1. The Spectrum of Use and the Historical Context
Lecture 2
Chapter 1 & 2

2. Drugs Are Old
Drugs have been around since the dawn of time… Probably

3. Coming on the Scene Alcohol as early as 6400 years BC (Middle East)
Cannabis 3000 years BC (Middle East)
Opium 5000 BC (China)
Tobacco 100 BC (Mexico)
Coca 3000 BC
Cocaine Extracted 1855
Heroin 1874
MDMA (XTC) 1912
LSD 1938

12. Despite the Laws People Still Use

13. Does Use Mean Abuse?

14. The Spectrum of Use Use – Periodic non-problematic use
Misuse – Periodic Use
Abuse – A pattern of misuse
Dependence – Compulsive problematic use often with physiological dependence

15. Use Many drugs can be used relatively safely
Most people who use drugs do not develop problems, however this depends on the drug
Drugs are used for many reasons
Social
Religious
Coping
Experimentation

16. Misuse Periodic circumscribed negative consequences
College students and alcohol
“It only happened once.”
Sometimes the consequences are catastrophic

17. DSM-IV Abuse 1. Failure to fulfill major role obligations
2. Use in hazardous situations
3. Legal Problems
4. Use despite problems 17

18. DSM-IV Dependence 1. Tolerance 2. Withdrawal
3. Larger amounts/longer period than intended
4. Inability to, or persistent desire to, cut down
or control
5. A great deal of time spent obtaining, using, or
recovering
6. Important activities given up or reduced
7. Use despite problems caused or exacerbated by use 18

19. How Does One Move Through the Spectrum?

20. Public Health Model
Agent Factors – Properties of the drug or substance
Host Factors – Characteristics of the person
Environment Factors – Context/Situation

21. Perspectives on Substance-Related Disorders: An Overview (cont.)
Five Main Categories of Substances
Depressants – Result in behavioral sedation
Stimulants – Increase alertness and elevate mood
Opiates – Primarily produce analgesia and euphoria
Hallucinogens – Alter sensory perception
Other drugs of abuse – Include inhalants, anabolic steroids, medications

22. The Depressants: Alcohol Use Disorders
Psychological and Physiological Effects of Alcohol
Central Nervous system depressant
Affects several neurotransmitter systems
Specific target is GABA
Effects of Chronic Alcohol Use
Alcohol intoxication & withdrawal
Associated conditions – Dementia & Wernicke’s disease
Fetal alcohol syndrome

23. Alcohol: Some Facts and Statistics
In the United States
Most adults view themselves light drinkers or abstainers
Over 50% of the U.S. (> 12 years age) report current use
15 million Americans are alcohol dependent
Rates are highest among Caucasian & Native Americans
Males use and abuse alcohol more than females
Violence is associated with alcohol
Alcohol alone does not cause aggression

24. Stimulants: An Overview
Nature of Stimulants
Most widely consumed drug in the United States
Such drugs increase alertness and increase energy
Examples include amphetamines, cocaine, nicotine, and caffeine

25. Stimulants: Amphetamine Use Disorders
Effects of Amphetamines
Produce elation, vigor, reduce fatigue
Effects are followed by extreme fatigue and depression
DSM-IV-TR Criteria for Amphetamine Intoxication
Ecstasy and Ice
Produces effects similar to speed, but no “comedown”
2% of college students report using Ecstasy
Both drugs can result in dependence
Amphetamines stimulate CNS by
Enhancing release of norepinephrine and dopamine
Reuptake is subsequently blocked

26. Stimulants: Cocaine Use Disorders
Effects of Cocaine
Short lived sensations of elation, vigor, reduce fatigue
Blocks reuptake of dopamine
Highly addictive, but addiction develops slowly
DSM-IV-TR Criteria for Cocaine Intoxication and Withdrawal
Psychological symptoms
Physiological symptoms
Most Cycle Through Patterns of Tolerance and Withdrawal

