PSY360: Abnormal Psychology-4th week

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Substance Use and Addictive Disorders

Dr. Sumaira Khurshid Tahira

Associate Prof NNU, China

6 / 2 3 / 2 0 2 1

Substance Use Disorders

 What is a drug?

 Any substance other than food that affects our bodies or

minds

 Current language uses the term “substance” rather than

“drug” to overtly include alcohol, tobacco, and caffeine

 About 9% of all teens and adults in the U.S. display

substance abuse or dependence

6/23/2021

Substance Use Disorders

 Some substances can also lead to long-term problems

 People who regularly ingest them may develop substance

use disorders

 Also called “addiction”

6/23/2021

Substance Use Disorders

 Tolerance: The adjustment that the brain and the body

make to the regular use of certain drugs so that ever

larger doses are needed to achieve the earlier effects

 Withdrawal: Unpleasant, sometimes dangerous reactions

that may occur when people who use a drug regularly

stop taking or reduce their dosage of the drug

6/23/2021

Substance Use Disorders

 There are several categories of substances used and

studied:

Depressants

Stimulants

Hallucinogens

Cannabis

6/23/2021

Depressants

 Depressants slow the activity of the central nervous system (CNS)

Reduce tension and inhibitions

May interfere with judgment, motor activity, and concentration

 Three most widely used depressants:

Alcohol

Sedative-hypnotic drugs

Opioids

6/23/2021

Inhibition, conscious or

unconscious constraint or

curtailment of a process or

behaviour, especially of impulses

or desires.

Inhibition or inhibitory control blocks

behaviors and stops inappropriate automatic

reactions, changing one response for a better,

more thought-out response adapted to the

situation.

Depressants: Alcohol

 All alcoholic beverages contain ethyl alcohol

 It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS (Central Nervous System)

Short-term: alcohol blocks messages between neurons

Alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker

6/23/2021

Depressants: Alcohol

 The extent of the effect of ethyl alcohol is determined by its

concentration (proportion) in the blood

A given amount of alcohol has a lesser effect on a large person than

on a small one

 Gender also affects blood alcohol concentration

Women have less alcohol dehydrogenase, an enzyme in the stomach

that metabolizes alcohol before it enters the blood

Women become more intoxicated than men on equal doses of alcohol 6/23/2021

Depressants: Alcohol

 Levels of impairment are closely tied to the concentration of

ethyl alcohol in the blood:( Blood Alcohol Concentration=BAC)

BAC = 0.06: Relaxation and comfort

BAC = 0.09: Intoxication

BAC > 0.55: Death

Most people lose consciousness before they can drink this

much

6/23/2021

Depressants: Alcohol

 The effects of alcohol subside only after alcohol is

metabolized by the liver

The average rate of this metabolism is 25% of an ounce per

hour

You can't increase the speed of this process!

6/23/2021

Depressants: Alcohol

 In any given year, 6.6% of the world's population will fall into a

pattern of abuse or dependence

 13.2% experience one of the patterns sometime during their life

 7.4% of all adults in the U.S. display an alcohol use disorder over

a one-year period while over 13% display it at some point in their

lives

 Men outnumber women 2:1

6/23/2021

Is All Drug Misuse the Same?

 DSM-5 has combined two past disorders, substance abuse (excessive

and chronic reliance on drugs) and substance dependence (excessive

reliance accompanied by tolerance and withdrawal symptoms) into a

single category—substance use disorder.

 Critics worry that clinicians may now fail to recognize and address the

different prognoses and treatment needs of individuals who abuse

substances and those who depend on substances.

6/23/2021

Depressants: Alcohol

 Alcohol use disorder

In general, people who abuse alcohol drink large amounts

regularly and rely on it to enable them to do things that would

otherwise make them anxious

Eventually the drinking interferes with social behavior and the

ability to think and work

Individual patterns of alcohol abuse vary

6/23/2021

Depressants: Alcohol

 Alcohol dependence

 For many people, the pattern of alcohol misuse includes dependence

 They build up a physiological tolerance and need to drink greater amounts to feel

its effects

 They may experience withdrawal, including nausea and vomiting, when they stop

drinking

 A small percentage of alcohol-dependent people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”)

 Alcohol withdrawal can be fatal 6/23/2021

What is the personal and social impact

of alcoholism?

