substance abuse part 2 ch.

epsilon alcoholism

Studied less intensively Seen as different from other species Described as "periodic alcoholism" Marked by periodic binge drinking

Testing and Ethical Issues

Testing and Ethical Issues Testing programs instituted by sports organizations and colleges; each different Expensive to administer Street chemists produce new drug faster than they can be detected Drugs undermine the sense of fair competition on which all sports rest Personal excellence, sound mind in a healthy body Discipline training, effort Will the public turn away from a sport where winning is based on performance enhancing drugs?

Performance Enhancing Drugs

Drugs, substances, techniques are banned by IOC, NCAA and other agencies Certain drugs, such as steroids and human growth hormone, are used to increase muscle mass, strength, and confidence. EPO and the practice of blood doping, are used to increase endurance. Amphetamines increase energy and confidence. A few, like beta blockers, are used to calm the athlete and prevent a racing heart

Hematological and Immune system alcohol

Each part of blood system affected Red blood cells Major function is carrying oxygen Reduced production of bone marrow White blood cells involved in fighting infection immune system reduced Platelets key to forming blood clots , decreased platelets- bruising, bleeding gums, nose, GI tract; ETOH cause hyperspleanism Medical complications: anemia, increased bleeding, higher risk of infection

Specifiers alcohol

Early remission from a DSM-5 alcohol use disorder is defined as at least 3 but less than 12 months without alcohol use disorder criteria (except craving) Sustainedremissionisdefinedasatleast12 months or longer without criteria (except craving). Additional new DSM-5 specifiers include "in a controlled environment" where access to alcohol is restricted.

Chemistry of Alcohol

Hundreds of alcohol made either naturally through fermentation, or industrial use through synthesized methods. Common forms of alcohols Ethylalcohol-primarypsychoactivecomponentinallalcoholic beverages Methylalcohol-toxicindustrialsolvent Isopropylalcohol-usedinshavinglotion,shellac,antifreeze, antiseptics, and lacquer Butylalcohol-usedinmanyindustrialprocesses

Determinants of Blood Alcohol Concentration (BAC)

If same weight and if consume equal amounts woman will have approximately 30% higher BAC because: Women have less alcohol dehydrogenase in the stomach so less metabolized during first-pass metabolism Women have a lower percentage of body water than do men of comparable size, so there is less water to dilute the alcohol Changes in gonadal hormone levels during menstruation affect the rate of alcohol metabolism. Women absorb more alcohol during their premenstrual period than at other times

Neurotransmitter and Withdrawal alcohol

Initially increases the effectiveness of GABA, blocking the energy chemicals and causing drowsiness Brain down regulates by increasing the energy chemicals and decreasing the GABA receptors resulting in hyper arousal Kindling (inverse tolerance): repeated episodes of intoxication and withdrawal intensify subsequent withdrawal symptoms and can cause seizures

Illicit Drugs alcohol

Process not the same for illicit drugs Can't be so casual Must weigh pleasure with potential problems Cost-benefit will determine use Must use psychosocial resources earlier in the game Need to justify any use The more reinforcing the effects are the more serious the negative consequences have to be to impact use

Species of Alcoholism alpha alcoholism

Purely psychological dependence Not loss of control nor inability to abstain Hallmark: drinking to handle problems Progression not inevitable Recognized as what others might call "problem drinking"

Performance Enhancing Drugs more

Erythropoietin • a hormone that control red blood cell production • Exogenous EPO stimulates production of erythropoietin • Blood doping: transfuse extra blood to increase red blood cell count to carry oxygen. Own blood re- infused 5-6 weeks later

Warning Signs of Solvent Abuse

Headaches Chemical Odor Red, glassy, watery or dilated eyes Inflamed nose, nose bleeds Rashes around the nose Tremors Short term memory issues Emotional instability Cognitive impairment Slow, thick, slurred speech Staggering gate, disorientation Lack of coordination

Compulsive Shopping

Is compulsive shopping a biologically driven disease of the brain, a learned habit run amok, an addiction in its own right, or a symptom of the other dysfunctions — most notably depression — that so often accompany it? Where is the line between avid shopping (a norm widely observed in the United States) and compulsive shopping? And how, if this is an illness, is it best treated? Compulsive shopping did not make it into the DSM V as a diagnosable mental disorder though hoarding comes under OCD.

Smart Drugs/Drinks

A recent development in nontraditional medication is the growing use of smart drugs, drinks, and nootropics. Boost intelligence, improve memory, detoxify body These are promoted as natural, healthy, and legal substitutes for club drugs or other illegal substances. Smart drinks: vitamins, powdered nutrients, amino acids to slow aging process Nootropics are comprised of natural and prescription drugs that are supposed to improve memory, cognition, and memory retrieval, enhance conversion of short term memory to long term Increase brain supply of certain neurotransmitters such as acetylcholine

What percentage of the 140 million drinkers in the United States has developed addiction? 10-12% 6-8% 12-15% 8-10%

10-12%

The effects of psilocybin mushrooms last about 3 to 6 hours. 12 to 24 hours. 10 to 50 minutes. 1 to 2 days.

3 to 6 hours.

What percentage of people don't drink alcohol at all: 30-35% 40-50% 50-60% 66-70%

30-35%

Binge drinking is defined as consuming ___ or more drinks at one sitting for males and ___ or more for females. 13, 12 5, 4 7, 6 10, 8

5, 4

Stage 3: harmful use

Characteristics Hallmark sign is presence of negative consequences but use continues despite this Mood change, leaves drinker less comfortable after use Passing over "invisible line" Nature of "invisible line" unspecified: possibly mix of genetics, social, and environmental factors Discrepancy between actual & desired effects Discrepancy between values and behavior changes in personality Defense Mechanisms: Rationalization (drink only beer, quit when want, not in a.m. etc) projection, (host faulty) euphoric recall Suppression -- won't think about it

MAGICAL THINKING - GAMBLER'S FALACY

Cognitive distortions are common and 70% of gambling related thoughts illogical Magical thinking: thinking equates with doing: denies validity of laws of chance Gambler's fallacy: belief one can control random events Machines programed to take advantage of illogical and distorted thinking High # of winning combos appear just above or below win line - thinking on the verge

Acute Effects of Alcohol

Definition: Acute effects are the immediate effects Many organ systems affected by alcohol GI system: irritant, impedes digestion Kidneys - pituitary ADH (antidiuretic hormone) depressed creating large amount of dilute urine Central nervous system Circulatory - vasodilator of surface vessels that creates a warmth sensation yet cools the body

Nervous System alcohol

Dependence accompanieslong-term heavy use accommodationtochronic presence of alcohol Elements of dependence Tolerance:nervesystemadapts--increasedrateof metabolism/decrease behavioral impairment withdrawal on ceasing or reducing use: jumpiness, edginess, hyperactivity, edginess to tremors , hallucinations, seizures etc. possiblecraving--"need"

Complications of Sex Addiction

Develop other mental health conditions Depression, anxiety, stress, isolation, low self worth, no peace of mind Neglect and/or lies to significant others and family. Large financial debts purchasing pornography and sexual services. Contract HIV, hepatitis, and other STD's which puts others at risk. Arrested for sexual offenses, high risk behaviors Lose focus at work, which puts job at risk. Loss of it Unwanted pregnancies Guilt/shame

Which of the following describes behavioral tolerance? The body changes so it metabolizes alcohol more efficiently. The brain neurons and other cells become more resistant to the effects of alcohol. The liver eventually becomes less able to metabolize alcohol. Drinkers learn how to "handle their liquor" by modifying their behavior so they don't appear to be intoxicated.

Drinkers learn how to "handle their liquor" by modifying their behavior so they don't appear to be intoxicated.

• Reinforcement of Compulsive Behaviors:

Engaging in the activity itself can lead to compulsive behavior • Big win gambling, especially early in career • Eat to change mood versus sustenance of life • Anticipation of ownership of coveted items, seeking pleasure with no financial responsibility • Compulsive sex can lead to avoidance of normal emotional and sexual relationships

Internet Usage

TheInternetpopulationaroundtheworldhasgrownexceptionally fast in a little over a decade, rising from 16 million users in 1995 to approximately 12 billion in 2010. What is the attraction • Provides an outlet where anonymity can be maintained and do previously avoided things that would not do otherwise. • Individuals with low self-esteem feel protected from face-to-face confrontation • Reduces feelings of loneliness • Provides a social forum where individuals may feel less inhibited. • Inexpensive, always available, controllable by the Net surfer, validating (doesn't criticize), convenient, escapist, rewarding • Less threatening than actual human interaction

Binge-Eating Disorder

Is marked by recurrent episodes of binge eating without the use of vomiting, laxatives, or other compensatory activities to eliminate the food Mild: 1 - 3 binge eating episodes per week Moderate: 4 - 7 binge eating episodes per week Severe: 8 - 13 binge eating episodes per week Extreme: 14 or more binge eating episodes per week Symptoms include: Frequent episodes of eating large quantities of food Feeling a lack of control while overeating or binging Eating rapidly and swallowing without chewing Eating when uncomfortably full Eating large amounts when not physically hungry Eating alone to avoid the embarrassment of eating too much Feeling disgusted and distressed when overeating

Characteristics of Gamblers

Recreational, social gamblers - the majority Professional Gamblers: make a living at it Antisocial gamblers: steel to gamble, no conscience Pathological gamblers Action seeking: frenetic, exciting, action Escape-seeking: often drawn to slot machines

Volatile solvent Inhalants- Short Term Effects

Stimulation Elevated Mood Reducedinhibitions Illusion, hallucinations Delusions Similar to alcohol intoxication

Which of the following describes dispositional tolerance? Drinkers learn how to "handle their liquor" by modifying their behavior so they don't appear to be intoxicated. The body changes so it metabolizes alcohol more efficiently. The liver eventually becomes less able to metabolize alcohol. The brain neurons and other cells become more resistant to the effects of alcohol.

