Psych 350 ch. 11

Treatment of Substance Use Disorders: Alcohol Use Disorders

-DETOXIFICATION AND ABSTINENCE -Alcoholics Anonymous (AA)/12-Step Programs -cognitive behavioral therapies, motivational enhancement therapy -biological treatments

for a 160 lb. individual, each drink is

.02 BAC%

substance abuse

Use in a way that is dangerous or causes substantial impairment (e.g., affecting job or relationships)

neurochemical effects of alcohol

• Alcohol has both specific and nonspecific effects on nervous tissue. •GLUTAMATE -- major excitatory NT in CNS. ethanol reduces glutamate activity in brain's memory centers; Decreased ability to consolidate memory (i.e. "blackouts"); Rebound hyperexcitability caused by up-regulation of NMDA receptors (e.g. withdrawal symptoms) •GABA INCREASES- MAJOR INHIBITORY NT; agonist on the GABAa receptor in a similar fashion to benzodiazepines (i.e., alcohol increases GABA activity); increases Cl- influx thus increasing neural inhibition.

Substance use disorders in DSM-5

• pattern of substance use leading to significant impairment and distress Symptoms (need 2+ within a year): •Taking more of the substance than intended •Desire to cut down use •Excessive time spent using/acquiring/recovering •Craving for the substance •Role disruption (e.g. can't perform at work) •Interpersonal problems •Reduction of important activities •Use in physically hazardous situations (e.g. driving) •Keep using despite causing physical or psychological problems •Tolerance •Withdrawal

biochemical factors of substance-related disorders

•(1) LONG-TERM POTENTIATION - Certain dopamine receptors (D1) are potentiated via burst firing of responses to addictive drugs - this rapid burst firing leads to a hypersensitivity to the substances •This model, called the incentive-sensitization theory, has received considerable support in animal studies •(2) LONG-TERM SYNAPTIC DEPRESSION - chronic use also leads to a depression of D2 dopamine receptors - results in decreased sensitivity to the rewarding effects of "normal" life events •This "reward-deficiency syndrome" suggests that people may turn to drugs (or food) to stimulate this pleasure pathway, particularly in times of stress

Cannabis use disorder prevalence

•12-month prev. rate = 2.54%; lifetime = 6.27% (Hasin et al., 2016) •A common assumption about the risk for CUD among users is that it is rare, based on findings from 25 years ago that few cannabis users developed CUD (Anthony et al, 1994; Joy et al, 2017) •However, Hasin et al. (2016) found that 19.5% of lifetime cannabis users met criteria for DSM-5 CUD, of whom 23% were symptomatically severe (⩾6 criteria) Of these, 48% were not functioning in any major role (e.g., work, school) •Thus, CUD in users is not rare and can be serious

21 drinks

•21 drinks = 315 ml ethanol/hr = BAC .35 - .40: coma, brain center which controls heart & lungs partially anesthetized •How common? Rutledge et al. (2008): 12% of both male and female 21st birthday drinkers reported consuming exactly 21 drinks •an additional 22% of male birthday drinkers and 12% of female birthday drinkers reported consuming more than 21 drinks •35% of female and 49% of male birthday drinkers had BACs of 0.26 or higher (a level associated with potential serious medical outcomes)

Alcoholics Anonymous (AA)/12-Step Programs

•Largest self-help group for problem drinkers •Based on "disease model" à alcoholism is a powerful disease that requires a "higher power" to control; Clients find message useful although there is very little evidence to support this model in the scientific literature on etiology •Regular meetings provide support, understanding, and acceptance •Promotes complete abstinence

Pharmacological Vulnerability

•Premise: Genetically based individual differences in alcohol effects are related to risk for developing Alcohol Use Disorders (AUDs) •Those with a family history of AUDs show less sensitivity to the effects of a given dose of alcohol •Schuckit and colleagues have demonstrated that low sensitivity predicts alcohol use disorders prospectively in young adulthood.

opioid use disorder treatments

-Reducing access to painkillers -Has had modest gains for some, but for others have pushed users to heroin and fentanyl -Medication-Assisted Treatment (MAT); Using other drugs to combat opioid cravings

opioid use from 1999-2018

-almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids. -This rise in opioid overdose deaths can be outlined in 3 distinct waves

