CHAPTER 13 SUBSTANCE-RELATED DISORDERS

SUBSTANCE-USE DISORDERS Problems associated with using and abusing drugs like alcohol, cocaine, and heroin, which alter the way people think, feel, and behave. Substance dependence Maladaptive pattern of substance use that leads to clinically significant impairment or distress Substance abuse Recurrent and significant adverse consequences related to substance use

SUBSTANCE DEPENDENCE Tolerance Withdrawal Ingestion of more than intended Persistent desire or unsuccessful effort to use less Spending a lot of time on obtaining, using, or recovering from the substance Reduced social, occupational, or recreational activities due to use of substance Continued use despite knowledge of the psychological and/or physical problems caused Presence of 3 or more of the above in a 12-month period

SUBSTANCE ABUSE Recurrent substance use leading to failure to fulfill work, school, home obligations Recurrent substance use in hazardous situations, like driving Recurrent substance-related legal problems, like arrests Continued substance use despite persistent social or interpersonal problems caused by using the substance, such as getting in fights The presence of three or more of the above within a 12-month period

SUBSTANCE INTOXICATION Disturbances of perception wakefulness attention thinking judgment motor behavior interpersonal behavior Level of intoxication depends on the substance the dose history of use person’s tolerance person’s expectation of use environment or setting in which substance is ingested

ALCOHOL-RELATED DISORDERS Ethyl alcohol, or ethanol, is the alcohol in beer, wine, hard liquor Alcohol blocks messages between nerve cells First affects frontal lobes where reasoning, memory, judgment, and inhibitions take place Next affects cerebellum, seat of motor and muscle control, balance, five senses Finally affects the spinal cord and medulla, which governs breathing, heart rate, and body temperature BAC of 0.5% or more can lead to death

ALCOHOL USE AND RISK 70% of Americans drink occasionally 21- to 34-year olds drink the most Half of all alcohol is consumed in binge sprees (5 or more drinks at a time) Alcohol use in US implicated in 40% of traffic fatalities 50% of deaths from falls 52% of fire-related deaths 38% of drowning deaths 20% of health-related expenditures

THEORIES OF ALCOHOL DISORDERS Biological Metabolic, genetic, and neural processes Psychodynamic Effort to change negative emotional states Behavioral Learned from modeling and social reinforcement Cognitive Expectations about effects of alcohol Interactional Stress precipitates use in people with predisposition to use

TREATMENT OF ALCOHOL DISORDERS Biological Drug Management of withdrawal symptoms Psychodynamic Psychotherapy provides little benefit unless family contexts of drinking explored Cognitive-behavioral Aversive conditioning Covert sensitization Controlled drinking Relapse prevention Community-based treatment Alcoholics Anonymous most widely used

ALCOHOL-RELATED DISORDERS: RISK FACTORS Poverty Neighborhood disorganization Childhood behavior problems Poor family management practices Family conflict Lack of family cohesion Academic failure Social pressure to use Alienation and rebelliousness Rejection by peers

OTHER DRUGS Barbiturates Tranquilizers Opioids Cocaine Amphetamines Hallucinogens Phencyclidine (PCP) Inhalants Cannabis Nicotine Caffeine

BARBITURATES AND TRANQUILIZERS Depressing effect on central nervous system Dangerous in combination with alcohol Barbiturates often prescribed to relieve anxiety and prevent convulsions Tranquilizers can lead to tolerance and thus overuse

OPIOIDS Drugs with morphine-like effect that bind to brain’s opioid receptors Sometimes called narcotics Heroin and morphine most commonly used Endorphins, enkephalins, and polymorphins are body’s endogenous opioids Cause change in mood, sleepiness, mental clouding, constipation, slow respiratory system Withdrawal can be severe Methadone maintenance is most widely used treatment

COCAINE From leaves of coca bush Stimulates central nervous system and decreases appetite Can produce mania, paranoia, and impaired judgment Crack is more potent form and is highly addictive Treatment focuses on self-help and social support (AA-type programs)

AMPHETAMINES Psychomotor stimulants Affect central nervous system and cardiovascular system Moderate use Wakefulness, alertness, elevated mood High dosage Nervousness, dizziness, confusion, elevated blood pressure Tolerance develops rapidly Methamphetamines Chemically similar but has greater impact on central nervous system

HALLUCINOGENS Also known as psychedelics Central nervous system action produces alterations in consciousness Natural hallucinogens Mescaline Psilocybin Synthetic hallucinogens STP LSD Abuse leads to respiratory or cardiovascular collapse and psychotic behavior Treatment consists of support groups of enhancing social skills

PHENCYCLIDINE (PCP) Synthetic chemical Causes disorientation and hallucination User may feel dissociated Users may develop severe depression or psychosis Effects may be irreversible

INHALENTS Volatile substances or organic solvents (gasoline, spray paint) Produce changes in perception Use may lead to withdrawal from social, occupational, or recreational activities More commonly used by young people Use can lead to dependence with tolerance and withdrawal symptoms

CANNABIS Most often used in marijuana form Hashish is the solidified resin of the cannabis plant Major active ingredient in cannabis is THC Marijuana use Impairs motor coordination and perception Affects short-term memory and learning Treatment Relapse prevention Social support groups

NICOTINE Chemical found in tobacco Stimulates acetylcholine receptors Increases heart rate and blood pressure Can be highly addictive Cessation requires commitment to change implementation of change relapse prevention Nicotine gum and patch may be helpful if used with counseling.