Chapter 12- Substance-Related and Addictive Disorders
stimulants
cocaine, amphetamines, caffeine, nicotine- associated with positive feelings, bursts of energy, and alertness.
alcohol-related disorders
in the U.S about 12.5% of males and 5% of females would meet criteria for alcohol use disorder. -lifetime prevalence is estimated to be 42% for males and 20% for females. almost half of all US males. -alcohol intake includes pleasant subjective experiences which are related to the effects of alcohol on neurotransmitters as serotonin, endorphins, and dopamine; alcohol will decrease inhibition by reducing effects of the GABA system, which is associated with anxiety. however, if the amount of alcohol intake is increased, it will increase the effects of GABA, which can lead to sedation. this is why it is listed as a depressant. 6.2% of all male deaths are related to alcohol compared with 1.1% for females. twin studies suggest that 40-60% of the variance in dependence can be accounted by genetics.
what percentage of people in the US used illicit drugs in the past month?
no past month illicit drug use- 238.1 million people past month drug use- 27 million people (10.2%)
naturally occurring substances
marijuana, hallucinogens, and opioids are naturally occurring substances.
moderate, heavy and binge drinking
moderate drinking is define by the NIAAA as no more than 4 drinks in a single day, and no more than 14 drinks a week for a man. binge drinking: consuming enough alcohol in a 2-hour period to have a BAC of 0.08g/dL 0.08 is the legal definition of being intoxicated. BAC: 0.01-0.06- relaxation sense of well-being loss of inhibition lowered alertness joyous. -impairments: thought judgement coordination concentration 0.06-0.10- blunted feelings disinhibition extraversion impaired sexual pleasure. -impairments: reflexes impaired reasoning depth perception distance acuity peripheral vision glare recovery. 0.11-0.20- over expression emotional swings angry or sad boisterous -impairments: reaction time gross motor control staggering slurred speech 0.21-0.29- stupor lose understanding impaired sensations -impairments: severe motor impairment loss of consciousness memory blackout 0.30-0.39- sever depression unconsciousness death possible. -bladder function, breathing heart rate >0.40- unconsciousness death -breathing heart rate almost 2/3 of all Americans over 18 have had at least one drink in the past year. -around 40% of men and 20% of women have at least one drink a week. -23% of population participated in binge drinking in the last 30 days. highest in college populations.
can drugs change your brain?
the rewarding effect of drugs is based on their ability to increase dopamine. one important pathway related to addiction is the mesolimbic dopamine system. this system begins with the ventral tegmental area (VTA) which is located near the base of the brain and ending in the prefrontal cortex. -these pathways connect with the nucleus accumbens, prefrontal cortex (PFC), dorsal striatum, and amygdala.
principles of effective treatment
1. addiction is a complex but treatable disease that affects brain function and behavior 2. no single treatment is appropriate for everyone 3. treatment needs to be readily available 4. effective treatment attends to multiple needs of the individual, not just his or her drug abuse 5. remaining in treatment for an adequate period of time is critical 6. behavioral therapies-including individual, family or group counseling are the most commonly used forms of drug abuse treatment 7. medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. 8.an individuals treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs 9.. many drug-addicted individuals also have other mental disorders 10.medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long term drug abuse 11. treatment does not need to be voluntary to be effective 12. drug use during treatment must be monitored continuously as lapses during treatment do occur 13. treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other diseases.
