Addiction Exam 2

risks of stimulants

(s21): Stimulant abuse can cause high body temperature, irregular heart rate, cardiovascular system failure, and fatal seizures. It can also result in hostility or feelings of paranoia. Individuals who abuse prescription drugs by injecting them expose themselves to additional risks, including contracting HIV (human immunodeficiency virus), hepatitis B and C, and other blood-borne viruses.

Why the American Psychiatric Association does not have Internet Addiction in the DSM

- "Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: • excessive gaming • sexual preoccupations • e-mail/text messaging

What has been at estimated cost of the War on Drugs over the past forty years? S.14

- $1 trillion

Diagnosis of Sexual Addiction. Aviel Goodman s.11,12,13,14

- A condition in which some form of sexual behavior that can function both to produce pleasure and reduce painful affects is part of a pattern that has two key features; • 1. recurrent failure to control the sexual behavior. • 2. continuation of the behavior despite significant harmful consequences. - No specific form of sexual behavior in itself defines sexual addiction. Addiction is determined not on the basis of a specific behavior or its frequency, but rather on the basis of how the behavior relates to and affects a person's life with regard to his/her health, relationships, work, etc. -Description: • A behavior involving significant and destructive loss of control over sexual impulse. • Sex addicts are motivated to gratify their sexual impulses regardless of interference with relationships, work, or danger to reputation, status, or health. • Eventually, the need for sexual activity increases and the person's behavior is driven by the desire to experience the sex act. • Feelings of guilt or remorse may persist but are not sufficient to prevent the recurrence of the behavior, even after repeated attempts. • Addicts cannot stop, even when they attempt to try and stop. • Most sex acts culminate in a sexual orgasm. • A sense of excitement (high) often accompanies the sex seeking behavior even if orgasm is not achieved. • The person spends a great deal of time in the behavior including fantasizing, preparation and engaging in sexual activity

In How the War on Drugs Betrayed Us, which groups of people have been over-represented since the 1970s in terms of arrests in the war on drugs?

- African Americans

Name the group that is more likely (how many times more) to be arrested even though they do not commit as many crimes as other groups

- African Americans in 2010: 5 times the arrests - Caucasians commit more drug related offenses

Is eating an addiction:

- Cant take away food totally - Can help create a healthier relationship with food - Fmri of obese women

Pros of Harm Reduction Model

- Compassionate, understanding - Not focused on changing the person but accepting on who they are - Provide many services - No guilt or shame - Make it safe until they are ready - More options (treatment, less court) EX; LEAD, successful

definition of Porn addiction s. 29

- Currently, there is no clear medical definition or diagnosis for pornography addiction. It straddles the line between full blown addictive behavior and a 'bad habit'. - Addiction like symptoms: • An inability to lessen use despite a desire to do so. • A great deal of time is spent in viewing pornography. • It substitutes for other activities that are important. • Use is continued despite the knowledge that it is sociologically harmful. - Two important symptoms that are thought to be lacking are withdrawal and tolerance. It is this lack of physical consequences that shifts pornography away from a clear-cut addiction and toward the psychological realm of an obsession. • Tolerance may not be true

Describe the difference between decriminalization and legalization of drugs?

- Decriminalization is used to reduce or abolish criminal penalties (reduce is what makes the two different), criminal penalties are no longer in effect/lesser penalty (weed, can buy and use but not develop) - Legalization abolishes criminal penalties but there may be restrictions (regulation), making a particular action legal, alcohol (regulated and can buy at a store)

Smokeless tobacco s.33

- E-cigarettes - Lower nicotine cigarettes - People adjust their smoking behavior to obtain a consistent amount of nicotine (e.g., taking more puffs and inhaling more deeply) - Lower tar cigarettes - Tar is the sticky brown material seen on the filter of a smoked cigarette - Safe but not safer (exploding, gateway drug)

Origins of the Gateway Drug Theory

- First popularized in the 1980s, the gateway drug theory asserts that adolescent use of tobacco, alcohol or marijuana increases an individual's risk of using and/or developing addiction to other licit and illicit substances that may be perceived as more harmful, such as opioids, cocaine and methamphetamines • The term was coined by Dr. Denise Kandel of Columbia University whose research found evidence that the use of nicotine in rats suppressed the activation of two genes that act as "cut-off" switches for the effects of cocaine. Subsequent studies supported that alcohol had similar effects. The term was quickly politicized and cannabis was substituted...the results have been clear...more confusion about the Gateway Drug Theory. the gateway drug theory asserts that adolescent use of tobacco, alcohol or marijuana increases an individual's risk of using and/or developing addiction to other licit and illicit substances that may be perceived as more harmful, such as opioids, cocaine and methamphetamines

Similarities and Differences between pathological gambling and substance use disorders

- Individuals with PG or SUD experience the thoughts and behaviors associated with the disorder as ego-syntonic; experience pleasure, minimize/deny the problems. S.4 - Compelling evidence demonstrates significant changes in brain activity and brain structure in people identified as problematic gamblers. (serotonin, dopamine, norephinephrine, and opiod receptors appear to be changed) s. 5 - The rationale for this change is that the growing body of scientific literature, especially research on the brain's reward center, has revealed many commonalities between pathological gambling and substance-use disordersincluding : s.6 • cravings • highs in response to the gambling, alcohol or drug; • the hereditary nature of all of these disorders; • evidence that the same forms of treatment (e.g., 12-step programs, cognitive behavioral therapy) seem to be effective for both gambling and substance-use disorders. • The DSM-V Work Group cited studies showing a high rate of co-occurring substance use disorders with pathological gambling. - One of the most definitive analyses of the gambling data is the National Comorbidity Survey Replication (NSC-R), In a nationally representative sample of 9,282 English-speaking adults: s.7 • Almost all participants who had pathological gambling during the course of their lifetime also had another lifetime psychiatric disorder (96.3 percent), • And 64.3 percent suffered from three or more disorders. Substance-use disorders were significantly elevated among participants with pathological gambling

In the film The House I Live In, parallels are drawn between the treatment of drug addicts and other populations across the last 100 years who have been scapegoated. Name three of these groups and describe how they are similar.

- Kill the poor wed be better off (seperate the weak economically) - Holocaust (jews) - Rwandan genocide - Similarities: chain of destruction, have to have an enemy for everything, this group of people are the cause of woe and If we hate them we will be better off

Winners of Who is making money off the war on drugs

- Mexican drug cartels (Sinaloa, Los Zetas, Gulf Cartel: 6.6 million just to US, Forbes List - Banks: HSBC, Bank of American, money loundery, turning a blind eye) weapon manufacturing: need weapons), - police forces or private security contractors (Merida Initiative: plan Mexico, agreement between US and Mexico against drugs, help each other), prison made 300 million for a private prison,) Big business: Plan Columbia, US promises to decrease cocaine us in Columbia even though it went up, war on drugs helped economics, helping businesses

Abuse and Dependence potential ???

