Substance Use Disorders

(Substance) Withdrawal

Physiological and psychological consequences when individual discontinues or reduces substance use (eg. restlessness, anxiety, cramps, death)

Discontinuation of alcohol in heavy user

"Withdrawal symptoms" 1. Anxiety 2. Depression 3. Weakness 4. Restlessness 5. Difficulty sleeping 6. Muscle tremors (face, fingers, eyelids, other small musculature) 7. Elevated BP, pulse, temperature

Motivational Interviewing-SUD

1. A patient-centered and directive approach 2. Addresses ambivalence and discrepancies between a person's current values and behaviors (eg. party, bu need to study) 3. and their future goals

Ethnic differences in SUDs

1. African American youth have substantially lower usage rates than whites 2. Hispanics have the highest rates or lifetime usage for powder cocaine, crack cocaine, heroin, and methamphetamines

Violence leads to substance use

1. Aggressive individuals more likely to select (or be pushed into) social contexts where substance use is encouraged or accepted 2. Lifestyles of violent individuals conducive to significant substance use/abuse geneXenvironment correlation: peer rejection shapes addiction.

Frequent Users-SUDs

1. At age 7, compared to experimenters: little concern for moral issues somatic problems, indecisive, untrustworthy, lacks confidence, cannot admit mistakes 2. At age 11, compared to experimenters: eviant from peers, emotionally labile (moody) inattentive, gives up easily, suspicious/distrustful over-reactive

Abstainers- SUDs

1. At age 7: conventional in thought, eager to please, planful, verbally modest, does not actively seek autonomy 2. At age 11: anxious/fearful, not lively or energetic, constricted, not open to new experiences, cautious, looks to others for direction, lacks assertiveness

Substance Use Disorders (SUDs)

1. Consist of substance dependence and substance abuse 2. Criteria for substance abuse involve one or more harmful and repeated negative consequences of substance use over the last 12 months

Short term effects of Alcohol

1. Enters the bloodstream through small intestine (metabolized by the liver) 2. Effects vary by gender, height, weight, liver efficiency 3. Biphasic effect

Treatment and Prevention of SUD

1. Family Based approaches 2. Motivational Interviewing 3. Adolescents with more severe levels of abuse, unstable living conditions, or co-morbid psychopathology require an inpatient or residential setting 4. Effective approaches address multiple influences (peer, family, school, and community) on the individual

Childhood Precursors of SUDs

1. Frequent users 2. Abstainers

Substance use and housing

1. Greek housing 2. Lives off campus 3. Lives in Campus Dorm **except with illicit drugs and currently uses marijuana **social context is not causal people choose their environment based on substance accessibility

Personality/temperment Characteristics of SUD

1. Increased sensation seeking preference for novel, complex, and ambiguous stimuli 2. Positive attitudes about substance abuse and having friends with similar attitudes (alcohol expectancies) 3. Perceiving oneself to be physically older than same-age peers and striving for adult social roles- try to gain friends with similar perspectives

Biphasic effect-SUD

1. Initially, alcohol STIMULATES (sociability and well-being) 2. Later, alcohol DEPRESSES (increases in negative emotions)

Psychopharmacological Model

1. Intoxication effects induce or cause disinhibition, cognitive/perceptual changes, neurochemical 2. Chronic substance use may also influence Withdrawal Sleep deprivation Nutritional deficits Neuropsychological Impairment Enhance Psychopathology or negative personality traits more paranoid, easier to be violent

Substance Dependence (compared to abuse)

1. Involves either TOLERANCE or WITHDRAWAL

Prevalence of Alcohol Abuse

1. Lifetime prevalence 20% men 8% women 2. 8.5% of Americans met DSM criteria for alcohol abuse or dependence at a given time 3. Rates of dependence among younger women are increasing approaching that of men 4. White adolescents and adults more likely to abuse alcohol than African Americans 5. Gap narrows for high school drop outs 6. Alcohol abuse particularly problematic in Native American Communities

Family Factors and Substance Use

1. Parental alcohol use (ENVIRONMENTAL AND/OR GENETIC MEDIATION) 2. Psychiatric, marital, or legal problems in the family linked to drug abuse 3. Lack of emotional support from parents increases use of cigarettes, marijuana and alcohol 4. Lack of parental monitoring linked to higher drug usage

Reasons why students use illicit of controlled prescription drugs

1. Reduce Stress 2. Get high 3. Social pressure 4. Experiment 5. Help study 6. Lose inhibitions 7. Enjoyment 8. Can't stop

Reasons why students say they drink

1. Reduce stress 2. Enjoy the taste 3. Get drunk 4. Socialize 5. Social Pressure 6. Low inhibitions 7. Can't stop

Social Context of SUD

1. Social influence and social selection 2. Less peer influence during adolescence during adolescence- drug users selection of similar friends or projecting own use into reports regarding peers 3. KEY UNRESOLVED QUESTION: peer rejection as causing later substance problems or as INDICATING other risk factors accounting for substance problems

