Substance Use Disorders IV (Chapter 11) April 9, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

Disease model of alcoholism Twelve step treatment From Last Class

Twelve Step treatment critical analysis: go go Jgk&feature=related Jgk&feature=related oY oY Twelve Steps of Alcoholics Anonymous

Exam Review Chapter 7 (Mood Disorders) Major depressive and manic episodes Nature, causes, and treatment of: Major depressive disorder Bipolar disorder Suicide 15 questions from this section

Exam Review Chapter 8 (Eating Disorders) No questions on Sleep Disorders Anorexia Bulimia Causes Treatment 9 questions form this section

Exam Review Chapter 11 (Substance-Related Disorders) No questions on Impulse Control Disorders Substance abuse and dependence Alcohol: effects, cultural patterns, disease model Addictive properties of different substances Properties and effects of different substances Treatments 16 questions from this section

Addictive Properties of Common Drugs

Which of the following drugs is most addictive? 1. Nicotine 2. Heroin 3. Cocaine 4. Alcohol 5. Caffeine 6. Marijuana Drug Addictiveness

Addictive Properties of Common Drugs

Sedative, Hypnotics, & Anxiolytics Stimulants Opioids Hallucinogens Other Drugs of Abuse Brief Review of Different Substances

Sedative, Hypnotic, or Anxiolytic Substance use Disorders Drugs in this class Sedatives – calming (e.g., barbiturates) Hypnotic – sleep inducing Anxiolytic – anxiety reducing (e.g., benzodiazepines)

Sedative, Hypnotic, or Anxiolytic Substance use Disorders Effects similar to large doses of alcohol Synergistic effect when combined with alcohol Adverse effects Dependence, tolerance, withdrawal, overdose

Stimulants Nature of stimulants Most widely consumed class of drug in the US Drugs increase alertness and increase energy Examples include amphetamines, cocaine, nicotine, and caffeine

Stimulants: Amphetamines Used for all-nighters, weight control, and high Effects: Elation, vigor, reduce fatigue Followed by extreme fatigue and depression Prescription stimulants (for ADHD) increasing becoming drugs of abuse The NY Times: When Stimulants Are Bad times-when-stimulants-are-bad/ times-when-stimulants-are-bad/

Stimulants: Nicotine Approximately 25% of Americans smoke Effects: Stress relief, relaxation, wellness, pleasure Withdrawal: depression, insomnia, irritability, anxiety, increased appetite Highly addictive and extremely difficult to quit Cues that elicit urges to smoke are ubiquitous Users dose themselves frequently

Stimulants: Caffeine Used regularly by 90% of Americans Effects of the “gentle” stimulant Found in tea, coffee, cola drinks, and cocoa products Small doses elevate mood and reduce fatigue Regular use can result in tolerance and dependence

Opioids: An Overview Opiate – narcotic-like chemical in opium poppy Examples: heroin, opium, codeine, and morphine Effects: Pain relief, euphoria, drowsiness, slowed breathing High doses can be fatal Withdrawal symptoms can be lasting and severe Elevates risk for HIV High mortality rates for addicts

Hallucinogens: An Overview Substances that alter perceptions of the world Examples: Marijuana, LSD Effects: Delusions, paranoia, hallucinations, and/or altered sensory perception

Hallucinogens: Marijuana Active chemical is tetrahydrocannabinol (THC) Effects: Heightened sensory experiences, mood swings, paranoia, hallucinations Varies greatly from person to person Minimal tolerance, withdrawal, dependence Medicinal uses and controversies

Hallucinogens: LSD Derivative of ergot fungus Effects: Perceptual changes, depersonalization, hallucinations Very rapid tolerance Withdrawal symptoms are rare Can produce psychotic reactions Interesting historical note: LSD and the Salem Witch Trials of 1692

Other Drugs of Abuse: Steroids “My lawyers have advised me that I cannot answer these questions without jeopardizing my friends, my family and myself.” -Mark McGwire