- No overdoses, but lots of hospital visits due to intoxication - Higher doses of THC (resin) - Infrequent smokers o Experience similar but more intense effects compared with experienced smokers due to lower tolerance o At high THC concentrations, many report negative effects such as mild paranoia and hallucinations

Cons of the Harm Reduction model

- Not simply (complex, empathy, not often done) - Supporting drug use - Motivates user to keep use No serious risk

What have been the successes of the war on drugs?

- Nothing - The right or wrong of drug prohibition quite simply rests in whether or not the cost (imprisoning people, heavy spending on law enforcement, etc.) has been worth the benefit (reduced drug use, we are told.) - Not reduction has happened (cost does not weight the benefits even if its was dishonorable)

definition of gambling (not DSM)

- Placing something of value at risk in the hopes of gaining something of greater value - Common perceptions of gambling involve either high risk, fairly rapid outcomes, or both.

The four pillars of social policy of drug addiction that were briefly identified in lecture are? Which of these four polices seems to get most of the financial support

- Prevention: trying to keep people to stop using harmful substances or behaviors - Harm reduction: looking for ways to not punish but reduce the harmful effects of addiction (the up-and-coming movement) - Treatment: helping people change their lifestyles, halfway houses, inpatient - Enforcement: war on drugs, all money towards social policy is to enforcement such as punishment/strictness in life, most of government money goes towards this

Withdrawal symptoms associated with cannabis ????

- Reduction of anandamide due to no THC

Medical uses of marijuana

- Renewed interest in potential medical uses led to a review of older reports • May be effective as an anticonvulsant in some cases when preferred medication is ineffective • May relieve tension and migraine headaches - Reduces fluid pressure in the eyes • May be useful in glaucoma patients • Limited program in which NIDA supplied medical-grade marijuana cigarettes to certain patients on a "compassionate use" protocol - Reduces severe nausea caused by certain drugs used to treat cancer • 1985: Oral TCH (dronabinol; brand name Marinol) licensed for sale to cancer patients experiencing nausea from chemotherapy • 1993: Approved to stimulate appetite in AIDS patients

Pornography symptoms

- Secretive actions • The use of pornography requires a secretive, hidden set of actions that would cause difficulties/embarrassment if discovered. This isn't just seeking privacy for masturbation, but includes concealing the amount and type of pornography viewed. - Money problems • Financial difficulties, such as maxed-out credit cards or secret accounts - Changes in sleep patterns • Sleep schedule changes in the pursuit of more, or a specific type of pornography. - Guilt • Strong and disturbing sense of guilt at amount or type of pornography. - Neglecting family • Neglecting loved ones or obligations (to spouse or family) because of pornography. - Risk motivated • Risk taking behavior to procure 'forbidden' images.

SASH statistics for pornography s.25,16

- Society of Advancement of Sexual Health • Tracking data from 2010 by Nielsen Online2 showed that more than 25% of those with Internet access at work viewed pornography during working hours. This is an increase from 2007 figures. • 25 million Americans visit cyber-sex sites between 1-10 hours per week. Another 4.7 million in excess of 11 hours per week. (MSNBC/Stanford/Duquesne Study, Washington Times, 1/26/2000)

Symptoms of video game addiction Emotional

- Some of the emotional signs or symptoms of video game addiction include: • Feelings of restlessness and/or irritability when unable to play • Preoccupation with thoughts of previous online activity or anticipation of the next online session • Lying to friends or family members regarding the amount of time spent playing • Isolation from others in order to spend more time gaming

Symptoms of video game addiction physical s 20-21

- Some of the physical signs or symptoms of video game addiction include: • Fatigue • Migraines due to intense concentration or eye strain • Carpal tunnel syndrome caused by the overuse of a controller or computer mouse • Poor personal hygiene

Co-occurrence of eating disorders and SUD

- There is a significant rate of co-occurrence of eating disorders and substance use disorders in both clinical and research samples. - Prevalence of substance abuse with ED is 50% compared to the 9% prevalence of substance abuse in the general population. - Conversely, 35% of individuals with substance use disorders report having EDs compared to a rate of 1-3% in the general population. • Childhood trauma: The role of childhood trauma such as sexual abuse in both SUDs and EDs has been explored. Childhood distress can predict the onset of many psychiatric disorders but not exclusively EDs and SUDs. Ø Depression cited as a co-occurring link between EDs and SUDs.

Pros to making internet addiction a DSM diagnosis

- Those diagnosed with IA show pattern similar to that of other addictive disorders, such as excessive use, withdrawal, tolerance, and negative social repercussions, including impaired vocational and academic performance. - Preliminary evidence points to an opiatergic component to IA, possibly treatable with opioid receptor blockers.This is consistent with general mechanisms known to underlie addictive disorders • By classifying IA as a psychiatric disorder, we will encourage those with IA symptoms to seek help and treatment, thus reducing morbidity and mortality, hospitalization, and legal and psychiatric complications. Classification of IA as a bona fide disorder may also reduce unnecessary barriers, stereotypes, and discrimination associated with public perceptions about excessive internet use. • A discrete diagnostic category for IA will focus clinical attention on a severely impaired, at-risk population to a degree not possible if IA were incorporated into existing DSM categories or relegated to the Appendix of DSM-V. Research and teaching efforts will also be stimulated if IA is an official DSM-V diagnosis

Dependence Potential of opioids s.50

- Tolerance • Tolerance develops to most effects from both medical and recreational usage • Higher doses needed to maintain effects • Cross-tolerance exists among all the opioids (opiates as well) • Psychological processes play a key role in tolerance • Dependent individuals develop a conditioned reflex response to the stimuli associated with taking the drugs - Physical dependence • Symptoms of withdrawal appear in sequence following the timing of the most recent dose and the individual's history of use • Opioid withdrawal is unpleasant but rarely life-threatening • Methadone (long-lasting synthetic opioid) produces withdrawal symptoms that appear - Psychological dependence • Positive reinforcement • Positive effects reliably follow use of the drug • Negative reinforcement • Use of the drug removes withdrawal symptoms Fast-acting injectable opioids are most likely to lead to dependence

Trends in US Alcohol Consumption. What are average amounts of alcohol consumed? S.20,21,25

