency of relapse Explains frequency of relapse  Incentive-sensitization theory Distinguish Wanting (craving for drug) from Liking (pleasure obtained by taking the drug) Distinguish Wanting (craving for drug) from Liking (pleasure obtained by taking the drug) Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.) Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.) Sensitivity to cues induces and strengthens wanting Sensitivity to cues induces and strengthens wanting  Brain imaging studies show that cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use © 2012 John Wiley & Sons, Inc. All rights reserved.

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38  Mood alteration Tension reduction may be due to “alcohol myopia” Tension reduction may be due to “alcohol myopia”  User focuses reduced cognitive capacity on immediate distractions  Less attention focused on tension-producing thoughts Effect similar for smoking Effect similar for smoking However, alcohol and nicotine may increase tension when no distractions are present However, alcohol and nicotine may increase tension when no distractions are present  Crying in one’s beer  Expectancies about drug effects People who expect alcohol to reduce stress and anxiety are most likely to drink People who expect alcohol to reduce stress and anxiety are most likely to drink Drinking and positive expectancies influence each other positively Drinking and positive expectancies influence each other positively © 2012 John Wiley & Sons, Inc. All rights reserved.

39  Personality factors that predict onset of substance-related disorders: Negative emotionality or negative affect Negative emotionality or negative affect Desire for increased arousal and positive affect Desire for increased arousal and positive affect Low constraint Low constraint  Harm avoidance, conservative moral values, and cautious behavior  Kindergarten children who were rated high in anxiety and novelty seeking more likely to get drunk, smoke, and use drugs in adolescence © 2012 John Wiley & Sons, Inc. All rights reserved.

40  Alcohol is the most common abused substance worldwide Highest consumption in France, Spain, and Italy where consumption is widely accepted Highest consumption in France, Spain, and Italy where consumption is widely accepted  Men consume more alcohol than women but differences vary by country Israel Israel  Men drank 3x as much as women Netherlands Netherlands  Men drank 1½x as much as women  Availability Usage is higher when alcohol and drugs are easily available Usage is higher when alcohol and drugs are easily available  In 2003, drug use among youths who had been approached by drug dealers was 35 percent, compared to just under 7 percent among youths who had not been approached © 2012 John Wiley & Sons, Inc. All rights reserved.

41  Family factors Parental alcohol use Parental alcohol use Marital discord, psychiatric or legal problems in the family linked to substance use Marital discord, psychiatric or legal problems in the family linked to substance use Lack of emotional support from parents increases use of cigarettes, marijuana, and alcohol Lack of emotional support from parents increases use of cigarettes, marijuana, and alcohol Lack of parental monitoring linked to higher drug usage Lack of parental monitoring linked to higher drug usage © 2012 John Wiley & Sons, Inc. All rights reserved.

42  Social network Social influence or social selection? Social influence or social selection? Bullers et al. (2001) found evidence for both Bullers et al. (2001) found evidence for both  Having peers who drink influences drinking behavior (social influence) but individuals also choose friends with drinking patterns similar to their own (social selection)  Advertising and media Countries that ban ads have 16% less consumption than those that don’t Countries that ban ads have 16% less consumption than those that don’t © 2012 John Wiley & Sons, Inc. All rights reserved.

43  In 2009, 1.5 million people over the age of 12 received treatment for alcohol abuse or dependence Over 17 million people over the age of 12 were in need of treatment for alcohol or drug problems, but did not get it Over 17 million people over the age of 12 were in need of treatment for alcohol or drug problems, but did not get it Only 1 in 4 who are physiologically dependent ever get treatment Only 1 in 4 who are physiologically dependent ever get treatment  Inpatient hospital treatment Detoxification Detoxification  Withdrawal from alcohol under medical supervision  The therapeutic results of hospital treatment are not superior to those of outpatient treatment  May be necessary for those without social support or with other serious psychological problems  Alcoholics Anonymous (AA) Largest self-help group for problem drinkers Largest self-help group for problem drinkers Regular meetings provide support, understanding, and acceptance Regular meetings provide support, understanding, and acceptance Promotes complete abstinence Promotes complete abstinence Although some studies have shown AA participation predicts better outcome, recent studies suggest AA no more effective than other forms of therapy Although some studies have shown AA participation predicts better outcome, recent studies suggest AA no more effective than other forms of therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

