ch.11

(box, binge drinking in college, p.396)

-

(genetic vulnerability, p.393)

--possibility of a genetic predisposition to developing alc abuse probs -heritibility plays an imp role in a person's developing sensitivity to the addictive power of drugs like alc -review 39 studies (fams if 6,251 alcoholics and 4,083 nonalcoholics followed over 40yrs) = almost 1/3 of alcoholics had at least 1 parent w/ an alc problem -study (children of alcoholics) = for males, having 1 alcoholic parent increased rate of alcoholism from 12.4% to 29.5% and having 2 alcoholic parents increased rate to 41.2%. for females w/ no alcoholic parents, the rate was 5%; and for those w/ 2 alcoholic parents, it was 25% -adoption studies also provide evidence for a genetic vulnerability for alc problems -study (children w/ alcoholics and nonalcoholics who were all adopted by nonalcoholic families), = children of alcoholic parents adopted by normal foster parents were nearly 2x twice as likely to have alc problems by their late 20s (compared to control of adopted kids whose bio parents were nonalcoholics) -study, (compared alcoholic parents' sons who were adopted in infancy by nonalcoholic parents and sons raised by their alcoholic parents), = both adopted and nonadopted sons later evidenced high rates of alcoholism (25% and 17%) -thus, being born to an alcoholic parent sig increases the risk of becoming an alcoholic -another approach to studying the precursors to alc-related disorders is to study prealcoholic personalities - individuals who are at high risk for substance abuse but who are not yet affected by alcohol -an alcohol-risk personality has been described as --> an individual who has an inherited predisposition toward alc abuse and who is impulsive, prefers taking high risks, and is emotionally unstable -research shows that those who are genetically predisposed to developing drug/alc prob but who have not yet acquired the prob = show different physio patterns than nonalcoholic men in several ways -those at risk tend to exp greater decreases in stress following alcohol ingestion, show different alpha wave patterns on EEGs, and have larger conditioned physio responses to alc cues (than individuals who were considered to have a low risk for alcoholism) -some ethnic groups (particularly asians and native americans) have abnormal psycho reactions to alc --> a phenomenon referred to as "alcohol flush reaction" -asian and eskimo ppl have tendency to have a hypersensitive reaction including flushing of the skin, a drop in bp, heart palpitations, and nausea following ingestion of alcohol -this physio reaction found in roughly 1/2 of all asians, and result from a mutant enzyme that fails to break down alcohol molecules in the liver during the metabolic process -although cultural factors may also play a role, the relatively lower rates of alcoholism among Asian groups might be related to extreme discomfort associated with the alcohol flush reaction

(biological causal factors in alc abuse and dependence, p.392)

-2 imp factors involved: -(1st) the ability of most/all addictive substances to activate areas of the brain that produce intrinsic pleasure and somtimes immediate, powerful reward -(2nd) involves the person's biological makeup, or constitution, including his/her genetic inheritance and the environmental influences (learning factors) that enter into the need to seek mind-altering substances to an increasing degree as use continues -development of alc addition is complex: constitutional vulnerability and env encouragement, as well as the unique biochemical properties of certain psychoactive substances

(alcohol related disorders, p.385)

-WHO says not to use the term "alcoholic" but instead "harmful use of alochol" - drinking that causes detrimental health and social consequences for the drinker, the ppl around the drinker and society at large, as well as the patterns if drinking that are associated w/ increased risk of adverse health outcomes -WHO *heavy episodic drinking* - the consumption of 6 or more alc drinks on at least 1 occasion at least once per month

(alcoholics anonymous, p.399)

-a practical approach for rehab, alcoholics anonymous (AA) -through "fundamental spiritual change" -operates primarily as a self-help counseling program in which both person-to-person and group relationships are emphasized -accept both teens and adults, no dues or fees, no keep records or case histories, does not participate in political causes, not affiliated w/ religious sect -although spiritual development is a key aspect of this treatment approach -the term "alcoholic" is used by AA to refer to either ppl who are currently drinking excessively or to ppl who have stopped drinking but must, according to AA philosophy, continue to abstain from alc consumption in the future -AA view: one is an alcoholic for life, whether or not one is drinking; one is never "cured" of alcoholism but is instead "in recovery" -imp aspect of AA rehab: appears to lift the burden of personal responsibility by helping alcoholics accept that alcoholism is bigger than they are -henceforth, they can see themselves not as weak willed or lacking in moral strength but rather as simply having an affliction- they cannot drink- (just as many ppl may not be able to tolerate certain types of meds) -insight into their problems, a new sense of purpose, greater ego strength, and a more effective coping techniques -continued participation can help prevent relapse -AI-Anon family groups and Alateen are designed to bring family members togetjer to share experiences and problems, to gain understanding of the nature of alcoholism, and to learn techniques for dealing w/ their own probs living in a family w/ one or more affected individuals -reports have only been anecdotal bc AA does not directly participate in external comparative research efforts -AA's 12-step program = inconclusive -AA has NOT been shown to be any more effective than other trt approaches, and more studies needed for effectiveness