- Use peaked in 1981, followed by a decline, mirroring patterns of illicit drug use - Decline particularly significant for distilled spirits - About one-third of Americans abstain - Average consumption among drinkers = about 3 drinks per day—but most drink far less - Half of all alcohol consumed in the United States is consumed by about 10 percent of the drinkers Regional differences in the United States - Stress index: Drinking rates higher in states where people experience a great deal of social stress and tension - Drinking norms: Drinking rates higher in states where people tend to approve of the use of alcohol to relieve stress Gender differences: Males more likely to drink than females, and more likely to drink more Drinking among college students - College students drink more than their nonstudent peers - Many campuses have banned sale and advertising of alcohol, and many fraternities have banned keg parties - Alcohol use and drinking behavior hasn't changed significantly in response - Today's college students are less likely to drink and drive compared to students in the early 1980s

Cybersex cons s35,36

- Users engage in cyber sex to the exclusion of personal relationships. • Families and jobs are neglected •. Cybersex may progress to arranging off-line encounters leading to STIs and possible violence such as sexual assault. - This can negatively impact intimate relationships • Partners report feeling ignored, devalued, or betrayed due to their mate's compulsive behavior on-line. - Cybersex often requires the "double life" associated with many addictions. - Cybersex can become financially, socially, emotionally, spiritually exhausting.

What have been some of the unintended consequences to the war on drugs?

- Video of Richard Nixon: consequence in terms of race, African Americans have been arrested 5 times more in 2010 even though Caucasians commit more drug crimes, - Mandatory minimum sentences: crack (5 grams for 5 years), powder cocaine (500 gram for 5 years, used for richer communities) - 1.5 million arrests - Federal government has spent 1 trillion dollars even though no data shows a change

In the film The House I Live In, the five step Chain of Destruction

- identification : anyone who uses drugs (people who are the cause for destruction, cause harm - Altruism: hate drug users, (how to hate them, how to take their homes/jobs, separate from society move to ghettos), - Confiscation: new laws, any property they find during arrest can be seized (take away liberties, laws change, take property), - Concentration: go to prison (concentrate into facilities, prison, camps - Annihilation: not yet, but preventing births, violence (death, withholding resrouces, not having kids)

Cons of legalization of drugs

- may create more drug addicts - Black Market could still remain - Drug tourism would become a problem (people from other countries come and take drugs) May send the wrong message

Losers of Who is making money off the war on drugs

- minority groups - races that are seen as dangerous

When kids are engaged in excessive recreational screen time, what important areas of functioning are often neglected

- thinking and problem solving skills - physical activity, - social and emotional skills, - recreational and helping skills

Commonly abused classes of prescription medication and some of their common drug names s.6

-opioids -central nervous system depressants -stimulants

Gambling Cognitive distortions

-s 16-18 • Attribution: Many problem gamblers believe that their winning is a direct result of their skill and efforts and can not be attributed to random luck. • Magical thinking. Many problem gamblers believe that thinking or hoping in a certain way will bring about a win or that random outcomes can be predicted. They may also believe they are special in some way and that their specialness will be rewarded with a win. • Superstitions. Many problem gamblers believe that lucky charms, talismans, or certain articles of clothing, ways of sitting, may cause a win or a loss. • Selective recall. Many problem gamblers tend to remember their wins and forget or minimize their losses. • Systems. Many problem gamblers may believe that by learning or figuring out a certain system (a pattern of betting in a particular way), the house advantage can be overcome. - The development of computerized technologies has made it much more difficult to "predict". • Personification of a gambling device. Some problem gamblers attribute human characteristics to inanimate objects, which are part of the gambling process, thinking that a particular machine or game is punishing, rewarding or taunting them. • "Near miss" beliefs. Some problem gamblers reduce the number of losing experiences in their minds by thinking they "almost" won. This justifies further attempts to win. Near misses can be as stimulating, or even more stimulating, than actual wins. • Chasing losses. Some problem gamblers believe that they have not really lost money to gambling, but that it can be "won back" by further gambling.

Video game Ted talk

1. temporarily escape 2. They are social, clean slate for new social connections 3. They are a challenge, a mission, achievement paradigm 4. You see progress, you see rewards for your effort -parents need to not allow their children to be on the technology that much -find motivations in other ways -don't punish, no judgement

3 types of gambling

1.Recreational Gambling: once and a while, not super exciting, lottery tickets, poker for pennies 2 & 3. § Problem Gambling & Pathological Gambling (s/11) § Gambling beyond their means § Incur substantial debt § Experience bankruptcies § Experience "bailouts" § Are willing to risk close relationships Resort toillegal behaviors

Prevalence of use worldwide (2019) from WHO

147 million is estimated to use

Cost of addiction (lives lost) s.29

8.1 million

why is too much technology a bad thing for children and teenagers? S.5

Children's brains were not designed for extensive exposure to these rapidly paced technologies. For normal child development, children need to have the same types of learning experiences that have been utilized for eons. Children need many hours of face-to-face interaction, reading, exploring, playing, being engaged in creative and imaginative play, learning basic social skills that involve sharing, problem solving and turn taking.

According to Johan Hari, author of Chasing the Scream (TED Talk), what is the opposite of addiction?

Connection

The Debate: Portugal's Decriminalization vs. War on Drug (s. 22)

Decriminalization: - No sign of major increase in Portugal - Legalizes small amount - Others say crime has gone down - We supply the things so you don't have to break and enter - use slightly goes up but addiction and HIV went significantly don't - Resources and money went back to treatment War on drugs: - Crimes has increased slightly (crime and drug relationship) - Much more complex - Crime and heroin (vast majority in prison has done 50-200 act have done crime before doing drugs) - Get people hooked on methadone without intent to get them off - No idea what the world would look like (small isolated societies have tested) - Just having treatment makes it simple and not complex, which addiction and drugs are not - Portugal has not decriminalized supply - Freedom to do drugs, but freedom for children to live in a drug free home Key point: there is no life that every decision has no cost (war on drugs has costs but so could decriminalizes, look inot our self, why do we need to find an outside

What does acronym LEAP stand for? S.3

Law Enforcement Against Prohibition

Country that decriminalized all drug use

Portugal The Portugal experiment (video, s.8):

· What is the percentage of patients in drug rehab that have come through the criminal justice system according to the documentary.

o 1 in 3 people are referred to drug treatment through CJS

Entourage Effect. Be able to describe this concept from the video.

o 500 chemicals in cannabis, cant take one out, need all of them to get the plant o Mechanism which cannabis compounds (CBD) work better in combination with other chemicals than being isolated, cant just use CBD to cure epilepsy need the whole plant

What is methadone?

o A synthetic drug that is similar to morphine in its effects but longer lasting o Can be used as a substitute for other drugs like morphine and heroin o Methadone clinic: drink, one dose, prescribed for pain o Not in my backyard

