Chapter 10: Substance related & impulse control
Carlos psychiatrist treats him for a cocaine abuse by delivering a shock when Carlos attempts to use cocaine, a treatment known as ________, in contrast, Lisa's therapist has her imagine having painful seizures at the same time that Lisa is thinking about using cocaine, a treatment known as ________: A) Aversion therapy; covert sensitization B) Contingency management; relapse prevention C) Narcotics anonymous; controlled use D) Agonist substitution; adversive treatment
A
Geno is a recovering alcoholic. To help with his treatment, Gino's physician prescribed a drug that causes Gino to experience shortness of breath and severe vomiting if he drinks. What drug has the physician prescribed? A) Antabuse B) MDMA C) Amyl Nitrate D) PCP
A
Match the disorder with the corresponding symptoms: This disorder affects somewhere between 3 to 5% of the adult American population and is characterized by the need to gamble. A) Gambling disorder B) Intermittent explosive disorder C) Kleptomania D) Pyromania
A
Match the example with the following term: Unfortunately, the heroin addict may become permanently ___________ on methadone. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
A
________ is the need for greater amounts of drug to experience the same affect, where as _______ is the negative physical response that occurs when a drug is not taken: A) Tolerance; withdraw B) Delirium; withdraw C) Dependence; withdraw D) Accommodation; abuse
A
substance abuse
A pattern of psychoactive substance used leading to significant distress or impairment in social and occupational rules and and hazardous situations. A separate category was created for substance abuse in DSM3 and since then we have acknowledged the complex biological and psychological nature of the problem.
substance intoxication
A physiological reaction, such as impaired judgment and motor ability, as well as mood change, resulting from the ingestion of a psychoactive substance. For many of the substances we discuss here, intoxication is experienced as an impaired judgment, mood changes, and lowered motor ability
Meth
A purified, crystallized form of amphetamine, is ingested there smoking. This drug causes marked aggressive tendencies and stays in the system longer than cocaine, making it particularly dangerous.
Controlled drinking/relapse prevention
An extremely controversial treatment approach to alcohol dependence, and which severe abusers are taught to drink in moderation. - The results of the study suggests that control drinking may be a viable alternative to abstinence for some alcohol abusers, although it clearly isn't a cure
Match the disorder with the corresponding symptoms: This rarely diagnosed disorder is characterized by episodes of aggressive impulses and can sometimes be treated with CBT, drug treatments, or both. A) Gambling disorder B) Intermittent explosive disorder C) Kleptomania D) Pyromania
B
Match the example with the following term: Heroin and methadone are ________, which means they affect the same neurotransmitter receptors: A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
B
Research shows that the way individuals think about drug influences the way they act when using it. This phenomenon is known as the: A) Tolerance paradigm B) Expectancy effect C). Dependency model D) Opponent process theory
B
Dr. Myers prescribed medication to help control a patient's seizures. The patient reports that the medication also makes her feel calm and helps her sleep. Dr. Myers most likely prescribed a(n): A) Hallucinogen B) Opiate C) Benzodiazepine D) Amphetamine
C
For marijuana users, reverse tolerance occurs when: A) Chronic use renders the user unable to feel high B) A first time user does not feel high C) More pleasure from the drug is reported after repeated use D) A chronic user experiences withdrawl symptoms
C
Match the disorder with the corresponding symptoms: This disorder begins with the person feeling a sense of tension that is released and followed with pleasure after he has committed a robbery A) Gambling disorder B) Intermittent explosive disorder C) Kleptomania D) Pyromania
C
Match the example with the following term: Methadone is used to help heroin attic's kick the habit and a method called_________. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
C
Match the following disorder with its corresponding effects: Disorder that deprived a person of the ability to resist acting or a drive or Tim Tatian. A) Substance related and addictive disorders B) Dementia C) Impulse control disorder D) Alcohol use disorder E) Wernike-Korsakoff Syndrome
C
One psychological component of addiction may involve taking a drug to avoid negative feelings associated with coming down from a high. What theory describes this use of substance to avoid worsening lows? A) Tolerance theory B) Substance cycle theory C) Opponent process theory D) Pollydependence theory
C
The definition of substance abuse according to the DSM-5 is based on: A) How much of the substance is consumed per day B) How much of the substance is consume per week C) How significantly the substance interferes with the users life D) The type of substance used
C
Withdrawl from opiates
Can be so unpleasant that people may continue to use these drugs despite a sincere desire to stop (excessive yawning, nausea and vomiting, chills, muscle aches, diarrhea, and insomnia).
Match the disorder with the corresponding symptoms: Individuals with this disorder are preoccupied with fires and the equipment involved in setting and putting out fires. A) Gambling disorder B) Intermittent explosive disorder C) Kleptomania D) Pyromania
D
Match the example with the following term: ___________ drugs block or counteract the effects of psychoactive drugs and are sometimes effective in treating attics. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
D
The primary neurotransmitter affected by cocaine is _________, where as the primary neurotransmitter affected by opiates is _______: A) GABA; norepinephrine B) Acetylcholine; GABA C) Norepinephrine; dopamine D) Dopamine; GABA
D
Which of the following statements most accurately describes the relationship between gender and alcohol consumption: A) Women are more likely to use alcohol, but men are more likely to be heavy drinkers B) Men are more likely to use alcohol, but women are more likely to be heavy drinkers C) Women are more likely to use alcohol and be heavy drinkers D) Men are more likely to use alcohol and be heavy drinkers
D
Two types organic brain syndrome that may result from long-term heavy alcohol use:
Dementia (However, mild to moderate intake of alcohol, especially wine, they actually serve a production role in cognitive decline as we age) Wernike-korsakoff syndrome
Alcohol
Depressant The most commonly used in abused depressant substance
Depressants
Depressants primarily decrease central nervous system activity. Their principal effect is to reduce our level of psychological arousal and help us relax. Alcohol Barbiturates (sedatives: Amytal, Seconal, Nembutal) Benzodiazepines (antianxiety: Valium, Xanax, Halcion) hypnotic anxiolytic drugs (prescribed for antianxiety) These substances are among the most likely to produce symptoms of physical dependence, tolerance, and withdrawal.
