chapter 10

physiological effects of Marijuana

- THC is detected b cannabinoid receptors located throughout the brain - the largest concentrations of these receptors are in the basal ganglia, cerebellum, hippocampus, and cortex - when THC is detected by these receptors, it causes a reduction in the cell's metabolic activity and the activity of neurotransmitters - the specific effects of THC depend on where it is detected (for example, THC detected by the basal ganglia effects movement and coordination, whereas THC detected by receptors in the cortex affects thinking, judgment, and problem solving - respiratory problems, circulatory problems, and cancer - suppress immune functioning - impair people's sensory and motor functioning, increasing their likelihood of injury

According to DSM-5, a Substance Use Disorder is

- a maladaptive pattern of substance use leading to clinically significant impairment or distress -including children and adolescents, show at least two of 11 possible symptoms within a 12 month period - the symptoms can be organized into four clusters i. impaired control ii. social impairment iii. risky use iv. pharmacological criteria

acute tolerance

- adolescents can experience it during a single drinking episode - people experience the greatest effects of alcohol after only a few drinks, with diminishing effects after each successive drink - many adolescents often try to "chase the high" by continuing their alcohol use after reaching this period of diminishing returns.

dual diagnoses

- adolescents who have both a Substance Use Disorder and a psychiatric diagnosis - they show more school-related difficulties, greater family conflict, more emotional distress, and more legal problems - they also show poorer prognoses - they are more likely to have substance use problems during adulthood, experience long-term psychiatric illness, and develop personality disorders.

Binge drinking

- excessive alcohol us can result - can cause fatigue, dizziness, nausea, and blackout - physiologically, may also produce severe impairment in judgment and problem solving -is associated with disturbances in balance and coordination, slurred speech, restlessness and irritablity, and problems with heart rate and repiration

amotivational syndrome

- many chronic marijuana users show decreased motivation and goal-directed behavior

Substance-Induced Mental Disorder

- occurs when someone develops a mental disorder that is caused by the use or withdrawal of a substance -any of the classes of substances can induce a mental disorder - two classes of disorders are most common: depressants (alcohol, sedatives, hynotice, sometimes elicit depressive disorders after prolonged use, and anxiety disorders and insomnia upon withdrawal); stimulants (amphetamine and cocaine, sometimes elicit psychotic disorders after their use and depresive disorders upon withdrawal

marijuana use and schizophrenia

- repeated marijuana use may increase the likelihood of psychotic symptoms, especially among those adolescents who have a genetic predisposition toward Schizophrenia

primary prevention programs - media campaigns

- two national media campaigns have also targeted alcohol and other drug use among children and adolescents and began in 1987, the partnership for a Drug Free America (PDFA) produced television ads designed to provide substance abuse education to youths and their parents - in the late 1990s, a second media campaign was conducted by the White House Office of National Drug Control Policy. -this campaign resembled the PDFA campaign and consisted largely of television ads directed toward parents and children -the ads were designed to 1)increase parent-child communication about alcohol and other drugs, 2)increase parental monitoring of children's peer groups and after-school activities, 3)decrease children's positive beliefs and expectations about substance use, and 4)decrease youths' actual use of alcohol and other drugs - an evaluation of the campaign demonstrated that the program reached a large number of families. it also increased parent-child communication about substance use. however, the campaign was largely unable to increase parental monitoring or decrease children's subsequent substance use - in fact, exposure to the media campaign was actually associated with an increase in children's intentions to use marijuana. it is possible that youths who were told to abstain from certain drugs, like marijuana, strongly resented these prohibitions. to exert their autonomy, they may have decided to use the drug.