Body can metabolize about ___________ per hour; nothing can speed this

.5 oz (.02 BAC%)

alcohol effect on CNS

1 dk/hr = BAC .02: little change 2 dk/hr = BAC .05: drinker "buzzed", judgment center of brain affected, inhibitions lowered 3 dk/hr= BAC .10: judgment is very poor, muscle coordination depressed, staggered gait, slurred speech 10 dk/hr = BAC .20: emotions erratic, poor memory

widely studies cannabinoids

2 widely studied: 9-Tetrahydrocannabinol (THC) Cannabidiol (CBD) THC's analgesic effects modulated by activating CB1 and CB2 receptors In contrast, CBD does not activate CB1 or CB2 - acts at multiple receptor types

2015, 2015, and 2017 opioid crisis info

2014 paper in JAMA Psychiatry - 75% of heroin users in treatment started with painkillers 2015 CDC analysis - people addicted to painkillers are 40x more likely to be addicted to heroin 2017 study - 52% of people in treatment started with painkillers; 33% initiated with heroin (up from 8.7% in 2005)

history of alcohol

8000 B.C. mead was brewed from fermented honey. 3700 B.C. The Egyptians brewed a thick beer called "hek". The Sumerians also brewed beer and drank quite a bit of it 1700 B.C.: Babylonians created wine; Some historians argue that wine contributed to the fall of Rome Role of alcohol in American history; pilgrims ran out of beer and decided to stick around; colonies became more industrialized and mass produced alcohol with higher alcohol content (rum); drunkenness became a bigger problem; drunkards in big cities were ridiculed even though everyone drank

epidemiological context of alcohol

Alcohol use rapidly increases during adolescence, peaking in the early-mid 20s •AUDs show roughly a similar pattern Implications •Etiological theory needs to address the developmental processes that can help explain this strong, age-graded phenomenon •Processes responsible for desistence (offset) are important for understanding the population prevalence and persistence

The "rule of thirds" from decades of alcohol intervention research:

About a third of people maintain recovery from alcohol addiction due to AA, Another third get something out of AA but not enough for full recovery, and Another third get nothing at all. That's potentially two-thirds of people who can't get into recovery solely through AA or 12-step treatment

physical effects of alcohol

Alcohol increases blood circulation to the skin Increase in loss of body heat (hypothermia) GSR (galvanic skin response - sweat system) is suppressed Heart rate decreases Stimulation of acid and pepsin in stomach Reduced release of antidiuretic hormone = increased urination = dehydration

alcohol metabolism

Alcohol molecules are hydrophilic and lipophilic ABSORPTION: •Small amounts are absorbed in the mouth •Most absorbed in the small intestine Alcohol metabolism is a two step process. •Alcohol travels to the liver via capillaries in small intestine and portal vein; (1) The enzyme alcohol dehydrogenase (ADH) converts it to acetaldehyde; (2) Aldehyde dehydrogenase (ALDH) breaks down acetaldehyde into acetic acid and water

prescription heroin

Another option, more common in other countries (Canada, UK, Spain, Portugal, Netherlands): •Prescription heroin - associated with steep drops in street heroin use •Randomized controlled trial pub'd in New England Journal of Medicine (2009) - 67% reduction in use in prescription heroin group vs 47% in methadone group

national drug overdose deaths involving any opioid, number among all ages, by gender, 1999-2018

Any opioid includes prescription opioids (and methadone), heroin and other synthetic narcotics (mainly fentanyl or fentanyl analogs). Opioid-involved overdose deaths rose from 21,088 in 2010 to 47,600 in 2017 and remained steady in 2018 with 46,802 deaths. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2018 (Source: CDC WONDER).

binge drinking episodes among age groups

Binge drinking is most common among younger adults aged 18-34 years, but more than half of the total binge drinks are consumed by those aged 35 and older.5 Binge drinking is twice as common among men than among women. Four in five total binge drinks are consumed by men.