Match the example with the following term: The _________ model involves therapy that helps individuals remove ambivalence about stopping their drug use by examining their beliefs about the positive and negative aspects of drug use. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
E
Match the example with the following term: ________ Is a controversial treatment for alcohol abuse because of a negative but Lawn experimental finding, but also because it conflicts with the believe in total abstinence. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
F
The media and parental influences have no effect on adolescent drug use; it is solely a peer pressure factor. True or false
Falls
The expectancy effect is illustrated when a person who expects to be less inhibited when drinking alcohol is given a placebo and acts or feels normally. True or false
False
Use of crack cocaine by a pregnant woman always adversely affects the developing fetus: True or false
False
Stimulants are produced only in a laboratory. True or false
False - Can occur naturally
Amphetamines are naturally occurring drugs that induce feelings of elation and bigger and can reduce fatigue. True or false
False - Produced in labs
Match the example with the following term: In _______, Substance use is paired with something extremely unpleasant (like alcohol and vomiting with Antabuse): A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
G
Match the example with the following term: By imagining unpleasant scenes, the ________ technique helps the person associate the negative effects of the drug with drug use. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
H
Match the example with the following term: In _______ the clinician and the client worked together to decide which behaviors the client needs to change in which reinforcers will be used as rewards for reaching set goals. A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
I
Match the example with the following term: It has been difficult to evaluate rigorously the effects of alcoholic anonymous, because the participants are: A) Dependent B) Cross tolerant C) Agonist substitution D) Antagonist E) Relapse prevention F) Controlled drinking G) Aversion therapy H) Covert sensitization I) Contingency management J) Anonymous
J
Wernicke-Korsakoff syndrome
Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. It may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers.
Biological treatments for substance related disorders:
Scientists are trying to find ways to prevent people from experiencing the pleasant highs associated with drug use or to find alternative substances that have some of the positive affects without their addictive properties: - Agonist substitution (Replacing one drug with a similar one (methadone for heroin, nicotine gum and patches for cigarettes) - Antagonist substitution (Blocking one's drug effect with another (naltrexone for opiates and alcohol) - Aversive treatment (Making taking a drug very unpleasant - ie, using Antabuse causes nausea and vomiting when mixed with alcohol, to treat alcoholism) - Drugs to help recovering person deal with withdrawl symptoms (clonidine for opiate withdrawl; sedatives for alcohol, etc) - Other biological approaches
DSM-5 Diagnostic criteria for hallucinogen intoxication:
Similar to those for cannabis: perceptual changes such as objective intensification of perceptions, the personalization, and hallucinations. - Physical symptoms include pupillary dilation, rapid heartbeat, sweating, and blurred vision
Past view of substance use
Substance use was considered a sign of moral weakness, and the influence of genetics and biology was hardly acknowledged.
Inhalants
Substances whose fumes are sniffed or inhaled to give effect. Include: spray paint, hairspray, paint thinner, gasoline, amyl nitrate, nitrous oxide (laughing gas), nail polish remover, felt tip markers, airplane glue, contact cement, dry cleaning fluid, spot remover. - They are rapidly absorbed into the bloodstream through the lungs when inhaled from containers or on cloth. Usually includes dizziness, slurred speech, lack of coordination, euphoria, and lethargy. - Users build up a tolerance to the drugs and withdraw (sleep disturbances, tremors, irritability, and nausea) can last from 2 to 5 days. Long-term use canned damage bone marrow, kidneys, liver, lungs, nervous system, and brain. If users are startled, this can cause a cardiac event that can lead to death (sudden sniffing death) Inhalant use disorder is the same as the other use disorders except for # 11 withdrawl
Sedative, hypnotic, or anxiolytic-related disorders: clinical description
The DSM-5 criteria for sedative, hypnotic, and related disorders do not differ substantially from those for alcohol disorders. - Both include maladaptive behavior all changes such as inappropriate sexual or aggressive behavior, variable moods, impaired judgment, impaired social or occupational functioning, slurred speech, motor coordination problems, and unsteady gait. - These drugs affect the brain by influencing the GABA neurotransmitter system, although by mechanism slightly different from those involving alcohol. If you drink alcohol after taking a benzodiazepine or a barbiturate or combine these drugs, the total effects can reach dangerous levels.
withdrawl delirium
The frightening hallucinations and body tremors that result when a heavy drinker withdrawals from alcohol. Also known as delirium tremens (DT).
Sedative, hypnotic, or anxiolytic (drug used to reduce anxiety)-related disorders
The general group of depressants also include sedative (calming), hypnotic (sleep inducing), and anxiolytic (anxiety reducing) drugs - these drugs include: - Barbiturates - Benzodiazepines
Benzodiazepines
The most common group of antianxiety drugs, which includes Valium, Xanax, Halcion, or Dalmane also used to treat insomnia. They show some side effects, such as cognitive and motor impairment, and may result in substance dependence. Relapse rates are extremely high when such drug is discontinued. In general, benzodiazepines are considered much safer than barbiturates, with less risk of abuse and dependence. Reports I miss use of Rohypnol (roofies), however, shows how dangerous some benzodiazepines can be.