(environmental intervention, p.398)

-a total trt program for alc abuse or dependency usually requires measures to alleviate a person's aversive life situation -environmental support important for recovery -often become estranged from fam or friends bc of their drinking and either lose their job or jeopardize -as result, lonely and live in impoverished neighborhoods -simply having ppl learn more effective coping techniques may not be enough if their social environment remains hostile and threatening -for those who have been hospitalized, halfway houses are often imp adjuncts to their total trt program -halfway houses - designed to assist them in their return to family and community

(behavioral and cognitive-behavioral therapy, p. 399)

-behavior therapy = often effective -several types exist -aversive conditioning therapy - presentation of a wide range of noxious stimuli w/ alc consumption in order to suppress drinking behavior -ex, ingestion of alc paired w/ electric shock or drug that produces nausea -one approach involves intramuscular injection of emetine hydrochloride, an emetic (before nausea, drink alc, so that the sight, smell, taste becomes associated w/ severe retching and vomiting. that is, conditioned aversion to the taste and smell of alc develops) -w/ repetition, this classical conditioning procedure acts as a strong deterrent - probably bc it adds an immediate and unpleasant physio consequence to the more general socially aversive consequences of excessive drinking -cognitive-behavioral therapy (CBT) - common -combines CBT strategies of intervention w/ social-learning theory and modeling of behavior -often referred to as "skills training procedure" -usually aimed at younger problem drinkers who are at risk for developing more severe drinking probs bc of an alcohol abuse history in family or their current heavy consumption -relies of techniques like imparting specific knowledge about alc, developing coping skills in situations associated w/ increased risk of alc use, modifying cognitions and expectancies, acquiring stress management skills, and providing training in life skills -only modest effects in trt of alc problems -self-control training techniques, such as BMI, in which goal of therapy is to get alcoholics to reduce alcohol intake without necessarily abstaining altogether -great deal of appeal for some drinkers -one approach involves altering the drinker's social networks, found to be successful -motivational interviewing w/ adolescents was found to be promising in decreasing substance use -now even computer-based self-control training program, shown to reduce problem drinking in a controlled study -it os difficult for extremely dependent alc users to abstain totally from drinking. thus, many alcoholics fail to complete traditional treatment programs

(marital and other intimate relationships, p.395)

-adults w/ less supporting realtionships tend to show greater drinking following sadness or hostility -excessive drinking often begins during crisis periods in marital or other intimate personal relationships, particularly crises that lead to hurt and self-devaluation -marital relationship may actually serve to maintain the pattern of excessive drinking (produce or enable spouse's drinking) -ex, husband usually unaware the fact that many of the decisions he makes everyday are based on the expectation that his wife will be drinking; these expectations may lead to drinking behavior more likely -husband or wife may also begin to drink excessively -thus, one important concern in many trt programs involves identifying the personality or lifestyle factors in a relationship that tend to foster the drinking in the alc-abusing person -excessive use of alc is one of the most frequent causes of divorce in US, and is often a hidden factor in the 2 most common causes (financial and sexual problems) -can be highly stressful; the stress of divorce and the often erratic adjustment period that follows can lead to increased substance abuse -family relationship probs have also been found to be central to the devel of alcoholism -study, defined six family relationship factors that were sig associated w/ devel of alcoholism in the ppl they studied: -the most imp family variables that were considered to predispose an individual to substance use probs: presence of an alcoholic father, acute marital conflict, lax maternal supervision and inconsistent discipline, many moves during the family's early years, lack of "attachment" to the father, and lack of family cohesiveness

(treatment of alcohol-related disorders, p.397)