Substance Withdrawal

- withdrawal symptoms are always problematic, causing distress or impairment in academic, occupational, or social functioning

Substance Intoxication

-if intoxication causes distress or impairment, the person can be diagnosed with Substance Intoxication - symptoms differ based on the drug consumed

Stimulants

-include medication and drugs that typically enhance dopaminergic activity in the central nervous system -they include medications used to treat ADHD, such as amphetamine and methylphenidate, as well as illegal drugs, such as cocaine - have immediate effects on the central nervous system, producing extreme euphoria, energy and sociability -however, they can also produce anxiety, agitation, and anger; racing heart; shallow breathing; and cognitive problems

substance

alcohol, drugs, medications

pharmacodynamic tolerance

chronic alcohol use is associated with. over sustained periods of time, the sensitivity of the neuroreceptors that respond to alcohol gradually decreases - for example, long term alcohol use is associated with decreased sensitivity of GABA and dopamine receptors - individuals who drink frequently may not exhibit the same sedating effects of alcohol due to this decrease in sensitivity to GABA - frequent drinkers may also require more alcohol to achieve a state of euphoria due to decreased dopamine activity - decrease receptor sensitivity is believed to be a homeostatic mechanism, that is , a way for the body to compensate for the individual's history of excessive alcohol use.

Sedatives, Hypnotics, and Anxiolytics

include nearly all medications used to treat anxiety and insomnia (benzodiazepines, barbiturates) -tend to augment GABA, the brain's primary inhibitory neurotransmitter -their immediate effect is drowsiness and anxiety reduction -tolerance can develop quickly -withdrawal symptoms include autonomic hyperactivity (sweating, rapid pulse), hand tremor, insomnia, agitation and anxiety

Hallucinogens

include substances, such as lysergic acid diethylamide (LSD), psilocybin ("mushrooms") and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) -bind to serotonin receptors and stimulate the locus coeruleus, and area of the brain that regulates many other regions cause unusual perceptions and thought, distortions in sense of time, disorientation, and anxiety reduction -elicit anxiety, depression, paranoia, and impaired judgement and decision making

alcohol

is a depressant that enhances GABA, the brain's primary inhibitory neurotransmitter -also blocks glutamate, a major excitatory neurotransmitter. -it produces a biphasic effect on the nervous system, resulting in euphoria and sociability in low doses and slurred speech, coordination problems, and cognitive impairment in higher doses

cannabis

is a naturally occuring drug that contains delta-9-tetrahydrocannabinol (THC) -when ingested, it affects a wide range of neurotransmetters and rain areas. -it effects including euphoria, anxiety reduation, unusual perceptions and thoughts, slowed reaction time, increased appetite, and low motivation for goal-directed activiiy

substance use disorder

when people show a problematic pattern of alcohol or other drug use that interferes with their daily functioning or causes significant psychological symptoms

How does the dopaminergic mesolimbic pathway operate?

- alcohol stimulates dopaminergic neurons in the VTA - the VTA, in turn, increases dopamine levels in a nearby brain area, the nucleus accumbens, producing subjective feelings of euphoria, pleasure, and emotional well-being - these pleasant effects constitute the fist phase of the "biphasic" response to alcohol, and they are the primary reason most people, especially adoescents, drink.

Secondary Prevention Programs

- are designed for youths at risk for developing substance use problems - most are ecologically based; they target at-risk youths in certain areas or neighborhoods -programs are usually designed for middle-school students whoa re about to transition form childhood to early adolescence -ecologically based prevention programs target multiple risk factors simultaneously: 1. information is provided to adolescents about substance use and misuse. adolescents are also taught techniques to avoid substance use with peers 2. parents are taught about adolescent substance use problems and steps that they can take to decrease the likelihood that their adolescents will use alcohol and other drugs 3. ecologically based programs address the child's larger social system: school, peers, and the community. some programs offer after-school activities to promote abstinence to entire peer groups -other programs work with community officials and police to limit adolescents' access to alcohol and other drugs

delta-9-tetrahydrocannabinol (THC)