Tolerance
The need for increased amounts of a substance to achieve the desired effect, and a diminished effect with continued use of the same amount.
Psychological dependence
The use of increasingly greater amounts of the drug to experience the same affect (tolerance) and a negative physical response when a substance is no longer ingested.
Nicotine addiction
Top of the list for easy to get hooked on and hard to get off
Amphetamines have been used as appetite suppressants. True or false
True
In ingredient of the beverage Coca-Cola in the 1800s was cocaine. True or false
True
Negative reinforcement is involved in the continuance of drug use, because drugs often provide escape from pain, stress, panic, and so on. True or false
True
Regular use of stimulants can result in tolerance and dependence on the drug: True or false
True
Research with both animals and humans indicates that substance abuse in general is affected by our genes, although not one particular gene. True or false
True
To some extent, all psycho active drugs provide a pleasurable experience, creating positive reinforcement. True or false
True
alcohol use disorder
a cognitive, biological, behavioral, and social problem associated with alcohol use and abuse
impulse control disorders
a group of psychiatric disorders characterized by the inability to resist an impulse despite potential negative consequences. Suffers often perceived by society as having a problem simply due to lack of "will" (Being uncomfortable, doing something to make it better, it makes it worse) DSM-5 includes three additional impulse control disorders: - Intermittent explosive disorder - Kleptomania - Pyromania
impulse control disorders
disorders in which a person acts on an irresistible, but potentially harmful, impulse - intermittent explosive disorder - kleptomania - pyromania
Barbiturates
drugs that depress central nervous system activity, reducing anxiety but impairing memory and judgement It's sedative and addictive drug such as Amytal, Seconal, or Nembutal that is used as a sleep aid. Overdosing on these is a common means of suicide
antagonist drugs
medications that block or counteract the effects of psychoactive drugs. When it is given to a person who is dependent on opiates, it produces immediate withdrawal symptoms, and extremely unpleasant effect. - A person must be free from these withdrawal symptoms completely before starting naltrexone, and because it removes the euphoric affect of opiates, the user must be highly motivated to continue treatment.
tobacco-related disorders
nicotine in tobacco is a psychoactive substance that produces patterns of dependence, tolerance, and withdrawal Cognitive, biological, behavioral and social problems associated with the use and abuse of nicotine. 20% of people in the US smoke
psychoactive substances
substances, such as drugs, that alter mood or behavior This also includes more common place legal drugs such as alcohol, nicotine, and caffeine. These drugs also affect mood and behavior and can become addictive - they account for more health problems in a greater mortality rate and all illegal drugs combined.
Substance use
the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning
Match the following disorder with its corresponding effects: A class of disorders that affect the way people think, feel, and behave. A) Substance related and addictive disorders B) Dementia C) Impulse control disorder D) Alcohol use disorder E) Wernike-Korsakoff Syndrome
A
State whether the following case describes: A) Use, B) Intoxication or C) Use disorder Over the past year Henry picked up a habit of having a cigarette every day at lunch. Instead of sitting in the lounge with his friends he goes to his favorite spot in the courtyard and has his cigarette. If for some reason he is unable to have his cigarette after lunch, he is not dependent on it and can still function normally:
A
Hallucinogen related disorders
Changes to enter another reality in which they don't have access to otherwise (they don't want their current reality) - Altered mental and emotional perception - Distortion (sometimes dramatic) of sensory perceptions Hallucinogens essentially change the way they use or perceive the world. Sight, sound, feelings, and even smells are distorted, sometimes in dramatic ways, and a person under the influence - cannabis - LSD - ecstasy
Component treatment for substance use disorders:
Most comprehensive treatment programs aimed at helping people with substance use disorders have a number of components thought to boost the effectiveness of the "treatment package." Goal: counteract the positive associations with substance use with negative associations: - Covert sensitization - Contingency management - Community reinforcement approach - Motivational enhancement therapy (MET) - CBT
Treatment for gambling disorder
Treatment is difficult Those with gambling disorder exhibit a combination of characteristics, including denial of the problem, impulsivity (these interfere with affective treatment) - Effectiveness for gamblers anonymous suggest that 70 to 90% drop out of these programs and the desire to quit must be present before intervention. - CBT interventions help reduce the symptoms of gambling disorder DSM-5 includes another potentially addictive behavior: Internet gambling disorder - as a condition for further study
Social causes of substance related disorders:
Two views of the substance related disorders characterized contemporary thought: - Moral weakness model of dependence: drug use is seen as a failure of self-control in the face of temptation; this is a psychosocial perspective. Proponents of this model see drug users is lacking the character or moral fiber to resist the lure of drugs. - Disease model of dependence: assumes that drug use disorders are caused by underlying psychological causes: this is a biological perspective. Those who are described in this model think that just as diabetes or asthma can't be blamed on the afflicted individuals, neither should drug use disorders. Neither perspective does justice to the complex interrelationship between the psychosocial and biological influences that affect substance disorders: a comprehensive view of substance related disorders that include both psychosocial and biological influences is needed for this important suicidal concern to be addressed adequately
Can you use drugs and not abuse them?
Yes, but we do not know ahead of time who might be likely to lose control and abuse these drugs and who is likely to become dependent with even a passing use of a substance. Dependence can also present without abuse - i.e. morphine
pyromania
an impulse-control disorder that involves having an irresistible urge to set fires: Characteristics: - Irresistible urge to set fires - The person feels attention or an arousal before setting a fire and a sense of gratification or relief while the fire burns. Treatment: - is generally CBT and involves helping the person identify the signals that initiate the urges and teach him coping strategies to resist the temptation to start fires These individuals will also be preoccupied with Buyers and the associated equipment involved in setting and putting out these fires (Only 3% of arsonist have pyromania) - Research examine the role of a family history of fire setting along with comorbid impulse disorder: .
