Ab Psych Chpt 14

Alcohol Use Disorder (AUD)

"Excessive" use is defined by having 5 or more drinks on one occasion (at least monthly) or >14 drinks per week for men, and 4 drinks on one occasion (at least monthly) or >7 drinks per week in the past 12 months for women. Excessive alcohol use causes 88,000 deaths a year. More than half (52.7%) of Americans ages 12 and up reported current alcohol consumption. Of those, 176.6 million alcohol users, an estimated 17 million have an AUD.

College Drinking Statistics

20% of college students meet the criteria for an AUD. According to a national survey, almost 60% of college students drank alcohol in the past month, almost 2 out of 3 of them engaged in binge drinking during that same timeframe. Death: About 1,825 college students die from alcohol-related unintentional injuries, including motor-vehicle crashes. Assault: About 696,000 college student are assaulted by another student who has been drinking. Sexual Assault: About 97,000 students report experiencing alcohol-related sexual assault or date rape. About 1 in 4 college students report academic consequences from drinking.

E-cigarettes/Vaping

4.5% of Americans currently use. 15% were never-cigarette smokers. More than half the current e-cigarette users (51.2%) were younger than 35 years. E-cigarettes are almost certainly less lethal than conventional cigarettes. Compared to regular cigarettes, e-cigarettes do not produce the tar or the toxic gases found in cigarette smoke. E-cigarettes may renormalize tobacco use. E-cigarettes have been associated with increased risk of conventional cigarette use and transition to use of illicit substances.

Tobacco Use Disorder

According to the CDC, more than 480,000 deaths each year are caused by cigarette smoking. Tobacco use and smoking do damage to nearly every organ in the human body, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other illnesses. In 2014, an estimated 66.9 million Americans aged 12 or older were current users of a tobacco product (25.2%). Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (35%), followed by adults aged 26 or older (25.8%), and by youths aged 12 to 17 (7%).

Cognitive Behavioral Therapy

Anticipating likely problems and enhancing patients' self-control by helping them develop effective coping strategies. Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations.

Adverse effects of tobacco

Cancer CAD COPD Emphysema Premature all-cause mortality Children of smokers have are more likely to have respiratory illness and SIDS. Secondhand smoking is associated with Decreased pulmonary function Increased risk for lung cancer Increased mortality rates from CAD Smokeless tobacco increases risk of mouth, cheek, and tongue, cancers by 50x

Behavioral Therapies for Substance Use Disorders

Cognitive Behavioral Therapy Contingency Management Interventions/Motivational Incentives The Matrix Model

Heroin

Heroin is an opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Most commonly injected, sniffed, snorted, or smoked heroin. Nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids first.

Schedule 2 drugs

High potential for abuse and have medical use with severe restrictions oxyContin cocaine Ritalin methadone Adderall fentanyl vicodin

Schedule 1 drugs

Highest potential for abuse, no therapeutic use, (Heroine marijuana LSD)

Opioid Use Disorder

Opioids: Codeine, Fentanyl, Vicodin, Demerol, OxyContin, Methadone Opioids reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation, and can depress respiration. In 2014, an estimated 1.9 million people had an opioid use disorder related to prescription pain relievers and an estimated 586,000 had an opioid use disorder related to heroin use. Overdoses with opioids led to almost 17,000 deaths in 2011. Since 1999, opiate overdose deaths have increased 265% among men and 400% among women. Withdrawal symptoms can include negative mood, nausea or vomiting, muscle aches, diarrhea, fever, and insomnia.

Caffeine Use Disorder

Regular use reported by 90% of adults Repeated use can result in a strong desire to drink caffeine, difficulties in controlling use, and sometimes a physical withdrawal state. May result in dependence, withdrawal if use is ceased, and physical symptoms such as nervousness, insomnia, gastrointestinal upset, tachycardia, incontinence, and muscle twitches.

Stimulant Use Disorder

Stimulants: Vyvanse, Adderall, Ritalin, Concerta, Ecstasy, Cocaine Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. An estimated 913,000 people ages 12 and older have a stimulant use disorder because of cocaine use, and an estimated 476,000 people have a stimulant use disorder as a result of using amphetamines.

Substance Use Disorder Characteristics

Using larger amounts or for longer time than intended. Persistent desire or unsuccessful attempts to cut down or control use. Great deal of time obtaining, using, or recovering. Craving Fail to fulfill major roles (work, school, home). Persistent social or interpersonal problems caused by substance use. Important social, occupational, recreational activities given up or reduced. Use in physically hazardous situations. Use despite physical or psychological problems caused by use. Pharmacological Criteria Tolerance, Withdrawal Severity of substance use disorders: mild, moderate, or severe.