-alc abuse and dependence are difficult to treat bc many ppl who abuse alc refuse to admit that they have a problem before they hit "rock bottom", and many who do go into trt leave before therapy is completed -overall, less than 1/3 of those w/ alc use disorders receive trt -available trts for al-related disorders show modest effects -a multidisciplinary approach to the trt of drinking problems appears to be most effective bc the problems are often complex, requiring flexibility and individualization of treatment procedures -also, a substance abuser's needs change as trt progresses -trt objectives usually include detoxification, physical rehab, control over alcohol abuse behavior, and the individuals' realizing that he/she can cope w/ the problems of living and lead a much more rewarding life without alcohol -traditional treatment programs usually have as their goal abstinence from alcohol -however, some programs attempt to promote controlled drinking as a trt goal for problem drinkers -ex, the BMI procedures discussed earlier attempts to modify clients' behavior through providing info and advice about the consequences of the substance use in an effort to challenge the users about their use- but leaves the responsibility to the individual -no matter what the trt method, relapse is common, and many see relapse as a factor that must be addressed in the trt and recovery process

(the clinical pic of alc-related disorders, p.388)

-alc consumption decreases behavioral inhibition, impairs learning and memory, and neg impacts judgement, decision making, and motor coordination

(the physical effects of chronic alcohol use, p.390)

-alc that is taken in must be assimilated by the body, except for the approx 5-10% that is eliminated through breath, urine, and perspiration -the work of alc metabolism is done by the liver, but when large amoutns of alc are ingested, the liver may get seriously overworked and eventually suffer irreversible damage -15-30% of heavy drinkers develop cirrhosis of the liver - a disorder that involves extensive stiffening of the blood vessels -many of the 36,000 annual cirrhosis deaths every year are alc related (CDC) -alc is also a high-calorie drug -a pint of whiskey (enough to make about 8 to 10 cocktails) provides about 1,200 calories (about half of the day requirement) -thus, consumption of alc reduces a drinkers appetite for other food -bc alc has no nutritional value, the excessive drinker can suffer from malnutrition. -heavy drinking impairs the body's ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins -many alc abusers also exp increased gastrointestinal symptoms such as stomach pains

(sociocultural factors, p.397)

-alc use is a pervasive component in the social life of Western civilization (social events, before and during meals, etc) -alc is often seen as a "social lubricant" or tension reducer that enhances social events -the effect of cultural attitudes -Muslims and Mormons, prohibit alc -orthodox Jews limited use to religious rituals -incidence of alcoholism in these groups is minimal -incidence of alcoholism is high among Americans -study, highest alc rates among young ppl in Denmark and Malta (1 in 5 students drunk alcohol 10 times within the past 30 days) -Argentina, Canada, Chile, Japan, New Zealand, and US make up less than 20% of world population and yet consume 80% of the alcohol -the behavior that is manifested under the influence of alcohol also seems to be influenced by cultural factors -study, most ppl express view that aggressive behavior frequently follows their "many" drinks. however, the expectation that alcohol leads to aggression is related to cultural traditions and early exposure to violent or aggressive behavior -exact combo of factors that results in a persons becoming an alcoholic is still unknown

(psychosocial causal factors in alc abuse and dependence, p.394)

-also develop a powerful psychological dependence as well- they become socially dependent on the drug to help them enjoy social situations

(prevalence, comorbidity, and demographics of alcohol abuse and dependence, p.386)

-among the most destructive of the psychiatric disorders bc of the impact excessive alc can have on users' lives and those of their families and friends -13% of ppl in US meet DSM criteria for alcohol abuse at some point in lives, about 5% for alcohol dependence -(more %, p.386) -binge drinking - having at least 5 drinks on one occasion in the past month -heavy drinkers - having at least 5 drinks at least 5 times in the past month -heavy drinking associated w/: vulnerability to injury, marital discord, becoming involved in intimate partner violence -lifespan of alc dependence about 12yrs shorter -lowers performance on cog tasks (e.g. prob solving), and the more complex the task the more impairment -organic impairment (including brain shrinkage) occurs in high proportion of ppl w/ alc dependence -alc abuse associated w/ increased risk of wide range of neg. health outcomes such as diabetes, stroke, cardiovascular disease -alc more frequently associated w/ both violent and nonviolent crime than drugs such as weed, and people w/ violence-related injuries are more likely to have a positive breathalyzer test -alc abuse & dependence in US are across all age, educational, occupational, and SES -alc abuse strong presence in workplace -problem drinkers - ppl experiencing life probs as a result of alc abuse -more problem drinkers are men (5x the frequency of women)... gap narrowed w/ substance abuse disorders. -no difference in alc abuse btw blacks and whites... native americans have higher rates, asian americans have lower rates -problem drinking may develop during any life period from early childhood through old age -10% of men over 65yrs are heavy drinkers -over 37% of alcohol abusers experience at least one coexisting mental disorder -given that alc is a depressant, depression is highly comorbid -also high comorbidity w/ eating disorders -many alcoholics die by suicide -alc abuse co-occurs w/ high frequency w/ personality disorders (PD) as well -the diagnosis of substance use disorder in DSM5 is based on a pathological pattern of behaviors that are related to the use of a particular substance (e.g. alc)

