Chapter 10 Substance Related Disorders
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Abnormal Psychology, Eleventh Editionby Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson
Chapter 10 Substance Related Disorders
+ Percentage of Indonesian Population Reporting Drug Use in 2003-2006 (Based on BNN survey)
Jakarta : 23%
Medan : 15%
Bandung : 14%
Surabaya : 6.3 %
Maluku utara : 4.3 %
Padang : 5.5 %
Kendari : 5%
Marijuana : 74.9 %
Anti-Depressant : 32.5 %
Ecstasy : 25.7 %
Amphetamine : 21.5 %
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Based on areas Based on substance
+Substance Dependence and Abuse
Occupational or social problems, much time trying to obtain substance, continued use despite problems, etc.
Involves either tolerance or withdrawal Tolerance
Greater amounts required to produce desired effect
Withdrawal Physiological and psychological
consequences when individual discontinues or reduces substance use Restlessness, anxiety,
cramps, death
Maladaptive use of substance No physiological dependence
In 2006, 22 million met criteria for dependence or abuse. Of those 15 million involved
alcohol.
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Dependence ( Adiction) Abuse
+Alcohol Dependence and Abuse
Alcohol abuse Negative social and occupational effects No tolerance, withdrawal, or compulsive usage
Alcohol Dependence More severe symptoms such as tolerance and withdrawal Withdrawal results in:
Anxiety Depression Weakness Restlessness Insomnia Muscle tremors
Face, fingers, eyelids, other small musculature Elevated BP, pulse, temperature
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+Alcohol Abuse and Dependence
Delirium tremens (DTs)Can occur when blood alcohol levels drop
suddenlyResults in:
Deliriousness Tremulousness Hallucinations
Primarily visual; may be tactile
2.5% of alcohol abusers develop dependence
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+Alcohol Abuse and Dependence
Polydrug abuse Many users abuse multiple substances
e.g., cigarettes, cocaine, marijuana 85% of alcohol are smokers
Synergistic Some combinations of drugs produce stronger
reaction Alcohol and barbiturates
May cause death Alcohol and heroin
Alcohol reduces amount of heroin needed to produce lethal dose
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+Prevalence of Alcohol Abuse
Lifetime prevalence (Kessler et al., 1994) 20% for men 8% for women
Lifetime prevalence: Abuse - 17% Dependence – 12%
Binge drinking 5 drinks in short period 43.5% prevalence among college students
Heavy use drinking 5 drinks, 5 or more times in a 30 day period
17.6% prevalence among college students
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+Short-term Effects of Alcohol
Enters the bloodstream through small intestine metabolized by the liver
Effects vary by concentration Concentration varies by gender, height,
weight, liver efficiencyAffects brain areas associated with error monitoring and
decision making.
Biphasic effect Initially stimulates Later depresses
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+Short-term Effects of Alcohol
Effect of ingesting large amounts Impaired speech and vision Interference in complex thought processes Poor coordination Loss of balance Depression and withdrawal
Interacts with several neural systems Stimulates GABA receptors Increases dopamine and serotonin Inhibits glutamate receptors
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+Long-term Effects of Alcohol
Malnutrition Alcohol interferes with digestion
and absorption of vitamins from food
Deficiency of B-complex vitamins Amnestic syndrome
Severe loss of memory for both long and short term information
Cirrhosis of the liver Liver cells engorged with fat and
protein impeding functioning Cells die triggering scar tissue
which obstructs blood flow
Damage to endocrine glands and pancreas
Heart failure
Erectile dysfunction
Hypertension
Stroke
Capillary hemorrhages Facial swelling and redness,
especially in nose
Destruction of brain cells Especially areas important to
memory
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+Fetal Alcohol Syndrome
Heavy alcohol intake during pregnancy Fetal growth slowed
Cranial, facial and limb anomalies occur
Moderate alcohol intake 1 drink per day Learning and memory impairments Growth deficits
Total abstinence recommended by NIAAA
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+Nicotine and Cigarette Smoking
Nicotine Addicting agent of tobacco Principal alkaloid
Active chemicals that give drugs their physiological and psychological altering properties
Stimulates dopamine neurons in mesolimbic area Involved in reinforcing effect
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+Prevalence and Health Consequences Prevalence decreased since mid 1960s although use
increased through the 1990s, among white adolescents
More prevalent among white & Hispanic youth than African Americans African Americans less likely to quit and more likely to get
lung cancer Metabolize nicotine more slowly
Chinese Americans have lower lung cancer rates Metabolize less nicotine
More prevalent among men than women Exception: 12 to 17 year olds
Secondhand smoke (ETS, environmental tobacco smoke) Higher levels of ammonia, carbon monoxide nicotine and tar Causes 40,000 deaths per year in US