Cocaine

a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Euphoria, energy, talkativeness,

CBT/Relapse Prevention

high risk situation; increased self-esteem & increased sense of self efficacy; reduced relapse rate

aversion therapy

induce an unpleasant reaction in an attempt to discourage cravings. Alcohol: Disulfiram, Naltrexone

Replacement Therapy

legal substances are used to replace more harmful substances. Opioids: Methadone, Marijuana

Substance Use Disorder

occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home

Methadone, Suboxone

opiate drugs that reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the "high" associated with the drug addiction

Transtheoretical Model

precontemplation, contemplation, preparation, action, maintenance, relapse

Naltrexone

reverse an opiate overdose when used intravenously, but when taken orally, it may reduce the craving for alcohol.

SIDS (sudden infant death syndrome)

the sudden and unexplained death of an infant less than one year old

Substance Use Disorder symptoms

-Psychological dependence is a form of dependence that involves emotional-motivational withdrawl symptoms (e.g., state of unease or dissatisfaction, reduced capacity to experience pleasure, or anxiety) upon cessation of drug use or engagement in certain behaviors -Involves a desire to use a drug or perform a behavior to avoid the unpleasant withdrawal syndrome that results from cessation of exposure to it

Outcomes of Behavioral Treatments

A meta-analysis reviewing the efficacy of Relapse Prevention across 26 studies examining alcohol and drug use disorders found a relatively small effect (r=.14) for RP actually reducing substance use but a large effect (r=.48) for improvement in overall psychosocial adjustment. A meta-analytic review of CBT for drug dependence including 34 randomized controlled trials found an overall effect size in the moderate range (d = 0.45) Larger treatment effect sizes were found for treatment of cannabis, followed by treatments for cocaine, opioids, and, poly-substance dependence. Of individual treatment types, there was some evidence for greater effect sizes for contingency management approaches relative to relapse prevention or other cognitive behavioral treatments.

Hookah

Hookah is an instrument used to smoke tobacco in which the smoke is cooled and filtered by passing through water 1 Hour of Hookah... is equal to smoking 40- 400 cigarettes 70% more nicotine than ONE cigarette -36x more tar -15x more carbon monoxide -70%more nicotine than ONE cigarette

Marijuana and increased risk of heart attack

Marijuana also raises heart rate by 20-100 percent shortly after smoking. It is estimated that marijuana users have a 4.8 times increase in the risk of heart attack in the first hour after smoking. This risk may be greater in older individuals or in those with cardiac vulnerabilities.

Marijuana Use Disorder

Marijuana is the most-used substance after alcohol and tobacco. In 2014, about 22.2 million people ages 12 and up reported using marijuana during the past month. The average age when one starts using is approximately 18.5. In the past year, 4.2 million people ages 12 and up met criteria for a substance use disorder based on marijuana use.

Marijuana

Marijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant Cannabis sativa, which contains the psychoactive (mind-altering) chemical delta-9-tetrahydrocannabinol (THC), and cannabidiol (CBD)

Marijuana effects

Marijuana smoke is an irritant to the lungs, and frequent marijuana smokers can have many of the same respiratory problems experienced by tobacco smokers, such as daily cough and phlegm production, more frequent acute chest illness, and a heightened risk of lung infections. One study found that people who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than those who don't smoke marijuana, mainly because of respiratory illnesses. It is not yet known whether marijuana smoking contributes to risk for lung cancer.

Effects of Marijuana

Marijuana's immediate effects include distorted perception, difficulty with thinking and problem solving, and loss of motor coordination. Withdrawal symptoms include inability to sleep, anxiety, depression, headaches, and cravings within a week of ceasing heavy use. Long-term use can contribute to respiratory dysfunction, impaired memory, and exposure to cancer-causing compounds. Heavy marijuana use in youth has also been linked to increased risk of developing mental illness and poorer cognitive functioning.

Cocaine symptoms

Most seriously, people who use can suffer heart attacks or strokes, sudden death. related deaths are often a result of cardiac arrest followed by an arrest of breathing. Also loss of sense of smell, nosebleeds,

What are the biggest challenges today?

Of the 21.5 million total people that reported criteria for substance use disorders, 7.6% of them received treatment. Of those who enter into a rehabilitation program, estimates suggest that nearly 50-90% of users will relapse after treatment. Though a larger number of alcohol abusers do not enter rehabilitative treatment, approximately 1.2 million people in the United States will enter a treatment program for their condition

SUD symptoms

Symptoms of stimulant use disorders include craving for stimulants, failure to control use when attempted, use of larger amounts over time, development of tolerance, and spending a great deal of time to obtain and use stimulants Withdrawal symptoms that occur after stopping or reducing use, including fatigue, vivid and unpleasant dreams, sleep problems, increased appetite, or irregular problems in controlling movement.

Contingency Management Interventions/Motivational Incentives

Tangible rewards to reinforce positive behaviors. In Voucher Based Reinforcement (VBR), the patient receives a voucher for every drug-free urine sample provided. The voucher has monetary value that can be exchanged for food items, movie passes, or other goods. Prize Incentives: chances to win cash prizes instead of vouchers. Participants supplying drug-negative urine or breath tests get entered into a raffle to win a prize.