medications to treat addiction
1. agonist drug- a substance that binds to the receptor in the brain and produces cellular activity that mimics the function of the illicit drug without producing the high -methadone is an opioid agonist. used for heroin. 2. antagonist drug- blocks the receptor site in the brain so that the illicit drug does not produce an effect; by blocking or counteracting the effects of the illicit drug, it no longer is experienced as rewarding and addictive -naltrexone- used for opioid addiction and alcohol -varenicline (chantix)- for tobacco use. 3. aversive drug: becomes aversive when the drug of abuse is taken -disulfiram (Antabuse)- interferes with metabolism of alcohol and produces unpleasant reactions
treatment substance-related disorders
1. psychological approaches: include CBT, motivational interviewing, and family or couple approaches. 2. psychopharmacological agents
Drug Use in the US
1970's and 1980s- society's view on drugs change with the "crisis on addiction". President Richard Nixon began its "war on drugs" -over 51% of Americans are 18 or older regularly use alcohol, while 18% use tobacco. -for those under the legal drinking age of 21, some 22.8% report drinking alcohol and 4.9% report tobacco use. -in 2014, approximately 27 million Americans age 12 or older used an illicit drug in the past month. -illicit drugs include marijuana, cocaine (crack), heroin, hallucinogens, inhalants, and prescription-type psychoteherapeautics. -marijuana is the most commonly used illicit drug- 22.2 million people or 8.4% of the US population. -the use of cocaine and amphetamines has decreased since the 1980s. marijuana has shown a recent increase. college-age individuals (18-20 years old) show the highest % of illicit drug use. -overall, drugs are used more by males than females throughout the world.
genetic, environmental and evolutionary influences
40-60% of vulnerability to addiction can be attributed to genetic factors. genetic contribution to addiction is 50%. environmental factors: stress and low socioeconomic level are associated with greater drug use. in adolescents, peer pressure can play an important role
controlled drinking approaches
based on the idea that a person can learn to use alcohol in moderation in contrast to AA approach which suggests total abstinence.
12-step program
a community in which individuals with addiction problems meet and follow the principles described in the 12 steps; forms the basis for Alcoholics Anonymous (AA). -establoshed in the 1930s by William Wilson and Robert Holbrook Smith. -more than 114,000 groups worldwide. 65% of members are men, 35% women with an average of 49 years. 12 steps: 1. we admitted we were powerless over alcohol-our lives and become unmanagable 2. came to belief that a power greater than ourselves could restore us to sanity 3. made a deacon to turn our will and our lives over to the care of God as we understood Him. 4.made a searching and fearless moral inventory of ourselves 5. admitted to God, ourselves and to another human the nature of our wrongs 6. were ready to have God remove all these defects of character 7.humbly ask Him to remove our shortcomings 8. made a list of all persons we harmed and became willing to make amends to them all 9. made direct amends to such people wherever possible, except when to do so we would injure them or others 10. continued to take personal inventory and when we were wrong admitted it 11. sought through prayer and mediation to improve our conscious contact with God, praying only for knowledge of his will for us and power to carry it out 12. having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
cannabis
a plant species also referred to as marijuana; the resin is referred as hashish; the main psychoactive ingredient in cannabis is THC -4% of the population of the world uses cannabis and the US is one of the larger users. has been used worldwide for at least 4,000 years for its psychoactive effects. it came to the US during the 1900s. during the 1960s, it became a recreational drug of choice for many people in the US. small doses- produce enjoyable positive feelings associated with being high. states in which time stands still. person may see his or her own ideas as exceptionally creative and important. can influence appetite increasing hunger or the munchies. -larger doses: can produce negative feelings such as anxiety and paranoia. hallucinations and persecutory delusions have been reported. THC affects receptors in the hippocampus, the cerebellum, the basal ganglia, and the neocortex. affects receptors that release GABA, an inhibitory neurotransmitter related to anxiety. continued use of cannabis by those with a recent onset of psychosis was associated with earlier relapse of the psychotic symptoms, more frequent hospitalization, and poorer social functioning. -direct relationship between cannabis and symptoms of hallucinogens and delusions. heavy cannabis use increases risk of psychotic symptoms and schizophrenia. -genetic factors may play a role in those individuals who use cannabis and go on to develop psychosis. associated with earlier age of onset of psychotic disorders.
caffeine
a stimulant found naturally in different amounts in the leaves and seeds of various plants including coffee beans, tea leaves and cocoa beans. -works through the CNS and increases resting energy expenditure within 30 min of ingestion. its effects will last about 4 hours. increases serotonin concentration in the region of the brain stem. increases alertness, ability to concentrate, problem solving, wakefulness and the feeling of energy and elevates mood. 85% of children and adults in the US consume caffeine daily. headaches are reported in about 10% of regular users who have not used caffeine for the past 24 hours. -people may experience stomach problems, trouble sleeping, anxiety, irritability, and nervousness from increased caffeine intake.