· Hari discusses as the explanation forward by Peter Cohen from the Netherlands about addiction. He calls it something else. Explain this.

o Bonding o When happy and healthy you can bond with others, when cant you bond with anything that can give you relief o You don't do drugs because you have connections, have others to care about who care about you o Government penalizing/people victimizing o Portugal: decriminalizing all drugs, used all money used for that in the past to help addicts, government works with housing/jobs and pays for helping the addict

· Describe how Johan Hari challenges the notion that drugs have chemical hooks that cause addiction. What example does Hari use to suggest that addiction is not about the drugs?

o Compares going to doctor and given morphine, given it for awhile time, those people should become addicts yet they don't (grandmas with hip replacement) o Ex: Rat Park study/ Vietnam War Study

What have been the efforts made by our government to carry out the war on drugs?

o Hypothetically cutting off their connection if they keep using

· What are the three problems associated with research related to pornography addiction.

o Lack of control groups because there were no college age people who have not seen internet porn § Healthcare providers normally assume these are primary symptoms that cause the addiction but may actual be the result of the addiction o Its hard to believe that sexual activity can cause addition because sex is healthy § Internet porn is not sex o Researchers have not asked porn users about their symptoms of arousal addiction that mimic ADHD, social anxiety, depression, performance anxiety, and OCD

· What is L.E.A.D.?

o Law enforcement assisted diversion o Stop decriminalizing drug use o Program that makes an arrest an intervention o Treatment and assistance on demand and no incarceration o LEAD counselor is in contact, help with housing, keeping up o Outreach (Kristina, o Limit harmful behavior (harm reduction model) o No penalize, offers incentives o Better than jail because they stop using for jail time then do immediately o Reduce overdose, theft, crimes, recidivism o 2x a month they discuss services (case manager, law enforcement) o Let them be on their own time table (nt clean, complex, takes empathy) o Help improve quality of life, start w relationship

Why do older men appear to recover more quickly from porn use, regaining their previous sexual functioning than younger men

o Older men did not begin using internet porn to satisfy their needs, they had different/less immediate sources/constant new stimuli o New generations are starting with internet porn

· Describe the process of how pornography becomes addictive.

o Our prefrontal cortex, Nucleus accumbus and VTA evolved to drive us towards natural rewards (such as mating, bonding, and food) o Extreme amounts of natural rewards override our natural reward system with dopamine o dopamine makes it become addicted o binge mechanism (getting the goods while they can) was an evolutionary advantage o excess chronic consumptions lead to binge mechanism (delta-fos b mechanisms which is a molecular switch which accumulates in the brains reward circuit, this build up of delta fosB starts to alter brain structure), cravings for more, continued consumption, structural brain changes o first numbed pleasure response to other pleasures like seeing family, second hyperactivity in porn only thing gives them excitement, third willpower erodes as frontal cortex changes o reduced pleasure responses in the brain compared to non addicts o gradually desensitization to old stimuli and current sexual relationships

· Medical Marijuana: Active ingredients for medicine. What is the active ingredient for medical marijuana?

o Primary psychoactive agent in Cannabis is delta-9-tetrahydrocannabinol (THC) o THC is chemical in weed that makes you high, good for kids who are taking medicine § Thc latch on to receptors and releases dopamine o CBD. Cannabidol, quiet electrical activity in the brain § Low thc and cbd are good medicines, good for epilepsy o 500 chemecials

· According to Hari, citing Bruce Alexander, what is addiction most likely about (if not a chemical)?

o Rat park study o It is about your cage, an adaptation for your environment

· Why is it difficult to study the changes in the brain from drugs? Be able to explain this from the video.

o THC is the drug that makes us high o Studies are challenging because it almost impossible to control the human variables of everyday life, while mice and rats are more easily controlled o Small studies are more likely to contain high levels of variability o Video shows a study about weed users and non weeds user. Effects nucleus acacumbis and amaydala

· How does Dr. Nora Volkov describe what cocaine-all addictive substances- does to the brain?

o use of brain imaging to discover dopamine, a chemical released by the brain allowing us to feel pain or pleasure, is at the root of addiction. Here, Alan discusses her research and talks with Paul Flora, a cocaine addict. o In order to stop the brain needs to be fully working/developed o Areas of the brain that want you to make rational decsions is effected by repeated use of drugs o Experimentation and pressure from peers can create an addict (free will?) o Need empathy for this disease

DSM def of gambling

s.8 § Needing to gamble with more money to get the same excitement from gambling as before. § Feels restless or irritable when trying to reduce or stop gambling. § Keeps trying to reduce or stop gambling without success. § Gambling is frequently on the person's mind -- both reliving past gambling experiences, and planning future gambling events. § Gambles when feeling depressed, guilty or anxious. § Tries to win back gambling losses. § Lies to cover up how much they are gambling. § Loses not only money, but also relationships, their job, or a significant career opportunity as a result of gambling. § Becomes dependent on other people to give them money to deal with financial problems that have been caused by gambling. § The gambling behavior is not better accounted for by a Manic Episode

Risks of CNS depressants

s20): Individuals who abuse CNS depressants, including benzodiazepines, tranquilizers, barbiturates, and sedatives, place themselves at risk of seizures, respiratory depression, and decreased heart rate

Adverse health effects of caffeine

tummy issues

Common features of EDs and SUDs s.40

· Both are important diseases where loss of control and compulsive use are preeminent. · Both are diseases with diverse groups with unknown etiology. · Both are characterized by chronic relapse. · Both involve the acquired pathological attachment to the agent of their ultimate compromise and possible destruction. · Both may involve a host of risk factors which predispose a person to extreme reward after consumption or use thereby making repetition more likely to occur. · Both involve denial and reluctance to accept that they are in fact ill and in need of treatment. · Both can be relapse triggers for each other. · Drugs are used to decrease eating and eating is used to decrease drug taking. · Both can result in early death. · Both generally involve early experimentation; one with drugs, the other with dieting.