 Alcoholism destroys families, social relationships, and careers

Plays a role in suicides, homicides, assaults, rapes, and accidents

Long-term excessive drinking can seriously damage physical health

Long-term excessive drinking can cause major nutritional problems

Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) and increased risk of miscarriage

6/23/2021

Depressants: Sedative-Hypnotic Drugs

 Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation

and drowsiness

At low doses, they have a calming or sedative effect

At high doses, they function as sleep inducers or hypnotics

 Sedative-hypnotic drugs include barbiturates and benzodiazepines

6/23/2021

Depressants: Barbiturates

 Widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep

 They can cause many problems such as abuse, dependence, and overdose

 At low doses, they reduce excitement in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate

 At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death

6/23/2021

Depressants: Barbiturates

 Repeated use of barbiturates can quickly result in a pattern

of abuse and/or dependence

A great danger of barbiturate dependence is that the

lethal dose of the drug remains the same, even while the

body is building a tolerance for the sedative effects

Barbiturate withdrawal is particularly dangerous

because it can cause convulsions

6/23/2021

Convulsion is a

sudden, violent,

irregular

movement of a

limb or of the

body, caused by

involuntary

contraction of

muscles and

associated

especially with

brain disorders

Depressants: Benzodiazepines

 Benzodiazepines are often prescribed to relieve anxiety

Most popular sedative-hypnotics available

◼Class includes Xanax, Ativan, and Valium

 Benzodiazepines have a depressant effect on the CNS by binding

to GABA receptors and increasing GABA activity

Benzodiazepines relieve anxiety without causing drowsiness

◼Less likely to slow breathing and lead to death by overdose

6/23/2021

Depressants: Opioids

 This class of drug includes both natural (opium, heroin, morphine,

codeine) and synthetic (methadone) compounds and is known collectively as “narcotics”

Each drug has a different strength, speed of action, and

tolerance level

6/23/2021

Depressants: Opioids

 Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”)

Injection seems to be the most common method of use, although

other techniques have been increasing in recent years

An injection quickly brings on a “rush” – a spasm of warmth and

ecstasy that is sometimes compared with orgasm

This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”)

6/23/2021

Depressants: Opioids

 Opioids create these effects by depressing the CNS

Opioids bind to the receptors in the brain that ordinarily

receive endorphins (NTs that naturally help relieve pain and

decrease emotional tension)

When these sites receive opioids, they produce pleasurable

and calming feelings, just as endorphins do

In addition to reducing pain and tension, opioids can cause

nausea, narrowing of the pupils, and constipation 6/23/2021

Depressants: Opioids

 Heroin use exemplifies the problems posed by opioids:

After just a few weeks, users may become caught in a pattern

of abuse (and often dependence)

Users quickly build a tolerance for the drug and experience

withdrawal when they stop taking it

Early withdrawal symptoms include anxiety and restlessness;

later symptoms include twitching, aches, fever, vomiting,

diarrhea, and weight loss from dehydration 6/23/2021

Depressants: Opioids What are the

dangers of heroin abuse?