- is known to affect a wide range of neurotransmitters, including norepinephrine, dopamine, glutamate, GABA, and serotonin - the multiple brain areas and neurotransmitters affted by THC likely account for the diverse effects of the substance on people s behavior

marijuana

- is the most commonly used illegal drug -contains dozens of compounds known to affect brain chemistry. These compounds fall into a certain class called cannabinoids - the most powerful cannabinoid is delta-9-tetrahydrocannabinol (THC)

psychological effects of Marijuana

- moderate doses of marijuana usually produce mild intoxication - within seconds of use, people often feel lightheaded and dizzy - some people report tingling sensations in their limbs - after a few minutes, most people experience feelings of euphoria, disinhibition, and increased energy and sociability -continued use (10-30 minutes) produces reductions in anxiety, a general sense of relaxation, and a state of emotional well-being or contentment -cognitive and motor processes are usually slowed (they may show slowed movements, speech, or problem-solving ability) - slowed cognitive and motor responses can interfere with people's abilities to perform complex mental activities (complete homework) and motor activities (drive a car) - effects typically last a few hours - larger doses of marijuana can cause paradoxical effects: increased anxiety and agitation, perceptual distortions or visual hallucinations, and parnoia

Limitations of inpatient treatment

- most inpatient programs incorporate twelve-step philosophies into their treatment package - twelve-step programs include Alcoholics Anonymous,:s (NA) - proponents of these programs conceptualize alcohol and other drug use as a disease - from this perspective, substance use disorders are medical conditions that develop because of genetics, are maintained because of biology and "brain chemistry," and deleteriously affect the person's social, emotional, and spiritual life. - proponents of twelve-step programs argue that individuals must first acknowledge that they have the disease and that they are powerless to overcome its effects -twelve-step programs have demonstrated efficacy among adults with substance use problems. - however, less information is available regarding the efficacy of twelve-step treatment for adolescents - the programs that are administered as part of inpatient treatment tend to be highly effective, probably because adolescents are living in controlled environments with limited opportunities for substance use -some participants are able to maintain treatment gains 6 to 12 months after program completion, however, adolescents released from these inpatient programs have high rates of relapse. approximately 60% relapse within 3 months of discharge and as many as 80% relapse within one year

Pharmacological Criteria: withdrawal

- occurs when the person a. experiences negative physiological symptoms when they stop or reduce substance use b. takes a different substance to avoid these negative symptoms -adolescents who frequently use marijuana for many years may develop withdrawal symptoms if they discontinue use. symptoms might include increased anxiety, agitation, irritability, and concentration problems.

multidimensional family therapy

- one type of family therapy that has been used for adolescents with substance use problems -targets four dimensions of family functioning that are relevant to the adolescent's well-being: 1. the adolescent's substance use 2. the caregiving practices of the adolescent's parents 3. the quality of the parent-adolescent relatiolnship 4. other social factors that can influence the adolescent's substance use, such as his peer relationships or involvement in school

inpatient treatment and twelve-step programs

- some adolescents with serious substance use disorders participate in 28-day inpatient treatment programs -although inpatient treatment programs vary, most have three goals: 1. to attend to the adolescents' immediate medical needs and to detoxify her body 2. to help the adolescent recognize the harmful effects of the substance on her health and functioning 3. to improve the quality of the adolescent's relationships with others -to accomplish these goals, nearly all inpatient programs require adolescents to abstain from alcohol and other drug use during treatment - inpatient programs typically provide individual and group therapy to adolescents - staff members also offer family therapy sessions designed to improve parent-adolescent communication and problem solving -before the end of treatment, staff members help the adolescent and family members prepare for a return to school and home - most inpatient programs incorporate twelve-step programs include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)

Inhalants

- such as gasoline, glue, paint thinners, spray paints, and household cleaners -when ingested, ingredients in these substances produce a wide range of effects on the brain and central nervous system - effects include euphoria, anxiety reduction, and passivity -can also produce disorientation, slurred speech, slow reaction time, poor judgement, and death

harm reduction approach

- the primary goal of therapy is to help adolescents identify and avoid alcohol use that has great potential for harm

Monitoring the Future (MTF)