Pediatric Guidelines for Television time (screen time in general) and the average amount of time children and teenagers spend with screens. S.4

· One to two hours per day and no televisions in children's bedrooms was the recommendation. In 2001, the AAP again made recommendations about television time. Again, one to two hours of television time, no television in children's bedrooms and no television for children under the age of two. (2013 had same recommendation, s.5) · Child ages 4-7 are exposed to an average of four to five hours of recreational screen time each day. · Older children and teenagers range from seven to eleven hours daily of total screen time when texting and social media are included. S.6

Gateway Drug Theory explanations against cannabis being the gateway drug to hard drugs

Ø Every drug is a gateway drug if used during adolescence or young adulthood while brain development is still underway. Ø Whether it's nicotine, alcohol, marijuana or opioids, the age of the person initiating use - not the specific substance itself -increases the risk of using other addictive substances and developing addiction Ø graph (67% just use cannabis on its own) Ø Alcohol tends to be used before cannabis. It is uncommon for those who use hard drugs to not have used alcohol or tobacco first. Ø 2005 National Survey of Drug Use and Health (NSDUH) in the United States found that, compared with lifetime nondrinkers, adults who have consumed alcohol were statistically much more likely to currently use illicit drugs and/or abuse prescription drugs in the past year Ø Slide 30 study of rats using drugs in a certain order Ø On the other hand, many have argued that some drugs, such as marijuana, when used to control pain actually reduce the likelihood of a person seeking harder drugs.

Gateway Drug Theory explanations FOR cannabis being the gateway drug to hard drugs

Ø For: 1. Some individuals are willing to try any substance. The "gateway" drugs are merely the ones that are most commonly available at an earlier age than the harder drugs. Ø 2. When teenagers discover that marijuana is not as dangerous as they have been told, credibility of adults is eroded. This may lead them to believe all anti-drug messages are nonsense. Ø 3. Harder drugs are available and mixed with casual drugs like cannabis in the black market. The environments in which "gateway" drugs are used can sometimes overlap with the ones in which harder drugs are used, especially in societies that prohibit the substances. Ø 4. Dealers of the harder drugs are unwilling to expose themselves to those not already using the "gateway" drugs.

Health problems associated with gambling

Ø Hypertension Ø Insomnia Ø Gastrointestinal complaints Ø Cardiac Arrest Ø Sustained stress (increase salivary cortisol, immune system changes, elevated heart rate, higher levels of epinephrine and norepinephrine in metabolites)

Effects on the family

Ø Problem and Pathological Gambling may include damaging behaviors to loved ones; Ø Domestic violence Ø. Child abuse Ø Child neglect Ø High rate of divorce Ø Poor mental and physical health of family members

According Nicholas Carr (lecture), why has smart phone-cell phone use taken off and become so difficult to manage? S.10-12

• "The smartphone, through its small size, ease of use, proliferation of free or cheap apps, and constant connectivity, changes our relationship with computers in a way that goes well beyond what we experienced with laptops," • That's because people keep their smartphones near them from the moment they wake up until the moment they go to bed, and throughout that time the devices provide an almost continuous stream of messages and alerts as well as easy access to a myriad of compelling information sources. • The smart phone creates an environment of almost constant interruptions and distractions. The smartphone, more than any other gadget, steals from us the opportunity to maintain our attention, to engage in contemplation and reflection, or even to be alone with our thoughts." • While the average user checks his or her smartphone 35 times a day -- for about 30 seconds each time, when the information rewards are greater (e.g., having contact info linked to the contact's whereabouts), users check even more often. (NOT FROM CARR)

Common Characteristics Shared by all Addictive Behaviors (DiClemente) s. 5

• 1. They represent habitual patterns of intentional, appetitive behaviors; • 2. They can become excessive and produce serious consequences; • 3. There is stability of these problematic behavior patterns over time; • 4. There are interrelated psychological and physiological components to the behavior; • 5. In every case, individuals who become addicted to these behaviors have difficulty stopping or modifying them.

Strategies for reducing cell phone use s.14-17

• 1. Track your cellphone use. The more you keep track of the time you spend messaging or talking on your cellphone, the better you'll be able to control it. Jot down in a notepad when you're talking, messaging, or conducting other activities on the phone. Keep the journal for a week's time, then review the amounts of time you're spending on each activity. • 2. Start the weaning. Take it slow and start with the least important activity you use your phone for. Commit to reducing the time spent on that phone activity just 10% the first week. Try to cut things short sooner rather than later. • 3. Commit to being in the moment. Commit to turning the cell phone off, or at least putting it away out of sight, when engaged in a face-to-face conversation with another person. • 4. You don't need that kind of connection. So many people spend so much time on their cellphones because they believe it is a necessary part of their connections with others, or with their ability to be reached and respond instantly to any and all kinds of communications. For what purpose? • 5. You're not as important as you think you are. Some people check email via their cell phone incessantly because they believe something so important might come up it requires their immediate attention. • 6. Turn it off. Yes, that's right. Turn it off. There's nothing you need to do in the middle of the night that the cell phone will alert you to that won't be there in the morning. Turning it off and putting it away gives you conscious control of this little piece of technology...and of your life. • 7. Technology works for us, not the other way around. If technology is taking control of your life — creating stress, anxiety, arguments with other people in your life, or financial hardships — then you have a backwards relationship with technology. • 8. Create Boundaries. Put your phone on silent. Stop alert notifications. Why do you need a notification to let you know someone "liked" your Facebook picture? Designate a time to check in and stick to it • 9. Out of sight out of mind. During family time or hanging out with friends, put your cell phone someplace where you won't hear or see it. • 10. DON'T sleep with your phone. The old excuse that "it's my alarm clock" just won't do. Buy an alarm clock - and store the phone somewhere else besides your nightstand or bed.Cell phone addiction doesn't have to ruin your life, your work, or your relationships with others. If these tips still don't help, it might be a sign that cell phone addiction is more of an issue in your life than you realized.

Prevalence of gambling

• A lifetime prevalence of problem gambling is estimated to range between 0.4% and 3.4% of adults in this country. • Adults: 1.6% • Adolescents 4.6% • Convicted Felons: 14.23% • Rates higher for adults with diagnosed psychiatric illness including SUDs

Obesity Statistics- who is obese? S. 34

• A person is considered obese when his or her body mass index (BMI) is over 30 or weight is 20 percent or more above normal weight. "Morbid obesity" refers to being more than 100 pounds over normal weight or having a BMI of 40 or greater. -Obesity is a disease that affects an estimated 34 percent of adults age 20 and over in the United States. - This amounts to more than 72 million people.About 32.2 percent of American men and · About 35.5 percent of American women are obese · The number of overweight and obese Americans has increased almost continuously since 1960. About 68 percent of U.S. adults were estimated to be either overweight or obese by the 2007-2008 National Health and Nutrition Examination Survey

Cybersex data s. 37, 38

• Actual numbers of individuals engaged in internet cybersex is unknown. Difficult to measure. • Majority do not appear to experience adverse consequences. • 6-10% of Internet users report being concerned about possible adverse consequences due to on-line sexual activities. • Studies indicate 1% of surfers report their capacity to function in day-to-day activities is impaired. • Spend endless hours daily surfing sex sites, masturbating to sexual images, engaging in mutual on-line sex.

