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Kearney_3e_PPT_Ch091.pptxNormal Substance Use and Substance Related Disorders: What Are They?
Substance-Related Disorders: Features and Epidemiology
Stigma Associated with Substance-Related Disorders
Substance-Related Disorders: Causes and Prevention
Substance-Related Disorders: and Treatment
Many of us engage in substance use that somehow affects our behavior. Such use is normal and may not lead to significant problems if we use the drug carefully.
Normal Substance Use and Substance-Related Disorders: What Are They?
Substances affecting our behavior
Examples include alcohol, nicotine, caffeine, or a morphine derivative
Substance-related disorder
Substance use to a severe degree
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Some people engage in substance use to a greater degree than normal. In severe cases of misuse, daily functioning is impaired, or some physical harm takes place. This describes a substance-related disorder.
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Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Emotions
Cognitions
Behaviors
Normal
Stable mood.
No concern about substance use.
Occasional but appropriate alcohol use or use of medication.
Mild
Moderate
Substance-Related Disorder – Less Severe
Substance-Related Disorder – More Severe
Mild discomfort about the day, feeling a bit irritable or down.
Thoughts about the difficulty of the day. Worry that something will go wrong at work.
Drinking a bit more than usual; relying on medication to sleep.
Considerable stress and sadness (note that opposite
emotions occur when drug is used).
Dwelling on negative aspects of the day; worry about
threats to one’s job or marriage. Thoughts about ways
to hide substance abuse.
Drinking alcohol regularly at night; occasionally
missing work on Mondays; heavy use of medication.
Intense stress, sadness, and feelings of emptiness;
agitation about not having access to a specific
drug or drugs.
Frequent thoughts about using substances and
worry about harm to personal health.
Regular intoxication such that many days are
missed from work; arguments with spouse about
substance use; arrests for impairment.
Extreme stress, sadness, and feelings of emptiness.
Extreme agitation when drug is not available.
Thoughts focused almost exclusively on drug
use and self-destruction of one’s lifestyle.
Very frequent intoxication; loss of job or marriage;
physical addiction to a drug; seeking to secure
or use drugs most of the time.
Continuum of Substance Use and Substance-Related Disorders
Substance-related disorders, like other disorders, occur on a continuum of normal to severe.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Substance Use Disorder
Repeated use of substances to the point that recurring problems are evident
Alcohol use disorder
Diagnostic criteria is listed in Table 9.1
Substance-use disorders usually involve impaired control, social impairment, risky use, and tolerance and/or withdrawal.
DSM-5: Alcohol Use Disorder
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
DSM-5: Alcohol Intoxication
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Slurred Speech
Incoordination
Unsteady gait
Nystagmus
Impairment in attention or memory
Stupor or coma
Substance Intoxication
Substance intoxication is a reversible condition brought on by excessive use of alcohol or another drug.
For example, these are some of the main diagnostic criteria for alcohol intoxication in the DSM-5.
DSM-5: Alcohol Withdrawal
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
1) Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm)
2) Increased hand tremor
3) Insomnia
4) Nausea or vomiting
5) Transient visual, tactile, or auditory hallucinations or illusions
6) Psychomotor agitation
7) Anxiety
8) Generalized tonic-clonic seizures.
Substance Withdrawal
Substance withdrawal refers to maladaptive behavioral change when a person stops using a drug.
Here are some of the behaviors associated with alcohol withdrawal.
Types of Substances
Depressants
Stimulants
Opiates
Hallucinogens
Marijuana
Other drugs
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Depressant, or sedative, drugs are those that inhibit aspects of the central nervous system.
Stimulant drugs activate or stimulate the central nervous system.
Opiates (sometimes called narcotics or opioids) are drugs commonly used to relieve pain or cough, such as morphine or codeine.
Hallucinogens are drugs that cause symptoms of psychosis, such as hallucinations (seeing or hearing things not actually there), disorganized thinking, odd perceptions, and delirium (a cognitive state of confusion and memory problems).
Marijuana comes from Cannabis sativa, or the hemp plant, that contains an active ingredient known as THC (delta-9-tetrahydrocannabinol).
Other drugs also relate to excessive substance use: designer drugs or club drugs, inhalants, and steroids are some examples.
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Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Acid (LSD)
Club drugs
Cocaine
Ecstasy/MDMA
Heroin
Inhalants
Marijuana
Methamphetamine
PCP/phencyclidine
Prescription medication
Acid, blotter, and many others
XTC, X (MDMA); Special K, Vitamin K (ketamine); liquid ecstasy, soap (GHB); roofies (Rohypnol)
Coke, snow, flake, blow, and many others
XTC, X, Adam, hug, beans, love drug
Smack, H, ska, junk, and many others
Whippets, poppers, snappers
Pot, ganga, weed, grass, and many others
Speed, meth, chalk, ice, crystal, glass
Angel dust, ozone, wack, rocket fuel, and many others
Commonly used opioids include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil); common central nervous system depressants include barbiturates such as pentobarbital sodium (Nembutal), and benzodiazepines such as diazepam (Valium) and alprazolam (Xanax); stimulants include dextroamphetamine (Dexedrine) and methylphenidate (Ritalin)
Types of Substances (cont’d.)
