Chapter 9 : Substance Use Disorders

Detoxification

Medically supervised discontinuation of substances for those with substance use disorders; also referred to as detox.

Stimulants

Named for their effect on the Central Nervous System - Include nicotine and amphetamines - cocaine, crack - amphetamines, methamphetamines, Ritalin, and MDMA.

Substance Use Disorders

Psychological disorders that are characterized by loss of control over urges to use a psychoactive substance, even though such use may impair functioning or cause distress.

Binge Drinking (Heavy Episodic Drinking)

at least 0.08% in a 2-hour period

Use of the word "Addiction"

- Some clinicians have avoided using the term because of its negative moral connotations. - Others are in favor of using the term. They define "Addiction" as : The compulsion to seek and then use a psychoactive substance either for its pleasurable effects or with continued use, for relief from negative emotions such as anxiety or sadness.

Goals of Treatment

- Abstinence - Harm Reduction

Alcohol Use Disorder (Alcoholism)

- Craving - Loss of Control, which consists of an episode of drinking during which the person finds it difficult to stop compulsively drinking - Physical Dependence, which brings withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking; and - Tolerance, which causes a person to need to drink greater amounts of alcohol to get "high" - Blackouts

Classical Conditioning

- Drug cues

Social Factors that Contribute to Stimulant Use Disorders

- Dysfunctional family interactions are correlated with the presence of substance use disorders - An individual's substance use is related to that of his or her peers. - Norms and perceived norms influence substance use - Substance use disorders are correlated with economic hardship and unemployment.

Neurological Factors that Contribute to Depressant Use Disorders

- Increased GABAnergic system -> increased inhibition of anxiety - Indirectly activate dopamine-reward system - Generally cause NS to be less responsive. - Some directly activate DRS, including nucleus accumbens and the ventral tegmental area. - Association btw drug-related stimuli and drug use can activate the limbic system.

Psychological Factors that Contribute to Stimulant Use Disorders

- Observational learning: modeling - Operant conditioning : -Posotive and negative reinforcement - Classical Conditioning : Drug cues

Other Abused Substances

- Opioids, - Hallucinogens - Dissociative Anesthetics

Operant Conditioning

- Positive reinforcement (reward craving) - Negative reinforcement (relief craving) - Negative reinforcement (for withdrawal symptom)

Three Ways to Develop Substance Use Disorders

1. Arise unintentionally, as can occur through environmental exposure. 2. Can develop when the psychoactive element is a side effect, and the substance is taken for medicinal reasons unrelated to the psychoactive effect. 3. Can develop as a result of the intentional use of a substance for its psychoactive effect. - Common Liabilities Model - Gateway Hypothesis

Medications

1. They interfere with the pleasant effects of drug use 2. They reduce the unpleasant effects of withdrawal 3. they help maintain abstinence Depressants minimizes withdrawal symptoms by substituting a less harmful drug in the same category for the more harmful one. Disulfiram (Antabuse), a medication for treating alcohol use disorder. Naltrexone (reVia and Vivitrol) helps maintain abstinence. Most wide in the U.S. minimal side effect

Comorbidity of SUD

50% Alcohol - have another psychological disorder 75% Another substance - have another psychological disorder 64% alcoholic - have another type of substance disorder Common comorbid disorders : Mood disorders, PTSD, schezophrenia, ADHD marked by sustaining attention and physical hyperactivity.

Prevalence

9%

Polysubstance Abuse

A behavior pattern of abusing more than one substance.

Psychoactive Substance

A chemical that alters mental ability, mood, or behavior.

Motivational Enhancement Therapy

A form of treatment specifically designed to boost a patient's motivation to decrease or stop substance use by highlighting discrepancies between stated personal goals related to substance use and current behavior; also referred to as motivational interviewing.

Antabuse

A medication for treating alcohol use disorder that induces violent nausea ad vomiting when it is mixed with alcohol.

Stages of Change

A series of five stages that characterizes how ready a person is to change problematic behaviors: precontemplation, contemplation, preparation, action, and maintenance. 5% smokers in 2 years

Craving

A strong desire or urge to use the substance.

Family Therapy

A treatment that involves an entire family or some portion of a family.

Depressants

Alcohol, opiates, barbiturates, and benzodiazepines (diazepam (Valium)) Contrast to stimulants, deppresants slow a person down, decreasing behavior activity and level of awareness.

Korsakoff's Syndrome

Chronic memory problem lead by alcohol Enlarged ventricles Hangover indicates withdrawal, headaches, weakness, tremors, anxiety, higher blood pressure, seizures, and increased heart and breathing rates. (in extreme case: fever, agitation, and irritability, uncontrollable shaking, confusion, convulsions, and visual hallucinations.

Opioids : Narcotic Analgesics

Derived from the Opium poppy plant Best characterized as exogenous opioids - Methadone - Heroin - Codeine, Morphine, and Synthetic derivatives found in prescription pain relief medications such as oxycodone (OxyContin), hydrocodone (Vicodin) ,and others. Prescribed for persistent couphone, severe diarrhea, and severe pain.

Sedative-Hypnotic Drugs

Reduce pain and anxiety, relax muscles, lower blood pressure, slow breathing and heart rate, and induce sedation and sleep. Can cause poor concentration, memory problems, confusion, fatigue, and even respiratory arrest. When mixed with another depressant, such as alcohol, the effect can be lethal. - Barbiturates - Benzodiazepines

Tolerance

The biological response that arises from repeated use of a substance such that more of it is required to obtain the same effect.

Reward Craving

The desire for the gratifying effects of using a substance

Relief Craving

The desire for the temporary emotional relief that can arise from using a substance.

Common Liabilities Model (Problem Behavior Therapy)

The model that explains how neurological, psychological, and social factors make a person vulnerable to a variety of problematic behaviors, including substance use disorders; also called problem behavior therapy. - Adolescents who exhibited "problem behaviors" were likely later in life to develop a substance use disorder. - "Impulsivity"

Gateway Hypothesis

The proposal that use can become a use disorder when "entry" drugs serve as a gateway to (or the first stage in a progression to) use of "harder" drug.

Substance Intoxication

The reversible dysfunctional effects on thoughts, feeling, and behavior that arise from the use of a psychoactive substance.

Withdrawal

The set of symptoms that arises when a regular substance user decreases or stops intake of an abused substance.

Drug Cues

The stimuli associated with drug use that come to elicit conditioned responses through their repeated pairing with use of the drug.

Delirium Tremens (DTs)

The symptoms of alcohol withdrawal that include uncontrollable shaking, confusion, convulsions, visual hallucinations, and fever. within 4 days

Dopamine Reward System

The system of neurons, primarily in the nucleus accumbens and ventral tegmental area, that relies on dopamine and gives rise to pleasant feelings.