Cannabis-Related Disorders
relatively mild, distorted perception of time, paranoia, bewilderment, mood swings, dizziness, tremors, numbness The most routinely used illegal substance (5-15% in western culture) - Perhaps more than any other drug it can produce different reactions and people (i.e. sense of well-being, mood swings, paranoia) The feelings of well-being produced by small doses can change to paranoia, hallucinations, and dizziness when larger doses are taken. Research on frequent cannabis users suggest that impairment of memory, concentration, relationship with others, and employment may be negative outcomes of long-term use Major signs of withdrawal do not usually a car with cannabis. Chronic users who quit do you report a period of irritability, restlessness, appetite loss, nausea, and difficulty sleeping.
designer drugs
synthetic substances meant to imitate the effects of narcotics and hallucinogens Disassociative anesthetics class of drugs - causes pain relief and the feelings of being out of one's body. - Originally developed by pharmaceutical companies to target specific diseases and disorders. - MDMAS (Ecstasy or Molly) a these drugs are able to heighten a persons auditory and visual perception, as well as a sense of taste and touch. - GHB (Gamma-hydroxybutrate) or liquid ecstasy is a depressant that at low doses can produce a state of relaxation and increased tendency to verbalize, but at higher doses or with alcohol or other drugs can result in seizures, severe respiratory depression, and coma. - May cause irreversible memory loss and other cognitive problems
Motivational Enhancement Therapy (MET)
*method of counseling where the client's internal motivation is the driving force for changing problem bx *FRAMES (feedback, emphasis on personal responsibility, clear advice to change, a menu of alternative, therapist empathy, facilitation of client self efficacy) *Goes hand in hand with the stages of change Used in arenas where sessions are infrequent Proposes that behavior change in adults is more likely with empathetic and optimistic counseling (The therapist understands the clients perspective and believes that he can change Dash a focus on a personal connection with the clients core values: - I reminded the client about what he cherishes the most, MET intends to improve the individuals believe that any changes made will have positive outcomes in the individual is therefore more likely to make the recommended changes.
The opposite of addiction is not sobriety but:
- Attachment Each person's drug of choice matters - it gives us a huge clue The addiction isn't really the problem - it's a solution to their problem
The substances are grouped in six general categories in our book:
- Depressants: these substances result in behavioral sedation and can induce relaxation (alcohol, sedative and hypnotic drugs, and Benzodiazepines) - Stimulants: these substances cause us to be more active and alert and can elevate mood (amphetamines, cocaine, nicotine, caffeine) - Opiates: the major effect of these substances is to produce analgesia (inability to few pain) temporarily (reduce pain) and euphoria (heroin, opium, coding, morphine) - Hallucinogens: these substances alter sensory perception and can produce delusions, paranoia, and hallucinations (cannabis, LSD) - Other drugs of abuse: other substances that are abused but do not fit neatly into one of the categories (inhalents, anabolic steroids, other over-the-counter and prescription medication). These substances produced a variety of psychoactive effects that are characteristic of a substance is described in the previous categories - Gambling disorder: as with the ingestion of the substances above, individuals who display gambling disorder are unable to resist the urge to gamble which, in turn, results and negative personal consequences
Withdraw from alcohol includes:
- Sleep problems - Nausea - Vomiting - Gastritis - hematemesis (vomiting blood) - Dry mouth - Blotchy complexion - mild peripheral Adema (Swelling of lower legs or hands)
kleptomania
A recurrent failure to resist urges to steal things not needed for personal use or their monetary value: Characteristics: - Recurring failure to resist urges to steal I need an items - The person begins to feel a sense of tension just before stealing, which is followed by feelings of pleasure or relief while the theft is committed. - Hi comorbidity with mood disorders and, to a lesser degree, with substance abuse/dependence Treatment: - Behavioral interventions or anti-depressant medication These people score high on assessments of impulsivity, reflecting their inability to judge the immediate gratification of stealing compared with a long term negative consequences Patients with this often report having no memory about the act of shoplifting
Intermittent Explosive Disorder (IED)
A type of impulse-control disorder characterized by repeated episodes of impulsive, uncontrollable aggression in which people strike out at others or destroy property Characteristics: - Acting on aggressive impulses that result in assault or destruction of property - Current research has focused on how neurotransmitters and testosterone levels interact with psycho social influences (stress, parenting styles) - It may be used as a legal defense - insanity for all violent crimes Treatment: - CBT: (i.e. helping the person identify and avoid "trigger" for aggressive outbursts) and approaches modeled after drug treatments appear the most effective for these individuals
DSM-5 - Gambling debts order
A. Impairment and distress and four or more of the following in a 12 month period: 1. Needs to gamble with increased amounts of money in order to achieve desired excitement 2. Is restless or irritable when attempting to cut down or stop gambling 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling 4. Often is preoccupied with gambling 5. Often gambles when feeling distressed 6. After losing money gambling, often returns another day to get even 7. Lies to conceal the extent of involvement with gambling 8. Has jeopardized or lost significant relationships, jobs, or educational or career opportunities because of gambling 9. Relies on others to provide money to relieve desperate financial situations caused by gambling 10. Not better explained by manic episode Mild (4-5) Moderate (6-7) Severe (8+)
Caffeine intoxication
A. Recent consumption of caffeine - typically a high dose well in excess of 250 mg B. Five or more of the following developing shortly after caffeine use 1. Restlessness 2. Nervousness 3. Excitement 4. Insomnia 5. Flushed face 6. Diuresus 7. Gastrointestinal disturbance 8. Muscle twitching 9. Rambling flow of thought and speech 10. Tachycardia or cardiac arrhythmia 11. Periods of inexhaustibility 12. Psycho motor agitation C. Causes clinically significant distress or impairment in social, occupational or other important areas of functioning D. Not due to another medical condition, mental disorder, or other substance.