The body changes so it metabolizes alcohol more efficiently.

The area of the brain responsible for many of the effects of marijuana such as control of pain, anxiety, fear, and a sense of novelty is the prefrontal cortex. amygdala. hippocampus. hypothalamus.

amygdala.

What is the brain chemical most similar to THC, the active ingredient in marijuana?. acetylcholine anandamide adenosine glycine

anandamide

Dextromethorphan acts as a psychedelic in combination with alcohol. at 10 to 15 times a normal dose. in combination with cocaine. after extended low-dose use.

at 10 to 15 times a normal dose.

Which of the following is classified as a psychedelic? belladonna khat ephedra betel nut

belladonna

Symptoms of acute alcohol poisoning includes all of the following EXCEPT respiratory depression. cirrhosis of the liver. CNS depression. cardiac failure.

cirrhosis of the liver.

When the liver develops scars internally, the condition is called fatty liver. cirrhosis. hepatitis. necrosis.

cirrhosis.

High-dose alcohol affects the central nervous system by ______ its function. At higher blood alcohol levels, this leads to ______ heart rate and breathing. decreasing | decreased increasing | increased decreasing | increased increasing | decreased

decreasing | decreased

Which of the following is not a stage in the Johnson model of emergent alcohol dependence seeking the mood swing learning the mood swing drinking to feel normal experimentation

experimentation

Under Jellinek's early classification of alcoholics, which were considered true alcoholics? beta and gamma alcoholics alpha and epsilon alcoholics alpha and beta alcoholics gamma and delta alcoholics

gamma and delta alcoholics

The part of the brain most involved in short-term memory is the hippocampus. orbito-frontal cortex. amygdala. medulla.

hippocampus.

The red eyes caused by marijuana smoking is due to increased blood flow through the mucous membranes of the eye. anandamide interaction with the sclera the irritation caused by the marijuana smoke. THC's interaction with the retinal fluid.

increased blood flow through the mucous membranes of the eye.

LSD belongs to which class of psychedelics? phenylalkylamine psychedelics cannabinoids psychedelics anticholinergic psychedelics indole psychedelics

indole psychedelics

Medical marijuana should NOT be used if the user is recovering from cocaine addiction. reacts to the psychoactive effects of the drug. is overweight. is over 60 years of age.

is recovering from cocaine addiction.

Many believe there are no serious withdrawal symptoms from stopping marijuana use because it persists in the body for so long a period of time. THC is quickly eliminated from the brain. the CB1 receptors don't change from extended use. there is no convincing research on the subject.

it persists in the body for so long a period of time.

Hallucinogen persisting perception disorder (HPPD) is the persistence of the psychedelic substance in the body weeks after ceasing use. mental flashbacks of sensations one had when using a psychedelic. the confusion of one sense for another such as sight for sound. a mental condition where one believes he or she is still using the psychedelic.

mental flashbacks of sensations one had when using a psychedelic.

Which neurotransmitter, when released by alcohol use, reduces pain? dopamine serotonin met-enkephalin glutamate

met-enkephalin

Which of the following speeds absorption of alcohol? eating before drinking mixing carbonated drinks with the alcohol chilling the alcohol mixing juice with the alcohol

mixing carbonated drinks with the alcohol

Metabolism of alcohol varies depending on the type of alcohol. varies depending on the make up of the user. occurs at a relatively defined continuous rate. occurs more slowly in men.

occurs at a relatively defined continuous rate.

All of the following are major withdrawal symptoms of chronic alcohol use EXCEPT DTs. trembling hand. hallucinations. seizures.

trembling hand.

other indoles

• Ibogaine • Low does acts as a stimulant and higher doses produces long acting psychedelic effects. • Morning Glory Seeds • Contains several LSD like substances, is 1/10th as potent as LSD • DMT (dimethyltryptamine) • Found naturally in South America tress, vines, shrubs, and mushrooms • Causes intense visual hallucinations, and a loss of awareness of surroundings lasting a s little as 10 minutes or up to an hour • Ayahuasca (yage) • Causes intense vomiting, diarrhea followed by a dreamlike condition that last up to 10 hours

illusion, delusion, hallucination

• Illusion: mistaken perception of an external stimuli: (rope a snake) • Delusion: a belief that is not swayed by reason or other contradictory evidence • Hallucination; sensory experience that doesn't come from external stimuli

indole

• Indoles exert effects via interactions with serotonin receptors (5HT2A) as serotonin areas of brain are most likely to generate hallucinations and illusions • Lysergic Acid Diethylamide (LSD) is synthesized to a crystalline LSD from ergotamine tartrate, dissolved in alcohol and dropped on blotter paper. Squares chewed or swallowed • "Acidheads" searching for psychological insight or quasi religious experiences; also peer pressure, curiosity

driving cannabis

• Measuring effect of marijuana on driving difficult • Drugpersistsfordaysin body • Eliminationratesvary drastically • Paucityofdataofblood levels of marijuana and impairment level • Usuallyanotherdrug, especially alcohol, in system • Testing level don't measure impairment, just use and less impairment than with alcohol with lower curve with increased use; • more paranoid and wary vs. overconfident in alcohol confident • When swift decision making required & reaction time important chance of error increased under the influence

marijuanna and the law

• Most widely used illicit drug in US and laws vary from state to state • Medicinal use legal in drug in US in 18 states and DC. • Reassessing penalties for possession though Supreme court ruling makes it in conflict with federal law which prohibits medical use • Economic factors • Cash crop, taxes, millions $$$ • Reduces arrest and incarcerations

withdrawal of cannabis

• Only after a long period of abstinence with the withdrawal effects appear as it persists in the system for a long time • Effect include within 3-7 days • Anger,inabilitytoconcentrate • Aches,pain,chills,sweatingcraving • Depression,sleepdisturbance, • Decreasedappetite,stomachpain • Marijuana use disorder and withdrawal included as a criterion for cannabis dependence in DSMV

Inhalants

AKA Deliriants Liquids that give off fumes that are stupefying, intoxicating and have psychedelic effects Different than drugs which are smokes or powders snorted Most abused adolescents and younger adults 12 - 17 y/o: 6.5% 18-25 y/o: 8.4% 26 and up: 8.3% Quickactingwithintenseeffects Cheap, readily available, widespread Readily accessible to children and adolescents More direct toxic effect on body tissues Not recognized as a drug problem

Formalizing Disease Concept

Actions by professional associations National Council on Alcoholism World Health Organization (ICD) American Psychiatric Associations (Diagnostic and Statistical Manual)

Absorption of Alcohol

Alcohol has predictable specific physiological effects Alcohol has calories but no nutritional value. It requires NO digestion to transform it into a form used by the body Small amount absorbed in mouth --highly water soluble Up to 20 % absorbed from stomach - first pass metabolism (M = 20%, F = negligible) Stomach Increases flow of hydrochloric acid ADH (gastric alcohol dehydrogenase) is produced by the stomach lining to facilitate the break down of alcohol. Women have significant lower levels of the enzyme yielding more ETOH to be absorbed into blood in small intestines. passage from stomach via pylorus valve -- PYLOROSPASM: Pyloric valve stuck closed ... hence vomiting Small intestine absorbed into bloodstream rapidly (80%) distributed throughout body -- highly soluble and able to pass through cell walls throughout the water content of the body and varies by amount of water in the tissues. (liver 64%, muscle, 84%, brain 75%) Passive diffusion

Stage 4: drinking to feel normal

Characteristics General feeling of dysphoria result of physical ,psychologica, and social factors No expectation of "pleasure" with drinking Ward off withdrawal effects

Respiratory System alcohol

Direct effects Alters rate of respiration Alters normal pulmonary Indirect effects Aspiration pneumonia Increased risk respiratory disease

salvia

DriedLeaveschewedand absorbed bucally, smoked, tea to drink- member of the mint family; short acting psychedelic • Uniquecomboofpsychic effects: Hallucinations, delirium, out-of-body sensations, inability to communicate or function physically