substance abuse, dependence, and addiction
addiction- dependence on a substance or process in which an individual experiences a strong motivation that results in an active wanting and seeking of the substance, which may be experienced as compulsive dependence- a way to describe addiction to a substance; three major components are 1)the desire to seek and take a certain substance, 2) the inability to avoid or limit the intake of the substance, and 3) the experience of negative emotional states when the substance is not available. -21.5 million individuals in 2014 could be considered substance dependent or abusing.
cocaine
comes from the naturally occurring coca plant, which is grown in South America. -it was used to make Coca-Cola around 1900. -its psychoactive effects include a mental alertness, heightening sensory experiences, and increased heart rate and blood pressure. -the form of Cocaine that is smoked is crack. refers to the sound made when the white cocaine crystals are heated to turn into a form that is smoked. -taking it through the nose results in a slower high that shows effects in 4-6 minutes. -cocaine has a shorter effect than other drugs. lasts 15-40 min. -in 2014, there was 1.5 million current cocaine users. that is about one half of 1% of the population. dopamine is normally released at the terminals and then removed from the receptors by reuptake. cocaine interferes with this process, resulting in an increase in dopamine. -nucleus accumbens and parts of PFC are involved.
pattern of addiction
craving: a step in the addiction pattern in which the individual loses control of the ability to limit intake of the drug. for example: even when the blood alcohol of a person with an alcohol addiction is high, he or she still drinks more. addiction cycle: 1. craving- drug expectation and attention bias 2. intoxication- impaired self-awareness 3. bingeing- loss of control 4. withdrawal- amotivation and anhedonia
opioids
derived from the opium poppy plant that have been used for thousands of years to control pain and bring on euphoric feelings. found at Neanderthal burial sites from 30,000 years ago. heroin, opium, morphine, methadone, and oxycodone. opioids became popular in the US after the Civil War for their ability to control pain. however, some people became addicted to them. the opium den is where people gathered to smoke this drug. with the hypodermic needle, it was injected into the bloodstream. endorphins are produced at times of stress and allow individuals to continue in combat or at a sports activity even when hurt.
CBT
designed to help person understand his or her thoughts toward substance abuse and create means to cope.
hallucinogens
drugs that alter perceptional experiences. mescaline, LSD, and ecstasy are able to alter perception, mood, and cognitive processes in unpredictable ways; also called psychedelics 1. somatic symptoms: dizziness, weakness, tremors, nausea, drowsiness, parenthesis (numbness or tingling) and blurred vision 2. perceptual symptoms: watered shapes and colors, difficulty in focusing on objects, sharpened sense of hearing, and synesthesias 3. psychic symptoms: alterations in mood, tension, distorted time sense, difficulty in expressing thoughts, depersonalization, dreamlike feelings, and visual hallucinations hallucinogens do not produce dependence and are relatively safe. do not show withdrawal symptoms. they do not directly affect dopamine. but a bad trip can include extreme anxiety and fearful psychotic like experiences the chemical makeup of hallucinogens is similar to the neurotransmitter serotonin. Albert Hoffmann discovered LSD in 1943. has been shown to be the most potent of all hallucinogens with effects that can last up to 12 hours. mescaline is the least potent.comes from the peyote cactus in the Western Hemisphere. certain Native American tribes used it in religious ceremonies. produces vivid mental images and an altered sense of time and space with a loss of a sense of reality. psilocybin comes from a type of fungus often referred to as magic mushrooms. affects the central nervous system through the functioning of serotonin to which it is chemically similar. identified by Sandoz Pharmaceuticals. Psilocybin produces heightened sensory experiences and perceptual distortions. it induces milder negative experiences compared to LSD such as anxiety and panic reaction.
motivational interviewing
focuses on the client's own goals and motivations as a way to change addictive behaviors. similar to client-centered approach of Carl Rogers.