- to estimate prevalence, scientists at the University of Michigan Institute for Social Research have annually assessed adolescent substance use in a project - these researchers collect data regarding adolescents' attitudes and overt behavior regarding substance use - in recent years, approximately 50,000 youths in eighth, tenth, and twelfth grades have completed anonymous surveys - their data allow us to determine normative substance use throughout adolescence and see trends in adolescents' substance use over the past 30 years -marijuana use is also fairly widespread, especially among older adolsecents (approximately 45% of high school seniors have tried marijuana; almost 18% have used it within the past month) - marijuana use is less common among younger adolescents. only about 15% of eighth-grade students report having tried the drug - in general, substance use has decreased over the past decade. the greatest reductions in substance use have been for drugs like marijuana, LSD, methamphetamine, and ecstasy - in contrast, occasional alcohol use among adolescents has remained fairly steady over the years - use of other drugs, especially prescription medications, seems to be on the rise among adolescents ***- data from MTF indicate that alcohol use during adolescence is developmentally normative. furthermore, marijuana use by older adolescents is fairly common, with almost half of twelfth-grade students admitting to trying marijuana

family therapies

- view adolescent substance use as a family problem - helping the adolescent manage anger could enhance her relationship with parents and decrease her likelihood of seeking support from deviant peers - one objective is to help parents manager their adolescent's substance use -the second objective of family therapy is to improve the quality of family functioning

Alcohol vs. Marijuana use among adolescents

-Alcohol is the drug most widely used by adolescents and is often overlooked as a possible drug of abuse because of its widespread availability in the United States as well as is legal in nearly all parts of the country, and it is heavily advertised on television and in magazines.Many adolescents and parents regard alcohol consumption as part of adolescent culture. Most adolescents drink alcohol at least occasionally at some point during their high school years. - Marijuana is the most commonly used illegal drug and contains dozens of compounds known to affect brain chemistry

Primary Prevention Programs - D.A.R.E.

-Drug Abuse Resistance Education (DARE), is the best known school-based program designed to prevent substance use problems and originated in Los Angeles in 1983 - it was originally intended to increase contact between police and school-age children -the program consisted of weekly visits by uniformed police officers to fifth- and sixth-grade classrooms. -officers discussed the dangers of substance use, ways to avoid peer pressure to use alcohol and other drugs, and techniques to promote abstinence. -DARE does not appear to be effective in reducing alcohol and other drug use -produced increases in children's knowledge of substance use problems but did not cause changes in children's substance use - although DARE is not effective in preventing alcohol use, nearly 80% of public schools in the United States continue to offer the program -three reasons for continuing to use DARE: 1. many leaders claimed that they never expected DARE to prevent substance use problems in the first place; 2. many supporters acknowledged that DARE might not be effective in reducing substance use, but it might be beneficial in other ways. (ex. DARE might improve relationships between school-age children and the police); 3. some school and community leaders dismissed the research finding altogether. they claimed that, based on personal experience, DARE was highly effective at reducing substance use problems in their community

DSM-5's developmentally insensitive criteria

-The symptoms most commonly seen among adolescents who misuse or abuse alcohol and other drugs are absent from the DSM-5 criteria -ex. two of the most frequently occurring signs of alcohol use problems among adolescents are low grades and truancy. However, neither sign is included in the current diagnostic criteria. Consequently, some researchers have developed more developmentally appropriate criteria for adolescent substance use problems. These criteria inclyde a) breaking curfew, b) lying to parents, c) showing a reduction in grades, and d)engaging in truancy

associated disorders

-approximately 50% of adolescents int eh community with Substance Use Disorders show at least one other mental disorder -among adolescents referred to treatment, comorbidity ranges from 50% to 90%