Similarities between eating disorders and substance use disorders s.39

• Addictions and eating disorders share many common clinical features: • Cravings • Cognitive Dysfunction • Use to relieve negative affect: anxiety or depression. • Secretiveness about the problematic behavior • Social isolation • Maintenance of the problem behavior despite adverse consequences. • Denial of the presence or severity of the disorder. • Depression. • Experience of a transition where the behavior (food or substance) no longer relieves negative affect but now creates the feelings they were originally used to allay. Presence of identical or similar changes and function of brain neurotransmitter reward/pleasure system pathways

Cybersex pros

• Affordable • Accessible • Anonymous • Safe

Differentiating Sex addiction from healthy sex life s.17

• Are there aspects of sexual behavior that are hidden or kept secret, leading to a "double life?" • Is the behavior used in a exploitive manner? • Is the behavior palliative to painful emotions? • Is the person having difficulty with truly intimate relationships?

View of Alcohol Use during time of Revolutionary War

• Before American Revolution - People drank more alcohol than water - Drunkenness was viewed as misuse of positive product After American Revolution - Alcohol itself viewed as the cause of serious problems, an active agent of evil (temperance movement) - Alcohol was first psychoactive substance to become demonized in American culture

Binge eating disorder

• Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control. Someone with binge eating disorder may eat too quickly, even when he or she is not hungry. (APA) • It's important to differentiate binge eating disorder from simple over-eating. Over-eating happens only occasionally, and isn't accompanied by the overwhelming feelings — often experienced non-stop — of guilt, shame, and embarrassment that someone with binge eating disorder experiences. (APA • People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

BBGS

• Brief Biosocial Gambling Screen (BBGS) • Brief screens can help people decide whether to seek formal evaluation of their gambling behavior. • The 3-item BBGS is based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for pathological gambling. • BBGS directions: • Please indicate how you feel right now about your gambling by clicking below the statement that best describes your feelings. • 1, During the past 12 months, have you become restless, irritable or anxious when trying to stop/cut down on gambling? Yes No • 2. During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled? Yes No • 3. During the past 12 months, did you have such financial trouble that you had to get help from family or friends? Yes No

Physiological effects. What happens when a person ingests cannabis?

• Cardiovascular effects • Increased heart rate occurs after smoking marijuana and ingesting oral THC • Time course differs substantially following the two different methods of administration • Research findings on the effects of cannabinoids on blood pressure have been mixed • Cardiovascular risks of marijuana use haven't been shown in young, healthy users • People with cardiovascular disease should probably avoid marijuana and oral THC due to effects on heart rate

Similarities of Sex Addiction with Substance Use Disorders s.6,7,8

• Characteristic course: Sexual "addiction" as a disorder typically begins in adolescence or early adulthood and follows a chronic course with remissions and exacerbations • Continuing the behavior despite harmful consequences • Engaging in more of the behavior and eliminating other healthier behaviors from experience • Craving, excitement, preoccupation during preparatory activity. • Mood altering effects of the behavior • Sense of loss of control • Progressive development of the behavior • Tolerance. As behavior increases and is repeated, its ability to produce reinforcing effects is diminished • Withdrawal. Psychological and physical discomfort when behavior is discontinued. • Tendency to relapse after the behavior has been discontinued or control of behavior has been achieved • Neglect of other areas of life; relationships, hobbies, work...

Causes of concern: acute and chronic toxicity

• Cocaine use during pregnancy • Increased risk of miscarriage and torn placenta • Long-term effects of prenatal cocaine exposure still under study

Signs of abuse and dependence

• Complaining of vague symptoms to get more medication • Lack of interest in treatment options other than medications • Mood swings • Seeing several doctors and/or pharmacies to get more pills • Past history of drug addiction • On and off relief from anxiety • Using more than the recommended dose or dosage frequency of the medication Using prescription pills prescribed for others

Cybersex s 33

• Cybersex has been called the crack cocaine of sexual addiction. This is due to the relative immediate fix the person experiences when engaged in on-line sexual behavior. • Non-sex addicts may visit pornography sites on an occasional basis and not become sex addicts. However, persons already addicted to sexual behavior and persons who are vulnerable to the addictive process may quickly get hooked.

decriminalization

• Decriminalization means "to reduce or abolish criminal penalties for." Theoretically, decriminalization could mean legalization (and is preferred by some drug policy reformers), except for the "reduce" option. S,11 • Decriminalization is sometimes used to describe contradictory legal situations where marijuana, for example, is legal to possess and use, but not to acquire -- this is a partial legalization that leaves intact certain aspects of prohibition's side-effect (see below). Because of these confusions, for the purpose of this guide, we go with criminalized and legalized. • Decriminalization is the removal of criminal penalties for drug law violations (usually possession for personal use). S.7 • Roughly two dozen countries, and dozens of U.S. cities and states, have taken steps toward decriminalization. Thegoal of this is to shift resources and invest in treatment and harm reduction servicestherebyreducing the harms of drug misuse while improving public safety and health

symptoms of binge eating disorder

• Eating unusually large amounts of food in a specific amount of time • Eating even when you're full or not hungry • Eating fast during binge episodes • Eating until you're uncomfortably full • Eating alone or in secret to avoid embarrassment • Feeling distressed, ashamed, or guilty about your eating • Frequently dieting, possibly without weight loss

Social and public health costs of gambling

• Estimates of the amount of money spent on gambling in the U.S. rose from $17.4 billion in 1974 to $ 860 billion in 2001. • The costs attributed to problem gambling and pathological gambling have been estimated in the 1990's to be 5 billion annually.

Etiology of Sex addiction & Progression s. 19, 20

• Etiology unknown. • Estimated to afflict between 3-6% of Americans. • More frequently seen in men than women • Reports range between 3 to 1 and 4-1 • Usually begins in adolescence during hormonal changes and psychological challenge of consolidating a sexual identity that are normal parts of an individuals development. • The mastery of these adolescent challenges is altered in the sex addicts development. Progression: • The problem heightens during the ages of 20-40 when the disorder becomes full blown and often affects the person's life in negative ways. • Some research suggests the problem intensity diminishes after age 40. • Some research suggests that while the intensity diminishes, the fantasy and preoccupation with sex continues.