substance disorders in DSM-5 and ICD-10
intoxication: the effects of the psychoactive substance on the individual; effects are substance-related but typically involve impairment to psychological processes and behavioral abilities. -alcohol intoxication: soured speech, problems with attention and memory, inability to make coordinated motor movements, passing out. -marijuana: increased appetite, a different experience of time, a withdrawal into inner experience, a cognitive and emotional overvaluation of ideas, and anxiety. withdrawal: the symptoms experienced when a psychoactive substance is used less or no longer used -alcohol: tremors, problems with sleep, nausea or vomiting, anxiety, and autonomic nervous system overactivity such as sweating or fast heart rate. an extreme form of alcohol withdrawal is delirium tremens (DTs). disordered use: the condition in which a person experiences signifiant impairment or distress from use of a psychoactive substance.
gambling
lottery tickets, legal gambling in Las Vegas and many other places in US. poker tournaments on TV, online poker, internet etc. 78.4% of national survey gambled at least once in lifetime. pathological gambling- a disorder in which gambling continues even despite negative consequences such as consistent losses and an inability to control one's gambling behavior. -lifetime prevalence of 2.3% and a 12-month prevalence of less than 1% (0.3%) -show highest comorbidity for other substance use disorders substance tolerance- individuals with both gambling and substance abuse disorder develop tolerance and must consume more fo the drug to have the same effect. -withdrawal effects 4 cognitive-emotional processes in pathological gambling: 1. behavioral conditioning 2. experience of cues, which bring forth urges to gamble 3. impulsivity 4. impaired executive functioning in pathological gamblers
amphetamines
stimulants that result in positive feelings, a burst of energy, and alertness. -first developed in a lab in the 1880s. it was introduced as medicine in 1930s. introduced as Benzedrine, pills. -during 1930s and 40s amphetamines were prescribes by health professionals for more than 30 diseases including epilepsy, Parkinson's disease, schizophrenia, migraines, and behavioral problems in children. -during WWII, they were given to soldiers as pep pills to give them an edge in combat. common ones were Benzedrine, Dexedrine, and Methedrine, methamphetamine. amphetamine-type drugs are the second most widely used drug throughout the world, the first is cannabis. -they affect the dopamine system to produce euphoric experience. there are less positive long-term effects. -Brian changes in the development of compulsive patterns of use, produces negative brain changes consistent with brain injury, methamphetamine produces changes in the individual's cognitive functioning. problems with methamphetmaine: -motor activities such as skill movements or perceptual speed -problems in the ability to shift attention. -memory attention and decision making problems -physical appearance Methamphetmaine is known as speed, crystal meth or crank. methcathinone is known as cat.
tobacco and nicotine
tobacco- a plant that originated in the Americas with native populations smoking or chewing its leaves after Columbus's voyages to the New World beginning in 1492, tobacco was carried home and began to spread throughout Europe. in the 50's, tobacco was associated with cancer. today tobacco is the leading cause of preventable disease and death in the US. -19% of adults 25 years of age and older in the US were cigarette smokers. the majority of tobacco use is in less developed countries. nicotine- the addictive substance in tobacco; it is a stimulant substance found in plants of the nightshade family; it can have varied effects on the body, which makes it function as both a stimulant and depressant. -nicotine influences dopamine neurons in the midbrain. -nicotine can alter the inhibitory effects of GABA and enhance the learning of external cues with tobacco use and experience. nicotine effects: -decreases in appetite -boosts mood and may even relieve minor depression; many people will feel a sense of well-being -raises the level of blood sugar (glucose) and increases insulin production -increases bowel activity, saliva, and phlegm -increases heart rate by around 10-20 beats per minute -increases blood pressure by 5-10 mmHG -may cause sweating, nausea, and diarrhea -stimulates memory and alertness withdrawal symptoms: -intense craving for nicotine -anxiety, tension, restlessness, frustration, or impatience -difficulty concentrating -drowsiness or trouble sleeping- bad dreams -headaches -increased appetite and weight gain -irritability or depression