(use of medications in treating alcohol abuse and dependency, p.397)

-bio approaches include variety of trt measures such as meds to reduce cravings, to ease the detoxification process, and to treat co-occurring health and mental health problems that may underlie the drinking behavior

(expectations of social success, p.395)

-cognitive expectation may play imp role in both the initiation of drinking and in the maintenance of drinking behavior -reciprocal-influence model: adolescents begin drinking as a result of expectations that using alc will increase their popularity and acceptance by their peers -from this perspective, alc use teenagers can be countered by providing young people with more effective social tools and with ways of altering these expectations before drinking begins -prevention efforts should be targeted at children before they begin to drink so that the positive feedback cycle of reciprocal reinforcement between expectancy and drinking will never be established -time and experience do have moderating influences on these alcohol expectancies, although heavy drinking in early college years can result in risky behavior and low academic motivation -study, longitudinal college students, found there was sig decrease in outcome expectancy over time. that is, older students showed less expectation of the benefits of alc than beginning students -moderating - a moderating variable is a variable that influences the association between 2 other variables. for ex, depression is common after bereavement. however, men who have a spouse tend to be more likely to be depressed than women who have lost a spouse. in this case, gender is a key moderating variable for the bereavement-depression relationship.

(alcohol's effects on the brain, p.388)

-complex -lower levels: activated brains "pleasure areas", which release endogenous opioids that are stored in the body -higher levels: depresses brain functioning, inhibiting one of the brain's excitatory neurotransmitters (glutamate), which in turn slows down activity in parts of the brain -inhibition of glutamate impairs ability to learn and affects the higher brain centers, impairing judgement and other rational processes and lowering self-control -as behavioral restraints decline, drinker may indulge in impulses -lack of motor coordination soon becomes apparent, drinkers discrimination and perception of cold, pain, and other discomforts are dulled -typically exp warmth, expansiveness, and well-being -unpleasant realities screened out and feelings of self-esteem and adequacy rise -0.08% = considered intoxicated (law, driving car) -muscular coordination, speech, vision are impaired and thought processes are confused -even before this level of intox, judgement becomes impaired (may misjudge) -when BAC reaches 0.5% (levels differ) = the entire neural balance is upset and the person passes out -unconsciousness acts as a safety device bc concentrations above 0.55% are usually lethal -it is the amount of alcohol actually concentrated in the bodily fluids, not the amount consumed, that determines intoxication -effects of alc differ depending on: physical condition, amount of food, duration of drinking, gender, tolerance -women metabolize alc less effectively than men and thus become intoxicated on lesser amounts -*intoxication* - state of being affected by one or more psychoactive drugs -effects of alc dont stop at intoxication (e.g. hangover) -hangover symptoms: headache, nausea, fatigue and cog impairment for 8-24hrs after consuming alc -leading theory on what causes alc hangovers focusing on dehydration along w/ the buildup of alc metabolites such as acetaldehyde, and the triggering of body's immune response -(box) hangover severity is most pronounced when BAC reaches 0 (in this ex, at 12-14hrs after the start of alc consumption)

(medications to block the desire to drink, p.397)

-disulfiram (Antabuse), a drug that causes violent vomiting when followed by ingestion of alcohol, may be administered to prevent an immediate return to drinking -seldom advocated as the sole approach bc an alc-dependent person may simply discontinue the use of Antabuse when he/she is released from a hospital or clinic and begins to drink again -primary value: their ability to interrupt the alcohol abuse cycle for a period of time during which therapy may be undertaken -side effects for Antabuse: ex, alcohol-based aftershave lotion can be absorbed through the skin, resulting in illness; requires careful medical maintenance; cost is higher than that for many other more effective trts -naltrexone - an opiate antagonist that helps reduce the craving for alc by blocking the pleasure-producing effects of alcohol -acamprosate - drug (properties still being studied) -study, 122 randomized control trials, both naltrexone and acamprosate are effective at decreasing drinking and heavy drinking