Nitrous Oxide : Effects

Effects: Dizziness Giddiness Disorientation Silly Laughter Buzzing in ears Visual hallucination Leads to: Confusion Headache Feeling of wanting to pass out Impaired motor skills

withdrawal alcohol

Evidence of tolerance and dependence Ability to stop cravings badly impaired and remains so - stop switch weaker than in a normal person Triggered by relative lowering of blood alcohol level 85-95% will not have life threatening symptoms Can occur even when continue to drink Minorwithdrawaldevelopsinheavydrinkersin7- 34 days and major symptoms 48-87 consecutive days Fourwithdrawalsyndromeswithsomerequiring medical care: Minor withdrawal: hyper arousal Major Withdrawal alcoholic hallucinosis convulsive seizures delirium tremens (DTs)

classification of all arounders

Indoles: • LSD, psilocybin mushrooms • Phenylalkylamines • peyote, MDMA (ecstasy) • Anticholinergics • belladonna, datura • Individually classified • ketamine, PCP, salvias divinorum • Cannabinoids • marijuana plants

marijuana

ManyspeciesofCannabis: plants used for stronger fiber for rope etc., some for better food, some medicinally, some psychedelic effects • Cannabisplant: • Hemp: plants high in fiber • Cannabis: high in psychoactive resins • THC (delta-9- tetrahydrocannabibol) • Variesbystatebutaverageof 6% of US population uses Species of Marijuana • Cannabis sativa: smokable leaves, THC high psychedelic • Cannabis indica: "India hemp" source of worlds hashish • Cannabis ruderalis: low THC • Crushes,rolledintojoints, smoked in pipes • Bhang: stem, leaves low potency • Ganja: strong leaves, flower top • Charas: concentrated resin; potent

all arounders

Psychedelics: LSD, psilocybin, mushrooms, peyote, ecstasy, & marijuana • Stimulantsordepressants • Dramaticallyaltersusers perceptions of surroundings and thoughts • Reasoningtakesabackseatto the intensified sensations generated by illusions, delusions, and hallucinations • Object:alterconsciousness vs. getting a rush • Notconsideredpsychotropic Plantbasedpsychedelicsused throughout the centuries for religious, social, ceremonial and medical purposes • Synthetichallucinogenshave greatly expanded drugs available: DMT, LSD, MDA, MDMA, 2C-B, PCP, designer cannabinoids • Countercultureof1960's-70's • Popularwithyoung,White, users

Sports and Drugs

Three major types of drugs: Therapeutic drugs: analgesics, muscle relaxants, asthma etc. Performance-enhancing Recreational and mood altering

Blackouts:

acts normally, awake, but cannot remember what said and done Electrochemical disruption of brain Recent memory function impaired Cognition, behavior, remote memory and brain function relatively intact Generally dose related Positive correlation -- extent and duration of drinking 30-40% of social drinkers have had blackouts No evidence that blackouts alter judgment or behavior Brownout: partial recall of events that took place

Hyper-arousal minor withdrawal syndrome

earliest and most common withdrawal Includes — anxiety, irritability loss of appetite rapid heart beat tremulousness "the shakes" Sweating, rapid pulse unable to sleep/insomnia Duration usually subsides in 2-3 days but irritability and sleep problems can persist If doesn't subside, more serious withdrawal Basis for early am drinking, to treat withdrawal

LSD

o Pharmacology: o Effects potent, appear 15 -60 minutes, peak 2-4 hours, last 6-8 hours o Tolerance develops rapidly but disappears few days after cessation o Withdrawal mental and emotional o Physical and Mental Effects o Effects similar to stimulants o Sensory distortions (seeing sounds, feeling smells -synesthesia), dreaminess, depersonalization, alters mood, impaired concentration, motivation, impaired reasoning and loss of judgment o Increases heart rate and BP, higher body temperature, dizziness, reduced appetite, and sweating o Bad trips (Acute anxiety reactions) • Mental Illness & LSD • Once believed would augment psychotherapy • Can aggravate an existing mental illness • Rarely does but can result in prolonged psychotic reactions • Flashbacks & Hallucinogen Persisting Perceptual Disorder (HPPD) - flashbacks triggered months to years later; appears similar to PTSD • Dependence: Psychological not physical dependence though tolerance can develop rapidly

tx psychodelics

• Clients usually white, male and under 24 • Use not usually daily • Withdrawal for GHB and marijuana managed • Focus on substance induced disorders (mental illness, intoxication); • Traditional counseling, education, self help, family dynamics, social consequences • Diagnosis of mental disorders difficult until drug clears the system • Bad Trips (acute anxiety reactions). Talk down • A Acceptance • R Reduction of stimuli • R Reassurance • R Rest, calm, relax • Talk-down • Medical help if non-responsive • Counseling, education, self-help • "Bum tripper" PCP or ketamine • HPPD: hallucinogen persisting perception disorder

robitussin dm

• DM is an opioid which acts on the cough center and in non prescription cough suppressants • High concentrating of dextromethorphan cues psychoactive and psychedelic effects (10-15 x normal) • Many states kept behind the counter; therapeutic dose 10-50 mg with 120 in 24 hrs. Abusers take 300- 600mg

Types of alcoholism: modern classification

• Developments: • Discovery of nucleus accumbens - pleasure center • Discovery of endogenous neurotransmitters • Genetic research • Imaging techniques • Primary Alcoholism • no psychological condition that leads to development of alcoholism • Secondary Alcoholism • grows out of major psychological problem or psychiatric illness; also called Reactive Alcoholism • Familial vs. non-familial

addiction cannabis

• HigherTHChasincreasedcompulsiveliabilityand severity of withdrawal symptoms and many have difficulty discontinuing it • Psychologicaladdictionalargefactoroftenmoresothan physical • Cannabisuseanddependencehaveheritable components as well as psychiatric effects • Dependencemorelikelytooccurwhenstartin adolescent • Notnecessarilya"gatewaydrug."Usersusuallyuse alcohol and tobacco first and may hang around other users of other drugs creating more opportunities

magic mushrooms

• Psilocybin & Psilocin active ingredient in "shrooms" • Found in hundreds of different species of mushrooms varying greatly in strength; effects 3-6 hours • Cause nausea and other physical symptoms, visceral, before psychedelic effects take place ; less than LSD

long term cannabis

• RespiratoryComplications • Smokecontainsmixof toxic gasses and particle matter • Unrefinedandunfiltered commonly causing coughing and symptoms of acute bronchitis • Phlegmincreasedbutnot cleared • noclearlinkbetweenpot and lung cancer though does damage the lungs • ImmuneSystem • Cofactor in progression of HIV • Enhanced growth of tumors as suppresses anti-tumor immune response • AcuteMentalEffects • Smoke to satisfy the schizophrenia-related need for relaxation, sense of self- worth, and distraction • Can't readily discern mental problems as precipitates or consequences of use

medical use of marijuanna

• System abused by over prescribing medical marijuana cards • Sold as buds, brownies, laced butter, in foods and cookies, extracts for inhaler, soft drinks • Denver : $360.00 (6 weeks) • Contains irritants, fungi carcinogens, insecticides • When smoked respiratory problems • Issues for cross addiction and recovering individuals • Medical effects: • Muscle relaxant • Pain killer • Nausea • Appetite stimulant and weight gain in wasting illnesses (cancer, AIDS) • Seizure disorder • Multiple sclerosis and other autoimmune disease • Some types glaucoma • Need standardized plant with reliable levels of THC to be able to rely on it as medicine • Placebo effect: calming and anxiety relief makes people feel better

Alcohol

Ethyl alcohol is a product of fermentation and is the least toxic of alcohols. Yeast combines with plant sugars and excretes alcohol and carbon dioxide 14% alcohol highest strength naturally Distillation produces higher concentration 100 proof = 1/2 water & 1/2 alcohol (thus 86 proof bourbon = 43 % ETOH; 100% alcohol not possible (dilutes self with air water) Categories of alcoholic beverages Beer - produced from fermented grain Wine - produced from fermented fruit Distilled spirits - varying concentrations of alcohol made from fermented grains, potatoes, vegetables, and other plants. Energy drink and alcohol The caffeine masks the impact of alcohol, therefore people do realize how inebriated they are. FDA placed a warning on drinks that combined alcohol and caffeine

Levels of Use

Abstention Experimentation Curiosity but no subsequent drug seeking Social recreational No established pattern Habituation (regular but no major impact) Abuse (negative consequences) Addiction (major dysfunction but continue use)

Alcohol Use Disorder - Addiction

AlcoholUseDisorderrequires2offollowing criteria: Alcohol is often taken in larger amounts over longer than intended period There is a persistent desire and unsuccessful efforts to cut down or control alcohol Great deal of time in activities necessary to obtain alcohol, use alcohol, or recover from its effects. Craving or strong desire to use alcohol** Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home* Substance use disorder requires 2 of following criteria: • Continued alcohol use despite persistent or recurrent social and interpersonal problems caused or exacerbated by he effects of alcohol* • Important social, occupational, or recreation activities given up or reduced because of alcohol use • Recurrent use of alcohol when hazardous physically* • Alcohol use continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol Substance use disorder requires 2 of following criteria: • Tolerance defined by either: • Need for markedly Increased amount of alcohol to achieve intoxication for desired effect • A markedly diminished effects with continued use of the same amount of alcohol • Withdrawal manifested by either: • Symptoms listed in Alcohol Withdrawal (criteria A and B) • Alcohol or a closely related substance, such as a benzodiazepine taken to avoid withdrawal symptoms * Formerly Substance Abuse criteria ** New

Performance Enhancing Techniques

Androstenedione and DHEA: natural hormone and precursor to testosterone Beta Blockers: lower BP and by blocking nerve cell activity in brain calm and steady the body Erythropoietin (EPA) Blood oxygen booster that stimulates bone marrow to produce more red blood cells that carry oxygen Thickens blood (viscosity) and increase clots Increase danger with sweating, edema

