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Chapter12.pdf
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Chapter 12: Substance-Related and Addictive Disorders
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Substance Use Disorders
} Substance: A chemical that alters a person’s mood or behavior when it is smoked, injected, drunk, inhaled, or swallowed in pill form.
} Substance abuse: Maladaptive pattern of substance use occurring within a 12-month period that leads to significant impairment or distress.
} Substance dependence: Maladaptive pattern of use manifested by cognitive, behavioral, and physiological symptoms during a 12-month period and caused by continued use of substance.
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Substance Use Disorders
} Withdrawal: Physiological and psychological changes that occur when an individual stops taking a substance.
} Tolerance: Extent to which the individual requires larger and larger amounts of a substance in order to achieve its desired effects, or the extent to which the individual feels less of its effects after using the same amount of the substance.
} Substance intoxication: The temporary maladaptive experience of behavioral or psychological changes that are due to the accumulation of a substance in the body.
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Substance use disorder
} A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using a substance even though it causes significant problems in his or her life.
} Clinicians diagnose substance use disorders by assessing the individual in four categories of symptoms: } impaired control } social impairment } risky use } pharmacological changes
} New diagnostic term has fewer negative connotations than the term “addiction”
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Disorders Associated with Specific Substances
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Substance abuse
} 24.6 million Americans (9.4% of the population) used illicit drugs at least once in the preceding 30 days. } Marijuana is the most commonly used illicit drug
} Rates of current illicit drug use vary considerably by demographic group.
} The rates of illicit drug use generally decline linearly with age from the peak of 23% at ages 18 to 20 to 2% at ages 65 and older.
} Between the years of 2013 and 2014, the rate of illicit drug use in the past month increased from 5.7% to 8.9%, a statistically significant increase
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Figure 1: Past Month Illicit Drug Use Among Persons Aged 12 or Older: United States, 2013
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Substance abuse
} Most drugs of abuse directly or indirectly target the reward center of the brain by flooding its circuits with dopamine.
} Overstimulation of the reward system produces the euphoric effects that abusers seek and leads them to repeat the behavior in order to repeat the experience.
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Figure 2: Effects of Drugs of Abuse on Dopamine Pathways
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Figure 3: Comorbidity of Substance Use and Psychological Disorders
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Alcohol
} Alcohol is a depressant } A psychoactive substance that causes the depression of central
nervous system activity. } Immediate effects
} Sedating } Central nervous system depressant } Potentially fatal in excess
} Potentiation compounds these effects
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Alcohol Effects
} Long-term effects } Permanent brain damage } Dementia
} Wernicke’s disease } Korsakoff’s synodrome
} Harmful changes in the liver, gastrointestinal system, bone density, muscles, and immune system
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Figure 4: Current, Binge, and Heavy Alcohol Use
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Theories and treatment of alcohol dependence
} Biological } Genetic factors
} Medications } Naltrexone } Disulfiram } Acamprosate
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Theories and treatment of alcohol dependence
} Psychological } Dual-process theory } Alcohol myopia theory
} Treatment } Cognitive-behavioral interventions } Motivational approaches } Expectancy manipulation } Relapse prevention } Combined behavioral intervention
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Theories and treatment of alcohol dependence
} Sociocultural } Family, community, & cultural stressors } Children of alcoholics at greater risk
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Substances Other Than Alcohol
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Stimulants
} This category of drugs includes substances that have an activating effect on the nervous system. } Amphetamine } Methamphetamine } Cocaine
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Figure 5: Long-term Effects of Methamphetamine on the Brain
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Figure 6: Cocaine in the Brain
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Cannabis
} Marijuana } Most commonly used illicit drug in the United States } 70% of first-time drug users chose marijuana } The average age of initiating marijuana use in 2013 was 18
years. } Marijuana also has the highest levels of past year dependence
(4.2 million in 2013 in the United States) } Hashish
} Contains a more concentrated form of THC, comes from the resins of the plant’s flower
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Table 3: Summary of Effects of Cannabis on Executive Functions
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Hallucinogens
} Hallucinogens are drugs that cause people to experience profound distortions in their perception of reality. } LSD } Peyote } Psilocybin } PCP } MDMA
} Included in hallucinogen-related disorders are use and intoxication, but not withdrawal.