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45  Cognitive and Behavioral Treatments Contingency-Management Therapy Contingency-Management Therapy  Patient and family reinforce behaviors inconsistent with drinking  e.g., avoiding places associated with drinking  Teach problem drinker how to deal with uncomfortable situations  e.g., refusing the offer of a drink Relapse prevention Relapse prevention  Strategies to prevent relapse  Motivational interventions Designed to curb heavy drinking in college Designed to curb heavy drinking in college © 2012 John Wiley & Sons, Inc. All rights reserved.

46  Controlled drinking Belief that problem drinkers can consume alcohol in moderation Belief that problem drinkers can consume alcohol in moderation Avoid total abstinence and inebriation Avoid total abstinence and inebriation Guided self-change Guided self-change  Medications Antabuse (disulfiram) Antabuse (disulfiram)  Produces nausea and vomiting if alcohol is consumed Other medications include naltrexone, naloxone, and acamprosate Other medications include naltrexone, naloxone, and acamprosate  Most effective when combined with CBT © 2012 John Wiley & Sons, Inc. All rights reserved.

47  Peer behavior important If others in social network stop smoking, increases likelihood that individual will also stop If others in social network stop smoking, increases likelihood that individual will also stop  Physician’s advice By age 65, most smokers have quit By age 65, most smokers have quit  Scheduled smoking Reduce nicotine intake gradually over a few weeks Reduce nicotine intake gradually over a few weeks  Nicotine replacement treatments Gum, patches, or inhalers Gum, patches, or inhalers Reduce craving for nicotine Reduce craving for nicotine Combining patch with antidepressants (Wellbutrin) improved success rate Combining patch with antidepressants (Wellbutrin) improved success rate © 2012 John Wiley & Sons, Inc. All rights reserved.

48  Detoxification central to treatment  Psychological treatments Desipramine and CBT showed effectiveness for cocaine use Desipramine and CBT showed effectiveness for cocaine use  CBT especially helpful for users with high dependence levels Contingency management Contingency management  Vouchers that can be traded for desirable goods are given to users who abstain Motivational interviewing or enhancement therapy Motivational interviewing or enhancement therapy  CBT plus solution focus therapy effective for alcohol and drug use Self-help residential homes Self-help residential homes  Non-drug environment  Group therapy  Guidance and support from former users © 2012 John Wiley & Sons, Inc. All rights reserved.

49  Heroin substitutes Synthetic narcotics Synthetic narcotics  Methadone, levomethadyl acetate, bupreophine  Used to wean heroin users from dependence  Opiate antagonists Naltrexone Naltrexone  Prevents feeling high © 2012 John Wiley & Sons, Inc. All rights reserved.

50  Often aimed at adolescents  Utilize some or all of the following elements: Enhancing self-esteem Enhancing self-esteem Social skills training Social skills training Peer pressure resistance training Peer pressure resistance training Parental involvement in school programs Parental involvement in school programs Warning labels on alcohol bottles Warning labels on alcohol bottles Education regarding alcohol impairment Education regarding alcohol impairment Testing for drugs and alcohol at school or work Testing for drugs and alcohol at school or work Correction of beliefs and expectations Correction of beliefs and expectations Inoculation against mass media messages Inoculation against mass media messages Peer leadership Peer leadership © 2012 John Wiley & Sons, Inc. All rights reserved.

51 Copyright 2012 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. © 2012 John Wiley & Sons, Inc. All rights reserved.


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