(development of alc dependence, p.389)

-excessive drinking can be viewed as progressing insidiously from early- to middle- to late-stage alcohol-related disorder (although some dont follow this pattern) -alc is dangerous even in small amounts, but some argue moderate amounts not harmful to most ppl -pregnant women: no safe level has been established -fetal alcohol syndrome (FAS) - a condition that is caused by excessive alcohol consumption during pregnancy and results in birth defects such as mental retardation

(genetics- the whole story?, p.393)

-genetic transmission in the case of alc-related disorders does not follow the hereditary pattern found in strictly genetic disorders -importantly, the majority of children who have parents w/ alc-related problems do not themselves develop substance abuse disorders- whether or not they are raised by their bio parents -overall, even tho much evidence implicated genetic factors in the etiology of alcoholism, we do not know the precise role they play -at present, appears that the genetic interpretation of alcoholism remains an attractive hypothesis; however, additional research needed -it is NOT likely that genetics alone will account for the full range of alcohol and drug problems -social circumstances powerful in providing both availibility and the motivation to use alc and drugs

(group therapy, p.398)

-group therapy shown to be effective, especially for substance-related disorders -confrontational give-and-take of group therapy, ppl who abuse alc often forced to face their problems and their tendencies to deny or minimize them -can be extremely difficult for those who have been engrossed in denial -such trt helps them see new possibilities for coping with circumstances that have led to their difficulties -often paves way to learn more effective ways of coping and other positive steps toward dealing w/ their drinking probs -sometimes, spouses and children invited to join the group therapy meetings -other situations, family trt is itself the central focus of therapeutic efforts -given alc can cause strains on family relationships, family therapy involves a delicate balance of educating the drinker about familial consequences of his/her drinking, discussing any role that the family may have played in facilitating the drinking behavior (if any), and making plans for how the family can function most adaptively in the future

(causal factors in the abuse of and dependence on alcohol, p.392)

-some have stressed the role of genetic and biochemical factors; others pointed to psychosocial factors, viewing problem drinking as a maladaptive pattern of adjustment to the stress of life; and others emphasize sociocultural factors such as the availability of alc and social approval of excessive drinking -some combo of thee seems to influence risk for developing alcohol abuse or alc dependency -there may be several types of alc abuse and dependency, each w/ somewhat different patterns of bio, psychosocial, and sociocultural causal factors

(psychosocial effecrs of alc abuse and dependence, p.390)

-heavy drinkers often suffer from chronic fatigue, oversensitivity, and depression -initially, may seem like alc provides a crutch for dealing w/ stress -excessive alc use eventually becomes counterproductive, and can result in impaired reasoning, poor judgement, and gradual personality deterioration -behavior typically becomes coarse and inappropriate, and the drinker often assumes increasingly less responsibility, loses pride in personal appearance, neglects spouse and family, and becomes irritable and unwilling to discuss the problem -may be unable to hold job, generally becomes unqualified to cope w/ new demands that arise -general personality disorganization and deterioration may be reflected in loss of employment and marital breakup -general health will deteriorate, and brain and liver damage will occur -evidence that: alcoholic's brain is accumulating diffuse organic damage even when no extreme organic symptoms are present, and even mild to moderate drinking can adversely affect memory and problem solving -extensive alc consumption is associated w/ an increased amount of organic damage in later life -FRMI shows that this damage is partially reversible if the person abstains from alc use

(box, fetal alcohol syndrome (FAS), p.390)

-heavy drinking, particularly binge drinking and heavy drinking during the early days of pregnancy -frequent physical and behavioral abnormalities, including growth deficiencies, facial and limb irregularities, damage to the CNS, and impairment in cog and motor functioning -overall reduction in brain size and prominent brain shape abnormalities, with narrowing in the parietal region aling with refuced brain growth in portions of the frontal love -children with FAS show sig working memory (WM) deficits and altered activation patterns in some brain regions -(CDC): there is no safe amount, pregnant moms should abstain

(medications to reduce the side effects of acute withdrawal, p.398)