Major substances and their street names and effects are listed here. In this chapter, we focus on the main categories of drugs including depressants, stimulants, opiates, hallucinogens, and marijuana.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Alcohol
Binge drinking can lead to many untoward consequences.
Depressants inhibit the central nervous system, whereas stimulants activate the central nervous system.
Alcohol is perhaps the most widely used of these. It affects the neurotransmitter GABA, which is an inhibitory neurotransmitter, producing disinhibited behavior. The initial effects of this are the elated “high” associated with alcohol consumption. Drinking past this point results in the more excitatory areas of the brain becoming depressed. Symptoms with this stage of drinking might involve more aggressive behavior, impaired judgment and attention, overconfidence in one’s problem solving ability, impaired sexual performance, and memory impairment.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Copyright © Cengage Learning
Fetal Alcohol Syndrome
People are dealing with alcoholism are at risk for a variety of health problems, including cirrhosis of the liver, Korsakoff’s syndrome, and fetal alcohol syndrome (FAS) for the offspring of women who abused alcohol during pregnancy.
Characteristic facial features of individuals with fetal alcohol syndrome are pictured here. Slowed physical growth and cognitive impairment also accompany FAS.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Stimulants
Cocaine is often smoked in the form of crack.
Stimulants include caffeine, nicotine, cocaine, and amphetamines.
The pleasurable effects of meth are extremely intense and include strong euphoria, enhanced sexual drive and stamina, and lowered sexual inhibition. The drug helps stimulate pleasure centers in the brain to release large amounts of dopamine.
Downsides include brain and liver damage, malnutrition, skin infections, immune system problems, convulsions, stroke, and death.
These are booking photos of a woman arrested for meth use. They were taken only two years apart.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Opiates
Opiates include morphine, codeine, and heroin
Opiates stimulate different types of opiate receptors in the brain
Modern-day painkillers are also related to morphine and can be highly addictive
Commonly abused, heroin is a strong opiate that leads to an increased risk of cancer and infertility.
Prescription drug use is becoming one of the fastest-growing forms of substance-related disorder.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Many people who take LSD reportedly experience psychedelic
hallucinations marked by bright colors and shapes. Some artists have
tried to represent their experiences with the drug in art, as highlighted
in this edition of Life magazine.
Hallucinogens
Hallucinogens cause symptoms of psychosis such as hallucinations, disorganized thinking, odd perceptions, and delirium.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Marijuana
Angel Raich is seen with cannabis buds at her home in Oakland,
California. She began smoking after her doctor suggested it might ease
pain she suffers from an inoperable brain tumor.
Heavy users of marijuana may become physically and psychologically dependent. It produces feelings of joy, well-being, and humor and a dream-like state. But time feels distorted, memory and attention are often impaired, and long-term use can result in fertility problems. It is also used as treatment for glaucoma and other medical symptoms.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Epidemiology of Substance-Related Disorders
Substance use disorders are more common among males than females. Drug use is most common among people between 12 and 30 years of age.
The following graph shows percentage of individuals by age using illegal drugs.
Stigma Associated with Substance-Related Disorders
Social discrimination may be faced with respect to:
Employment
Housing
Interpersonal rejection
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Several interventions have been designed to reduce stigma associated with substance-related disorders. These interventions often involve learning about substance-related disorders, accepting difficult feelings, emphasizing human connection and mutual acceptance, focusing more on the process of thinking (i.e., thinking about how thinking happens in the mind) rather than the content of negative thoughts, exploring goals and values in life, communicating positive stories of people with substance-related disorders, and boosting employment skills.
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Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Prefrontal cortex
Nucleus accumbens
Ventricle tegmental area
Copyright © Cengage Learning
Biological Risk Factors for Substance-Related Disorders
The mesolimbic system is a major dopamine pathway implicated in sensations of pleasure and reward. It links to other areas central to addiction, including the amygdala, anterior cingulate, bed nucleus of the stria terminalis, hippocampus, insular cortex or insula, prefrontal cortex, and orbitofrontal cortex
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Environmental Risk Factors for Substance-Related Disorders
People often engage in substance use to relieve stress and depression.