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+Marijuana
Drug derived from dried and ground leaves and stems of the female hemp plant (Cannibis sativa)
Hashish Stronger than marijuana Produced by drying the resin exudate of the tops
of plants
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+Prevalence
Most frequently used illicit drug in US 15,000,000 reported using it in 2006
Peaked in 1979 then began to decline Rose again in 90s
Greater use by men than women although rates among women increased faster in 1990s
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+Effects of Marijuana
Major active ingredient THC (delta-9-
tetrahydrocannabinol)
Psychological Feelings of relaxation and
sociability Rapid shifts of emotion Interferes with attention,
memory, and thinking Decline in IQ over time
Heavy doses can induce hallucinations and panic
Impairment of skills needed for driving Impairment present for
several hours after ‘high’ has worn off
Physiological Bloodshot & itchy eyes Dry mouth and throat Increased appetite Reduced pressure within the
eye Increased BP Abnormal heart rate
May exacerbate preexisting cardiovascular problems
Damage to lung structure and function in long term users
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+Therapeutic Effects of Marijuana
Reduces nausea and loss of appetite caused by chemotherapy (Salan et al., 1975)
Relieves discomfort of AIDS (Sussman et al., 1996)
Analgesic effects due to ability of THC to block pain signals from reaching the brain.
Supreme Court rulings: Federal law prohibits dispensing marijuana for
medicinal purposes Medical use can be prohibited by federal
government even if states approve
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+Opiates
Group of addictive sedatives that in moderate doses relieve pain and induce sleep Opium Morphine Heroin Codeine
Synthetic sedatives Seconal and valium
Opiates legally prescribed as pain medications include: Hydrocodone combined with other substances yields
Vicodin, Zydone, and Lortab Oxycodone the basis for OxyContin, Percodan, & Tylox.
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+Prevalence of Opiate Use
Heroin Estimated1,000,000 individuals addicted to heroin in US
300,000 in 2006 alone From 1995 to 2002, rates of use among adults 18 to 25
increased from 0.8% to 1.6% Accounted for 62 to 82% of drug-related hospital
admissions in Baltimore, Boston, & Newark.
Heroin is more pure (25 to 50%) than in the past Increases likelihood of overdose
OxyContin prescriptions jumped 1800% between 1996 and 2000 (DEA, 2001) 2.8 million users (SAMSHA, 2004)
Can be dissolved for injection or snorting Street price from $25 to $40 per pill
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+Psychological and Physical Effects of Opiates Euphoria, drowsiness, reverie, and lack of
coordination Loss of inhibition, increased self-confidence Severe letdown after about 4 to 6 hours
Heroin and OxyContin Rush
Intense feelings of warmth and ecstasy following injection
Stimulate receptors of the body’s opioid system Endorphins and enkephalins
Tolerance develops and withdrawal occurs Muscle soreness and twitching, tearfulness, yawning Become more severe and also include cramps,
chills/sweating, increase in HR and BP, insomnia, & vomiting Withdrawal lasts about 72 hours
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+Psychological and Physical Effects of Opiates29 year follow up of 500 heroin addicts
(Hser, et al., 1993) 28% dead by age 40
Half by suicide, homicide, or accident One-third by overdose
Many users resort to illegal activities to obtain money for drugs Theft, prostitution, dealing drugs
Exposure to infectious diseases via shared needles e.g. HIV Evidence suggests that free needles reduces
infectious diseases associated with IV drug use
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+Synthetic Sedatives
Barbituates Induce muscle relaxation,
reduce anxiety, produce mild euphoria
In 1940s prescribed to aid sleep
Usage declined from 1975 thru 1990s but increased recently
Other synthetic sedatives Benzodiazepines
e.g., Valium, Ketamine
Stimulate GABA system
Heavy dosages Slurred speech Unsteady gait Impaired judgment &
concentration Irritability & combativeness Accidental suffocation due to
excessive relaxation of diaphragm muscles
Alcohol magnifies depressant effects
Tolerance & withdrawal Delirium, convulsions & other
symptoms
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+Stimulants: Amphetamines
Increase alertness and motor activity
Reduce fatigue
Amphetamines Synthetic stimulants
Benzedrine, Dexedrine, Methedrine Trigger release of and block reuptake of norepinephrine
and dopamine Produce high levels of energy, sleeplessness Reduce appetite, increase HR, constrict blood vessels in
skin and mucous membranes High doses can lead to:
Nervousness, agitation, irritability confusion, paranoia, hostility Tolerance can develop after only 6 days use (Comer et al.,
2001)
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+Stimulants: Methamphetamine
Amphetamine derivative (aka crystal meth) Can be taken orally, intravenously, or intranasally
(snorting) In 2006, over 700,000 people used
methamphetamine (SAMHSA, 2007).