The most immediate danger is overdose

The drug closes down the respiratory center in the brain, paralyzing

breathing and causing death

Death is particularly likely during sleep

Ignorance of tolerance is also a problem

About 2% of those dependent on heroin and other opioids die under the

influence of the drug each year

Dirty needles and other equipment can spread infection 6/23/2021

Stimulants

 Stimulants are substances that increase the activity of the central

nervous system (CNS)

Cause increases in blood pressure, heart rate, and alertness

Cause rapid behavior and thinking

 The four most common stimulants are:

 Cocaine

 Amphetamines

 Caffeine

 Nicotine 6/23/2021

Stimulants: Cocaine

 Most powerful natural stimulant known

 Cocaine produces a euphoric rush of well-being

 Produces this effect largely by increasing supplies of

dopamine at key neurons throughout the brain

 Also appears to increase norepinephrine and serotonin

6/23/2021

Stimulants: Cocaine

 High doses of cocaine can produce cocaine intoxication, whose

symptoms include mania, paranoia, and impaired judgment

 Some people also experience hallucinations and/or delusions, a

condition known as cocaine-induced psychotic disorder

 As the stimulant effects of the drug subside, the user

experiences a depression-like letdown, popularly called “crashing”

6/23/2021

A mental condition characterized by delusions of

persecution, unwarranted jealousy, or

exaggerated self-importance, typically worked

into an organized system.

Stimulants: Cocaine

 Cocaine abuse and dependence

Regular use may lead to a pattern of abuse in which the

person remains under the effect of cocaine for much of

each day and functions poorly in social relationships and

at work

Dependence on the drug may also develop

6/23/2021

Stimulants: Cocaine

 Cocaine abuse and dependence

Cocaine use in the past was limited by the drug's high cost

Since 1984, cheaper, more powerful versions of the drug have become

available, including:

A “freebase” form where the drug is heated and inhaled with a pipe

“Crack,” a powerful form of freebase that has been boiled down for

smoking in a pipe

Currently, 0.5% of all people over the age of 11 in the U.S. manifest

cocaine abuse or dependence in a given year 6/23/2021

Stimulants: Cocaine

 What are the dangers of cocaine?

Aside from its behavioral effects, cocaine poses significant

physical danger

The greatest danger of use is the risk of overdose

Excessive doses depress the brain's respiratory function, and stop

breathing

Cocaine use can also cause heart failure

Pregnant women who use cocaine have an increased likelihood of

miscarriage and of having children with abnormalities 6/23/2021

Stimulants: Amphetamines

 Amphetamines: stimulant drugs manufactured in the laboratory

Most often taken in pill or capsule form

Some people inject the drugs intravenously or smoke them for a

quicker, more powerful effect

 Like cocaine, amphetamines:

 Increase energy and alertness and reduce appetite when taken in small doses

 Produce a rush, intoxication, and psychosis in high doses

 Cause an emotional letdown as they leave the body 6/23/2021

Stimulants: Amphetamines

 One kind of amphetamine, methamphetamine, has had a major

surge in popularity in recent years

Almost 6% of all persons over the age of 11 in the US have

used this stimulant at least once

6/23/2021

Stimulant Use Disorder

 Regular use of either cocaine or amphetamines may lead to stimulant

use disorder

 The stimulant dominates the individual’s life

 Leads to poor function in social relationships and at work

6/23/2021

Stimulants: Caffeine

 World’s most widely used stimulant

 80% of the world's population consumes it daily

◼ Most is in the form of coffee; the rest is in the form of tea, cola, energy drinks,

chocolate, and over-the-counter medications

◼ 99% of ingested caffeine is absorbed by the body and reaches its peak

concentration within an hour

 Caffeine acts as a stimulant in the CNS, producing a release of dopamine, serotonin,

and norepinephrine in the brain

 Seizures and respiratory failure can occur at doses greater than 10 grams of caffeine

(about 100 cups of coffee) 6/23/2021

Stimulants: Caffeine

 Many people who suddenly stop or cut back their usual intake

experience withdrawal symptoms, including headaches, depression,

anxiety, and fatigue

 Studies suggest correlations between high doses of caffeine and heart

rhythm irregularities, high cholesterol levels, and risk of heart attacks

 High doses during pregnancy also increase the risk of miscarriage

6/23/2021

Hallucinogens, Cannabis, and Combinations

of Substances

 Hallucinogens

 Produce delusions, hallucinations, and other sensory changes

 Cannabis substances

 Produce sensory changes, but have both depressant and stimulant

effects

 Combinations of substances

6/23/2021

Hallucinogens

 Hallucinogens produce powerful changes in sensory perceptions (sometimes called “trips”)