Teen cybersex s 40

• Excessive internet sexual behavior may lead to social isolation, unhealthy sexual attitudes and future partner expectations, loneliness, depression, risk of being "tracked" by cybersex pedophile predators • May model what they believe relationships should be, resemble, or satisfy when it is unrealistic

Types of eating disorders/disordered eating (definition and description) (not DSM criteria)

• Food is a substance used both repetitively and destructively by either its prolonged restriction or episodic overconsumption •. Anorexia Nervosa • Bulimia Nervosa • Binge Eating Disorder s. 27-29

Smoking and health in other countries

• Four to Five million deaths worldwide each year • Perhaps as high as 8 million by 2030 • Third World demand for American cigarettes has increased markedly • Asian countries also experiencing increased demand for American cigarettes

Common causes of obesity s. 37

• Genetics. Obesity can often be traced to genes, and the brain can induce appetite tendencies. • Illness. Hypothyroidism, Cushing Syndrome and depression. • Psychological State. Mental illness and emotional problems. • Lifestyle habits. Poor diet and low levels of daily activity.

Cons to making internet addiction a DSM diagnosis

• Genuine physiological withdrawal and tolerance have not been demonstrated in controlled studies of IA. Impairments in social and vocational realms are probably due to underlying disorders, such as depression or OCD. • This claim is based on a single case report. Large-scale, randomized, controlled studies using PET and other neuroimaging techniques are needed before IA may be assimilated into the realm of addictive disorders based on pathophysiology • Not enough research done • By classifying IA as a "disorder," we will pathologize what is probably a developmentally "normal" (even if disapproved of) behavior, further expanding an already mushrooming catalogue of supposed "disorders." This will further undermine the public's trust in psychiatric diagnosis. Receiving a diagnosis of IA will increase, not decrease, unnecessary barriers, stereotypes, and discrimination. • IA symptoms should be subsumed under existing DSM categories, such as OCD or various impulse control disorders. Creating a separate category for IA will open the door to all kinds of new "disease" categories, as new technologies develop (e.g., iPhone addiction, holograph addiction, virtual reality addiction). KEY: IA—internet addition; DSM-V—The Diagnostic and Statistical Manual. If such research fails to support IA as a discrete disorder, it can be dropped from the revised DSM-V.

Populations that seem most vulnerable to prescription drug abuse and addiction

• Individuals of all ages abuse prescription drugs--data reported in the National Household Survey on Drug Abuse indicate that an estimated 36 million U.S. residents aged 12 and older abused prescription drugs at least once in their lifetime. • The survey also revealed that millions of teenagers and young adults abuse prescription drugs--2.7 million individuals aged 12 to 17 and 6.9 million individuals aged 18 to 25 abused prescription drugs at least once. • Prescription drug abuse among high school students is a particular concern. • According to the University of Michigan's Monitoring the Future Survey, more than: • 10 percent of high school seniors in the United States abused narcotics (other than heroin) at least once in their lifetime. • Nearly 17 percent abused amphetamines (a type of stimulant). • 10 percent abused barbiturates. 11 percent abused tranquilizers at least once.

History of Opioids: Typical addict in the 19th century. S46

• Initially, opioid dependence was not viewed as a major social problem. • Opium smoking was limited to certain groups •. Patent medicines were socially acceptable • Opioid dependence was viewed as a "vice of middle life" Typical user was a30-to-50-year-old middle class white woman, wife, and mother

Restart program: s. 33-35

• Internet Addiction Recovery Program in Fall City, Washington. The reSTART program is an inpatient Internet addiction recovery program which integrates technology detoxification (no technology for 45 to 90 days) which includes an individualized, holistic approach • drug and alcohol treatment • 12 step work, cognitive behavioral therapy (CBT) • experiential adventure based therapy • Acceptance and Commitment therapy (ACT) • brain enhancing interventions, animal assisted therapy • motivational interviewing (MI) • mindfulness based relapse prevention (MBRP) • Mindfulness based stress reduction (MBSR) • interpersonal group psychotherapy, individual psychotherapy • individualized treatments for co-occurring disorders, psycho- educational groups (life visioning addiction education, communication and assertiveness training, social skills, life skills, Life balance plan), • aftercare treatments (monitoring of technology use, ongoing psychotherapy and group work), and continuing care (outpatient treatment)

Cocaine estimated number of users vs. addicts

• It is estimated that about two million people are cocaine addicts in the United States, and that between 22 and 25 million people have used cocaine at least once.

legalization

• Legalization: A status where responsible adults may legally acquire, possess, and use a particular drug, although there may be restrictions on time, place and manner. • Legal does not mean unregulated. Supporters of legalization call for some regulation and control: (FDA) • Legalization of drugs is fully compatible with regulatory efforts restricting access to children, • forbidding use while driving or while working in safety-sensitive jobs, • banning use in certain locations or situations, • controlling the means for manufacture and distribution (including taxation and labeling), • creating standards for purity and potency.

Epidemiology of eating disorders

• Life-time prevalence rate of BED for women is 3.5% • Life-time prevalence rate of BED for men is 2.0%. • The prevalence of BED is even higher among obese and in those seeking bariatric surgery or other weight loss interventions.

Classification of Cannabis; (s0-31)

• Marijuana is a preparation of leafy material from the Cannabis plant that is smoked - Schedule 1 • - Marijuana is classified separately because its effects are varied and complex • Sedation • Pain relief • Hallucinations (in large doses)

Early use of Methamphetamines s39

• Methamphetamine hydrochloride crystals •. Ice or crystal meth •. Smokable • Methamphetamine abuse began in the western United States and then spread east; it is also now considered a "club drug" • Amphetamines were used in WWII to fight fatigue and later used to treat depression

Demographics of eating disorders s.31

• Most commonly developed in adolescence and young adulthood. • Can occur at any point in life. • Peak age of onset for AN is 13-17 • Peak age of onset for BN is late adolescence through young adulthood. • The development of BED develops in young to middle adulthood

Heroin withdrawal symptoms

• Not all users experience euphoria from initial dose • Tolerance to negative effects may develop more rapidly than tolerance to positive effects • Withdrawal is often similar to a mild case of the intestinal flu • People usually don't become dependent after one dose • Three to four injections needed daily to prevent withdrawal • Expensive habit (cost of drugs and paraphernalia) • Risk of overdose due to variable potency of different batches • Health problems associated with injection habit • Skin infections • Blood-borne infections • Masking of early symptoms of illness Some users "mature out"

medical uses of opioids

• Pain relief • Reduces the emotional response to pain and diminishes the patient's awareness of, and response to, the aversive stimulus • Typically causes drowsiness but does not induce sleep • Treatment of intestinal disorders • Reduces colic and counteracts diarrhea and the resulting dehydration • Cough suppressant •. Codeine has long been used to reduce coughing • It remains available in prescription cough medications

Prescription drug abuse definition

• Prescription drug abuse means taking a prescription medication that is not prescribed for you, or taking it for reasons or in dosages other than as prescribed. - Abuse of prescription drugs can produce serious health effects, including addiction