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Figure 7: The Impact of Ecstasy (MDMA) on Serotonergic Neurons
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Opioids
} An opioid is a substance that relieves pain. } Within opioid-related disorders are opioid use,
intoxication, and withdrawal. } Hydrocodone } Oxycodone } Morphine } Codeine } Heroin
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Figure 8: Unintentional Drug Overdose Deaths by Major Type of Drug, United States, 1999–2007
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Sedatives, Hypnotics, & Anxiolytics
} Sedatives have calming effects on the central nervous system
} Hypnotics induces sleep } Anxiolytics are anti-anxiety medications
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Caffeine
} Found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies.
} Increases: } An individual’s perceived level of energy alertness } Blood pressure
} May lead to increases in the body’s production of cortisol
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Tobacco
} Nicotine is the psychoactive substance found in cigarettes. } Stimulates the release of adrenaline (norephinephrine) } Increases blood pressure, heart rate, and respiration
} Individuals can be diagnosed with tobacco use disorder or tobacco withdrawal, but not tobacco intoxication
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Inhalants
} Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors. } Inhalants have similar effects as alcohol. } Slurring of speech, loss of coordination, euphoria, dizziness,
and, over time, loss of inhibition and control. } Four categories:
1. Volatile solvents 2. Aerosols 3. Gases 4. Nitrites
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Theories and treatment
} Biological } Genetic abnormalities
} Opioid receptor on chromosome 1 (OPRM1) } Chromosome 15 in a cluster of nicotinic receptor subunits (CHRNA-3,
-5, and -4) } Catechol-o-methyltransferase (COMT)
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Theories and treatment
} To prevent heroin relapse, clinicians may use one or more of three different medications: } Methadone } Buprenorphine } Naltrexone
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Theories and treatment
} Psychological } Cognitive behavioral therapy (CBT) is now widely understood
to be a crucial component of successful treatment. } Clinicians may combine CBT with motivational therapies, as
well as with behavioral interventions that focus on contingency management
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Biopsychosocial perspective
} Useful for: } Understanding substance dependence } Approaches to treatment
} Genetics } Action of substances on the central nervous system
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Non-Substance-Related Disorders
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Gambling disorder
} A non-substance-related disorder involving the persistent urge to gamble.
} This disorder is included with substance use disorders as it is now conceptualized as showing many of the same behaviors, such as: } Cravings } Increasing needs to engage in the behavior } Negative social consequences.
} Gambling disorder is estimated to be diagnosable in 0.6 percent of the U.S adult population.
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Gambling disorder
} People with gambling disorder also have high rates comorbidity: } Nicotine dependence (60 percent) } Dependence on other substances (58 percent) } Mood disorder (38 percent) } Anxiety disorder (37 percent)
} Mood and anxiety disorders are more likely to precede, rather than follow, the onset of gambling disorder
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Understanding gambling disorder (biopsychosocial perspective)
} Pathways model: } An approach to gambling disorder that predicts that there are
three main paths leading to three subtypes. } Genetic vulnerability interacts with the poor coping and
problem-solving skills of the person with gambling disorder. } This makes the individual particularly susceptible to early gambling
experiences
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Table 4: Common Cognitive Distortions in People with Gambling Disorder
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Substance disorders: the bio-psychosocial perspective
} Various treatment programs for people with substance- related disorders have emerged. } Biological treatment may involve the prescription of
substances that block or reduce cravings. } Behavioral treatment involves techniques such as contingency
management, cognitive behavioral therapy, and relapse prevention.
