Chapter 9 - Substance Related and Addictive Disorders
*Serotonergic System*
*Serotonin* associated with alcohol use and reinforcing properties of cocaine
Epidemiology of Opioid Use
-18% substance abuse treatments for opioids. -84.3% involved heroin -patterns of use vary by age, SES, education and type of drug used. (surveying is hard)
Prevalence of Sedative use
-average age of onset = 25 -59% are female -most commonly used by whites & those with higher levels of education
Gender and Pot
Boys more than girls. Men (8.3%) Females (4.3%)
Prevalence Rates of Cocaine use (ethnicity&gender)
Used more by males 1.4 million users in US 12 and up American Indians (2.0%) African Americans (1.6%) Whites (0.8%) Hispanic & Pacific Islander (0.2%) Asians (0.2%)
Agonist Substitution
substitues chemically similar safe medication for the drug of abuse ex- methadone
Barbiturates
"downers" act on GABA-ergic system in a manner similar to alcohol. -used to counteract effect of amphetamine (uppers) -common ones are Amatol, Nembutal, Seconal -can be swallowed or injected At *low doses*, benefits are: disinhibition & euphoria to help alleviate anxiety. -leads to slurred speech decreased respiration, fatigue, disorientation, lack of coordination, dilated pupils At *High Doses:* impaired memory and coordination, irritability and suicide ideation
Vaccines
(Immunopharmacotherapy) antibodies are produced that bind to targeted drug before it reaches the brain, and therefore blocks its positive reinforcing effects. -Immune response triggered when drug attaches to proteins in blood and antibodies for against drug.
Aversive Treatment
*Antabuse (disulfiram)*- prevents breakdown of acetaldehyde in alcohol, and the buildup of this substance in body produces a nauseous feeling. -get sick every time you drink alcohol -doesnt support continuous abstinence.
Behavioral Factors (Etiology)
*Operant Conditioning*- drug causes positive feeling so it will probably be used again. (pos. reinforcement) -Drug use also reinforced when using a drug removes a negative feeling (negative reinforcement) -Positive Reinforcement more important in initial stages of addiction, negative reinforcement more important as addiction progresses.
Types of Hallucinogens
*Psilocybin* (Magic Mushrooms) and *Mescaline* (product of the peyote cactus) are naturally occurring. *D-Lysergic Acid Diethylamide (LSD)* - synthesized in labratory
Epidemiology of CNS stimulants (genderðnicity)
-1.2 Americans ages 12 and up are users -prevalence is equal between men and women. -most do not use another drug in addition, if they do mostly marijuana. -greater among whites than all other ethnic groups
Developmental Factors leading to abuse
-Adolescents experiment. -earlier stage of abuse start and heavy drinking during adolescence are two risk factors. -drug use is progressive (ie- nicotine then marijuana then other illicit drugs) -Precipitating Factors (things that cause it to be progressive) may be increased access to drugs or the use of marijuana making one vulnerable to developing dependence on other drugs. -normal experiences and growth opportunities are missed due to excessive pot smoking.
Epidemiology of Caffeine (Sodas, Tea, Coffee, Lattes, Expresso, Energy Drinks)
-Most widely used drug worldwide -over 80% of words population consumes it daily -87% of US population in a day. Sodas: 2 to 5 mg per ounce (coke vs. mountain dew) Tea: 5 mg per ounce Coffee: 7 mg per ounce Lattes: 20 mg per ounce Expresso: 50 mg per ounce Energy Drinks: 10 - 100 mg per ounce
Epidemiology of Nicotine
-Trends in declines in the number of people who smoke -45.3 million adults and 3 million teens smoke -21.5% of smokers are men -17.3% are women -impacts all ethnic & SES groups.