Effects of Alcohol on CNS

Brain is organ most sensitive to alcohol's effects Alcohol is a depressant drug Affects structure of nerve cells and neurotransmitters Degree of impairment is dose-related Key measure: blood alcohol concentration (BAC) Different parts of brain are differentially impaired by presence of alcohol

cancer and systemic problems alcohol

Breast Cancer : association with heavy drinking and breast cancer at three + drinks daily. Risk of mouth, throat, larynx, esophageal cancer 6x greater Musculoskeletal Gouty arthritis: increased uric acid from liver disease Degenerative arthritis, septic arthritis, osteoporosis loss of minerals weakening of bones, aseptic necrosis (bone death)

Overdose and Toxicity

CNS and behavioral effects greatest if alcohol level rising. When BAC at .20 or above, the ability to form memories of events is impaired: either non or spotty. Anterograde amnesia: a short term memory Narrow window between dose that induces coma and a lethal dose Death BAC 0.50 - 0.70 equivalent to a fifth of 86-proof whiskey in 1 hour Acute lethal dose from 5-8 mg/kg of body weight Will vary with age, sex, physical health, degree of tolerance though an alcoholic can tolerate a dose that might kill another individual

Stage 2: seeking the mood swing

Change in mood available "on demand"-- can control the degree of mood swing by amount consumed Socially appropriate in many situations to celebrate, enhance good mood to deal with negative situations -strong impact No negative consequences

Stage 1: learning the mood swing

Characteristics Drinking induces a change in mood in positive direction As alcohol's effects wear off, mood returns to previous level Positive response due to pharmacology and social factors Learn physiological effects

Compulsive Shopping and Hoarding

Compulsive shopping may be considered an impulse control disorder, and obsessive compulsive disorder, or even a clinical addiction depending on the clinical source. Problemshandlingmoneyresponsibly isthehallmarkofalmostanyaddiction Compulsive shopping (oniomania) was at times diagnosed under impulse control disorders not otherwise specified I DSM IV TR (which also included sexual addition, self mutilation) ed Disorders Difficulty in parting or discarding possessions Clutter active living areas and substantially compromise intended use

Factors influencing absorption

Concentration of alcohol Stomach contents: food impedes passage of alcohol Highest level of concentration 30-90 minutes after consumed Amount consumed More rapid rate of absorption leads to rapid feeling of intoxication Also varies with type of beverage - higher the proof the quicker absorbed. Beer and wine have some food value slowing absorption though they have "bubbles" Carbonation of beverage (CO2) - carbonation speeds absorption

Alcohol Use Disorder

Definition of Disease: A pathological entity characterized usually by at least two of the following criteria 1) recognized etiology; 2) identifiable group of signs and symptoms 3: consistent anatomical alterations Jellinek was largely responsible for the shift from a defect model to an illness model. Alcohol a central feature in the individual's life Emerges gradually Both normal and symptomatic behavior Behavioral features initially Physical problems arise later

American Psychiatric Association DSMV

Devised a single set of circumstances that would apply to all substances i.e. withdrawal For purpose of diagnosis it is important to find the features that distinguish amongst illnesses and research reveled that alcohol abuse (ICD 9 "harmful use") did not necessarily result in dependence Severity of dependence to be identified as mild, moderate, severe Recovery full or partial remission, duration, early or full sustained (12 months)

Liver Disease: Gastrointestinal System alcohol

LIVER: Enzyme ADH begins breakdown of Alcohol Also: breaks down nutrients, toxins, medications; affected by gender, heredity, race and ethnicity Manufactures essential blood components including clotting factors; Stores vitamins including B-12 which is essential for red cells. Common medical complication Acute fatty liver : fatty acids don't get broken down and accumulate; 30-50% diet ETOH -reversible; deposits can accumulate after a few days of heavy use Alcoholic Hepatitis - inflammation of liver; may be reversible in some but can be fatal Cirrhosis: alcohol kills an excessive number of liver cells and causes scarring; cannot be reversed; 5-10 years of heavy drinking

Fetal Alcohol syndrome (FAS)

Leading cause of preventable birth defects Not restricted to alcoholic women Threshold around 1 drink per occasion Not an absolute threshold NIAAA recommends no more than 2 drinks per day US Surgeon General recommends no alcohol Features defining FAS lower birth weight small head size "dysmorphic" facial appearance developmental difficulties extending into adulthood mental retardation is common ADHD frequent no improvement with age

Elimination & Metabolism alcohol

Metabolism Alcohol is broken down and neutralized in body for removal (oxidation) Enzymes both present in the stomach and liver. Only organs that can breakdown ETOH to acetic acid. Acetic acid dispersed and broken down in cells and tissues to become carbon dioxide and water which can be handle by most any cell. Metabolism Other 95% broken down and neutralized in body for removal (oxidation) Liver, key organ Elimination (5%) Begins when enters bloodstream Removal unchanged Small amounts of alcohol exit body via breathe, urine, sweat Amount exhaled is constant and predictable relative to BAC -- basis of breathalyzers Excreted through kidneys

Caveats on Metabolism alcohol

Metabolismoccursatarelativelyspecificcontinuous rate Approximately 1 oz. of pure alcohol (1.5 drinks) is eliminated from the body every three hours Some variation of rate between people after extended drinking years Unmetabolized alcohol in the brain accounts for intoxication Alcohol metabolism impedes other liver function and contributes to many alcohol-drug interactions. Alcohol is first in line and "hogs" the liver function!

CNS disorders alcohol

Neuropsychological impairment Personality changes Frontal lobes and right hemisphere most affected Executive dysfunction Mental/EmotionalEffects Any mental, emotional, psychiatric condition possible Memory problems and inability to learn problem solving techniques

Low-to -Moderate Dose Use

No level of use alcohol is safe for everyone Contraindications Pre-existing physical or mental health problems that would be aggravated by alcohol Allergic High genetic or environmental susceptibility to addiction Pregnancy - CDC 0 drinks History of abuse or addiction At risk for breast cancer Medications that negatively react to alcohol Definition:drinkingthatdoesn'tcauseproblems for the drinker or for those around. Moderate drinking can create health problems: fetal alcohol syndrome, cardiac and circulatory HBP Potential problems aggravating medical conditions : gout, diabetes, ulcers, osteoporosis alcohol-medication interactions Physical Effects: No negative health consequences for most people Can be experimentation, social, even habituation Therapeutic use: disinfectant Tastes good, thirst quencher, relaxant, sleep inducer (but disturbs 2nd 1⁄2 sleep) Stimulant of appetite Reduce incidence of heart disease, plaque: anti-inflammatory; Lower risk of stroke: keeps blood platelets from clumping (1-2) Increases self confidence, sociability, reduce stress Increases sexual desire/facilitates opportunities/ not necessarily performance Beneficial effects can be obtained through exercise, diet, aspirin Psychological Effects: Lowers inhibitions, increase self-confidence, promote sociability Reduces tension, sedates Depressant and disinhibiting effects deepen negative emotions Increase high risk behavior: drunk driving, high-risk sexual activity and consequences Sexual Effects Increase desire, heighten orgasm in female, decreases erectile ability and delay ejaculation in males.

Causes of sexual addiction

No proven causes Cope with depression, anxiety, stress, low-self worth, pleasure Tolerance develops Exposed to pornography at young age Traumatic experiences in childhood Physical/sexual abuse and/or emotional trauma Abandonment, neglect/starved for love Brain abnormalities: Conditions and diseases Natural brain chemicals, Androgens (Sex hormones) Changes in brain circuitry

Alcoholic Hallucinosis Withdrawal Syndromes

Occurs in 25% of withdrawal Seen in first 24 hours True hallucinations: auditory and visual May include illusions & misinterpretation of real stimuli in environment May include nightmares Not evidence of underlying psychiatric problem -- individual oriented to time, place and person

CNS syndromes alcohol

Organic Brain Diseases Wernicke's syndrome--mid brain; ataxia, confusion Korsakoff's syndrome -- executive and memory functions affected (both caused by B-1 deficiency and toxicity); confabulation the hallmark; also ataxia; treat with thiamin Alcoholic cerebellar degeneration (dementia)

Other alcohol-related diagnoses (DSM-V)

Other DSM-V alcohol-related conditions Include: Alcohol intoxication Alcohol withdrawal Other alcohol- induced disorders Unspecified Alcohol Related Disorder

beta alcoholism

Physical problems of heavy drinking Absence of psychological or physical dependence (tolerance) Common in cultures with heavy drinking and inadequate diet; socially and economically impoverished groups

Signs & Symptoms sex addiction

Pornography (most frequent) Excessive Masturbation Multiple Sexual affairs, serial affairs Prostitutes Voyeurism Exhibitionism Avoiding emotional involvement Molestation, rape, and murder Unsafesex Onenightstands Multiple partners Obsessivedatingthroughadvertisements Sexualharassment Topless bar, strip joint frequently Phone,InternetSex Incest, sexual abuse

Reproductive System Males alcohol

Primarilyresultofliverdiseaseleadsto imbalance of sex hormones Signsandsymptoms diminished libido impotence and erectile dysfunction possible sterility "feminization" of features: breast enlarged, testicles shrink, decreased testosterone as impairs gonadal function Inability to experience normal sexual relationship

Reproductive System Females alcohol

Primary cause is liver disease leads to imbalance of sex hormones Signs and symptoms increased testosterone decreased fertility skipped menstrual periods Increased risk of spontaneous abortion Decreased desire and intensity of orgasms Fetal alcohol syndrome with pregnancy

High Dose Episodes

Purpose: often intoxication Can occur at any level Binge drinking: 5 drinks for males/4 for females at one sitting Highest in college and 21-25 years Heavy drinking: 5 drinks 5x month Depressant effects take over after enough drinks consumed, Mental and Emotional Effects Mental confusion, mood swings, loss of judgment, emotional turbulence Slurred speech Progressive mental confusion, loss of emotional control, REM interference Alcohol Poisoning: depression CNS leading to unconsciousness, respiratory and cardiac failure Hangovers: after effects include nausea, headache, vomiting, depressed feeling, many hours after alcohol eliminated Sobering Up: coffee, exercise, cold shower do NOT cure but rest and recovery to re-achieve equilibrium.