MAT data

DATA: MAT can cut mortality by half or more •Should be "Gold Standard • However, not widely available •Competes with American idea that abstinence is the only answer to addiction •Research shows that abstinence only treatments are highly ineffective for opioid addiction HOWEVER... •MAT does not work for up to 40% of opioid users

Stimulants: Nicotine-Related Disorders

Effects of nicotine •Stimulates nicotinic acetylcholine receptors in CNS •Results in sensations of relaxation, wellness, pleasure •Highly addictive •Relapse rates equal to those seen with alcohol and heroin Nicotine users dose themselves to maintain a steady state of nicotine Smoking has complex relationship to negative affect •Appears to help improve mood in short-term •Depression occurs more in those with nicotine dependence

drugs and the reward center

Key NT appears to be dopamine When dopamine is activated at this reward center, a person experiences pleasure Certain drugs stimulate the reward center directly Examples: cocaine, amphetamines, caffeine Other drugs stimulate the reward center in roundabout ways Examples: alcohol, opioids, marijuana

Biological Treatment of Substance-Related Disorders

Disulfiram (Antabuse) - blocks the enzyme acetaldehyde dehydrogenase, producing nausea and vomiting when alcohol consumed.; Bad side effects.; Low compliance; Does not affect cravings Naltrexone (ReVia and Revex) - opiate receptor antagonists block euphoric effects of ETOH.; Diminishes craving Acamprosate (Campral): GABA agonist and glutamate antagonist (like ETOH) prevents relapse and reduces withdrawal symptoms. SSRI's: results are inconsistent Cannabanoid agonists (like marijuana) may increase craving for ETOH Medications most effective when combined with CBT

Stimulants: Amphetamine Use Disorders

Effects of amphetamines •Produce elation, vigor, reduce fatigue •Such effects are usually followed by extreme fatigue and depression Amphetamines stimulate CNS by •Enhancing release of norepinephrine and dopamine •Reuptake is subsequently blocked •Some ADHD drugs are mild stimulants -E.g., Adderall, Ritalin •Ecstasy and crystal meth -Amphetamine effects, but without the crash -Both drugs have a high risk of dependence

Stimulants: Caffeine-Related Disorders

Effects of caffeine - the "gentle" stimulant •Used by over 90% of Americans •Found in tea, coffee, cola drinks, and cocoa products •Small doses elevate mood and reduce fatigue •Regular use can result in tolerance and dependence •Caffeine blocks the reuptake of the neurotransmitter adenosine DSM-5 Criteria for Caffeine Intoxication •Recent caffeine consumption, possibly in excess •Associated with physical symptoms including restlessness, anxiety, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling thoughts or speech, elevated or irregular heartbeat, excitement, inexhaustibility, motor agitation •Symptoms cause clinically significant distress or impairment

Stimulants: Cocaine-Related Disorders

Effects of cocaine -Short lived sensations of elation, vigor, reduce fatigue -Effects result from blocking the reuptake of dopamine -Highly addictive, but addiction develops slowly -1.9 million report use in US each year - Most cycle through patterns of tolerance and withdrawal -Withdrawal characterized by apathy and boredom > leads to desire to use again

Causes of Substance-Related Disorders: Social and Cultural Dimensions

Exposure to drugs is a prerequisite for use of drugs •Media, family, peers •Parents and the family appear critical Societal views about drug abuse •Sign of "moral weakness" - failure of self-control •Sign of a "disease" - caused by some underlying process The role of cultural factors •Influences how people use substances as well as how people think about substance users; E.g., cultural differences in light drinking, heavy drinking, no drinking etc. at certain social occasions •Cultural expectancies surrounding substance use may influence substance-related behavior •If drinking is thought to increase aggressiveness, people may act in more aggressive ways after drinking

An Integrative Model of Substance-Related Disorders

Exposure or access to a drug is necessary, but not sufficient Drug use depends on: •Social and cultural expectations •Positive and negative reinforcement •Genetic predisposition and biological factors •Psychosocial stressors

alcohol content

Fermentation process: •2 byproducts of glucose metabolism = CO2 and ethanol •200 quintillion ethanol molecules in .5 oz alcohol •Typical fermentation produces a maximum alcohol content of around 15%. To get a higher alcohol content one has to "distill" the alcohol from the water

long-term effects of alcohol

Malnutrition •Calories from alcohol lack nutrients •Alcohol interferes with digestion and absorption of vitamins from food Deficiency of B-complex vitamins •Amnestic syndromes Severe loss of memory for both long and short term information (Wernicke-Korsakoff Syndrome) Cirrhosis of the liver •Liver cells engorged with fat and protein impeding functioning •Cells die triggering scar tissue which obstructs blood flow •Liver disease and cirrhosis rank 12th in US causes of death. Damage to endocrine glands and pancreas Heart failure Erectile dysfunction Hypertension Stroke Capillary hemorrhages: Facial swelling and redness, especially in nose Destruction of brain cells: Less than previously thought, but some loss in memory areas

