Chapter 11 Substance-Related Disorders ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 11 Substance-Related Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Addictive behavior Introduction Behavior based on pathological need for substance or activity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Examples of abuse of substances Nicotine Alcohol Barbiturates Tranquilizers Amphetamines Heroin Ecstasy Marijuana

Introduction Substance abuse generally involves pathological use of substance resulting in Potentially hazardous behavior Continued use despite persistent social, psychological, occupational, or health problem Physiological need for increasing amounts of a substance © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Alcohol Abuse and Dependence Alcoholic Person with serious drinking problem whose drinking impairs health, personal relationships, and occupational functioning Alcoholism Dependence on alcohol that seriously interferes with life adjustment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Prevalence, Comorbidity, and Demographics of Alcohol Abuse and Dependence Alcohol abuse cuts across all age, educational, occupational, and socioeconomic boundaries Lifetime prevalence for alcohol abuse in U.S. is 13.4% More than 37% of alcohol abusers suffer from at least one coexisting mental disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Clinical Picture of Alcohol-Related Disorders At higher levels, alcohol depresses brain functioning At lower levels, alcohol stimulates certain brain cells and activates brain’s “pleasure areas” Alcohol has complex and often contradictory effects on the brain © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Clinical Picture of Alcohol-Related Disorders Excessive drinking progression of alcohol-related disorder Early stage Middle stage Late-stage © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Clinical Picture of Alcohol-Related Disorders Physical effects of chronic alcohol use Stomach pains Malnutrition Cirrhosis of liver © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Clinical Picture of Alcohol-Related Disorders Psychosocial effects of alcohol abuse and dependence Chronic fatigue Oversensitivity Depression Impaired reasoning Personality deterioration Several acute psychotic reactions fit the diagnostic classification of substance-induced disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Causal Factors in the Abuse of and Dependence on Alcohol esocorticolimbic dopamine pathway Center of psychoactive drug activation in brain Let’s take a closer look! © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 11.1: The Mesocorticolimbic Pathway © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Causal Factors in the Abuse of and Dependence on Alcohol Genetics Learning factors Genetics probably play an important role in developing sensitivity to the addictive power of drugs like alcohol Learning factors appear to play an important role in the development of substance abuse © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosocial Causal Factors in Alcohol Abuse and Dependence Take three minutes to see how many characteristics of potential alcohol abusers you can list. Potential alcohol abusers tend to Have parents who are negative role models Be emotionally immature Expect a great deal of the world Require an inordinate amount of praise and appreciation React to failure with marked feelings of hurt and inferiority Have low frustration tolerance Feel inadequate and unsure of their abilities to fulfill expected male or female roles Tend to be unable or unwilling to tolerate tension and stress Expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life Show greater drinking following sadness or hostility with less intimate and supportive relationships © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Causal Factors Religion Geographic location The incidence of alcoholism is minimal among Muslims and Mormons, whose religious views prohibit the use of alcohol The incidence of alcoholism is high among Europeans (15% in France) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Alcohol-Related Disorders Medications to block desire to drink Medications to lower side effects of acute withdrawal Biological approaches Biological approaches include: Medications to block the desire to drink Antabuse Naltrexone Medications to lower the side effects of acute withdrawal Valium © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Alcohol-Related Disorders Group therapy Environmental intervention Behavioral and cognitive-behavioral therapy Psychological treatment approaches © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Alcohol-Related Disorders Controlled drinking rather than abstinence Alcoholics Anonymous Other approaches © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatment of Alcohol-Related Disorders Success rates of alcoholism treatments “Project MATCH” success rates Motivational enhancement therapy success Relapse prevention programs Success of alcoholism treatments range from low rates for hardcore substance abusers to rates of 70-90% when modern treatment procedures are used “Project MATCH” found equal success rates among the following treatments: A 12-step program A CBT program Motivational enhancement therapy Relapse prevention programs attempt to maintain abstinence once the behavioral excesses have been checked © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Drug Abuse and Dependence Psychoactive drugs most commonly associated with abuse and dependence Narcotics Sedatives Stimulants Anti-anxiety drugs Pain medications Hallucinogens Caffeine and nicotine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Opium and Its Derivatives (Narcotics) Morphine Heroin These drugs were originally praised for their medical uses, but they are dangerously addictive © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Opium and Its Derivatives (Narcotics) Immediate effects of narcotics Alleviation of physical pain Relaxation and pleasant reverie Alleviation of anxiety and tension Euphoric spasm © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Opium and Its Derivatives (Narcotics) Long-term effects Physiological craving for the drug Withdrawal symptoms Gradual deterioration of well-being © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Opium and Its Derivatives (Narcotics) Other characteristics Endorphins Antisocial personality Narcotics subculture Some investigators have suspected that endorphins play a causal role A high incidence of antisocial personality has been found among heroin addicts In the U.S., addiction is associated with a narcotics subculture © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Opium and Its Derivatives (Narcotics) Treatment Initially similar to that for alcohol addiction Methadone and buprenorphine program Methadone and buprenorphine are often used in conjunction with a rehabilitation program © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cocaine and Amphetamines (Stimulants) Increase feelings of alertness and confidence Decrease feelings of fatigue © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cocaine and Amphetamines (Stimulants) Long-term amphetamine use Psychologically and physically addictive May result in brain damage and psychopathology © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Methamphetamine Highly addictive stimulant drug Increases level of dopamine in brain Known by some as “poor people’s cocaine” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Methamphetamine Rate, prolonged use, and treatment Substantial increased use in last 10 years Structural changes in brain with prolonged use Treatment resistant to treatment; relapse common © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Barbiturates (Sedatives) Central nervous system depressants that are similar to depressant effects of alcohol Once widely used to induce sleep © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Barbiturates (Sedatives) Barbiturate use outcomes Physiological and psychological dependence Lethal overdoses © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Barbiturates (Sedatives) Barbiturate users and withdrawal Dependence tends to be middle-aged people Withdrawal is a key treatment issue Dependence tend to be middle-aged people who rely on them as sleeping aids © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hallucinogens: LSD and Related Drugs Diverse group of drugs that cause alteration in perception, thought, or mood Cause individual to see or hear things in different and unusual ways © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hallucinogens: LSD and Related Drugs Mescaline Psilocybin Ecstasy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Ecstasy Chemically similar to methamphetamine Hallucinogen and stimulant Chemically similar to methamphetamine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Ecstasy results and popularity “Rush” and well-being AND serious adverse consequences Increasingly popular among young adults Increasingly popular as a party drug among young adults © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Classified as mild hallucinogen Marijuana Marijuana Classified as mild hallucinogen © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Effects Marijuana Euphoria Increased feelings of well-being Heightened perceptual acuity Relaxation Hallucination Effects Euphoria Increased feelings of well-being Heightened perceptual acuity Relaxation Hallucination © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychological treatment methods Marijuana Treatment Psychological treatment methods Psychological treatment methods have been shown to be effective in reducing use in dependent adults © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Stimulants: Caffeine and Nicotine Easy to abuse Readily available Addictive properties Difficult to quit Withdrawal symptoms Health problems and side effects Problematic for many reasons © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Pathological Gambling Similar to chemical addiction in several ways Personality factors Difficulties attributable to compulsive gambling Treatment problems Although pathological gambling does not involve a chemically addictive substance, it is similar in the following ways: The personality factors that tend to characterize addictive gamblers The difficulties attributable to compulsive gambling The treatment problems involved © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues Is the use of methadone effective in the treatment of heroin, or does it simply exchange one addiction for another? What other approaches are being evaluated? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.