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

2. 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

3. 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

4. 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

5. 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 years old (alcohol-related automobile accidents)
Violence is associated with alcohol

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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)

15. 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) .