Effects of Sedatives use
-can result in over sedation -problems thinking and interacting with others -w/ barbiturates tolerance develops rapidly, high overdose risk -Death results from depression of the brains respiratory center. -Withdrawl (Barbiturates): tremors, increased blood pressure and heart rate, sweating and seizures -Withdrawl (benzodiazepines): Same as alcohol. anxiety, insomnia, tremors, delirium
Health effects of Inhalant Use
-chronic exposure to fumes causes severe damage to all vital organs including brain, leading to decreased red blood cell production. -Neurological problems caused by damage to fatty tissue around nerve called Mylein that assists with rapid communication between nerves. - damage leads to muscle spasms and tremors -MRI shows shrinking of cerebral cortex, cerebellum, & brain stem leading to permanently impaired cognitive abilities.
Opioids
-from opium poppy EX: Heroine, morphine, and codeine -mimic effects of bodes natural opioids (*endorphins*) -produce pain relief, euphoria, sedation, reduced anxiety, and tranquility. which are released in response of pain -can be smoked, snorted, injected beneath skin "popped", or mainlined (injected into blood stream) - other than pain relief and sedation, cause narrowing of pupils, constipation, flushed skin, itching, lowered blood pressure, slow heart rate, low body temperature
Sociocultural, family & environment Factors leading to drug use
-genes and environment both affect. Family and peer influence, trauma and economic factors are associated w/ abuse. -cultural family or social factors can protect against substance abuse. ex: nicotine use is strongly against some religions.
Epidemiology of Pot
-most frequently used illicit drug -74% of those that use illicit drugs use marijuana -average age of first use = 18 -prevalence of use has not changed from 1991 to 2002 -Abuse and dependence however has increased (b/c amount of THC in pot has increased)
Physical Effects of Nicotine*
-stimulates adrenal glands, causing release of epinephrine, leading to a rush. -this leads to glucose release, increased blood pressure respiration and heart rate. -affects the pancreas by suppressing insulin secretion leading to mild hyperglycemia (high blood sugar) in smokers -nicotine releases dopamine, affecting brains pleasure & motivation centers (what makes it addicting)
Effects of opioid use
-tolerance develops very rapidly (after 2 or 3 days) -can overdose when taking a previously tolerated dose after a period of abstinence -Herion dangerous also b/c needle sharing (may get viral hepatitis, liver damage, infections, HIV) , tainted preparation, & violence - Lung & immune system problems & neurological problems b/c not enough blood flow to brain Withdrawl Symptoms: Can appear as soon as 4 to 6 hours after previous dose. -rapid breathing, yawning, crying, sweating & runny nose. With Chronic use: -hyperactivity, intensified awareness, agitation, increased heart rate, fever, dilated pupils, hot/cold flashes, loss of appetite, cramps and fever. -
Prevalence of Inhalant Use
10.7% youth age 12 to 17 used at least once in life. -males more likely -whites and hispanics have highest use, African americans have lowest rates.
Nicotine
A highly addictive component of tobacco that is considered to be both a stimulant and a sedative -Methods of delivery: cigarettes, cigars, pipes & smokeless tobacco. -Enters bloodstream via: Lungs (smoking) , Mucus Membranes of mouth or nose (chewing tobacco), Skin (transdermal nicotine patch) -rapid action (8 to 10 seconds) -temporary tension relief, helps w/ alertness and concentration. -has strong social determinants (provides instant social affiliation like "asking for a light")
Wernicke-Korasakoff Syndrome
Affects brain. caused by deficiencies in thiamine secondary to alcohol dependance. -characterized by cluster of symptoms: confusion, amnesia, confabulation (an adaptation to memory loss in which the individual fills in the blanks with made up info.) Wernickes encephalopathy - includes short term memory loss,paralysis of eyes and unsteady gait. -lose the ability to learn from experience, so they require care and 80% will not regain full cognitive function
Neurobiology causing Substance Abuse Disorders
All involved in reinforcement and reward associated with alcohol and drug use -Dopaminergic, opioid, serotonergic and GABA systems
CNS Stimulants (illicit drugs)
Amphetamines, Crystal Methamphetamine, Ecstasy Common effects -Euphoria -Increased energy -Mental alertness -Rapid speech -Appetite Suppression
Behavioral Therapies
Aversion Therapy: Drug/Alch. use paired with aversive stimulus (electric shock) -also relaxation training and biofeedback Contingency Management Approaches: adding rewards for treatment compliance -results in less drug use and longer periods of time ( in methampetamine users)
Sedative Drugs
Barbiturates and Benzodiazepines -both are Central nervous system depressants -cause sedation and decrease anxiety
Skills Training
CBT. substance abusers lack basic skills for everyday coping, -mainly focuses on building users social network and support system -Stragetgies are goal setting, self monitoring, efforts to limit use, rewards, functional analysis of drinking situations, learning alternative coping skills, & relapse prevention.