Natural hallucinogens

Mescaline

Psilocybin

Laboratory-produced hallucinogens

Lysergic acid diethylamide (LSD)

MDMA (Ecstasy) 6/23/2021

Hallucinogens

 LSD is one of the most powerful hallucinogens

 Brings on a state of hallucinogen intoxication (hallucinosis)

◼ Increased and altered sensory perception

◼ Hallucinations and/or synesthisia

 Effects wear off in about six hours

 LSD produces these symptoms by binding to serotonin receptors

 These neurons help control visual information and emotions, thereby causing the various effects of the drug on the user

6/23/2021

Hallucinogens

 More than 14% of Americans have used hallucinogens at some point

in their lives

 Tolerance and withdrawal are rare

But the drugs do pose dangers

Users may experience a “bad trip” – the experience of enormous

unpleasant perceptual, emotional, and behavioral reactions

Another danger is the risk of “flashbacks”

Can occur days or months after last drug use 6/23/2021

Cannabis

 The drugs produced from varieties of the hemp plant are, as a group, called

cannabis

They include:

Hashish, the solidified resin of the cannabis plant

Marijuana, a mixture of buds, crushed leaves, and flowering tops

 The major active ingredient in cannabis is tetrahydrocannabinol (THC)

The greater the THC content, the more powerful the drug

6/23/2021

Cannabis

 When smoked, cannabis produces a mixture of hallucinogenic, depressant,

and stimulant effects

At low doses, the user feels joy and relaxation

May become anxious, suspicious, or irritated

This overall “high” is technically called cannabis intoxication

At high doses, cannabis produces odd visual experiences, changes in

body image, and hallucinations

 Most of the effects of cannabis last 2 to 6 hours

Mood changes may continue longer 6/23/2021

Cannabis abuse and Dependence

 Marijuana was once thought not to cause abuse or dependence

 One theory about the increase in abuse and dependence is the

change in the drug itself

The marijuana available today is significantly more potent than

the drug used in the early 1970s

6/23/2021

Is Marijuana Dangerous?

 As the strength and use of the drug has increased, so have the risks of using it

 May cause panic reactions similar to those caused by hallucinogens

 Because marijuana can interfere with the performance of complex sensorimotor tasks and with cognitive functioning, it has caused many automobile accidents

 (Brady & Li, 2014)

 Marijuana use has been linked to poor concentration and impaired memory

 Long-term use poses additional dangers

 May cause respiratory problems and lung cancer

 May affect reproduction

 In males, it may lower sperm count

 In women, abnormal ovulation has been found

6/23/2021

Combinations of Substances

 People often take more than one drug at a time, a pattern called

polysubstance use

Researchers have studied the ways in which drugs interact with

one another, focusing on cross-tolerance and synergistic effects

6/23/2021

Combinations of Substances

 Cross-tolerance

 Sometimes two or more drugs are so similar in their actions on the brain and body that as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other (even if they have never taken it)

 Users who display this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other

Example: alcohol and benzodiazepines

6/23/2021

Combinations of Substances

 Synergistic effects

When different drugs are in the body at the same time, they may

multiply, or potentiate, each other's effects

This combined impact is called a synergistic effect, and is often

greater than the sum of the effects of each drug taken alone

6/23/2021

Combinations of Substances

 Synergistic effects

 One kind of synergistic effect occurs when two or more drugs have similar actions

Example: alcohol, barbiturates, benzodiazepines, and opioids

All depressants, these drugs may severely depress the CNS when mixed, leading to death

 A different kind of synergistic effect results when drugs have opposite (antagonistic) effects

Example: stimulants or cocaine with barbiturates or alcohol

May build up lethal levels of the drugs because of metabolic issues (stimulants impede the liver's processing of barbiturates and alcohol)

6/23/2021

What Causes Substance Use Disorders?