Chronic use damages brain Reduction in hippocampus volume (see figure 10.4;
abusers represented by yellow bars)
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+Stimulants: Cocaine
Alkaloid obtained from coca leaves Reduces pain Produces euphoria Heightens sexual desire Increases self-confidence and indefatigability
Blocks reuptake of dopamine in mesolimbic areas of brain
Overdose Chills, nausea, insomnia, paranoia, hallucinations; possibly heart attack &
death
Not all users develop tolerance Some become more sensitive
May increase risk of OD
In 2006, 2.4 million people over the age of 12 reported using cocaine, and 700,000 reported using crack (SAMHSA, 2007).
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+Stimulants: Cocaine
Crack Form of cocaine that quickly become popular in the 80s Rock crystal that is heated, melted, & smoked Cheaper than cocaine
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+Hallucinogens, Ecstasy, and PCP
Hallucinogen effects include: Colorful visual
hallucinations Synestesias
Overflow from one sensory modality to another
Alterations in time perception
Lability of mood Anxiety & paranoia
LSD d-lysergic acid
diethylamide
Psilocybin Extracted from mushroom
psylocube mexicana
Mescaline Active ingredient of peyote
Ecstasy Increase feelings of intimacy
and enhances mood Chemically similar to
mescaline and amphetamines
PCP (phencyclidine) Angel dust Animal tranquilizer Causes severe paranoia and
violence
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+Figure 10.5 Process of Becoming a Drug Abuser
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+Etiology of Substance-Related Disorders: Developmental approach
Li et al. (2001) Two paths to alcohol abuse 1. First group began drinking in early
adolescence, increased drinking throughout high school
2. Second group drank lesser amounts in early adolescence, increased drinking in middle school and again in high school.
Boys more likely to be in the first group, girls in the second group
Developmental studies do not account for all cases
Not an inevitable progression through stages
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+ Etiology of Substance-Related Disorders:Genetic Factors
Relatives and children of problem drinkers have higher-than-expected rates of alcohol abuse or dependence
Greater concordance in MZ than DZ twins In men
Alcohol, caffeine, smoking, marijuana, & drug abuse in general In women
Role of genetics less clear Fewer available studies Findings are mixed
Genetic and shared environmental risk factors for illicit drug abuse and dependence appear to be nonspecific
Ability to tolerate large quantities of alcohol may be an inherited diathesis Asians have low rates of alcohol abuse
CYP2A6 Gene associated with metabolism of nicotine Smokers with defect in this gene less likely to become dependent (Rao et al.,
2000)
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+Etiology of Substance-Related Disorders: Neurobiological Factors
Nearly all drugs, including alcohol, stimulate the dopamine system in the brain
Some evidence that people dependent on drugs or alcohol have a deficiency in the dopamine receptor DRD2
People take drugs to avoid the bad feelings associated with withdrawal Explains frequency of relapse
Incentive-sensitization theory (Robinson & Berridge, 19983, 2003) Distinguish
Wanting (craving for drug) Liking (pleasure obtained by taking the drug)
Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.)
Sensitivity to cues induces & strengthens wanting
Brain imaging studies show that cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use.
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+Etiology of Substance-Related Disorders: Psychological factorsMood alteration
Tension reduction may be due to “alcohol myopia” (Steele & Joseph, 1990) User focuses reduced cognitive capacity on immediate
distractions Less attention focused on tension-producing thoughts
Effect similar for smoking Cognitive distraction also reduces aggressive behavior
in intoxicated individuals However, alcohol and nicotine may increase tension
when no distractions are present.Expectancies about drugs effects influence
behavior People who expect alcohol to reduce stress & anxiety are most
likely to drink The greater perceived risk, the less likely it is to be used
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+ Etiology of Substance-Related Disorders: Psychopathology and Personality
Personality factors that predict onset of substance related disorders: Negative emotionality Desire for increased arousal and positive affect Constraint
Harm avoidance, conservative moral values, & cautious behavior
Kindergarten children who were rated high in anxiety and novelty seeking more likely to get drunk, smoke, and use drugs in adolescence.