Substance-Induced Disorders

-describe substance-specific syndromes caused by either the ingestion of alcohol or other drugs or their withdrawal

cognitive-behavioral therapies

-for substance use disorders has gained considerable popularity in recent years -view problematic substance use as a learned behavior that is acquired and maintained in four ways: 1. people often learn to use alcohol and other drugs through operant conditioning (ex. alcohol can be positively reinforcing to the extent that it gives people a subjective sense of satisfaction and well-being or enhances enjoyment during social interactions; alcohol can also be negatively reinforcing to the extent that it reduces tension or alleviates pain) over time, the reinforcing properties of alcohol lead to increased us 2. through classical conditioning, people learn to associate substance use with certain situations or mood states. (ex. an adolescent might use marijuana with a certain group of friends. he discovers that smoking with these friends allows him to relax and have a good time. Through classical conditioning, he associates this group of friends with marijuana use. In the future, these friends might serve as a trigger or "stimulus cue" for him to use again. 3. substance use is often maintained through social learning. specifically, family members sometimes model substance use. Adolescents might view substance use as an acceptable means to cope with stress or facilitate social interactions. similarly, peers often model and reinforce drug and alcohol use, communicating that to gain social approval, drug and alcohol use is not only acceptable but also expected 4. adolescents' beliefs mediate the relationship between events that trigger substance use and consumption of alcohol and other drugs. Strictly speaking, events do not cause people to use substances; rather, people's interpretations and thoughts about events lead to either substance use or abstinence. adolescents often hold distorted beliefs about situations that prompt their substance use.this distorted beliefs about situations that prompt their substance use -these distorted beliefs elicit drinking or other drug use *** -the techniques used in CBT target each of the four ways substance use problems develop and are maintained: 1. operant conditioning 2. classical conditioning 3. social learning 4. ways of thinking - first, the therapist asks the adolescent to monitor her substance use and note environmental factors or mood states that precede substance use (the therapist and adolescent try to find ways for her to avoid feelings that trigger alcohol use) -second, the therapist encourages the adolescent to consider the consequences of her substance use (specifically, the therapist and adolescent might conduct a cost-benefit analysis of using alcohol or other drugs - third, to help adolescents avoid substance use, therapists teach their clients specific skills to reduce the reinforcing effects of alcohol. the skills that they teach depend largely on the adolescents' reasons for using - fourth, most cognitive-behavioral therapists examine the beliefs that adolescents have about substances and challenge distorted cognitions that lead to problematic use. many adolescents overestimate the benefits of alcohol and dismiss its potentially harmful effects -the therapist might share data regarding typical alcohol use among adolescents of the same age and gender

Opioids

-include natural opioids (morphine), semisynthetics (heroin), and synthetic drugs that act like these substances (codeine, oxycodone, fentanyl) -synthetic opioids are often prescribed for pain reduction. -besides alleviating pain, they may produce euphoria, anxiety reduction and disorientation -tolerance can develop quickly -withdrawal symptoms can be severe and include dysphoria, nausea and vomiting, insomnia, muscle aches, and fever

Intoxication

-is defined as "a disturbance of perception, wakefulness, attention, thinking, judgment, psychomotor and/or interpersonal behavior" caused by the ingestion of a substance - does not caused distress or impairment, such as when a person experiences a sense of relaxation and gregariousness after a few drinks a part

withdrawal

-is defined as a "substance-specific problematic behavioral change... that is due to the cessation of, or reduction in, heavy and prolonged substance use" -include changes in overt actions (pacing), emotions (anxiety, cognitions (unpleasant dreams), and physiological functioning (rapid heart rate, nausea)

Pharmacological criteria: tolerance

-occurs when the person a. needs more of the substance to achieve intoxication b. the same amount of the substance produces diminished effects over repeated use -adolescents might discover that they need to drink more beer to achieve a buzz at parties or smoke more marijuana to experience a reduction in anxiety.

gateway hypothesis

-on one hand, longitudinal data indicate that the vast majority of adolescents who abuse stimulants and prescription medications have also used cigarettes, alcohol, and marijuana. - on the other hand, most adolescents who use cigarettes, alcohol, and marijuana do not use other illicit substances - we might conclude, therefore, that the abuse of hard drugs is almost always dependent on the use of cigarettes, alcohol, and marijuana - however, use of these softer drugs does not imply an escalation to other illicit substances