 Clinical theorists have developed sociocultural, psychological, and

biological explanations for substance abuse and dependence

No single explanation has gained broad support

Best explanation: a COMBINATION of factors

6/23/2021

Causes of Substance Use Disorders:

Sociocultural Views

 Some theorists propose that people are more likely to develop

patterns of substance abuse or dependence when living in stressful

socioeconomic conditions

 Others propose that substance abuse and dependence are more likely

to appear in families and social environments where substance use is

valued or accepted

6/23/2021

Causes of Substance Use Disorders:

Psychodynamic Views

 Psychodynamic theorists believe that people who abuse substances have

powerful dependency needs that can be traced to their early years

Caused by a lack of parental nurturing

Some people may develop a “substance abuse personality” as a result

Limited research does link early impulsivity to later substance use, but

the findings are correlational and researchers cannot presently conclude

that any one personality trait or group of traits stands out in substance

use disorders 6/23/2021

Causes of Substance Use Disorders:

Cognitive-Behavioral Views

 According to behaviorists, operant conditioning may play a key role

in substance abuse

 They argue that the temporary reduction of tension produced by a

drug has a rewarding effect, thus increasing the likelihood that the

user will seek this reaction again

 Similarly, the rewarding effects may also lead users to try higher

doses or more powerful methods of ingestion

6/23/2021

Causes of Substance Use Disorders:

Cognitive-Behavioral Views

 Other behaviorists have proposed that classical conditioning may play

a role in substance abuse and dependence

Objects present at the time drugs are taken may act as classically

conditioned stimuli and come to produce some of the pleasure

brought on by the drugs themselves

Although classical conditioning may be at work, it has not received

widespread research support as the key factor in such patterns

6/23/2021

Causes of Substance Use Disorders:

Biological Views

 In recent years, researchers have come to suspect that drug misuse

may have biological causes

 Studies on genetic predisposition and specific biochemical

processes have provided some support for this model

6/23/2021

Causes of Substance Use Disorders:

Biological Views

 Genetic predisposition

 Research with “alcohol-preferring” animals has demonstrated that their offspring have similar alcohol preferences

 Research with human twins has suggested that people may inherit a predisposition to abuse substances

 Clearer support for a genetic model may come from adoption studies

 Studies compared adoptees whose biological parents were dependent on alcohol with adoptees whose biological parents were not dependent

 By adulthood, those whose biological parents were dependent showed higher rates of alcohol use themselves

6/23/2021

Causes of Substance Use Disorders:

Biological Views

 Biochemical factors

Recent brain imaging studies have suggested that many

(perhaps all) drugs eventually activate a reward center or

“pleasure pathway” in the brain

The reward center apparently extends from the ventral

tegmental area of the brain to the nucleus accumbens and on to

the frontal cortex

6/23/2021

Causes of Substance Use Disorders:

Biological Views

 Biochemical factors

 A number of theorists believe that when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances

This theory, called the incentive-sensitization theory – has received considerable support in animal studies

 Other theorists believe that people who abuse substances suffer from a reward- deficiency syndrome

 Their reward center is not readily activated by “normal” life events so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress

 Defects in D2 receptors have been cited as a possible cause 6/23/2021

How Are Substance Use Disorders Treated?

 The value of treatment for substance abuse or dependence can be difficult to determine

 Different substance use disorders pose different problems

 Many people with substance abuse patterns drop out of treatment early

 Some people recover without any intervention at all

 Different criteria are used by different clinical researchers

 Many approaches have been used to treat substance use disorders, including psychodynamic, behavioral, cognitive-behavioral, and biological, along with sociocultural therapies