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+Etiology of Substance-Related Disorders: Sociocultural factors
Alcohol is the most common abused substance worldwide (Smart & Ogborne, 2000)
Men consume more alcohol than women but differences vary by country Israel
Men drank 3x as much as women Netherlands
Men drank 1½x as much as women
Availability Usage is higher when alcohol and drugs are easily available
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+Etiology of Substance-Related Disorders: Sociocultural factors
Family factors Parental alcohol use (Hawkins et al., 1997) Psychiatric, marital, or legal problems in the family
linked to drug abuse Lack of emotional support from parents increases
use of cigarettes, marijuana, and alcohol (Cadoret et la., 1995a)
Lack of parental monitoring linked to higher drug usage (Chassin et al., 1996; Thomas et al., 2000)
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+Etiology of Substance-Related Disorders: Sociocultural factors
Social network Social influence or social selection? Bullers et al.(2001) found evidence for both
Having peers who drink influences drinking behavior (social influence) but individuals also choose friends with drinking patterns similar to their own (social selection)
Advertising and Media Countries that ban ads have 16% less
consumption than those that don’t (Saffer, 1991)
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+ Treatment of Substance Related Disorders: Alcohol Abuse and Dependence
Inpatient hospital treatment Detoxification
Withdrawal from alcohol under medical supervision The therapeutic results of hospital treatment are not superior to those of
outpatient treatment
Alcoholics Anonymous (AA) Largest self-help group for problem drinkers Regular meetings provide support, understanding, and
acceptance Promotes complete abstinence Although some studies have shown AA participation predicts
better outcome, recent studies suggest AA no more effective than other forms of therapy.
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+ Treatment of Substance Related Disorders: Alcohol Abuse and Dependence
Couples and Family Therapy Emphasizes support from problem drinker’s partner Reduced problem drinking maintained1 year after therapy ended Also reduced couples’ overall level of distress
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+ Treatment of Substance Related Disorders: Alcohol Abuse and Dependence
Cognitive and Behavioral Treatments Contingency-Management Therapy
Patient and family reinforce behaviors inconsistent with drinking e.g., avoiding places associated with drinking
Teach problem drinker how to deal with uncomfortable situations e.g., refusing the offer of a drink
AKA Community-reinforcement approachRelapse Prevention
Strategies to prevent relapse Brief motivational interventions
Designed to curb heavy drinking in college
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+ Treatment of Substance Related Disorders: Alcohol Abuse and Dependence
Controlled drinking Belief that problem drinkers can consume alcohol
in moderation Avoid total abstinence and inebriation Guided self-change
Medications Antabuse (disulfiram)
Produces nausea and vomiting if alcohol is consumed Other medications include naltrexone, naloxone, &
acamprosate Most effective when combined with CBT
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+ Treatment of Substance Related Disorders: Nicotine Dependence
Peer behavior important If others in social network stop smoking, increases likelihood that individual
will also stop
Rapid smoking treatment Rapid puffing, focused smoking, & smoke holding
Scheduled smoking Reduce nicotine intake gradually over a few weeks
Physician’s advice By age 65, most smokers have quit (USDHHS, 1998b)
Nicotine replacement treatments Gum, patches, or inhalers Reduce craving for nicotine Combining patch with antidepressants improved success rate
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+ Treatment of Substance Related Disorders: Illegal Drug Abuse and Dependence
Detoxification central to treatment Psychological treatments
Desipramine and CBT showed effectiveness for cocaine use CBT especially helpful for users with high dependence levels
(Carroll et al., 1994, 1995) Operant conditioning
Tokens that can be traded for desirable goods are given to users who abstain (Dallery et al., 2001)
Motivational interviewing or enhancement thereapy CBT plus Rogerian therapy effective for alcohol and drug use
(Burke et al., 2003) Self-help residential homes for heroin users
Non-drug environment Group therapy Guidance and support from former users
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+ Treatment of Substance Related Disorders: Illegal Drug Abuse and Dependence
Drug replacement treatments and medicationsA meta-analysis of stimulant medication as a
treatment for cocaine abuse revealed little evidence that this type of medication is effective
Heroin replacements Synthetic narcotics
Methadone, levomethadyl acetate, bupreophine Used to wean heroin users from dependence
More effective if combined with psychological support & treatment (Lilley et al., 2000)
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+Prevention of Substance-Related Disorders
Often aimed at adolescents
Utilize some or all of the following elements: Enhancing self-esteem Social skills training Peer pressure resistance training Parental involvement in school programs Warning labels on alcohol bottles Education regarding alcohol impairment Testing for drugs and alcohol at school or work
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