Jellinek's Classifications alcohol

Recognized some cases didn't fit model of phases Led to formulation of Species of Alcoholism Product of era when developed (1952) Some elements discounted by later research example: significance of blackouts Delta and gamma species seen as "true" alcoholics

delta alcoholism

Similartogammaalcoholism Psychological physical dependence Cancontrolamountconsumedonany occasion But cannot cease drinking without withdrawal

Inhalants - Delivery

Sniffing Huffing (fumes from soaked rag) Bagging Spraying Balloons & Crackers Soaking clothing Bag over the head

DSM-V Severity alcohol

The threshold for alcohol use disorder diagnosis in DSM-5 is set at two or more criteria, in contrast to a threshold of one or more criteria for a diagnosis of DSM-IV substance abuse and three or more for DSM-IV alcohol dependence. Severity of the DSM-5 alcohol use disorders is based on the number of criteria endorsed: 2-3 criteria indicate a mild disorder; 4-5 criteria, a moderate disorder; and 6 or more, a severe disorder

gamma alcoholism

Tolerance,lossof control Psychological physical dependence Suggestedtobe most common type in US

Convulsive Seizures alcohol

Used to be called "rum fits" Most common in 12-48 hours after stopping alcohol Generalized, grand mal seizure Most commonly one or two seizures Complication: status epilepticus seizures follow one another Represents serious withdrawal one third of those with seizures go on to have DTs

Complications Chronic Use alcohol

Virtually all body systems affected with effects wide ranging and profound Resultofdirecteffectsofalcohol Resultofindirecteffects Mortality: heavy drinkers likely to die 15 years earlier than general population

Vernon Johnson model

descriptive useful in patient education four stages first two stages apply to all drinkers

Herbal Preparations & Smart Drugs

"Natural Cures:" St. John's Wort Echinacea Saw Palmetto Glucosamine Chondroiton Ginkgo biloba Vitamins Healing properties over-promoted Controlled studies scant

Effects of alcohol on CNS

Affects physical structure of nerve cell membranes and changes lead to changes in the function of nerve cells as they adapt to continual heavy use. May responsible for the phenomena of craving , tolerance, withdrawal, and loss of control. Neurotransmitters affected • Depresses activity of serotonin after initial elevation of mood as a result of initial surge of serotonin • Enhances GABA - an inhibitory transmitter. Slows transmission across the synapses of brain activity • Hastens release of norepinephrine (stimulating transmitter) , and dopamine - surge of pleasure • Glutamate intensifies the effects of dopamine and enhances a certain pleasurable stimulations • Increases levels of endogenous opiate - endorphins and anandamides activity which increases well being • Met-enkephalin release reduces pain

Volatile Nitrates

Amyl and butyl nitrates : ovc room fresheners, angina medication (amyl nitrate) Dilate blood vessels so the heart and brain and other tissues receive more blood(vasodilators) Effects start in 7-10 seconds and last 30-60 seconds Used also as aphrodisiac Inhalation produces feeling of fullness in the head, a rush, mild euphoria, dizziness, giddiness Excessive use causes oxygen deprivation, fainting, passing out, temporary asphyxiation

Therapeutic Drugs

Analgesics (painkillers) & anesthetics Muscle relaxants Anti-inflammatories (NSAIDs) Asthma Medications (beta2 agonists) Therapeutic drugs can mask true injuries and can cause an athlete to overuse injured muscles or tissue which could lead to long-lasting damage. Opioid analgesics and one or two of the muscle relaxants are the drugs most abused. Analgesics: (painkillers) topical and systemic Tolerance develops quickly Block pain without repairing the damage Range from aspirin to opioids (hydrocodone, morphine, codeine - ingested or injected Muscle relaxants: depress neural activity within skeletal muscles & reduce muscle tone Depressants, sedating, Used to treat strains, sprains, spasms, anxiety Soma, Robaxin, Flexeril, benzodiazepines (Valium, Klonopin Anti-Inflammatory Nonsteroidal: (NSAIDS) Aspirin ibupropin (Motrin, Advil), Celebrex Causes ulcers, renal problems Corticosteroids: cortisone and prednisone Significant side effects Asthma medications: (beta2 antagonists) Stimulant & slightly increase oxygen intake via bronchodilation Ephedrine based are banned 10% pop affected asthma aggravated by exercise 11-23% of all athletes affected EIA some banned others permitted: albuterol

Johnson paradigm

Assumptions: applies to all who use alcohol alcohol induces changes in the drinker's mood mood states can be charted on a spectrum from pain (discomfort) to euphoria (pleasure) Paradigm Shift - No longer must hit bottom "A love affair" -- strong relationship, bond

treatment cannabis

Availability of street level pot with high THC creates more dependence 4.8 (03) ^ 10.1% (08) - with very rare strains up to 25% • Physical and emotional dependence • Physical withdrawal rarely requires medical attention with onset delayed for days or weeks • Ambivalence about need for therapy • Motivational enhancement therapy, coping skills, relapse prevention are the major psychosocial interventions

anticholinergic psychedelics

Belladonna, henbane, mandrake, & datura (jimson weed, thornapple) • Contain hyoscyamine, atropine, scopolamine • Block acetycholine which regulates reflexes, aggression, sleep blood pressure, heart rate, sexual behavior, mental acuity, attention • Result can be delirium, high hr, thirst, raised body temp to dangerous level, hallucinations, separation from reality, deep sleep up to 48 hours

pharmacology of cannabis

Cannabis: 420 chemicals Liver converts to 60 metabolites, some psychoactive 20% THC absorbed Brain has natural receptors Endogenous cannabinoid transmitters or endocannabinoids Anandamidefitsintoreceptor sites in limbic system; Cb1 & CB2 receptors;( brain chemical similar to THC) 10x more anandamides than endorphins involving vast range of physical & mental functions Mainlyaffectsthepartsofthe brain that regulate • integration of sensory experiences with emotion • Control learning, memory, a sense of novelty, motor coordination and some automatic body functions • Increase or decrease sensitivity of mind to certain sensory input, in areas involved in stress • Difficult to overdose as few receptors in brain stem area controlling hr, breathing

Volatile Solvents

Carbon and hydrocarbon-based compounds that are volatile (turn to gas) at room temperatures: Gasoline,gasolineadditives,kerosene,paints,paintthinners, lacquers and thinner, nail polish remover, glues, plastic cements, air dusters Nitrous oxide, nitrates, spray paint, aerosol spray, lacquer thinner, correction fluid Absorbed immediately after inhalation and move to heart and brain, liver in 7-10 seconds

Internet Compulsion/Addiction

Compulsive involvement in chat groups, surfing, stocks or commodities watching, online gambling, sexual relationship, compulsive checking of e-mail, games, Facebook, • Some people experience a stimulant like rush online whereas others describe being tranquilized by their quiet isolation online. - Most problematic areas: - Cybersex addiction - Computer relationship addiction - Internet compulsion - Information addiction - Computer games addiction. - Social networking sites Symptoms: Logging on every chance there is at home, school, work (40 hours per week compared to 8 hours for non addicted) and checking email at all hours, constantly Thinking about the Internet/technology constantly Feeling irritable and anxious when not online and needing more time progressively to feel satisfied Neglecting responsibilities Allowing in person relationships to deteriorate Posting more message and downloading more data Eating in front of monitor

Other Sex Addictions

Cybersex Addiction 70 million people visit porn site, it is highly available and anonymous Can avoid expensive 900 phone calls, trips to X-rated stores, prostitutes Progressive often from masturbation using porn or when chatting, phone, and even meetings Pornography Porn addicts tend to ignore, replace or neglect significant relationships because of their fixation or obsession with pornography Masturbation addiction Self-Pleasure can be an addiction if it takes over one's life and the urge is uncontrollable.