Transtheoretical Model
CBT. -how to motivate one to get treatment/go through it. Five stages for behavior change: 1. Precontemplation- limited awareness of the problem, few emotional response to substance abuse, resistance to change. 2. contemplation- are are of problem and weight pos and neg aspects of their abuse 3. preparation- decision to take action within month 4. action stage- attempts to change environment, behavior or experiences 5. Maintenance stage- acquiring and engaging in behaviors needed to prevent relapse.
Caffeine
Central Nervous System stimulant with a kick that boosts energy, mood, awareness, concentration and wakefulness. -can be consumed safely in moderation but gives "crash" -long term side effects= tolerance, dependence, withdraw -other side effects: agitation (jitteriness), headaches, mood changes, rebound fatigue, & insomnia Neurotransmitters adenosine & serotonin help its effect. -has long half life (stays in blood stream long time) as long as 6 hours or more after last dose.
Inhalants
Drug most commonly used by teenagers -substances are cleaning fluid, gasoline, paint and glue that are used as a source of inhalable fume. - immediate effects lasting b/w a few minutes and few hours. -cause rapid sedation, euphoria and disinhibition, and dizziness, confusion, impaired motor skills. -can cause irregular heart beat and reparatory failure. -fumes can change brain chemistry & permanently damage brain and nervous system,
Twelve Step Approach
EX- Alcoholics anonymous begins w/ realization they are powerless to addiction & provides structure to remaining sober. -given sponsor, go to meetings.
Ecstasy & crystal meth
Ecstasy (MDMA): -interferes with reuptake of serotonin Crystal Meth: form of methamphetamines that produces longer lasting & more intense physiological reactions than powdered form. -can last for 12 hours or more
Hallucinogens
Hallucinogens: Produce altered states of bodily perception and sensation, intense emotions, detachment from self and environment, and feelings of insight with mystical or religious significance. -effects caused by disruption of nerve cells that influence transmission of the neurotransmitter serotonin, causing world to look very different -more common among males
Marijuana
Illicit drug -comes from cannibis saliva plant -leaves can be dried and used in food, drink or smoked -active ingredient is *tetrahydrocannabinol (THC)* -THC attaches to cannabinoid receptors in brain causing release of dopamine for pleasure (being high)
Functional Impairment of CNS stimulants
Increased heart rate and blood pressure -damage to blood vessels in brain can cause stroke -can develop psychotic symptoms like paranoid anxiety, confusion & insomnia (these symptoms can occur months & years after stopping) -over time users become more violent and aggressive -tolerance develops rapidly -withdrawl causes "crashes" marked by depression, irritability and long periods of sleep
Medicinal Marijuana (what states legal?)
Legal in: Alaska, Arizona, California, Colorado, Maine, Montana, Nevada, Oregon, Michigan & Washington in Hawaii: legal if seriously ill in Vermont: legal if have aids, cancer or MS -Therapeutic: relief from nausea, appetite loss, reduction of muscle spasms, chronic pain -need for controlled trials
*Dopaminergic system*
Main one -alcohol and drugs primary reward system in the brain. -Info travels from Ventral Tegmental Area to the nucleus accumbens up to the prefrontal cortex.
Ethnicity and Illicit Drug Use
Minorities in cities more likely to use b/c of poverty, violence & availability. -Usage lowest among asians -Highest among American Indians, then blacks,then whites. -Use lowest among those who graduated college
Gender differences with alcohol
More common among Males (6.93%) than females (2.55%) -Men at greater risk for heavy drinking (more than 5 drinks a day) -women more susceptible to negative health risks of drinking -
Antagonist treatments
Naltrexone is opioid antagonist against positive effects from positive reinforcement. -acts against the action of the drug to prevent pleasurable feeling that keeps you wanting to do the drug/drink. -reduces relapse risk of heavy drinking, but doesn't enhance abstinence.