Compared with all other drugs, caffeine can produce the most variable reaction in people. True or false
False - cannabis
contingency management
An operant conditioning approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior. The clinician and the client together select the behaviors that the client needs to change and decide on the reinforcers that will reward reaching certain goals.
Hallucinogenic substance
Any psychoactive substance, such as LSD (Most common hallucinogenic drug) Psilocybin, mescaline, that can produce delusions, hallucinations, paranoia, and altered sensory perception. - Some reach search shows that psilocybin may be helpful for anxiety and depression among those relieving cancer care. Tolerance develops quickly to a number of hallucinogens. For most hallucinogens, no withdrawal symptoms are reported. Even so, a number of concerns have been expressed about their use. One is the possibility of psychotic reactions. Most of these drugs bear some resemblance to neurotransmitters - one's body processes the substance without incurring any harm to organs including the brain: - LSD, psilocybin, lysergic amide, and DMT are chemically similar to serotonin - Mescaline resembles norepinephrine
Match the following disorder with its corresponding effects: The decline of intellectual abilities through, for example, excess consumption of alcohol. A) Substance related and addictive disorders B) Dementia C) Impulse control disorder D) Alcohol use disorder E) Wernike-Korsakoff Syndrome
B
State whether the following case describes: A) Use, B) Intoxication or C) Use disorder Brannon scored the winning goal for his high school soccer team and his friends take him out to celebrate. He doesn't smoke, but he doesn't mind drinking alcohol occasionally. Because Brannon has such a good game, he decided to have a few drinks. Despite his great performance in the game, he is easily irritated, laughing one minute and yelling the next. The more Brannon rambles on about his game winning goal the more difficult it is to understand him
B
State whether the following case describes: A) Use, B) Intoxication or C) Use disorder Gina started a new job five weeks ago and is about to be fired. This is her third job this year. She has been absent from work at least once a week for the past five weeks. She was reprimanded in the past after being seen at a local pub in a drunken state during regular office hours although she called in sick. At her previous job, she was fired after she came to work unable to conduct herself appropriately and with alcohol on her breath. When confronted about her problem, do you know went to the nearest bar and drink some more to try to forget about the situation:
C
State whether the following case describes: A) Use, B) Intoxication or C) Use disorder MARTY is a 24-year-old college student who started drinking heavily when he was 15. MARTY drinks a moderate amount every night. In high school, he would become drunk after about four beers; now his tolerance has more than doubled. MARTY claims alcohol relieve that pressure of college life. He wants a tempted to quit drinking, but he had chills, fever, diarrhea, nausea, and vomiting, and body aches and pains:
C
CBT for substance use disorders
CBT is an effective treatment approach for many psychological disorders and it is also one of the most well designed and study approach is for treating substance dependence. - This treatment address is multiple aspects of the disorder, including a person's reactions to cues and lead to substance use and thoughts and behaviors to resist use. - Another target of CBT address is the problem of relapse - Incidence of re-labs are dealt with as occurrences from which the person can recover; instead of looking on these episodes as inevitably lead into more drug use, people in treatment are encouraged to see them as episodes brought on by temporary stress or a situation that can be changed.
Statistics on use and abuse of alcohol
Caucasians report the highest frequency of drinking; lowest among Asians Alcohol does not cause aggression, but it may increase a persons likelihood of engaging in impulsive ask and it may impair the ability to consider the consequences of acting impulsively
adversive treatment
Clinicians in this area may prescribe drugs that make and just in the abused substance extremely unpleasant
What cocaine addiction looks like:
Cocaine addiction does not resemble that of many other drugs early on; typically, people find only that they have a growing in ability to resist taking more. - Fewer negative effects are noted at first; however, with continued use, sleep is disrupted, increase tolerance causes a need for higher doses, paranoia and other negative symptoms that in, and the cocaine use gradually become socially isolated. Chronic use may result in premature aging of the brain.
cocaine use disorders
Cognitive, biological, behavioral, and social problems associated with the use and abuse of cocaine. - Makes the heart beat more rapidly and a regularly and I can have fatal consequences. - Men are twice as likely to use cocaine as women. - Black individuals account for half of a missions to emergency rooms - Cocaine is in the same group of stimulants as amphetamines because it has similar effects on the brain on the dopamine system.
Match the following disorder with its corresponding effects: Disorder in which the effects of the drug impedes the ability to function properly by affecting her vision, motor control, reaction time, memory, and hearing. A) Substance related and addictive disorders B) Dementia C) Impulse control disorder D) Alcohol use disorder E) Wernike-Korsakoff Syndrome
D
The DSM-5 term substance related disorders includes 11 symptoms that range from relatively mild to more severe:
DSM-5 removed the previous symptom that related to substance related legal problems and added a symptom that indicates the presence of craving or a strong desire to use the substance. (Abuse and dependence no longer used) - doesn't include internet gambling or sexual addictions) Symptoms of other disorders can complicate the substance use disorder picture significantly: - Almost 3/4 of people in addition treatment centers have an additional psychiatric disorder. - This can happen for several reasons - drug intoxication and withdraw can cause symptoms of anxiety, depression, and psychosis. Disorder such as schizophrenia and antisocial personality disorder are highly likely to include a secondary problem of substance use.
