Chapter 11 Substance-Related, Addictive, & Impulse-Control Disorders

Perspectives on Substance-Related Disorders Use and abuse of psychoactive substances Wide-ranging physiological, psychological, and behavioral effects Associated with impairment and significant costs LEVELS OF INVOLVEMENT Substance use vs. substance intoxication Substance abuse vs. substance dependence (i.e. addiction) Tolerance vs. withdrawal – physiological reactions Drug-seeking behaviors – psychological dependence

Six Main Categories of Substances Depressants Behavioral sedation Stimulants Increase alertness and elevate mood Opiates Produce analgesia and euphoria Hallucinogens Alter sensory perception Other drugs of abuse Include inhalants, anabolic steroids, medications Gambling Disorder

The Depressants: Alcohol Related Disorders Central Nervous system depressant Influences several neurotransmitter systems Average person can metabolize 1 drink per hour Specific target is GABA Affects glutamate and serotonin systems Effects of Chronic Alcohol Use - severe Alcohol intoxication and withdrawal Withdrawal delirium (or DTs) Associated brain conditions – Dementia & Wernicke’s disease Fetal alcohol syndrome

Statistics on Alcohol Most adults consider themselves light drinkers or abstainers Over 50% of the U.S. (> 12 years age) report current use Alcohol use is highest among Whites & Native Americans; lowest amongst Asians Males use and abuse alcohol more so than females >3 million Americans are alcohol dependent Oldest and most widely used drug Leading cause of death amongst Americans 15-24 years old (alcohol-related automobile accidents) Violence is associated with alcohol

Depressants: Sedative, Hypnotic, or Anxiolytic-Related Disorders Sedatives – Calming (e.g., barbiturates) Hypnotic – Sleep inducing Anxiolytic – Anxiety reducing (e.g., benzodiazepines) Effects Are Similar to Large Doses of Alcohol Combining such drugs with alcohol is synergistic & dangerous All Exert Their Influence via the GABA Neurotransmitter System Barbiturate use declined, benzodiazepine use increased

Stimulants: Amphetamine Use Disorders Produce elation, vigor, reduce fatigue Such effects are followed by extreme fatigue & depression Physiological symptoms: heart rate & blood pressure changes, chills, vomiting, etc. Ecstasy (MDMA) and Ice (Crystal Meth) -Produces effects similar to speed, but without the crash -Both drugs have a high risk of dependence Amphetamines stimulate CNS by enhancing release of norepinephrine and dopamine Reuptake is subsequently blocked

Stimulants: Cocaine Use Disorders Effects of Cocaine Short lived sensations of elation, vigor, reduce fatigue Effects result from blocking the reuptake of dopamine Highly addictive, but addiction develops slowly Casual use of the drug has declined over time Most Cycle Through Patterns of Tolerance & Withdrawal http://www.druginfo.adf.org.au/images/cocaine_coca_leaves.jpg

Stimulants: Tobacco Use Disorders Results in sensations of relaxation, wellness, pleasure DSM-5 Criteria for Tobacco Withdrawal: depressed mood, insomnia, irritability, etc. Stimulates nicotinic acetylcholine receptors in CNS Depression occurs more in those with nicotine dependence Highly addictive More than 3 million die each year in smoking related causes More women die of lung cancer than breast cancer

Stimulants: Caffeine-Related Disorders Effects of - The “Gentle” Stimulant Used by over 90% of Americans Found in tea, coffee, cola drinks, and cocoa products Small doses elevate mood and reduce fatigue Regular use can result in tolerance and dependence Caffeine blocks the reuptake of the neurotransmitter adenosine & serotonin

Opioids: Types and Effects Opiate – Natural chemical in the opium poppy with narcotic effects Opioids – Natural and synthetic substances with narcotic effects (includes heroin, opium, codeine, and morphine) Often referred to as analgesics Induce euphoria, drowsiness, and slowed breathing Withdrawal symptoms can be lasting and severe High risk for HIV infection High doses can result in death Activate body’s natural opioid system (i.e. endorphins)

Hallucinogens: Marijuana and LSD Cannabis (Marijuana): Active chemical is tetrahydrocannabinol (THC) Symptoms - mood swings, paranoia, hallucinations Impairment in motivation not uncommon Withdrawal and dependence are uncommon LSD is one of the most common hallucinogenic drugs Others include: psilocybin (mushrooms) & mescaline Tolerance is rapid and withdrawal symptoms are uncommon DSM-5 Criteria for Marijuana and Hallucinogen Intoxication Can produce psychotic delusions and hallucinations Psychological and physiological symptoms are similar

Treatment of Substance-Related Disorders MOTIVATION Treatment is difficult Admitting the problem Motivation to work on the problem Prognosis is not positive GOALS Withdrawal process Abstinence Keep intake to a minimum if using Preventing exposure

Biological Treatment of Substance-Related Disorders Detoxification – best in hospital setting; 50% relapse Agonist Substitution Safe drug with a similar chemical composition as the abused drug Examples include methadone and nicotine gum or patch Antagonist Treatment -- block or counteract the effects of drugs (i.e. Naltrexone for alcohol) Aversive Treatment Drugs that make use of substances extremely unpleasant (i.e. Antabuse for alcohol)

Psychosocial Treatment of Substance-Related Disorders Inpatient vs. Outpatient Care Little difference in effectiveness Community Support Programs Alcoholics Anonymous (AA) and related groups (e.g., NA) Seem helpful and are strongly encouraged Balancing Treatment Goals Controlled use vs. complete abstinence Many substance abusers are comorbid for other psychological disorders as well (i.e. dual diagnosis) .