Effects of use of Hallucinogens
Psychological Symptoms: emotional swings, panic, & paranoia lead to dangerous behavior. -does not produce withdrawal symptoms -not considered addictive
Cognitive Factors (Etiology of substance abuse): Social Learning Theory
Social Learning Theory: biased belief systems that maintain substance abuse. -Substance abuse orders initiated & maintained by: 1. positive drug expectancies "this will make me feel good" 2. Minimal negative expectations "Ive never been caught" 3. Poor Self efficacy beliefs regarding their ability to cope without drugs. "I can't survive another day without a cigarette." Cognitions affect use: -Repeated exposure to drug and cues biases the info you recall about the drug, & use outweighs positives of being sober. ie: remembering the buzz but not the hangover.
Functional impairment from Alcohol (Delirium Tremens)
Withdrawl Symptoms: Tremors, anxiety, irritability, and agitation. In severe cases, can include hallucinations. *Delirium Tremens (DTs)* can last up to 3 to 4 days after stopping drinking. disorientation, severe agitation, high blood pressure and fever. -Benzodiazepines can help treat them, but if you drink too much alcohol counteracts their use and they don't work.
Substance *dependence*
a condition characterized by tolerance and withdrawal. *Tolerance*: diminished response to a drug after repeated exposure *withdrawl*: symptoms associated with physical dependence on a drug that occur when the drug is no longer taken.
Substance *intoxication*
acute effects of substance use (reversible and substance specific) -behavioral or psychologic changes in central nervous system
Ethnicity differences with alcohol
alcohol use higher in whites. -dependance higher in whites, native americans and hispanics than asians
Alcohol
also called Ethyl Alcohol -depressant -absorbed by the stomach and intestines into the blood stream -affects brains GABA firing which inhibits other brain activity (why its a depressant) -most common psychoactive drug
CB therapy - Avoidance and Relapse Prevention
avoidance of drug by putting yourself in different environment than did the drugs in. *Relapse Prevention*: uses functional analysis to identify antecedents and consequences of drug use, then to make alternative cognitive/behavioral skills to reduce risk. (find trigger, thoughts/feelings during use, consequences)
Stages of Motivational Enhancement Therapy
begins by identifying each persons place on the transtheoretical model. -interview gets them motivated for change (focussing on their strengths, getting them to make goals) -mainly affective on adolescents.
Nicotine Replacement Therapy
changes the method of drug delivery but not the drug itself. -in gum or patch -reduces withdrawal symptoms
effects of cocaine use
cocaine is highly addictive -stimulant effects are caused by inhibiting the reabsorption of dopamine by nerve cells -when more dopamine in synapses, more stimulation of brain reward pathways, then positive feeling -when tolerance develops, they take larger doses more often & are more exposed to dangerous effects like: anesthetic and convulsive effects (this is why deaths can occur after relatively low doses)
Potential Health Effects of Caffeine (caffeine intoxication)
consumption is now socially accepted, so health effects are overlooked. -can cause cardiovascular disorders, reproductive problems, osteoporosis, cancer and psychiatric disorders -large amounts can cause *caffeine intoxication*: includes physical symptoms like restlessness, nervousness, excitement, insomnia, flushed face, increased urination, gastro. disturbance, muscle twitch, rambling speech, fast heartbeat, agitation.