Steroids
Derived from or are a synthesized form of the hormone testosterone. They can be taken orally or through injection. Steroid use differs from other drug use because the substance does not produce a desirable high but instead is used to enhance performance and body size. - Dependence therefore seems to involve the desire to obtain the performance gains obtained rather than a need to re-experience an altered emotional or physical state (mood disturbances are common).
Stimulant Related Disorders: Cocaine
Derived from the leaves of the coca plant, a flowering bush indigenous to South America. And small amounts cocaine increases alertness, produces it Foria, increase his blood pressure and pulse, and causes insomnia and loss of appetite.
Stimulants
Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions. Make us more alert and energetic. Uppers - Hi and then crash. Takes them from a lower place so we can assume they are down Of all of the psychoactive drugs used in the United States, the most commonly consumed are stimulants. - Caffeine (Coffee, chocolate, mini soft drinks) - Nicotine - Stimulates the central nervous system. Results and sensations of relaxation, wellness, pleasure (Most addictive quickly) - Amphetamines (Ritalin, Aderall, estacy, crystal meth/ice) - cocaine - Short-lived sensations of elation, bigger, reduce fatigue. Highly addictive but develop slowly (men are two times more likely to use)
Cultural causes of substance use disorders:
Each culture has its own preferences for acceptable psycho active drugs, as well as its own prohibitions for substance is it finds unacceptable. Cultural norms affect the rates of substance use in important ways. Weather substance use is considered a harmful dysfunction often depends on the assumption of the cultural group. People of Asian dissent are more likely to have the AL2 gene, which produces a severe flushing effect after drinking
community reinforcement approach
Encouraging a person to change environmental conditions to make them more reinforcing than drug use. Several facets of the drug problem are addressed to help identify and correct aspects of the persons efforts to abstain: 1st - A spouse or friend who is not a substance use or is recruited to participate in relationship therapy to help the abuser improve relationships with other important people 2nd - Clients are taught how to identify the antecedents and consequences that influence their drug taking (Encouraged to avoid associations) 3rd - Clients are given assistance with employment, education, finances, or other social service areas that may help reduce their stress 4th - New recreational options help the person replace substance use with new activities
Biological causes of substance related disorders:
Familial and genetic influences: - Genetic factors may affect how people experience and metabolize certain drugs, which in turn may partly determine who or who will not become regular users (Genetic factors also predict which treatments may be effective) Neurobiological influences: - The brain appears to have a natural "pleasure pathway" that mediates our experience every ward. All abuse substances seem to affect this internal rewards center in the same way as you experience pleasure from certain foods or sex. - We know that amphetamines and cocaine act directly on the dopamine system. Other drugs, however, appear to increase the availability of dopamine and more round about and intricate ways. - We now understand the other neurotransmitters in addition to dopamine, including serotonin and norepinephrine, are involved in the brains reward system. One property of psycho active drugs is that they stop people from feeling bad, and effect as powerful as making them feel good. - Nuroplasticity increase drug seeking and relapse Researchers have identified individual differences in the way people respond to alcohol. Understanding these response differences is important because they may help explain why some people continue to use drugs until they require a dependence on them, where as others stop before this happens.
Treatment of Substance-Related Disorders
First step to recovery - admit we need help, that we have a problem, and that we need others to help overcome this chronic dependence. - The personal motivation to work on a drug problem appears to be important but not necessarily essential in the treatment of substance abuse (see below - summary). - Treating people who have substance related disorders is a difficult task and focuses on multiple areas: helping someone withdraw. Many programs also teach skills for coping with life stressors. Some biological treatments focus on how to cancel out the effects of the ingested substances. Biological treatments Psychosocial treatments Prevention Obstacles to successful treatment for substance use and dependence include a lack of personal awareness that one has a problem and an unwillingness to change. Substance dependence is treated successfully only in a minority of those affected, and the best results reflect the motivation of the drug user and a combo of biological and psychosocial treatments (best to use multiple approaches) *Programs aimed at preventing drug use may have the greatest chance of significantly affecting the drug problem
effects of caffeine
In small doses it can elevate your mood and decrease fatigue. And larger doses, it can make you feel jittery and cause insomnia. - People react vicariously to caffeine; some are sensitive to it, and others can consume relatively large amounts with little effect. - Regular use can result in tolerance and dependence - withdraw can lead to headaches, drowsiness, and unpleasant mood. - Caffeine seems to block adenosine reuptake. Adenosine Plays an important role on the release of dopamine and glutamate in the striatum, which may explain the elation and increased energy that come with caffeine use.
Withdrawl
Is severely negative psychological reaction to removal of a psychoactive substance, which can be alleviated by the same or similar substance. Withdraw from many substances can bring on chills, fever, diarrhea, nausea and vomiting, and aches and pains.
And integrative model to causes of substance related disorders:
It is clear that abuse and dependence cannot be predicted from one factor, be at genetic, neurobiological, psychological, or cultural. - Access to a drug is necessary but not sufficient for abuse or dependence. Exposure has many sources (media, parents, peers, and indirectly - lack of supervision). Whether people use a drug depends on social and cultural expectations, some encouraging and some discouraging, such as laws against possession or sale of drugs. The path from drug use to abuse independence is more complicated: - Major stressors - Genetic influences - Other psychiatric conditions: people with mood disorders or anxiety disorders my self medicate. We also know that continued use of certain substances change the way our brains work (neuroplasticity). The brain re-organize itself to adapt. Unfortunately this change in the brain increases the drive to obtain the drug and decreases the desire for other non-drug experiences - both of which contribute to continue use and relapse
substance dependence (addiction)
Maladaptive pattern of substance use characterized by the need for increased amounts to achieve the desired effect, negative physical effects when the substance is withdrawn, unsuccessful efforts to control its use, and substantial effort expended to seek it or recover from its effects
Other biological approaches to substance use disorder:
Medication is often prescribed to help people deal with the often disturbing symptoms of withdrawal. Because withdraw from certain prescribe medications (such as sedative drugs can cause cardiac arrest or seizures), these drugs are gradually tapered off to minimize dangerous reactions. In addition, sedative drugs (benzodiazepines) are often prescribed to help minimize discomfort for people with drawing from other drugs such as alcohol.