6/23/2021

Psychodynamic Therapies

 Psychodynamic therapists first guide clients to uncover and work

through the underlying needs and conflicts that they believe led to

the disorder then try to help them change their styles of living

 Research has not found this model to be very effective

 Tends to be of greater help when combined with other approaches

in a multidimensional treatment program

6/23/2021

Behavioral Therapies

 A widely used behavioral treatment is aversion therapy, an approach

based on classical conditioning principles

Individuals are repeatedly presented with an unpleasant stimulus

at the very moment they are taking a drug

After repeated pairings, they are expected to react negatively to

the substance itself and to lose their craving for it

6/23/2021

Behavioral Therapies

 Aversion therapy is most commonly applied to alcohol abuse/dependence

 In one version, drinking behavior is paired with drug-induced nausea and vomiting

 Another version of this approach requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking

 A behavioral approach that has been successful in the short-term is contingency management

 This procedure makes incentives contingent on the submission of drug-free urine specimens

6/23/2021

Cognitive-Behavioral Therapies

 These treatments help clients identify and change the patterns and

cognitions contributing to their patterns of use

 Relapse-prevention training

The overall goal is for clients to gain control over their substance-

related behaviors

Clients are taught to identify and plan ahead for high-risk situations

and to learn from mistakes and lapses

This approach is used particularly to treat alcohol use; also used to

treat cocaine and marijuana abuse 6/23/2021

Biological Treatments

 Biological approaches may be used to help people withdraw from

substances, abstain from them, or simply maintain their level of use

without further increases

These approaches have limited long-term success when used

alone, but can be helpful when combined with other approaches

6/23/2021

Biological Treatments

 Detoxification

 Systematic and medically supervised withdrawal from a drug

◼ Can be outpatient or inpatient

 Two strategies:

◼ Gradual withdrawal by tapering doses of the substance

◼ Induce withdrawal but give additional medication to block symptoms

 Detoxification programs seem to help motivated people withdraw from drugs

◼ For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high

6/23/2021

Biological Treatments

 Antagonist drugs

As an aid to resist falling back into a pattern of substance abuse or

dependence, antagonist drugs block or change the effects of the

addictive substance

Example: disulfiram (Antabuse) for alcohol

Example: naloxone for narcotics, naltrexone for alcohol

6/23/2021

Biological Treatments

 Drug maintenance therapy

A drug-related lifestyle may be a greater problem than the drug's direct

effects .Example: heroin addiction

Methadone maintenance programs are designed to provide a safe

substitute for heroin

Methadone is a laboratory opioid with a long half-life, taken orally once a

day

Programs were roundly criticized as “substituting addictions” but are

regaining popularity, partly because of the spread of HIV/AIDS 6/23/2021

Sociocultural Therapies

 Three sociocultural approaches have been applied to

substance use disorders:

Self-help programs

Culture- and gender-sensitive programs

Community prevention programs

6/23/2021

Sociocultural Therapies

 Self-help and residential treatment programs

 Most common: Alcoholics Anonymous (AA)

 Offers peer support along with moral and spiritual guidelines to help people overcome

alcoholism

 The abstinence goal of AA directly opposes the controlled-drinking goal of relapse

prevention training and several other interventions for substance misuse – this issue has

been debated for years

6/23/2021

Sociocultural Therapies

 Many self-help programs have expanded into residential treatment

centers or therapeutic communities.

 People formerly dependent on drugs live, work, and socialize in a drug-

free environment while undergoing individual, group, and family

therapies

6/26/2021

Sociocultural Therapies

 Culture- and gender-sensitive programs

A growing number of treatment programs try to be sensitive to the

special sociocultural pressures and problems faced by drug abusers

who are poor, homeless, or members of ethnic minority groups

Similarly, therapists have become more aware that women often

require treatment methods different from those designed for men

6/23/2021

Sociocultural Therapies

 Community prevention programs

Perhaps the most effective approach to substance use disorders is to

prevent them

Some prevention programs argue for total abstinence from drugs, while

others teach responsible use

Prevention programs may focus on the individual, the family, the peer

group, the school, or the community at large

The most effective of these prevention efforts focuses on multiple areas to

provide a consistent message about drug use in all areas of life 6/23/2021

6/26/2021