Other Drugs of Abuse: Inhalants

Nature of inhalants •Substances found in volatile solvents •Breathed directly into lungs Examples •Spray paint, hair spray, paint thinner, gasoline, nitrous oxide Properties and consequences •Rapidly absorbed •Effects similar to alcohol intoxication •Tolerance and prolonged symptoms of withdrawal are common

Stimulants: An Overview

Nature of stimulants •Most widely consumed drug in the United States •Such drugs increase alertness and increase energy •Examples include amphetamines, cocaine, nicotine, and caffeine DSM-5 criteria for stimulant intoxication •Recent stimulant use leading to significant impairment or psychological changes Accompanied by physical changes (e.g., change in HR/BP, dilated pupils, weight loss, vomiting, weakness, chills)

prevention of substance-use disorders

Often aimed at adolescents; Utilize some or all of the following elements: •Enhancing self-esteem •Social skills training •Peer pressure resistance training •Parental involvement in school programs •Warning labels on alcohol bottles •Education regarding alcohol impairment •Testing for drugs and alcohol at school or work •Correction of beliefs and expectations •Inoculation against mass media messages •Peer leadership

national drug overdose deaths number among all ages

Overall, drug overdose deaths declined from 2017 to 2018 with 67,637 drug overdose deaths reported in 2018. Deaths involving other synthetic narcotics other than methadone (including fentanyl and fentanyl analogs) continued to rise with more than 31,335 overdose deaths reported in 2018. Those involving cocaine or psychostimulants with abuse potential (mostly methamphetamine) also continued to trend upward (Source: CDC WONDER).

percent of high school seniors reporting use of prescription opioids

Past year prescription opioid misuse (reported in the survey as 'narcotics other than heroin') continued a significant decline among 12th graders, with 2.7 percent reporting use in 2019. A significant five-year decline was reported for Vicodin among 10th and 12th graders and for Oxycontin among 12th graders. Past year use of Vicodin declined from 3.4 percent in 2014 to 1.1 percent in 2019 among 10th graders and from 4.8 percent to 1.1 percent in the same period among 12th graders. Oxycontin was reported by 1.7 percent of 12th graders in 2019, a nearly 50 percent drop compared to 3.3 percent in 2014. Rates of prescription opioid misuse are now at their lowest levels since they were first recorded by the survey.

breakdown of first wave of the opioid crisis

Pharmaceutical Companies •Saw a growth market, marketed drugs as safe and effective; Evidence shows that opioids have more risks than benefits Physicians •As complaints of chronic pain have increased (100 million Americans), doctors needed a clear solution that didn't require complex assessment; Opioids provided an answer; They prescribed too much, and patients had a lot left over; CDC: enough prescribed in 2015 to medicate every American around the clock for 3 weeks As a result, the pills were often diverted: •To teens rummaging through parents' medicine cabinets •Family members •Friends •black market Roughly 21-29% of patients prescribed opioids for chronic pain misuse them; Between 8-12% develop an opioid use disorder

substance intoxication

Physical reaction to a substance (e.g., being drunk)

hangovers

Possible causes: •Acetaldehyde buildup •Gastric irritation •Rebound drop in blood sugar •Dehydration •Toxic effects of congeners Possible cures: •There no scientifically verified cures other than rehydration and rest. Contraindications: •Acetaminophen (e.g. Tylenol); Alcohol use increases certain liver enzymes that convert acetaminophen into a toxic substance - NO DRINKING IF YOU'VE TAKEN TYLENOL!!