-in cases of acute intoxication, the initial focus is on detoxification (the elimination of alc substances from the person's body), on trt of the withdrawal symptoms described earlier, and on the medical regimen for physical rehab -primary goals in trt of withdrawal symptoms: to reduce the physical symptoms char of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness -central to trt approaches are the prevention of heart arrhythmias, seizures, delirium, and death... these steps usually best taken at hospital or clinic, where drugs such as Valium have largely revolutionized the trt of withdrawal symptoms -such drugs overcome motor excitement, nausea, + vomiting; prevent withdrawal delirium and convulsions; and help alleviate the tension and anxiety associated with withdrawal -pharmacological trts w/ long-lasting benzos (e.g. diazepam) which reduce the severity of withdrawal symptoms, have been shown to be effective -concern of tranquilizers (drugs that depress the CNS, resulting in calmness, relaxation, reduction of anxiety, and sleeping) -concern tranquilizers does NOT promote long-term recovery and may simply transfer the addiction to another substance -some detox clinics altering to include a gradual weening from alc instead of sudden cutoff -maintenance of mild tranquilizers are sometimes given to patients withdrawing from alc to reduce anxiety and help them sleep -such use of meds may be LESS effective than no trt at all, however -usually patients must learn to abstain from tranquilizers as well as from alcohol bc they tend to misuse both -and, under the influence of meds, patients may even return to alc use

(psychological vulnerability, p.394)

-link btw alcohol-related disorders and such other disorders as antisocial, depression, and schizophrenia (to determine whether some ppl are more vulnerable to substance abuse disorders) -about 1/2 w/ schiz have either alc or drug abuse or dependence -antisocial PD, alcohol, and aggression are strongly associated -in survey of 8 alc trt programs, found that 57.9% of those in trt had a PD, w/ 22.7% meeting criteria for antisocial -also relationship btw depressive disorders and alc abuse, and may be gender differences -for whatever reason they co-occur, the presence of other mental disorders in patients who abuse alc or durgs is a very important consideration when it comes to trt (discussed later)

(psychological trt approaches, p.398)

-once drinking under control, detox is optimally followed psych trt, including: family counseling and use of community resources related to employment and other aspects of person's social life -individual therapy sometimes effective, but the focus of psychosocial measures often involves group therapy, environmental intervention, behavior therapy, and the approach used by AA and family groups such as AI-Anon and Alateen

(the neurobiology of addiction, p.392)

-psychoactive drugs differ in their biochemical properties as well as how rapidly they enter the brain -several routes: oral, nasal, and intravenous -alc is usually drunk (the slowest route) whereas cocaine is often self-administered nasally or by injection -central to the neurochemical process underlying addiction is the role the drug plays in activating the "pleasure pathway" -the *mesocorticolimbic dopamine pathway (MCLP)* - the center of psychoactive drug activation in the brain -the MCLP is made up of neuronal cells in the middle portion of the brain known as the ventral tegmental areas and connects to other brain centers such as the nucleus accumbens and then to the prefrontal cortex -this neuronal system is involved in such functions as control of emotions, memory, and gratification -alcohol produces euphoria by stimulating this area in the brain -research shows that direct electrical stimulation of the MCLP produces great pleasure and has strong reinforcing properties -drug ingestion or behaviors that lead to activation of the brain reward system are reinforced, so further use is promoted -the exposure of the brain to an addictive drug alters its neurochemical structure and results in a # of behavioral effects -w/ continued use of the drug, neuroadaptation to or tolerance and dependence on the substance develop

(psychoses associated w/ severe alc abuse, p.391)