Psychosocial treatments for substance use disorders:
Most research indicates a need for social support or therapeutic intervention: - Aversion therapy: to create negative associations with drug use (shocks with drinking, imagining nausea with cocaine use) - Contingency management to change behaviors by rewarding shows and behaviors - Inpatient facilities (Research suggests that there may be no difference between intensive residential setting programs and quality outpatient care and the outcomes for alcohol patients.) - AA and other variation (The foundation of AA is the notion that alcoholism is a disease and alcoholics must acknowledge their addiction to alcohol and its destructive power over them and look to a higher power to help them overcome their shortcomings) - Controlled Drinking/relapse prevention - Component treatment - Relapse prevention - Community reinforcement
effects of alcohol
Most substances described in this chapter, including cannabis, opiates, and tranquilizers, interact with specific receptors in the brain cells. The effects of alcohol, however, are more complex: - Alcohol influences a number of neuroreceptor systems, which makes it difficult to study -Alcohols antianxiety properties may result from its interaction with that GABA system - Although alcohol seems to loosen our tongues and makes us more sociable, it makes it difficult for neurons to communicate with one another The glutamate system is excitatory - it is suspected to involve learning and memory and it may be the Avenue through which alcohol affects our cognitive abilities. The serotonin system also appears to be sensitive to alcohol. This system affects mood, sleep, and eating behavior and is thought to be responsible for alcohol cravings.
Opiates
Narcotic effect- Pain relief and inducing sleep (Doctors prescribe, people get addicted - People have gotten used to that pain is bad) Refers to the family of substances that includes these opiates and synthetic variations (ie- methadone) and the similarly acting substances that occur naturally in our brains (enkephalins, beta-endorphins, dynorphines) - opium - morphine - codeine - heroin
Affects of nicotine and withdraw
Nicotine in small doses stimulates the central nervous system: it can relieve stress and improve mood. But it can also cause high blood pressure and increase the risk of heart disease and cancer. High doses can blur your vision causing confusion, lead to convulsions, and sometimes even cause death. Smoking has been linked with signs of negative affect such as depression, anxiety, and anger. Due to this, relapse maybe especially higher for women as compared to men. With drawl symptoms: depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, and increased appetite and weight gain.
Psychological causes of substance related disorders:
Not to use: - Fear of affects of drug use - Decision not to use drugs - Feelings of confidence and self-esteem without drug use To use: Positive reinforcement: - The feelings that result from using psychoactive substances are pleasurable in someway, and people will continue to take the drugs to recapture the pleasure. - In addition, the social contacts for drug taking may encourage use, even when the use alone is not the desired outcome. - Positive reinforcement in the use and the situation surrounding the use of drugs contributes to whether or not people decide to try to continue using drugs Negative reinforcement: -In addition to the initial euphoria, many drugs provide escape from physical pain (opiates), from stress (alcohol), or from panic and anxiety (benzodiazepines). - One premise is that substance use becomes a way for users to cope with the unpleasant feelings. Feelings of being in control Positive expectations/urges about what drug use will be like Avoidance of withdrawl symptoms Presence of other psychological disorders: mood, anxiety, etc.
Long term affects of heavy drinking
Often severe. Withdraw from chronic alcohol use typically includes hand tremors and, within several hours, nausea or vomiting, anxiety, transient hallucinations, agitation, insomnia, and at its most extreme, withdrawl delirium. Weather alcohol will cause organic damage depends on genetic vulnerability, the frequency of use, the length of drinking binges, the blood alcohol levels obtained during the drinking., And whether the body is given time to recover in between Consequences of long-term excessive drinking include liver disease, pancreatitis, cardiovascular disease, and brain damage
Causes of Substance-Related Disorders
Once thought to be moral weakness Combination of factors: -Biological -Psychological - cognitive - social - cultural Most psychotrip drugs seem to produce positive effects by acting directly or indirectly on the dopaminergic mesolimbic system (pleasure pathway) In addition, psychosocial factors such as expectations, stress, and cultural practices interact with the biological factors to influence drug use
Other drugs of abuse:
Other substances that are abused but do not fit neatly into one of the major drug categories (e.g., inhalants, steroids, designer drugs). These are used by individuals to alter sensory experiences: - The high associated with inhalants resembles that of alcohol intoxication and usually includes dizziness, slurred speech, incoordination, euphoria, and lethargy - Steroid use differs from other drugs because the substance does not produce a desirable high but instead is used to enhance performance and body size - Designer drugs heighten a persons auditory and visual perception, as well as a sense of taste and touch
Cocaine withdrawal
Post-use crash including severe depression and suicidality, hypersomnolence, fatigue, malaise, severe psychological craving Produce is pronounced feelings of apathy and boredom.