New study on AA

Review included studies comparing AA or 12-step facilitation treatment to other kinds of treatment, like CBT and motivational enhancement therapy, and different ways of facilitating the 12 steps The findings: AA and 12-step treatment were better than other treatment approaches for (1) continuous abstinence and(2) percentage of days abstinent, while likely producing "substantial cost-saving benefits." AA/12-step treatment did about as well as other treatments on remaining outcome measures; The findings apply only to alcohol addiction -- the review did not look at 12-step treatment's benefits for other drugs Although some studies have looked at this, there's generally a lack of evidence for AA and the 12-step approach when it comes to other substances, including opioid addiction. The findings don't mean that AA and the 12 steps work for everyone

substance abuse and dependence and the DSMs

Substance abuse and dependence were previously differentiated in DSM-IV, but that distinction is no longer present in DSM-5 disorders.

substance use

Taking moderate amounts of a substance in a way that doesn't interfere with functioning

Sedative, Hypnotic, or Anxiolytic-Related Disorders: An Overview

The nature of drugs in this class •Sedatives - calming (e.g., barbiturates) •Hypnotic - sleep inducing •Anxiolytic - anxiety reducing (e.g., benzodiazepines)Effects are similar to large doses of alcohol •Combining such drugs with alcohol is synergistic All exert their influence via the GABA neurotransmitter system DSM-5 criteria for this class of disorders •Same as for other classes of drugs (i.e., significant interference or distress accompanied by problems such as reduced activities or tolerance)

Beer Street (1751)

two prints issued in 1751 by English artist William Hogarth in support of what would become the Gin Act. Designed to be viewed alongside each other, they depict the evils of the consumption of gin as a contrast to the merits of drinking beer. On the simplest level, Hogarth portrays the inhabitants of Beer Street as happy and healthy, nourished by the native English ale, and those who live in Gin Lane as destroyed by their addiction to the foreign spirit of gin; but, as with so many of Hogarth's works, closer inspection uncovers other targets of his satire, and reveals that the poverty of Gin Lane and the prosperity of Beer Street are more intimately connected than they at first appear. Gin Lane shows shocking scenes of infanticide, starvation, madness, decay and suicide, while Beer Street depicts industry, health, bonhomie and thriving commerce.

cross-sectional and prospective studies of alcohol use

use and AUDs reveal a mean trend for alcohol involvement to increase during adolescence, peak during late adolescence and early adulthood (early-mid 20s) and then gradually decrease as adulthood progresses. Much of this age-related change has been attributed to changes in social roles and responsibilities such as marriage, parenthood and employment, a phenomenon called "maturing out." Notably, however, there is a great deal of individual variability in the course of alcohol involvement. While many individuals experience decreases in heavy drinking and AUDs during the third decade of life, others continue to drink heavily into middle adulthood. Researchers are increasingly relying on trajectory based data analysis to examine phenomenon that predict the persistence and desistence of heavy drinking and AUDs.

standard drink

~ .5 oz of ethanol (almost 15 ml) One drink equivalent is the amount of alcohol that the average body metabolizes in 1 hour

what is alcohol

• Alcohol is a solvent characterized by a hydroxyl group (-OH). • Ethyl alcohol is the only form that can be safely consumed. • It is produced by fermentation: the interaction of yeast with sugar. • The type of sugar determines the type of beverage: Grapes; Grain; Rice

Alcohol use disorder in the US

• Alcohol use disorder (AUD)is among the most prevalent mental health disorders in the US • An estimated 15.7 million (5.9%) of Americans age 12 or older have a past-year AUD diagnosis. •These rates are a public health concern: problem drinking in the US costs an estimated $249 billion per year and is the fourth-leading cause of preventable mortality

drinking episodes

• Binge Drinking - 5 or more drinks per occasion for men, 4 for women, on at least one day in the past 30 days; a pattern of drinking that brings blood alcohol concentrations (BAC) to 0.08 or above •Heavy drinking = binge drinking on 5 or more days in the past 30 days •High Intensity Drinking = drinking at levels far beyond binge threshold; 2 or more times the gender-specific binge drinking thresholds (i.e., 10 or more standard drinks for men, and 8 or more for women). •Binge drinking is strikingly prevalent in the United States; 66.7 million (24.9%) Americans age 12 or older report binge drinking in the past month

dopamine and alcohol

• ETOH produces increased activity in DA "reward centers" •Chronic ETOH use produces down regulation of DA receptors = Dysphoria and depression when ETOH use stops