-several acute psychotic reactions fit the diagnostic classification of substance-induced disorders -these reactions may develop in ppl who have been drinking excessively over long periods of time -such acute reactions usually last only a short time and generally consist of confusion, excitement, and delirium -these disorders often called *alcohol-induced psychotic disorders* bc they are marked by a temporary loss of contact w/ reality -*alcohol withdrawal delirium* (formerly *delirium tremens* may occur among those who drink excessively for long time -this reaction usually happens following a prolonged drinking spree when the person enters a state of withdrawal -slight noises or suddenly moving objects may cause considerable excitement and agitation -full-blown symptoms include: (1) disorientation for time and place, in which, for ex, a person may mistake the hospital for a church or jail, no longer recognizes friends, or identify hospital attendants as old acquaintances; (2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches; (3) acute fear, in which these animals may change in form, size, or color in terrifying ways; (4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested; (5) marked tremors of the hands, tongue, and lips; and (6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath -the delirium typically lasts from 3-6 days and is generally followed by a deep sleep. -when wake up, few symptoms remain, but frequently person is scared and may not resume drinking for several weeks or months -5-25% of patients w/ alc withdrawal delirium die as a result of convulsions, heart failure, and other complications -drugs like chlordiazepoxide (Librium) have demonstrated the ability to decrease withdrawal symptoms and with it the risk of death as a result of withdrawal -a 2nd alc-related psychosis: alcohol amnestic disorder -*alcohol amnestic disorder* (formerly Korsakoff's syndrome), one of the most severe alc-related disorders -primary symptom: memory defect (particularly w/ regard to recent events), which is sometimes accompanied by falsification of events (confabulation) -may not recognize pictures, faces, rooms, and other objects they have just seen, although they may feel these are familiar -increasingly tend to fill in their memory gaps w/ confabulations that lead to unconnected and distorted associations -may appear to be delirious, delusional, and disoriented for time and place, but ordinarily their confusion and disordered actions are closely related to their attempts to fill in memory gaps -the memory disturbance itself seems to be related to an inability to form new associations in a manner that renders them readily retrievable -usually occurs in long-time alc abusers after many years of excessive drinking -also show other cog impairments such as planning deficits, intellectual decline, emotional deficits, judgment deficits, and cortical lesions -the symptoms of alcohol amnestic disorder result from malnutrition, specifically lack of vitamin B (thiamine) -if correctly diagnosed w/in the first 48-72hrs, trt w/ thiamine leads to a reversal of this condition and memory functioning appears to be restored w/ prolonged abstinence -however, if undiagnosed and w/ disease progression beyond several days, the brain damage causing this condition becomes irreversible

(controlled drinking versus abstinence, p.399)

-several approaches been attempted, some alcoholics can learn to control alc intake -study, 4 long-term follow-up studies of controlled drinking treatment programs --> clear trend of increased numbers of abstainers and relapsed cases, also found a consistent (15%) ppl did control their drinking -controlled drinking was more likely to be successful in ppl w/ less severe alcohol problems -study, 18% can drink socially w/out probs during 6m follow-up -some have rejected this idea tho, like AA

(failures in parental guidance, p.394)

-stable family relationships and parental guidance are extremely important molding influences for children -stability often lacking in families of substance abusers -children who have parents that are extensive alcohol or drug abusers are vulnerable to developing substance abuse and related problems -children who are exposed to neg role models and family dysfunction early in lives or experience other neg circumstances bc the adults around them provide limited guidance often falter on the difficult steps they must take in life -these formative experiences can have a direct influence on whether they become involved in maladaptive behavior such as alc or drug abuse -in 1 sophisticated program of research aimed at evaluating the possibility that neg socialization factors influence alc use -replicated findings that alc abuse in parents is associated w/ substance use in adolescence -they found that parenting skills or parental behavior was associated w/ substance abuse in adolescents -specifically, alcohol-abusing parents are less likely to keep track of what their children are doing, and this lack of monitoring often leads to the adolescents' affiliation w/ drug-using peers. -also, stress and negative affect (more prevalent in families w/ an alcoholic parent) are associated w/ alc use in adolescence -extremely stressful childhood experiences such as physical abuse or child sexual abuse might also make a person vulnerable

(stress, tension reduction, and reinforcement, p.395)

-studies on patients undergoing substance abuse trt have shown high levels of trauma in prior histories (about 25-50% of PTSD patients also have substance use disorders) -98% of the american indian adolescents in their substance abuse study reported having a history of trauma such as threat of personal injury, witnessing of injury, or sexual abuse -study, controlled-treatment study of disaster workers who experienced PTSD after 9/11, = found that excessive alc use was associated w/ dropout of trt -in addition, high exposure to threatening situations and atrocities among Iraq War veterans has been associated w/ a positive screen for alcohol abuse -the typical individual who abuses alcohol is discontented w/ his/her life and is unable or unwilling to tolerate tension and stress -study, reported high degree of association btw alcohol consumption and negative affectivity such as anxiety and somatic complaints (in other words, many alcoholics drink to relax) -in this view, anyone who finds alcohol tension reducing is in danger of abusing alcohol, even w/out an especially stressful life situation -but, the tension-reducing causal model is difficult to accept as a sole explanatory hypothesis (if it were a main cause, we'd expect to be way more common) -also, this model does not explain why some excessive drinkers are able to maintain control over drinking and continue to function in society, whereas others are not