Family and Genetic Studies (Etiology)
genes and environment affect likelihood of substance abuse -environmental factors more important in determining whether a person starts smoking -genetic factors determine whether smoker becomes dependent. -genes overlap in those who have alcohol and nicotine dependence. -
Impairment caused by pot
heavy use results in: persistent memory loss, impairment of attention, learning skills, & motor movement. -head, neck and lung cancers -medicinal usage: THC used in chemotherapy from cancer, gluacoma and to stimulate appetite for AIDS. -withdrawl symptoms: restlessness, loss of appetite, trouble sleeping, weight loss, shaky hands, irritability and anxiety. -cravings and withdrawal cause addiction
Abstinence Violation Effect
how someone responds to a lapse (just once) determines whether it becomes a relapse.(complete return to substance abuse) -if think your a failure and you should just give up, could take you into a relapse. -can use it to motivate you
Cocaine
illicit drug -comes from leaves of coca plant -legal in 1800's (cigars, cigarettes, coca cola) -also once used as pain killer & relief from fatigue and hunger -powdered form can be snorted or dissolved in water and injected -crack cocaine is a smoked form of a rock crystal, highly addictive & delivers drug quickly via lungs for immediate effect.
Substance *abuse*
ingestion of substances leads to disruption in social, educational or occupational functioning.
"Licit" Drugs
legal drugs. Caffeine, alcohol, nicotine.
Amphetamines
legitimate uses trat asthma, nasal congestion, ADHD -prolong wakefulness & suppress appetite -made in laboratories, often cut w/ other substances 3 types: 1. amphetamines (Benzedrine) 2. Dextroamphetamines (Dexedrine) 3. Methamphetamine -increase release of dopamine, norepinephrine and serotonin in brain.
Women and Illicit Drug Use
less likely to be abusers & abuse at later ages than men -become dependent more quickly and have more severe consequences of drug use over shorter periods of time -associated with relationship issues -more likely than men to be comorbid, mainly with anxiety, depression and borderline personality disorder & PTSD
Alcohol Cirrhosis
liver disease that occurs in 10-15% of alcoholics. -slow deterioration of liver liver can no longer detoxify blood which causes scar tissue and damages blood flow.
Hallucinogen Persisting Perception Disorder
long term condition. experience perceptual distortions long after all traces of drug have left the system. -result of stress and fatigue -can be persistent or come back in short bursts or "flashbacks"
Substance *Use*
low to moderate use of a substance that does not impair functioning
Detoxification
medically supervised drug withdrawal, necessary to treat drug abuse. -meds can reduce symptoms like benzodiapines can reduce tremors.
Benzodiazepines
originally prescribed to treat anxiety -recommended dose short term: treats anxiety and insomnia -high doses: lightheadedness, vertigo, and muscle control problems. Ex: Valum, Xanax, Halcion -safer than barbiturates and have lower potential for abuse and dependance. -Rophinol = Roofies
Fetal Alcohol Syndrome
pregnant woman drinks alcohol and it passes through placenta and harms the fetus -children with this have facial abnormalities, and neurodevelopment abnormalities. also will have neurological problems with fine motor skills, hearing loss, school performance and impulse control problems.
*Opiod system*
reinforces effect of opiates, alcohol and nicotine. (this system involves how pleasurable we perceive drug to be) -Opiate Receptor Antagonist blocks effect of drug helps treat alcohol use.
*GABA system*
sedative drugs may act primarily through GABA systems
Drug- Compensatory Conditioned Responses
settings where drug use occurred, people you did drugs with, & paraphernalia used are all cues to begin using drugs. -Bodily changes occur when in presence of conditioned stimuli that counteract thoughts that you shouldn't be doing the drugs/drinking alcohol. -If you don't engage in substance use following the body changes, they feel a lot of pain, which then leads them to use the substances to escape withdrawal symptoms.
Functional Impairment of nicotine
use leads to addiction, -withdraw symptoms (depressed, insomnia, irritability, frustration, anxiety, restlessness, decreased heart rate, weight gain) -tobacco use is LARGEST PREVENTABLE CAUSE OF DEATH IN THE WORLD -can cause cardiovascular disease, cancer, respiratory illness. -smoking during pregnancy can cause premature birth, low birth weight, still birth, & SIDS.
sex and racial/ethnic differences in treatment
women are less likely to enter treatment than men (society views mothers that do drugs negatively so they don't get help) -women are more likely to drop out of treatment than men -minorities are less likely to seek/complete treatment. -minorities dont differ from non minorities in their response to treatment. -Latinos 1/3 less likely than whites to get help -african americans 1/2 as likely as whites to get help.