Acute behavioral effects of alcohol traced to "inhibitory" properties

• Inhibition of frontal lobe: Loss of behavioral inhibition, loss of planning, loss of impulse control = increased aggression, increased promiscuity, poor judgment. • Inhibition of amygdala: Loss of anxiety • Euphoria: Loss of inhibition of DA release in ventral tegmental area of nucleus accumbens (reward areas) • Analgesia: Inhibition of motor areas: slowed reaction time, poor coordination, decreased sexual performance

summary of substance-related disorders

• Most substances activate the dopaminergic pleasure pathway •Psychosocial factors interact with biological influences •Treatment of substance abuse disorders; Often unsuccessful; Highly motivated persons do best; Important to use comprehensive approach

physiological/Psychological effects of alcohol

• Processes are depressed in (roughly) the reverse order that they were acquired: •Complex cognitive skills (e.g. planning, problem solving) •Fine motor skills (e.g. playing guitar) •Gross motor skills (e.g. walking,) •Visual accommodation and reflexes (e.g. pulling hand away from stove) • Learning and memory is disrupted: •Attention to relevant stimuli •Ability to encode new information •Short term memory •Ability to retrieve info from long term memory (e.g. knowing where one lives)

Blood Alcohol Content

• The rate of absorption, distribution and clearance of alcohol are affected by many factors so behavioral effects are described based upon B.A.C. •B.A.C. = # milligrams ETOH per 100 milliliters of blood • In general, measurable behavioral effects begin to occur at a B.A.C. of 0.04%

second wave of the opioid crisis

• The second wave began in 2010, with rapid increases in overdose deaths involving heroin •Over time, especially as prescription opioids became more scarce, opioid users began moving towards more potent opioid derivatives •Approx. 4-6% of people who misuse prescription opioids transition to heroin •About 80% of people who use heroin first misused prescription opioids • Increased heroin supply and decreased painkiller supply •Prescription opioid painkiller deaths have leveled off (more associated with suicide risk) while fentanyl (especially) and synthetic opioid deaths have increased

first wave of the opioid crisis (1990s)

• began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999 •Doctors became increasingly aware of the burden of chronic pain •Pharma saw an opportunity and began to heavily market opioids; Misled doctors about the safety and efficacy of drugs such as OxyContin (produced by Purdue Pharma; not related to Purdue University!) •The drugs proliferated, making America the world's leader in opioid prescriptions

Percentage of U.S. population reporting alcohol use according to 2015 national survey on drug use and health (NSDUH)

•86.4% of people ages 18 or older reported that they drank alcohol at some point in their lifetime •70.1% reported that they drank in the past year •56.0% reported that they drank in the past month

The nature of substance use disorders

•Abuse of psychoactive substances •Wide-ranging physiological, psychological, and behavioral effects •Associated with impairment and significant costs

effects of opioids

•Activate body's enkephalins and endorphins •Low doses induce euphoria, drowsiness, and slowed breathing •High doses can result in death •Withdrawal symptoms can be lasting and severe

DSM-5 Criteria for Tobacco Withdrawal

•After several weeks of daily use, unpleasant symptoms upon stopping or reducing: •Insomnia, increased appetite, restlessness, trouble concentrating, anxiety and depression, irritability •Symptoms lead to clinically significant distress or impairment

hallucinogens

•Alter sensory perception (e.g., marijuana, LSD)

depressants

•Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)

Cognitive Behavioral Therapies (CBT)

•CBT has some solid scientific evidence behind it. Variations: •Contingency-Management Therapy: Patient and family reinforce behaviors inconsistent with drinking (e.g., avoiding places associated with drinking); Teach problem drinker how to deal with uncomfortable situations (e.g., refusing the offer of a drink) •Relapse prevention: Strategies to prevent relapse - cognitive and relaxation interventions •Controlled drinking: Approach based on premise that problem drinkers can consume alcohol in moderation; Avoid total abstinence and inebriation; Also known as Guided self-change - for motivated clients, very effective approach

delirium tremens (DTs)

•Can occur when blood alcohol levels drop suddenly •Results in: Deliriousness Tremulousness Hallucinations Primarily visual; may be tactile

Antagonistic treatment

•Drugs that block or counteract the positive effects of substances •Examples include naltrexone for opiate and alcohol problems