Eating Disorders

DSM - V: Feeding and Eating Disorders fall under three disorders Pica - ingesting nonuritive substances such as plaster, gum, wool, or string Rumination disorder - repeated regurgitation of food Avoidant/restrictive food intake disorder - a lack of interest in eating and the avoidance of many foods resulting in eating and the avoidance of many foods, resulting in weight loss and bad nutritional problems. DSM-V: Anorexia nervosa - an addiction to weight loss, fasting, and minimization of body size Bulimia nervosa - an addiction to binge-eating large quantities of food, often followed by purges using self-induced vomiting, fasting, or excessive exercise; body weight is on the low side of normal Binge-eating disorder - recurrent, episodes of binge eating where more than normal is eaten and a sense of lack of control grows strong 350 million individuals worldwide are obese and 750 million are overweight. In the US 35% of adults are obese (15% in 1980) Not all food addicts are obese Not all obese people are food addicts Overweight or obesity not in DSM V - but a condition that may be focus of clinical attention Environmental: Where food is readily available the natural subconscious control of the appetite and metabolism becomes ineffective It is necessary to take cognitive control of the appetite and eating habits The ability to alter metabolism to maximize one's intake is a survival trait but injurious in today's world.

Dependence inhalants

DSM-V Inhalant Use Disorder & Inhalant intoxication; Unspecified Inhalant-Related Disorder is the following symptoms occurring during or shortly after use Problematic pattern of use of hydrocarbon based inhalants leading to impairment Similar criteria and severity to SUD. Nitrates and anesthetics is psychoactive substance dependence NOS Treatment: removal from exposure; assess adverse psychiatric conditions, withdrawal seizures; implement standard psychosocial interventions

SEXUAL ADDICTION

DSMV DidNOTinclude Hypersexual Disorder Notunder"otherconditions that may be focus of clinical attention" (maybeseen under aegis of "sex counseling") or "conditions for further study." In DSMIV-R it would be diagnosed as Sexual Disorder NOS e.g. compulsive love relationships, fixation on an unattainable person, compulsive masturbation) Also seen as Impulse Control Disorder (hypersexuality) - receive pleasure no matter what the cost Obsessive Compulsive Disorder, but not OCD as goal is to OCD is reduce anxiety ICD defines it as "excessive sexual drive" Satyriasis (men) Nymphomania (women)

methods of using marijuana

Dabbing - vaporizing hash oil by "dabbing" it onto a hot element connected to a glass pipe. • BHO (butane hash oil) - extracts the THC by spraying butane or everclear alcohol through the buds, twigs, and leaves of marijuana. • THC residue in wax substance has high concentration approximately 90% THC • Shattered glass - resultant slush is highly filtered and allowed to solidify on flat surface. This intensifies the concentration of cannabinoids even further.

Effects - Side Effects of Addiction

Drugtreatment: Manyresearchersbelievethatdrugsthatact to stimulate serotonin activity can possibly be used to treat sexual addiction. (SSRI'S inhibit sexual activity) whereas drugs blocking it seem to increase sexual activity. Othermood-alteringdrugsthatlower inhibitions may lead to the high risk behavior SexAddictsanonymous,Sexaholics anonymous

PCP, Ketamine, salvia divinorum

Each generation discovers an obscure substance used by other cultures or recently been synthesized • PCP: liquid , crystal, tablets and smoke, snorted, swallowed, injected • Blocks sensory messages so dissolution of inhibitions, deadens pain, mind body separation, hallucinations (tactile, visual, auditory) • forgetfulness, inability to concentrate, aggressive and violent behavior, depersonalization, estrangement • Propensityforbadtrips,flashbacks;bothanterograde amnesia as well as retrograde (prior events) • Ketamine:dissociativegeneralanestheticusedinhuman and veterinary medical procedures and similar to PCP • Methodofdelivery:Crystalsnortedorsmokedincrackpipe • "K-land'(100-200mg):milddreamlikeintoxication,, sensations of mind/body separation, dizziness, free floating giddiness, slurred speech, impaired muscle coordination; combative, belligerent • K-hole:out-of-bodyneardeathencounter; depersonalization, hallucinations, delirium, bizarre mystical experiences; feel nothing if injured; can cause coma

Bulimia Nervosa

Eating disorder characterized by eating large amounts of food in one sitting (binging) followed by inappropriate methods of ridding oneself of the food to prevent weight gain. Self induced vomiting (80 - 90%) Use of diuretics and laxatives, fasting, and excessive exercise Are often ashamed of their behavior they consume food rapidly and purge secretly Effects of bulimia Dental complications Greater liability for alcohol and drug abuse Dependency on laxatives for normal bowel movements High rate of depression Greater risk of suicide

Food Addiction

Food addiction is a non-research validated contemporary term used to describe a pathological attachment to food. It is manifested by a compulsive, excessive craving for and consumption of food. According to Sheppard (1989), in "Food Addiction: the Body Knows, " food addiction the compulsive pursuit of a mood altering change by engaging repeatedly in episodes of binge eating despite adverse consequences. Food addicts are obsessed with food, preoccupied with weight and appearance, and they experience progressive loss of control over the amount of food they eat. Food is used to escape feelings, it is often secretive, and involves guilt, denial. It is a chronic, progressive and fatal disease: Condition never goes away, progressive because the symptoms always get worse over time and fatal because those who persist will die an early death due to its complication. These are the same indicators present in chemical dependency. Both ED and CD share four typical characteristics or symptoms: Experiences a powerlessness over food and subsequent uncontrollable self-destructive behavior, Exhibit an initial denial of the compulsive patterns and will fail to acknowledge the current or future consequences of these patterns. For a significant subgroup of individuals deterioration of symptoms and functioning will occur until intervention is begun. The great majority of families of those who have eating disorders or chemical dependency are affected. Earlier family dysfunction has often played a key role in the development of these self destructive patterns.

Food Addiction - Treatment

Food addiction needs to be addressed at the physiological level: Highly refined carbohydrates are most quickly converted to sugar. Sugar is nothing but a chemical and rapidly absorbed. Maintaining an efficient and even metabolic rate by consumption of slowly absorbed foods eliminates the subjective fatigue and mood swings and cravings associated with rapidly absorbed calorie dense carbohydrates. Surgery options Different medications Self-help groups (overeaters anonymous)

Jellinek's phases of alcoholism (1952)

Four stages 1952* Pre-alcoholic Phase Prodromal Phase - prodromal means signaling or warning Crucial Phase Chronic Phase * Similar to Johnson "I'll Quit Tomorrow" stages

Environmental Factors COMPULSIVE

Gambling: Proliferation of lotteries, machines, casinos, online access, legal off-track betting • Eating: Plentiful fast food, lack of need for daily activity • SEX: Copious sexual stimulation in the media • Internet: Games, chat rooms, social networking sites i.e. Facebook, Twitter • Credit availability: materialistic view of life, barrage of ads creating "needs"; 24/7 shopping networks • Abuse: History of physical, emotional sexual abuse

Performance Enhancing Techniques more

Herbal medicines GHB Soda doping Weight loss Diuretics Laxatives, Fasting, Vomiting, bulimia Saunas Recreational drugs use similar to general population and unless performance enhancing not usually tested for.

Herbal Preparations

Herbal preparations used for thousands of years with much of power due to placebo effect and belief in the healers Many modern medicines based on these Current herbal preps not rigorously tested Adverting promises often outstrip actual benefits Some contain prescription drugs, nonlabled fillers, carcinogens

Neurochemistry of Eating

Hormone ghrelin An empty stomach causes its release Effects hypothalamus which controls appetite and metabolism Hypothalamus triggers the release of dopamine which stimulates the conscious brain to search for food Leptin: hormone released by fat cells & GPL-1 Counteracts ghrelin Hypothalamus told to stop dopamine release and appetite reduced One theory postulates that consumption of food rich in carbohydrates in order to compensate for a brain serotonin deficiency resulting in a depressed mood. The carbohydrates serve the same function as antidepressant drugs with improved mood and diminished sensitivity to negative stimuli. The calm feeling produced, however brief, is the object of food addiction.

Recovery-Treatment gambling

Recovery necessitates correcting cognitive distortions Egotism and sense of entitlement Until devastated most won't admit have a problem Lack of facilities to treat gambling addiction Have withdrawal symptoms similar to alcoholism CBT: overcome "magical thinking" and participate in GA DSM IV -TR 321.31

Compulsive Behaviors

In popular psychology individuals often refer to many compulsive behaviors as addictions. In the DSM V only gambling has been classified in the substance use disorders and addictions category. ating, shopping, TV, internet, IM) - some were classified (DSM IVR) as impulse control disorders (i.e. pathological and gambling, hair pulling) - as seen as alter the brain chemistry in much the same way as addictive drugs do. • Compulsive behavior - People engage in compulsive activity for the same reasons they engage in drug use - instant rush, forget, reduce stress; mood alter. Impulse-ControlDisorders Failure to resist an impulse that is harmful to the individual or others but can starts out as pleasurable Increased state of arousal before committing the act Often followed by gratification, pleasure, remorse, guilt. Gambling and hair pulling not classified as ICD in DSMV Obsessive-compulsive disorders • Behaviors cause marked distress , impairment • Repetitive activity whose goal is to reduce anxiety, stress caused by obsessive thoughts, • Goal is not to provided pleasure and gratification though they may relieve stress • Ego-dystonic

Other Drugs

Inhalants: Volatile Solvents Nitrates Anesthetics Sport Drugs Other Animal extracts Herbal preparations Nootropics

Which of the statements about the potential danger of low-level alcohol use is true? Low level use can increase plaque formations which increases the risk of heart disease. Low level use is safe for individuals who have a high genetic/environmental susceptibility to addiction. Low level use is potentially dangerous for women who are at risk for breast cancer. Low level use is not dangerous for women who are pregnant.