Environmental risk factors include, stress, cognitive factors, learning, personality factors, family factors, cultural factors, and evolutionary influences.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Substance-related disorder
Genetic predisposition, impulsive personality, deviant peers, culture, family conflict, parental drug use, drug/learning experiences
Proximal factors
Activation of mesolimbic pathway, daily stress and depression, peer pressure, positive expectancies about drug use, availability of drugs
Reinforcers
Mood enhancement, relief from stress, belonging to a peer group, avoidance of withdrawal symptoms
Punishers
Ill physical effects, legal problems, cognitive decline, divorce and loss of jobs, tolerance
Distal factors
Causes of Substance-Related Disorders
Distal factors are background factors that indirectly affect a person and can generally contribute to a mental disorder. Biological distal factors with respect to substance-related disorders include genetic predisposition and perhaps temperaments such as an impulsive personality. Environmental distal factors include association with deviant peers, problematic family relationships, parental drug use, culture, and early learning and drug experiences.
Proximal factors are more immediate factors that directly affect a person and more specifically contribute to a mental disorder. Biological proximal factors include activation of the mesolimbic dopamine pathway upon drug use. Environmental proximal factors include stress, depression, peer pressure, positive expectancies about substance use, and availability of substances. Proximal factors may also include consequences of drug use, both positive and negative.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Prevention of Substance-Related Disorders
Prevention efforts aimed at adults, children, and adolescents
Techniques include:
Screening
Education
Managing stress
Increasing social support
Prevention of substance-related disorder can occur at the adult level, as with relapse prevention, or at the youth level to prevent abuse and dependence before they begin.
Universal efforts to prevent substance use disorder often target the public.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Focus on College Students: Substance Use
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Interviews
A frequent means of assessing many mental disorders
One commonly used screening interview is the Addiction Severity Index—6
Screening interviews are specifically designed to assess recent and lifetime problems with respect to substance use.
Motivational interviewing is an assessment and treatment strategy that involves obtaining information about a person’s substance-related problem and providing feedback to help increase his readiness for change.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Psychological Testing
Subscales of the Minnesota Multiphasic Personality Inventory (MMPI-2)
Addictions Acknowledgement Scale
Addiction Potential Scale
MacAndrew Alcoholism Scale
Therapists use psychological tests (MMPI-2) to screen and assess for drug use.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Observations from Others
Therapists conduct observations and solicit reports from others
May involve family members, partners, coworkers, and friends
Must have knowledge and consent of the person with the substance-related disorder
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Laboratory Testing
Handheld breathalyzers are available for self-testing one’s alcohol level.
Laboratory testing for substance-related disorders includes urine, blood, hair, saliva, and sweat screens for toxins. Recent alcohol use can be detected with breathalyzers.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Biological Treatment of Substance-Related Disorders
Agonists
Antagonists
Partial agonists
Aversives
Biological treatment for substance-related disorders includes medications such as agonists, antagonists, partial agonists, and aversives.
Agonists have a similar chemical composition to the excessively used drug—methadone’s similarity to heroin can be used to help reduce cravings and withdrawal symptoms.
Antagonists block the pleasurable effects of the drug, as naltrexone does for alcohol.
Partial agonists can act as agonist or antagonist depending on how much of a neurotransmitter is produced, and aversives make ingestion of the abused drug quite uncomfortable, as Antabuse does for alcohol.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Psychological Treatment of Substance-Related Disorders
Inpatient and residential treatment
Brief interventions
Cognitive-behavioral therapy
Family and marital therapy
Group therapy
Self-help groups
Psychological treatment of substance-related disorders generally involves inpatient and residential treatment, brief interventions, cognitive-behavioral therapy, family and marital therapy, group therapy, and self-help groups.
People who are intoxicated or dependent on a particular substance often must first undergo inpatient or residential treatment in which the major focus is detoxification and rehabilitation.
Brief interventions for substance-related disorders involve stabilizing or reducing substance use enough so more thorough forms of treatment can be applied.
Cognitive-behavioral therapy for substance-related disorders involves modifying irrational cognitions about drug use and identifying and changing high-risk situations that could lead to relapse.
Family, marital, and group therapies provide social support and reinforcement for abstinent behavior.
Self-help groups involve meetings of people with similar substance abuse problems who share support and experiences to maintain abstinence.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Long-Term Outcome for People with Substance-Related Disorders
Alcoholism
Remission rates over several decades are 27 to 69 percent
Significant illness and mortality is associated with chronic use
Injection drug users
Many enter paths of either cessation or persistent use and relapse
Treating people with substance-related disorders can be quite complicated and involve many pharmacological and psychological components. Relapse is also common in this population.
Many people who seek treatment for a substance-related disorder successfully control the problem, but some experience severe problems much of their life.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
What If I or Someone I Know Has a Substance-Related Problem?
Substance use monitoring
Consult self-help guides
Learn ways to cope with stress
Serious substance-related problem
Seek medical and psychological help from a qualified professional who specializes in substance use treatment as soon as possible
Chapter Reflections
What would you now say to a friend who might be using substances too much?
What separates “normal” from “abnormal” substance use?
What might friends help to reduce excessive substance use in people they know?