Designer drugs

•Drugs were originally produced by pharmaceutical companies to target diseases; then others began producing for recreational use •Cause drowsiness, pain relief and dissociative sensations •Ecstasy •BDMPEA ("nexus") •Ketamine ("Special K") •Often heighten auditory and visual perception, sense of taste/touch •Becoming popular in large social recreational gatherings (e.g., nightclubs, raves) •Produce tolerance and dependence

DETOXIFICATION AND ABSTINENCE

•Each year, about 2.0 million people over the age of 12 receive treatment for alcohol addiction; Over 17 million people over the age of 12 were in need of treatment for alcohol or drug problems, but did not get it; Only 1 in 4 who are physiologically dependent ever get treatment •Inpatient hospital treatment; Detoxification Withdrawal from alcohol under medical supervision; The therapeutic results of hospital treatment are not superior to those of outpatient treatment (but many concerns about outpatient rehab); May be necessary for those without social support or with other serious psychological problems

motivational enhancement therapy:

•Effective method of engaging people in treatment •Explore client goals, reasons for wanting or not wanting to change, and evaluate pathways to achieve those goals •Contrast to traditional "blame" approach

portugal and decriminalization of drugs

•Faced with a massive crisis associated with illicit drug addiction, Portugal de-criminalized ALL drugs in 2001 •Results aren't perfect, but huge reductions in HIV and drug-related crime

heroine

•Heroin (diacetylmorphine) is processed from morphine •Heroin is available medically in some limited circumstances, particularly in Europe and Canada. •Heroin use has been increasing in recent years •Number of people using heroin in the past year has more than doubled over the past 15 years, to nearly one million in 2016

AA effectiveness

•Historically uninterested in having effectiveness evaluated •HOWEVER: New study on AA effectiveness: Examine studies that analyzed the effects of AA or 12-step treatment, i.e., the typical AA meeting, thousands of which happen in churches and treatment centers all over the US on a daily basis; Also includes the more formal treatment programs that facilitate the 12 steps by guiding people to AA — an approach that more than 70 percent of addiction treatment facilities in the US use

other drugs of abuse

•Include inhalants, anabolic steroids, medications

stimulants

•Increase alertness and elevate mood (e.g., cocaine, nicotine)

Cannabis Use Disorder (CUD)

•Is cannabis addictive? If we define addiction as an acquired, chronic, relapsing disorder that is characterized by a powerful motivation to continually use the substance despite persistent negative consequences, then the answer is a clear YES •However, the addictive potential for cannabis is lower than for alcohol, cocaine, and tobacco. Much of the addictive process involved in cannabis use disorder relates to psychological processes associated with craving as well as physiological processes associated with reward processes (i.e., the dopamine system) •Can you overdose on cannabis? Yes, but it doesn't necessarily mean death; Ingesting cannabis can lead to severe and life-threatening health consequences for children; For adolescents and adults, an overdose looks like a more severe and unpleasant version of cannabis intoxication (e.g., confusion, paranoia, anxiety/panic, fast heart rate, delusions, hallucinations, nausea, vomiting); these can land people in the ER, or can dangerously interact with preexisting health problems - more often though it just leads to a bad time

substance dependance

•May be defined by tolerance and withdrawal •Sometimes defined by drug-seeking behavior (e.g., spending too much money on substance)

mortality rates for opioid addicts

•Mortality rates are high for opioid addicts •High risk for HIV infection due to shared needles

facts and statistics about alcohol in the US

•Most adults consider themselves light drinkers •Alcohol use is highest among Euro/White Americans (56.8%) •Males use and abuse alcohol more than females •23% of Americans report binge drinking •Violence is associated with alcohol But alcohol alone does not cause aggression

Hallucinogens: An Overview

•Nature of hallucinogens: Change the way the user perceives the world •May produce: Delusions, paranoia, hallucinations, altered sensory perception •Examples include marijuana, LSD •5-15% of people in Western countries smoke marijuana regularly LSD and other hallucinogens •LSD is most common form of hallucinogenic drug •Hallucinogenic effects are much more intense than marijuana •Tolerance is rapid and withdrawal symptoms are uncommon •Can produce psychotic delusions and hallucinations

tolerance

•Needing more of a substance to get the same effect / reduced effects from the same amount