Substance use and violence

1. Substance use CAUSES violence 2. Violence LEADS to substance use 3. Relationship is RECIPROCAL 4. Relationship reflects "third variable" (eg. potential common causes)

Illicit drug Use ages 12+

1. Two or more races 2. American Indian/Alaska Native 3. African American 4. White 5. Hispanic or Latino 6. Asian

High Risk Behaviors associated with alcohol

1. Unsafe sexual activity 2. Smoking 3. Drinking and driving

Substance Abuse (compared to dependence)

1. Use of drug interferes with ability to function (eg. fails to meet work or family obligations 2. No physiological dependence

(recent) Trend of SUD

1. cigarette use declines whereas daily marijuana use has increased 2. illicit drugs such as MDMA, opiats, cocaine and crack has increased

Prevalence of SUDs

12 % of american adolescents meet the criteria

Incentive-Sensitization Theory-SUD

2 (contrasting) constructs: 1. Wanting (craving for drug) 2. Liking (pleasure obtained by taking the drrug) 3. Dopamine system becomes sensitive to the drug and associated cues (eg. needles, rolling papers, etc.) 4. Sensitivity to cues induces and strengthens wanting

Binge drinking

5 drinks in a short period often linked to social context

DSM05 Criteria (SUDs)

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by AT LEAST TWO of the following within a year period 1. Substance is taken in large amounts, OR over a longer period than intended 2. Persistent desire or unsuccessful effort to cut down or control substance use 3. A great deal of time is spent in activities necessary to obtain, use, or recover from substance 4. There is a craving or strong desire or urge to use 5. Recurrent substance use results in failure to fulfill major role obligations 6. Continued substance use despite having recurrent social or interpersonal problems caused or exacerbated by the effects of the substance 7. Important social, occupational, or recreational activities are given up or reduced because of substance use 8. There is recurrent substance use in situations in which it is physically hazardous 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

Most prevalent and abused SUD

Alcohol

Best group from Berkeley Study

EXPERIMENTERS demonstrate more self control. without transition to abusive characteristics

Co-morbidity of SUD

Elevated Co-morbidity: 1. Self-medication hypothesis 2. Less appreciation for the negative consequences of use 3. Poor judgement with respect to peer group selection 4. Substance use/abuse exacerbates mental health disorders and psychopathology 5. Psychopathology accelerates onset of abuse or dependence (Depression unrelated to nicotine use or onset but significantly predicts nicotine addiction)

(Substance) Tolerance

Greater amounts of substance are needed to produce the desired effect

SUD in greater concordance with Mono-zygotic twins than Di-zygotic twins (Males and Females)

Men: alcohol, caffeine, smoking, marijuana, and drug abuse in general genetic liability is more significant Women: role of genetics is less clear

Family-based approaches-SUD

Modify negative interactions between family members, improve communication, and develop effective problem-solving skills to address areas of conflict Family as a unit

Drinking and stress

Mostly not stressed

Third variable explanation-SUD

Potential shared traits or characteristics 1. Temperament 2. Genetic Liability 3. Parental modeling (substance use and violence) 4. Disrupted familial relationships 5. Socioeconomic influences

Adolescent Drug Use and Psychological Health Study

QUESTION: Are there significant personality differences between 'abstainers', 'experimenters', and 'frequent users'. Prospective Longitudinal Study 1. N=101 18 year olds 2. Initally recruited at 3 years old 3. Assessed at 3,4,5,7 11,14,18 years old 4. Diverse social class and parent education 5. 66% African American, 25% White, 8% Asian

Course (SUDs)

Rates typically peak in late adolescence then decline during young adulthood 1. Alcohol use influences high risk behaviors 2. Girls who report dating aggression are 5X more likely to use alcohol than girls in nonviolent relationships; boys are 2.5 X more likely

Inherited diathesis

Toleration to alcohol is inherited. eg. Asians have lower rates of alcohol abuse, with evidence for physiological intolerance- protective outcome

Social selection

choosing friends with drinking patterns similar to their own, and influences drinking behavior further

Moderator of physiological intolerance and substance use

cultural/social context

Social influence

having peers who drink influences drinking behavior

Stress and alcohol use

implication that college students feel that offering stress as a reason of substance use is more socially equivalent is STATISTICALLY EQUIVALENT

Sex differences in SUDs

sex differences in lifetime prevalence rates are converging due to increased substance use among girls

Perceptions of substance use

students average estimate of the amount that their peers drink on their 21st birthday is 10.58 drinks. Students who drink on their 21st birthday report consuming on average 7.42 drinks. The higher the estimate of peer drinking on the 21st birthday, the more alcohol the student tends to consume on this occasion

Mesocorticolimbic Dopamine Pathway

the center of psychoactive drug activation in the brain Prefrontal cortex **executive decisions Ventral tegmental area **sub-sub cortical and most enriched in DA receptors Nucleus Accumbens **sensitive to reward, pleasure, aggression, fear