Low level use is potentially dangerous for women who are at risk for breast cancer.

Politics of Gambling

Proposed as a state tourist economic benefit but little influx for most states and social cost far exceed revenue; government encourage/legalizes Online gambling: Congress passed a law criminalizing the processing of online gambling transactions by banks and credit card companies Availability of gambling greatly effects numbers of problems and pathological gamblers. High rate of other addiction among gamblers. Women ^, older gamblers ^, college students high rates of gambling, minorities higher than Whites\ Problem & Pathological Gambling Problem gambling: problems in physical, psychological, sociological, vocational areas of life ($3000.00 year) Pathological gambling: persistence despite continual and significant disruption of most areas of one's life ($11,000.00 per year)

cardiovascular system alcohol

Medical complications Arrhythmias - irregular rhythm Hypertension (2-3x) Coronary disease ( ^ 6x) Cardiomyopathy - enlarged, flabby, inefficient heart Stroke

Long term effects: volatile substances

Mental and neurological deterioration Lower level mental functioning Injury to brain, liver, kidneys Anti social personality disorder common among abusers

Anorexia Nervosa

Most frequently diagnosed in young women 14 to 18 years old An estimated 90 to 95% of anorexics and bulimics are women Estimated .5 - 1% Anorexia Nervosa Restrictive type Binging - purging type Those with anorexia are afraid of putting on pounds and eventually may lose 15- 60% of their weight. They don't maintain normal body weight and often harbor distorted perceptions of their body's shape. Causes Compensatory behavior Method of controlling things Delusions/compulsions Changes in brain chemistry (endorphins) Effects of anorexia nervosa Strains all of the body's system especially the heart, live, and brain. Dehydrations from vomiting which can cause electrolyte imbalances Mild anemia, swollen joints, constipation, and lightheadedness Females can experience decrease in estrogen levels and amenorrhea Stomach gramps, dry skin, osteoporosis, sterility, miscarriage, and birth defects. Can result in death

Delirium Tremens alcohol

Most serious form of withdrawal and includes most of previous symptoms Earlywithdrawal,rather than clearing, worsens; occurs in less than 1% of drinkers Historicallyupto20% mortality "Delirium"refersto hallucinations "Tremens"refersto tremulousness, agitation, CNS activity Most serious form of withdrawal and includes most of previous symptoms Earlywithdrawal,rather than clearing, worsens; occurs in less than 1% of drinkers Historicallyupto20% mortality "Delirium"refersto hallucinations "Tremens"refersto tremulousness, agitation, CNS activity

Food/Sugar Addiction

Neurobiology studies show the similarity of drug addiction and binge eating: Bundles of nerve fibers lead from the mid-brain to the nucleus accumbens: Secrete unusually large amount of dopamine when we experience something surprising or pleasant Cocaine and amphetamines cause dopamine levels to rise at least 10 fold in the nucleus accumbens, delivering a rush to pleasure Same reward system controls our hypothalamus which regulates eating behavior Mice, genetically engineered to have no dopamine loose all desire to consume anything and starve to death Neurobiology studies show the similarity of drug addiction and binge eating: PET scans measuring the quantity of dopamine receptor in overweight volunteers found a close correlation with BMI The higher the BMI the fewer dopamine receptors Concluded that the extremely overweight individual suffer from a dopamine shortage and they seek new rewards in the form of food Brain compensates for excess dopamine by reducing its number of receptors Research indicates that compounds which block opioid receptors, specific nerve cell areas where the opioid chemicals carry out their actions in the brain, can reduce the intake of sweet foods. Although direct proof is still lacking, some scientists believe that this finding indicates that sweets create a release of opioids that activate the receptors and create a pleasurable response. When the reaction is blocked, so is the urge to consume sweets. In addition, it's known that some addictive drugs, like morphine, directly target the opioid receptors and create an intense response. This suggests that there are parallels between drugs and sweets. Drugs, however, likely cause much more powerful actions in the brain.

ANESTHETICS-Nitrous Oxide

Nitrous oxide is extremely popular with the 18- to 25- year-old set, and is often used at rave or music clubs and parties. Rapid onset, rapid dissolution and can cause freezing of lung etc. tissue if inhaled directly from canister Home canisters used for charging whipping cream canisters abused

OCD

Obsessive Compulsive Behaviors: Obsessions: Thoughts of contamination or repeated doubts Compulsions: Hand washing Checking Things Ordering Things Counting Time consuming Cause impairment and are excessive and unreasonable Obsessive Compulsive Behaviors: Trichotillomania Hoarding Disorder New to DSM V as a separate disorder In DSM IV saw Compulsive Hoarding only as a symptom of OCD. Now classified under Obsessive-Compulsive and related Disorders Hallmarks of both drug use and compulsive behaviors • Compulsion: think about using most of time • Tolerance: need greater amounts with ongoing use • Withdrawal: discontent when can't use • Abuse: continue use despite social, medical, family and legal consequences • Denial: problem, think can control • Relapse: tendency to return after abstinence Twin studies and obesity: • Shared environmental stressors not significant in affecting twins weight gain when raised separate Heredity & Environment • Triggered by genetic predisposition • Environmental stressors • Repetitive behavior itself .

tolerance of cannabis

Occurs rapidly though and usually users become more sensitive to desired effects of THC initially and quickly less sensitive • Pharmacodynamictolerance(reducednervecell sensitivity) is more common than reduce bioavailability (dispositional tolerance or speeding up the breakdown.) • Marijuana persists in the body of the chronic user for 3 months

phenylakylamine psychadelics

Peyote(mescaline) • UsedceremoniallybyNative Americans; sacramental in Native American Church of NA • Effectsquitelonglasting-12 hours ; LSD though "mellower" and more hallucinatory • Grey-greencrownsusedfresh or dried; eating , boiled as tea, ground an eaten as powder • Usually have severe nausea and vommitting Psycho-stimulants(MDA, MDMA & Club Drugs): similar to adrenaline and amphetamines • MDMA(Ecstasy):highpublic profile due to media interest • Capsule, tablet, powder • Used at raves, music clubs • Creates strong desire to move abut, dance and interact • Create a deeper empathy

ANESTHETICS - Nitrous Oxide

Oneofthehazardsofuse is passing out suddenly, which can lead to broken noses and concussions. Cognitive functioning diminished during peak Used often in dental procedures

Tolerance alcohol

Over an extended period, predictable changes take place in the body. Tolerance develops. The CNS adapts to its presence in increasing amounts. This defines alcohol as an addictive drug. Needs larger doses to produce the same effects as smaller doses. Result of CNS adaptation to alcohol - the brain defends itself Not simply associated with chronic use Dispositional (metabolic): metabolizes alcohol more quickly as liver creates more enzymes Parmacodynamic tolerance: brain cells becomes more resistant to effects of alcohol: cellular changes Reverse tolerance: liver eventually becomes less able to process Behavioral tolerance: learn how to "handle liquor" Acute tolerance develops from high dose alcohol use Select tolerance: not developed equally to all effects of alcohol Inverse tolerance or "kindling" - repeated bouts of use and withdrawal intensifies subsequent withdrawals

short term effects cannabis

Physical Effects (mainly amygdala) • Physical relaxation or sedation • Pain control • Coughing from lung irritation • Increased appetite "munchies" as enhances sensory appeal of food • Small to moderate loss in muscle coordination • Increased HR, decreased blood & eye pressure • Increased blood flow to eye mucous membranes (red eye) • Decreased nausea • Impairs tracking ability - trailing phenomenon (after image) Mental Effects • Slightconfusionandfeeling separated from environment • Drowsiness,analooffeeling • Difficultyconcentrating • Somestrongvarietiescause giddiness, alertness, distortions of time, color, sound • Paranoia&depersonification • Mildhypnotic • Moreempatheticfeeling Novelty • Stimulates amygdala's emotional function & makes even mundane objects interesting as alters way in which the brain process information • Down regulation with overstimulation (receptors retreat) and then even the truly interesting becomes boring- 2 weeks to re-emerge • Memory and Learning • Hippocampus involved in short-term memory • Cannabis severely limits available amount of short-term memory as acts as an agonist at GABA • Restored with stoppage but memories lost forever • Slows learning but less effect on long term memory • Longer and heavier the use more attention and cognitive functioning impaired but believe learning and thinking and communicating better • Distorted thinking (frontal cortex) so ability to discern what is or is not important diminished • Time • Temporaldisintegration distorts a sense of time • Timeseemstogoby faster • Distortedtime,impaired judgment, & short-term memory loss results in inability to perform multiple and interactive tasks

general effects: hallucinogens

Physical&Mental • Stimulate the sympathetic nervous system • Raise pulse, BP, breathing, sweating, nausea • Impact brain chemistry • Overload sensory pathways so acute awareness of all sensations • Synesthesia: crossover of mixing of senses ( i.e. see music as light patterns) • Affect mood

• MDAM (Ecstasy):

