1. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Disorders – Focus on Alcoholism

2. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance Abuse A substance is any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors.

3. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Conditions Recognized by the DSM-IV-TR Substance intoxication: Experience of significant maladaptive behavioral and psychological symptoms due to the effect of a substance on the central nervous system. Substance withdrawal: Experience of clinical significant distress in social, occupational, or other areas of functioning due to the cessation or reduction of substance use.

4. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Substance-Related Conditions Recognized by the DSM-IV-TR, continued Substance abuse: Diagnosis given when recurrent substance use leads to significant harmful consequences. Substance dependence: Diagnosis given when substance use leads to physiological dependence or significant impairment or distress.

5. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Abuse One or more of the following occurs during a 12- month period, leading to significant impairment or distress: 1.Failure to fulfill important obligations at work, home, or school as a result of substance abuse. 2.Repeated use of the substance in situations in which it is physically hazardous to do so. 3.Repeated legal problems as a result of substance use. 4.Confirmed use of the substance despite repeated social or legal problems as a result of use.

6. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Dependence Maladaptive pattern of substance use, leading to three or more of the following: 1. Tolerance, as defined by either: the need for markedly increased amounts of the substance to achieve intoxication or desired effect; markedly diminished effect with continued use of the same amount. 2. Withdrawal, as manifested by either: the characteristic withdrawal syndrome for the substance; the same or closely related substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended.

7. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 DSM-IV-TR Criteria for Substance Dependence, continued 4. There is a persistent desire or unsuccessful efforts to cut back or control use. 5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by the substance.

8. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Biological Theories Turning on the pleasure circuit – Addictive drugs as different as cocaine, marijuana, nicotine, and alcohol all seem to affect the “reward circuit” – Dopamine is key

9. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Repeated drug exposure changes brain function. (PET) images are illustrated showing similar brain changes in dopamine receptors resulting from addiction to different substances. The striatum (which contains the reward and motor circuitry) shows up as bright red and yellow in the controls (in the left column), indicating numerous dopamine D2 receptors. Conversely, the brains of addicted individuals (in the right column) show a less intense signal, indicating lower levels of dopamine D2 receptors. Drugs hijack the brain

10. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Biological Theories Genetic Factors – Collaborative Study on the Genetics of Alcoholism (COGA) began in 1989 (play Itunes interview with Laura Jean Bierut Science Talk 3/28/07) – Family history, adoption, and twin studies all suggest that genetics may play a substantial role in at least some forms of addiction. – Genes ALDH1 codes an enzyme which breaks down acetaldehyde. People with a slow-metabolizing gene variant have a decreased risk, by up to sixfold, for alcoholism. Asian populations (e.g., 44% of Japanese, 53% of Vietnamese) are much more likely to have this gene variant. Other genes (next slide)

11. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17

12. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17

13. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Behavioral and Cognitive Theories Children and adolescents learn alcohol-related behaviors from the modeling of their parents and important others in their culture. Early use of drugs predicts addiction. People who expect alcohol to reduce their distress and who do not have other, more adaptive means of coping available to them are more likely than others to drink alcohol when they are upset and are more likely to have social problems related to drinking.

14. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 PsychoSocioCultural Approaches Childhood trauma is a risk factor. Chronic stress combined with an environment that supports and even promotes the use of substances as an escape is a recipe for widespread substance abuse and dependence. Substance use, particularly alcohol use, is much more acceptable for men than for women in many societies.

15. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Treatment Approaches Handout (NIDA principles of effective treatment) Combination of therapies (evidence-based) Medications – disulfiram (Antabuse) – acamprosate (seems to quiet the glutamate system and improve abstinence rates) – naltrexone (opioid receptor antagonist, which also seems to reduce craving for alcohol) – topiramate (experimental -- appears to enhance early abstinence, stabilize mood and anxiety symptoms, and promote long-term abstinence) – antidepressants

16. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 17 Treatment Approaches Psychosocial approaches – CBT – Stress management – Relapse prevention (identifying triggers)