Other Drugs of Abuse: Steroids "I did take a banned substance. And for that, I am very sorry and deeply regretful.“ -Alex Rodriguez

Other Drugs of Abuse: Steroids Synthesized from testosterone Legitimate medical uses: asthma, anemia, breast cancer, men with inadequate sexual development Used illegally to increase body mass Do not produce a high Long-term mood disturbances and physical problems

Exposure/access to drug is necessary, but not sufficient, for abuse and addiction Use depends on social and cultural expectations Drugs are used because of pleasurable and/or reinforcing effects Reasons for drug abuse are complex Causes of Substance-Related Disorders

Biological Influences Drugs affect the pleasure or reward centers in the brain Biological changes occur with repeated drug use Unlike substance use, substance abuse and dependence has a genetic component

Psychological Influences Positive and negative reinforcement Pleasurable effects Self-medication (cope with negative affect) Expectancy effects Expectancies influence drug use and relapse

Social and Cultural Influences Exposure to drugs is a prerequisite for use Media, family, peers Parents and the family appear critical Cultural factors Influence the manifestation of substance use and abuse

Social and Cultural Influences The importance of context 42% of Vietnam war soldiers used heroin Half became dependent in Vietnam Three years after returning home, only 12% were still using heroin

Social and Cultural Influences Societal views about drug abuse Moral weakness Biological disease model (Twelve Steps) “War on drugs”

American Culture and Drug Use Assumptions of America’s “War on Drugs” 1. Illicit drug use is bad. How bad? Criminal OffenseAverage Prison Sentence Murder/manslaughter153 months Drugs 78 months Rape 67 months Burglary 51 months Aggravated Assault 50 months Source: U.S. Bureau of Justice Statistics

War on Drugs 2. Illicit drug use is unhealthy, uncontrollable, and addictive 3. Prevention and treatment programs work Project DARE Lynam et al. (1999) 10-year follow-up of 1, year olds Received either DARE or standard drug ed Long-term outcomes

American Cultural and Drug Use 4. People are unable to choose whether or not to take drugs or to regulate their use Thus, prohibition is necessary 5. There is an end to the drug war When is it over exactly?

Biological Treatments Agonist substitution Substitute safer drug with similar chemical composition Examples – methadone, nicotine gum/ patch Antagonistic treatment Blocks or counteracts pleasurable drug effects Examples - naltrexone for opiate and alcohol problems

Biological Treatments Aversive treatment Makes drug use extremely unpleasant Examples - Antabuse for alcoholism Efficacy of biological treatment Largely ineffective when used alone

Psychosocial Treatment Inpatient vs. outpatient care Comparable efficacy, not cost Controlled use (Sobell study) Project MATCH Compared 12 sessions of twelve step facilitation and CBT, and 4 sessions of motivational enhancement No differences in outcome No control group

Psychosocial Treatment Community support programs Alcoholics Anonymous and related groups Extremely popular but little evidence of benefits From a 2006 literature review: “No experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-Step approaches for reducing alcohol dependence or problems.”

Interventions Confrontation by family and friends Element of surprise, often humiliating Intended to break down “denial” and persuade client to enter treatment Confronts individuals with “cataclysmic consequences” if they do not enter treatment

Interventions Miller and Sovereign (1989) Two groups: 1) confrontational strategies 2) client-centered motivational interviewing Clients in confrontational group exhibited MORE resistance to treatment than in client-centered group and were more likely to be drinking a year later G. Alan Marlatt, Ph.D: “Once you have the person on board and involved and you have a good continued care program, things will happen in a good way. But if you say, ‘Do this or else,’ you take away a person’s choice and the consequences are negative.”

Analysis of Intervention Programs Not empirically supported Studies show high rate of entry into treatment following an Intervention, but: High rate of dropout Higher relapse following treatment (Loneck, Garrett, & Banks 1996)