(beginning of chapter, p.385) substance-related disorders

-using substances like alcohol and tobacco is statistically normal and not considered pathological --> but is considered to be disordered when consumed in excessive amounts leading to impairment and other neg consequences -*substance-related disorders* - _*addictive behavior* - behavior based on the pathological need for a substance -addictive behavior is one of the most prevalent and difficult-to-treat mental health problem facing our society today -the most commonly used problem substances are *psychoactive substances* - affect mental functioning in the CNS - alc, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and weed -the following distinctions are imp to understanding and diagnosing substance-related disorders: -*substance abuse* - generally involves an excessive use of a substance resulting in (1) potentially hazardous behavior such as dnd or (2) continued use despite a persistent social, psychological, occupational, or health problem -*substance dependence* - includes more severe forms of substance use disorders and usually involves a marked physio need for increasing amounts of a substance to achieve desired effects. dependence means that an individual will show a tolerance for a drug and/or exp withdrawal symptoms when the drug is unavailable -*tolerance* - the need for increased amounts of a substance to achieve the desired effects - results from biochemical changes in body that affect the rate of metabolism and elimination of a substance from the body -*withdrawal* - physical symptoms such as sweating, tremors, and tension tha accompany abstinence from a drug

(genetic influences and learning, p.394)

-when we talk about familial or constitutional differences, NOT strictly limiting our explanation to genetic inheritance -rather, learning factors appear to play an imp role the development of predetermined tendencies to behave in particular ways -having a genetic predisposition or biological vulnerability to substance abuse is NOT a sufficient cause of the disorder -the development of alc-related problems involves living in an environment that promotes initial as well as continued use of the substance -ppl become conditioned to stimuli and tend to respond in particular ways as result of learning -learning appears to play an imp part in the development of substance abuse and antisocial personality disorders PDs -there are numerous reinforcements for using alc everyday -research also shown that psychoactive drugs such as alc contain intrinsic rewarding properties- apart from the social context or the drug's operation to diminish worry or frustration

(DSM5 criteria for Alcohol use disorder, p.388)

A. a problematic pattern of alc use leading to clin. sig. impairment or distress, as manifested by at least two of the following, occurring w/in a 12m period: (1) alc is often taken in larger amounts or over a longer period than was intended (2) there is a persistent desire or unsuccessful efforts to cut down or control alc use (3) a great deal of time is spent in activities necessary to obtain alc, use alc, or recover from its effects (4) craving, or a strong desire or urge to use alc (5) recurrent alc use resulting in a failure to fulfill major role obligations at work, school, or home (6) continued alc use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alc (7) important social, occupational, or recreational activities are given up or reduced bc of alc use (8) recurrent alc use in situations in which it is physically hazardous (9) alc use is continued despite knowledge of having a persistent or recurrent phys or psych problem that is likely to have been caused or exacerbated by alc (10) tolerance, as defined by either of the following: (a) a need for markedly increased amounts of alc to achieve intoxication or desired effect (b) a markedly diminished effect w/ continued use of the same amount of alc (11) withdrawal, as manifested by either of the following: (a) the characteristic withdrawal symptoms for alc (refer to Criteria A and B of the criteria set for alc withdrawal, p.499-500) (b) alcohol (or a closely related substance, such as benzos) is taken to relieve or avoid withdrawal symptoms

(table 11.1, some common misconceptions about alc and alc abuse, p.387)

FACT: -alc is both a nervous system stimulant and a depressant -two 12-ounce cans of beer contain more than one ounce of alcohol -alcohol may interfere w/ sleep -impaired judgement can occur long before motor signs of intoxication are apparent -it is the actual amount of alcohol in the bloodstream rather than the mix that determines intoxication -drinking coffee does not affect the level of intox -exercise and cold showers are futile attempts to increase alc metabolism -it is the amount of alc that determines whether one becomes a substance abuser -there are more individuals in trt programs for alc problems than for weed abuse -heavy alc use can be manifested in organic brain damage before liver damage is detected -the physio symptoms accompanying withdrawal from heroin are no more frightening or traumatic to a person than alc w/drawal. actually, alc withdrawal is potentially more lethal than opiate withdrawal -28% of men and 50% of women in the US are abstainers