Physicaleffectssimilarto amphetamines but milder • Tightness in muscles and spasms • Trismus (jaw spasm) and bruxism(teeth clenching) before psychic effects • Tolerance to mental effects develops rapidly so seek greater dose and increase in physical effects Ecstasy: Mental emotional effects • 1-4 hours happiness, clarity, peace, pleasure and altered sensory perception without depersonalization • Non sexual empathy, open mindedness, high self-esteem, "hug drug" • Overwhelms vesicles and serotonin reservoirs discharged depleted; receptors retreat (down regulation); depression and long lasting mood changers • High dose: acute anxiety More serious MDMA effects include • Water toxicity and electrolyte imbalances as well as dehydration • Pupil dilatation, blurred vision, and twitching eyelids • Headaches, agitation, nausea, and anorexia • Serotonergic axon apoptosis, resulting in thought and memory impairment • Rapid and potentially dangerous heart rhythm activity • Seizure activity, stroke, cardiovascular failure, and coma • Malignant hyperthermia

Human Growth Hormone (HGH)

Pituitary - stimulate growth in children and counteract adult HGH deficiency Increase muscle mass, skin thickness, connective tissue Side effects: Giantism, abnormal bone growth, metabolic and endocrine disorders Goiter Menstrual disorders Decreased sexual desire, impotence Decrease life span by 20 years

Characteristics of Sex Addiction

Porn/adult entertainment industry 100,000 websites /$100 billion per year 72 million visit porn sites monthly with 10% addicted Anonymity of internet feeds into traits of sex addicts Cyber-sexual addiction uses chat rooms and message boards to find partners; no more 900 numbers needed 70% of pornography traffic occurs during work hours 3 to 6% of the population 80% male Starts in teens and peeking in 40's

Skin alcohol

Primarily the result of indirect effects Nutritional deficiencies Hematological and liver disorders; jaundice Aftermath of accidents Rhinophyma (rum nose) - excessive tissue Prophyria cutanea tarda: increased pigmentation and hair growth; thinning of skin Rosacea- flushing inflammation Dilation of blood vessel

Jellinek's types of alcoholism (1941)

Primary or true: immediate liking and rapid uncontrollable progression Steady endogenous symptomatic drinkers: 2nd to psychiatric disorder Intermittent endogenous symptomatic drinkers: binge drinkers Stammtisch drinkers: alcoholism precipitated by outside causes and often started as social drinker

Gastrointestinal System alcohol

Problems due to alcohol's irritant properties on organs and tissues Possible irritation to Esophagus = esophagitis Stomach = gastritis and ulcers Can lead to nausea and vomiting; possibly sufficient to cause tears along GI tract; hemorrhaging, belching, loss of appetite, Periodontal disease Not absorb nutrients resulting in malnutrition and possibly hypoglycemia; or hyperglycemia Acute pancreatitis Chronic pancreatitis Diabetes

Volatile Solvents - Immediate Effects

Prolonged inhalation : Delirium with confusion, clumsiness, emotional instability, impaired thinking, coma Bothinitialandhighdosescan result in: Arrhythmias and myocarditis Pulmonary hypertension, respiratory distress Liver toxicity Blood problems

Food Addiction - Neurochemistry

Research indicates that high sugar foods (includes high fructose corn syrup) change the neurochemistry of appetite Overwhelms the dietary mechanism and reduces the bodies metabolic efficiency Resets the body's natural appetite Increases compulsive overeating (like drug synthesis) Sight, smell, taste of food affects norepinepherine : Endorphins released from orbital-frontal cortex and amygdala, the emotional center, stimulated

Stimulants

Start out as performance boosters increasing alertness, confidence, aggressiveness then tolerance & prolonged use self-defeating Most stimulants banned in competition Amphetamines: Meth, Adderall. Crank Increase strength 3-4 % and endurance 1.5% Tolerance develops Benefit from focusing effect and increased aggressiveness Caffeine: increases endurance slightly IOC limits to 12mg/ML before competition Ephedra (ma huang) Ephedrine (bronchodilator): jitters, hbp, anxiety, strokes and heart attacks lead to its ban by FDA, NFL, IOC, NCAA but not Baseball or Hockey

Anabolic-Androgenic Steroids

Steroids approved for human use in the US, but only by prescription. • Others human use in Europe, or animal use • Abusers use all types to try to improve their performance. • Athletes procure their drugs through gyms, online services, by mail, and of course, from street dealers Anabolic steroids are synthetic versions of the male hormone testosterone. Anabolic : muscle building Androgenic: producing masculine characteristics Stacking and cycling, using 20-200 times rec dose They increase muscle mass, confidence, and aggressiveness. They are effective but taint every athlete accused of using them and many who dont. They are banned by every sports organization AASs can be taken orally, adhesive patch, topical gel, 99% of "roid" users inject "Roid Rage" Compulsive use and addiction $200-400.00 week withdrawal

Other Addictions

The Virtual World via Electronics: Internet Internet Relationship Gaming Cell phone Texting TV The Real World Gambling Sex Pornography Relationship Shopping and Hording Food Self-mutilation

Definitions sex addiction

The high comes from chemicals released in the brain always searching for that feeling. Usually culminating in a sexual event involving orgasm over which no control followed by remorse, guilt, fear of discovery Those who engage in persistent and escalating patterns of sexual behavior acted out despite increasingly negative consequences to self and others. It is not sexual desire or frequency of sexual activity. An addict's compulsive use of sex to address nonsexual, emotional needs. Object can be pursuit of pleasure and/or desire to subdue pain Continuation of the sexual behavior despite significant harmful consequences.. Unusually intense sex drive or obsession with sex. Dominates thinking making it difficult to work or engage in healthy personal relationships. Associated with risk taking behavior.

Unusual Substances

The public will use anything to get high! Gasoline, Kava, Embalming Fluid (formaldehyde) Raid, Hairspray, Lysol Camel Dung Hashish Toad Secretion: bufo genus secretes a psychedelic

DSM V Gambling Disorder (312.31)

Under Non-Substance Related Disorders in Classification: Substance Related and Addictive Disorders Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress Exhibits 4 or more of 9 criteria Behavior not explained by manic episode Specify: Episodic: symptoms may subside for several months between episodes Persistent; meets criteria for multiple years Mild: 4-5; Moderate 6-7; Severe 8-9 criteria met

The effects of alcohol depend mostly on which of the following? type of alcoholic beverage all of the above percentage of body fat versus water amount used

amount used

If a person has only partial recall of events that took place when drinking, they experienced a blackout. a whiteout. anterograde amnesia. a brownout.

a brownout.

Peyote and MDMA are chemically related to adrenaline and amphetamine. endorphins and enkephalins. PCP and ketamine. LSD and psilocybin.

adrenaline and amphetamine.

Sinsemilla is all of the above a growing technique. a potent form of marijuana. a Spanish word that means without seeds.

all of the above

Which of the following drinking patterns increase the risk of becoming an alcoholic for a person under age 65: #1 More than 4 drinks per day for men; #2 More than 3 drinks per day for women; #3. 14 or more drinks per week for men;: #4 7 or more drinks per week for women? none of the above 2 and 4 only all of the above 1 and 3 only

all of the above

A more severe effect of MDMA is severe hypothermia. relentless chills. severe hyperthermia. excessive urination.

severe hyperthermia.

According to the definition of social/recreational use, which of the following is true? established pattern compulsive use sporadic infrequent drug-seeking behavior use for curiosity

sporadic infrequent drug-seeking behavior

Physically, LSD usually causes stimulation. depression. itching under the skin. uncontrolled shaking.

stimulation.

Marijuana can affect HIV/AIDS because it aggravates Kaposi's sarcoma. activates the lymphatic system. suppresses the immune system. increases mucous secretion.

suppresses the immune system.

The U.S. Supreme Court recently determined that the federal government has the right to supercede state laws that permit medical marijuana. medical marijuana may be used only in clinics. the use of marijuana for medical purposes is legal but it may not be sold. each state may govern its own use of medical marijuana.

the federal government has the right to supercede state laws that permit medical marijuana.

Temporal disintegration refers to marijuana's effect on blurring of vision and hearing. the sense of time. the right and left temporal lobes. the sense of location.

the sense of time.

Most alcohol is absorbed in the esophagus. the stomach. the colon. the small intestines.

the small intestines.

Marijuana persists in the body of a chronic user for up to one week. three months. one month. 8 months.

three months.

What is the object of using psychedelics? to overcome low self-esteem all of the above to alter a user's perception of reality to heal physical illnesses

to alter a user's perception of reality

GAMBLING

• • GAMBLING With the advent of Native American casinos, state lotteries, and other state-sponsored gambling, the # of compulsive and problem gamblers has risen from 2% to approximately 6%. Half of all embezzlements are due to gambling. Gambling is a $337 billion dollar industry. US Losses: $80.5 billion Problems as severs as drugs. Gamblers Anonymous defines gambling as "any betting or wagering, for self or others, no matter how slight or insignificant, where the outcome is uncertain or depends on chance or skill." To a compulsive gambler, even an Internet game can be played compulsively US is into slot machines, horse racing, lotteries, keno, blackjack, dog racing, and sports betting-really took off in 1970s Dollars spent only partially recycled in the community; politicians get "off" from raising taxes and receive contributions for campaigns;