Tobacco

-the chemical nicotine, found in tobacco - has both stimulating and anxiety-reducing effects -short-term use can result in pleasure, enhanced concentration, reduced tension and anxiety, and decreased restlessness and agitation

DSM-5 recognizes three Substance-Induced Diorder

1. Substance Intoxication 2. Substance Withdrawal 3. Substance-Induced Mental Disorder

five principle of motivational interviewing

1. she approaches the adolescent in an accepting and nonjudgment way. The therapist expresses empathy, warmth, and genuine concern for the adolescent and avoids signs that she disapproves of the adolescent's alcohol use or disagrees with his attitudes about drinking (the therapist's goal is to understand and accept the adolescent, not to persuade him to adopt others' beliefs about drinking 2. the therapist develops discrepancies between the adolescent;s short- and long-term goals and his current alcohol use 3. the therapist rolls with resistance and avoids argumentation. If the adolescent becomes defensive, angry or avoidant, the therapist assumes it is because she is not adequately understanding and appreciating the adolescent's perspective 4. the therapist supports any commitment to change, no matter how small. the therapist sees herself as being "in the adolescent's corner," supporting and encouraging his decisions regardless of whether they agree with her own 5. the therapist promotes the adolescent's self-efficacy, by pointing out successful change no matter how small

comorbidity of substance use

ADHD - is the most frequently occurring psychiatric disorder shown by adolescents with Substance Use Disorders - approximately 15% to 30% of adolescents with ADHD eventually develop a Substance Use Disorders - conversely, most (50 - 75%) adolescents with Substance Us Disorders have ADHD -adolescents with ADHD and substance use problems show more severe symptoms of both disorders and greater impairment in overall functioning -their substance use tends to be longer and more resistant to treatment than that of individuals without ADHD - after treatment for substance use problems, youths with ADHD are more than twice as likely to relapse compared to adolescents without ADHD CD - approximately 35% to 40% of adolescents with substance abuse also meet diagnostic criteria for CD -furthermore, nearly 90% of youths with substance use disorders show at least some problems with oppositional, defiant, or disruptive behavior - among adolescents with CD, alcohol and other drug abuse is usually part of a much larger problem with impulsive, disruptive, and destructive behavior depression and anxiety - approximately 25% to 50% of adolescents with substance use problems are depressed - comorbid depression and substance use problems can sometimes be explained by shared genetic and psychosocial risk factors - adolescents with substance use problems show greater likelihood of suicidal thoughts, suicide attempts, and suicide completion than their counterparts without substance us disorders - mood problems, especially depression, associated with substance use partially account for the relationship between substance use and suicidal ideation -approximately 10 -40% of adolescents with substance use problems show comorbid anxiety -the relationship between substance use and anxiety is complex -some anxiety disorders usually precede the development of adolescents' substance use problems (some adolescents use alcohol and other drugs to cope with social anxiety or unwanted memories of traumatic experiences

specifiers of SUD

In early remission: After full criteria for a substance use disorder were previously met, none of the criteria for substance use disorder have been met for at least 3 months but for less than 12 months ( with the exception that criterion A4, craving, or a strong desire to use the substance, may be met) in sustained remission: after full criteria for a substance use disorder were previously met, none of the criteria for a substance use disorder have been met at any time during a period of 12 months or longer (with exception that criterion A4, craving, or a strong desire to use the substance, may be met) specify current severity: Mild: presence of 2-3 symptoms Moderate: Presence of 4-5 symptoms Severe: Presence of 6 or more symptoms

effects of alcohol use: Biphasic effects on cognition and emotion

Mild to moderate use produces one set of effects: - increased arousal - increased sociability - increased euphoria -reduced anxiety extended consumption produces a different cluster of (largely aversive)effects: - sedation - cognitive and motor impairments -heart and respiratory problems - other health risks