Cannabis

•One of world's most widely used psychoactive substances •Approx. 183 million people, or 3.8%of the world's population, used marijuana in 2015 (UN World Drug Report, 2017) •Most frequently used psychotropic drug in the U.S. after alcohol In 2018 more than 11.8 million young adults used cannabis in the last year • 33 states and Wash. D.C. have enacted medical marijuana legalization, and 11 states and D.C. have enacted recreational marijuana legalization •Cannabis sativa/indica contains over 450 different chemical compounds 100 different cannabinoids, which interact with the body's own endogenous (internal) cannabinoid system

the nature of opiates and opioids

•Opiate - natural chemical in the opium poppy with narcotic effects •Opioids - natural and synthetic substances with narcotic effects •Often referred to as analgesics; Analgesic = painkiller

opioids after 2016

•Opioid overdoses increased 30 % from July 2016 through September 2017 in 52 areas in 45 states •The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017 •Opioid overdoses in large cities increase by 54 percent in 16 states

withdrawal

•Physical symptom reaction when substance is discontinued after regular use

opiates

•Produce analgesia and euphoria (e.g., heroin, morphine, codeine)

Causes of Substance-Related Disorders: Neurobiological Influences

•Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a reward center or "pleasure pathway" in the brain •The reward center extends from the ventral tegmental area of the brain to the nucleus accumbens and on to the frontal cortex •THE REWARD CENTERS INVOLVE ACTIVATION OF THE DOPAMINE SYSTEM

Causes of Substance-Related Disorders: Psychological Dimensions

•Role of positive and negative reinforcement •Early on, drug use may be seeking a euphoric high (positive reinforcement) • Later, drug use will be seeking escape from withdrawal/crash (negative reinforcement) •Substance abuse as a means to cope with negative affect •Self-medication, tension reduction •Drugs offer escape from life stressors

Agonist substitution

•Safe drug with a similar chemical composition as the abused drug •Examples include methadone and nicotine gum or patch

Nature of anabolic-androgenic steroids

•Steroids are derived or synthesized from testosterone •Used medicinally or to increase body mass •Users may engage in cycling or stacking •Do not produce a high •Can result in long-term mood disturbances and physical problems

Results of family, twin, and adoption studies

•Substance abuse has a genetic component; Example: certain genes confer risk for heroin abuse in Latino and Black populations •Much of the focus has been on alcoholism; Genetic differences in alcohol metabolism > impact which drugs are most effective for treating alcohol use disorders •Multiple genes are involved in substance abuse

DSM-5 now speels out criteria for

•Substance intoxication for different types of substances (e.g., alcohol, stimulants) •Substance use disorders for different types of substances •Withdrawal from different types of substances

why does AA work for some people

•The review didn't look at how and why AA and 12-step facilitation treatment work, but researchers have studied that question for years. •Despite the 12 steps' emphasis on spirituality, researchers find that spirituality actually isn't the key component in general, even if it's helpful for some individuals •Rather, the power of AA and the 12 steps lies in how they shift social networks, bringing people who struggle with alcohol addiction together •Gives people an important outlet for discussing challenges and coping mechanisms related to addiction with others, while also providing a social check on unwanted behaviors

Cannabis Withdrawal Disorder

•Well-recognized - affects 33% of daily users and 50-95% of heavy users in treatment upon cessation of use begins 1-2 days after cessation, peaks at 2-6 days; remits at 1-2 weeks •Defined in DSM-5 as 3 or more of the following: anxiety, restlessness, depression, irritability, insomnia/odd dreams, physical symptoms (e.g. tremors), decreased appetite

THC effects

•While THC is classified as a mild hallucinogen, its effects are quite variable May include euphoria, mood swings, paranoia, hallucinations, reduced concentration - all dose dependent

sex/gender and alcohol

•Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood •Women become more intoxicated than men on equal doses of alcohol

third wave of the opioid crisis

•began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl •Fentanyl dispersion continues to change; found in combination with heroin, counterfeit pills, cocaine •Heroin being cut with more potent synthetic opioids: •Fentanyl - 80-100x more potent than morphine •Carfentanil - 10,000x more potent than morphine; 100x more potent than fentanyl