DSM-5 Diagnostic criteria for intoxication in amphetamine use disorders:
Psychological, biological, behavioral, and social problems associated with amphetamine use and abuse include significant behavioral symptoms, such as euphoria or affective blunting, changes in sociability, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviors, impaired judgment, and impaired social or occupational functioning. Also psychological symptoms - blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, muscular weakness, respiratory depression, just pain, seizures or coma. - Severe intoxication or overdose can cause hallucinations, panic, agitation, and paranoid delusions. - Amphetamine tolerance builds quickly, making it doubly dangerous. Withdraw often results in apathy, prolonged periods of sleep irritability, and depression.
substance-related and addictive disorders
Range of problems associated with the use and abuse of drugs such as alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and behave. These are extremely costly in human and financial terms Include: depressants, stimulants, opiates, hallucinogens
agonist substitution
Replacement of a drug on which a person is dependent with one that has a similar chemical makeup, an agonist. Used as a treatment for substance dependence. - Research suggests that when addicts combine methadone with counseling, mini reduce the use of heroin and engage and less criminal activity. - Addiction to smoking is also treated by substitution process - nicotine patch (But works best with psychological therapy) A newer agonist - buorenorphine - Blocks the effects of opiates and seems to encourage better compliance then would a non-opiate or opiate antagonist.
All of the ________ use disorders in the DSM-5
Significant impairment or distress in at least two of the following over a 12 month period: 1. Substance often taken in larger amounts over longer periods of time than intended 2. Persistent desire or unsuccessful efforts to cut down or control use 3. A great deal of time is spent in activities necessary to obtain substance, use substance or recover from its affects 4. Craving or a strong desire or urge to use substance 5. Recurrent substance use resulting in a failure to major obligations 6. Continued substance use despite having recurrent social or interpersonal problems caused or exacerbated by the effects of substance 7. Important social, occupational, or recreational activities are giving up or reduced because of substance use 8. Recurrent substance use and situations in which it is physically hazardous 9. Substance use is continue despite knowledge of having a persistent or recurrent psychological or physical problem caused or exacerbated by substance 10. Tolerance (diminished affect or needing more to achieve intoxication) 11. Withdrawal as manifested by: (4-12 hours after) A. The characteristic withdrawal syndrome for substance B. Substance (or closely related to substance) is taken to relieve or avoid withdrawal symptoms Mild (2-3) Moderate (4-5) Severe (6+)
Stimulant related disorders: Amphetamines
Stimulant medication used to treat hypersomnia by keeping the person awake during the day, and to treat narcolepsy, including sudden onset episodes, by suppressing rapid eye movement sleep - often misused. - In low doses these can induce feelings of elation and vigor and can reduce fatigue. But you crash after a period of elevation. - They also reduced appetite and some people take them to lose weight. - Some of the drugs (Ritalin and Adderall) are even given to children with ADHD Ecstasy - makes you feel happy and love everyone and everything. Math - a purified, crystallize form of amphetamine, is ingested there smoking
effects of amphetamines
Stimulates the central nervous system by enhancing the activity of norepinephrine and dopamine - they can lead to hallucinations and delusions.
drug seeking behaviors
The repeated use of a drug, a desperate need to and just more of the substance (stealing money to buy drugs, standing outside in the cold to smoke), and the likelihood that use will resume after a period of abstinence our behaviors that define the extent of substance use disorder (psychological dependence).
Cognitive causes of substance related disorders:
What people expect to experience when they use drugs influences how they react to them. - A person who expects to be less inhibited when she drinks will act less in habited whether she actually drinks alcohol or a placebo she thinks is alcohol (expectancy affect) DSM-5 includes cravings as one of the criteria for diagnosing a substance related disorder: - Research is underway to determine how cravings may work in the brain and if certain medications can be used to reduce these urges and help supplement treatment.
substance use disorder
When the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. DSM-5 Defines substance use disorder in terms of how significantly the youth interferes with the users life. Substance use disorder is usually described as addiction. In order to meet criteria for a disorder, a person must meet criteria for at least two symptoms in the past year that interfered with his life or bothered him a great deal. When a person has four or five symptoms = moderate range. Six or more symptoms = severe. Drug seeking behaviors (symptom)
alcohol-related disorders
a cognitive, biological, behavioral, and social problem associated with alcohol use and abuse Apparent stimulation is the initial effect of alcohol, although it is a depressant. With continue drinking, however, alcohol depresses more areas of the brain, which impedes the ability to function properly Higher in males (decreased testicles size): highest among Caucasian Americans Violence is associated with alcohol, the alcohol alone does not cause aggression
gambling disorder
a disorder marked by persistent and recurrent gambling behavior, leading to a range of life problems - Problem gamblers display the same types of cravings and dependence as persons who have substance related disorders - Similar brain systems appear to be involved with those addicted to gambling as seen in persons with substance related disorders
caffeine-related disorders
cognitive, biological, behavioral, and social problems associated with the use and abuse of caffeine Caffeine is the most common of the psychoactive substances, but can still lead to problems similar to that of other drugs
hallucinogen use disorders
cognitive, biological, behavioral, and social problems associated with the use and abuse of hallucinogenic substances
opioid-related disorders
cognitive, biological, behavioral, and social problems associated with the use and abuse of opiates and their synthetic variants (Heroin, opium, morphine, etc.) - Opiates relieve pain and induce sleep. They induce euphoria, drowsiness, and slow breathing. High doses can lead to death if respiration is completely depressed. - The high or rush experience by users comes from activation of the body's natural opiate system The rise an opiate use has been deemed an epidemic and public health crisis in the United States. Also, because these drugs are usually injected IV, users are at increased risk for hepatitis C and HIV.
covert sensitization
cognitive-behavioral intervention to reduce unwanted behaviors by having clients imagine the extremely aversive consequences of the behaviors and establish negative rather than positive associations with them