27. Opioids: An Overview The Nature of Opiates and Opioids
Opiate – Narcotic like chemical in the opium poppy
Opioids – Substances that produce narcotic effects
Often referred to as analgesics (i.e., help relieve pain)
Examples include heroin, opium, codeine, and morphine
Effects of Opioids
Activate body’s enkephalins and endorphins
Low doses – Euphoria, drowsiness, and slow breathing
High doses can be fatal
Withdrawal symptoms can be lasting and severe

28. Other Drugs of Abuse: Designer Drugs
Drugs produced by pharmaceutical companies for diseases
Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples
All heighten auditory and visual perception (taste and touch)
Popular in nightclubs, raves, or large social gatherings
All designer drugs can produce tolerance and dependence

29. Causes of Substance-Related Disorders: Family and Genetic Influences
Results of Family, Twin, and Adoption Studies
Substance abuse has a genetic component
Much of the focus has been on alcoholism
Genetic differences in alcohol metabolism
Multiple genes are involved in substance abuse

30. Causes of Substance-Related Disorders: Neurobiological Influences
Results of Neurobiological Research
Drugs affect the pleasure or reward centers in the brain
The pleasure center – Dopamine, midbrain, frontal cortex
GABA turns off reward-pleasure system
Inhibition of neurotransmitters for anxiety / negative affect

31. Causes of Substance-Related Disorders: Psychological Dimensions
Role of Positive and Negative Reinforcement
The self-medication and the tension reduction hypotheses
Substance abuse as a means to cope with negative affect
Opponent-Process Theory
Why the crash after drug use fails to stop drug use
Role of Expectancy Effects
Expectancies influence drug use and relapse

32. Causes of Substance-Related Disorders: Social and Cultural Dimensions
Exposure to Drugs is a Prerequisite for Use of Drugs
Media, family, peers
Parents and the family appear critical
Societal Views About Drug Abuse
Sign of moral weakness – Failure of self-control
Sign of a disease – Caused by underlying processes
The Role of Cultural Factors
Influence the manifestation of substance abuse

33. An Integrative Model of Substance-Related Disorders
Exposure or Access to a Drug
Is necessary, but not sufficient for abuse and addiction
Drug Use Depends on Social and Cultural Expectations
Drugs Are Used Because of their Pleasurable Effects
Drugs Are Abused for Reasons that are More Complex
The premise of equifinality
Stress may interact with psychological, genetic, social, and learning factors

35. From A Psychological Standpoint
Drug abuse and dependence are disorders of behavior
Not only do each have health implications, abuse and dependence have extreme psychosocial implications
People make changes in their alcohol/drug abuse behavior in the same way they make changes in all other behaviors
Much alcohol and drug abuse/dependence is related to psychopathology
Most people stop on their own

36. Substance Abuse Treatment
“Self-Help” (AA NA CA Rational Recovery)
Psychosocial Interventions
Medications

37. Self-Help 12 Step Fellowships
Alcoholics Anonymous Narcotics Anonymous
View of Problem: Spiritual disease
Tools: 12 steps to recovery
Mechanism: Powerful social support
Issues: Effective for those who stick. Can be difficult to stick

38. Psychosocial Interventions
Behavioral and Cognitive Behavioral
View of Problem: Behavioral disorder.
Tools: Functional analysis, contingency management and cognitive interventions as well as relapse prevention
Mechanisms: Skills improvement, attitude change, coping w/psychopathology
Issues: Highly researched treatments. Very effective. Not sure how they work actually.

39. Psychosocial Interventions
Motivational Interviewing
Alternative to confrontational approach
Designed to move individual through stages of change
Brief (1-4 sessions)
Effective as stand-alone and a booster to treatment

40. Pharmacotherapy Alcohol Dependence Drug Dependence Antabuse Naltrexone
Methadone & Naltrexone (Heroin)
Antidepressants (Cocaine)
Cocaine vaccine?????

41. Outcome Abstinence vs. Harm Reduction AA/NA, CBT, MI are all effective
Meds can be as well
Stage-matched interventions
The longer people stick the better they do
Most often takes multiple treatments
Social support after treatment is critical
Treatment works better than jail in the short and long run