Why people don't take prescription drug abuse as seriously as illicit drug abuse? S.12

• Prescription drug addiction is a growing problem that many people don't take as seriously as they should. • Since the medications were originally prescribed by a doctor, they feel that prescription drug abuse is different than when the person is using street drugs. Prescription drug addicts are addicted, in the same way than those who get hooked on cocaine, heroin, or other types of illegal drugs are addicted. • Comes from a doctor, is regulated

Causes of prescription drug dependence

• Prescription medications are drugs and they work on the user's brain in the same way their illegal counterparts do. • When a person who is addicted to prescription drugs uses them, the medication changes the brain's chemistry, making it less effective at producing chemicals like dopamine or endorphins. • Since the brain has stopped producing these chemicals itself, they must be introduced through another source. At this point, the prescription drug addict has become physically dependent on the medication • Seniors are especially at risk for prescription drug addictions, simply because they are prescribed drugs more often that other groups. • For example, a doctor may prescribe a tranquilizer after they have experienced a traumatic event, such as the death of their spouse. • The person feels calmer and is able to sleep better with the medication, so they take it more often than the doctor directs. When they run out, they go back to the doctor for another prescription, and this is how the addiction starts.

Prohibition and Criminalizaation: s.2-4

• Prohibition: The combined efforts by government and others to enforce and promote criminalization. • Criminalization: A status where the manufacture, distribution, and/or possession of a particular drug is results in criminal penalties if caught (felony or misdemeanor charges, jail, fines, probation, criminal record), regardless of time, place, or manner. - Prohibition depends on three primary techniques: Stopping the availability of drugs(interdiction • Stopping the availability of drugs (interdiction, eradication) • Using criminal penalties as a deterrent • Arresting dealers/users

Pros to decriminalization of drugs

• Reducing the number of people arrested; • Reducing the number of people incarcerated;(fewer arrests, fewer incarceration, resources go from law enforcement to health system, focus on other policing issues) • Increasing uptake into drug treatment; • Reducing criminal justice costs and redirecting resources from criminal justice to health systems; • Redirecting law enforcement resources to prevent serious and violent crime • Diminishing unjust racial disparities in drug law enforcement and sentencing, incarceration and related health characteristics and outcomes. • Minimizing the social exclusion of people who usedrugs and creating a climate in which they are less fearful of seeking and accessing treatment, utilizing harm reduction services and receiving HIV/AIDS services. • Improving relations between law enforcement and the community. • Protecting people from the wide-ranging and debilitating consequences of a criminal convictions

Jon Grant: Characteristics that Substances share with other Addictive Behaviors

• Repetitive and compulsive engagement in a behavior despite adverse consequences • Diminished control over problematic behavior • Appetitive urge or craving state prior to engagement in problematic behavior • Hedonic quality during the performance of the problematic behavior

Demographics of gambling

• Sex, age and race appear to influence gambling behaviors. • Men are 2Xs more likely to develop problem gambling than women. • Women suffer from more physical and mental health complications at the same level of severity of disordered gambling. • Among teenagers boys to girls, the ratio of problem gambling is estimated between 3:1 and 5:1 • Boys gamble more frequently and wager larger amounts, begin at an earlier age, and more often prefer skill-based games. • African Americans are disproportionately represented in populations of disordered gamblers

Differences of sex addiction and pornography addiction s. 4

• Source of excitement • Focus of time, resources Ø Pornography as a subset of sex addiction.

What do stimulants do? Why do people use them?

• Stimulants are substances that keep a person going mentally and physically • Cocaine and amphetamines are restricted stimulants • Caffeine and nicotine are readily available stimulants

Caffeine Pharmacology Effects

• Stimulation - Caffeine partially offsets the effects of fatigue on both mental and physical tasks, but it may not improve performance in well-rested individuals - High caffeine consumption among college students is associated with lower academic performance • Headache treatment: Helps relieve both migraine and non-migraine headaches • Hyperactivity treatment: High doses may decrease hyperactivity • Sobering up? - Caffeine does not lower blood alcohol concentration and will not help a person sober up

Why patients typically present for treatment s.18

• Strong tendency to compartmentalize the behavior or dissociate themselves from the behavior. • Present for treatment because of threat of : • divorce, • job loss due to spending time on-line at sex sites or sexual harassment • confrontations with the legal system

Considerations about sex addiction: s. 16

• The diagnosis of sex addiction is complicated by the reality that many patients are usually not forthcoming about their behavior. • Feelings of shame persist, creating defensiveness and denial. • Patients minimize impact of behaviors on others and selves. • Patients engage in denial, preferring to see themselves as having a strong sex drive instead of a sex addiction.

Adverse health effects of smoking tabacco s.35

• The leading cause of preventable death among Americans • Lung cancer (see top right) • Cardiovascular disease • Chronic obstructive lung diseases, including emphysema (see bottom right) • Risk increases for those who start young, smoke many cigarettes, and continue to smoke for a long time • Smoking is the single greatest avoidable cause of death - Increased risk of miscarriage, low birth weight, and SIDS • Later effects on physical and intellectual development • Neurological problems, problems with certain reading and mathematical skills, and hyperactivity • Effects are of the same type and magnitude as those reported for "crack babies," and many more pregnant women smoke than use cocaine

PUEM s.24,25

• The term pathological use of electronic media (PUEM) is less emotionally "loaded" and more encompassing than internet addiction. • "PUEM would permit incorporation of problems related to new electronic technologies without endlessly multiplying psychiatric diagnoses. At present, PUEM should not be considered a discrete diagnosis. However, in my view, a detailed description of PUEM should be added to the DSM-V appendix, as a "condition for further study." • There may also be several places within the text of DSM-V to indicate that PUEM is indeed a maladaptive and potentially harmful condition, perhaps best understood as an impulse control disorder with a prominent affective component. • In the mean time, PUEM-type symptoms, including those corresponding to IA, could be categorized under the current DSM-IV category of "impulse-control disorder not otherwise specified (NOS)" (312.30).

genetics s. 38

• There is evidence that there can be a genetic predisposition to internet addictive behaviors: • The theory is that individuals with this predisposition are thought to not have an adequate number of dopamine receptors or have an insufficient amount of serotonin/dopamine, thereby having difficulty experiencing normal levels of pleasure in activities that most people would find rewarding. • To increase pleasure, these individuals are more likely to seek greater than average engagement in behaviors that stimulate an increase in dopamine, effectively giving them more reward but placing them at higher risk for addiction.

Causes of concern for caffeine

• There is no clear evidence that moderate caffeine consumption is dangerous • Cancer: Caffeine is not a risk factor in human cancer • Reproductive effects: - High consumption of caffeine reduces a woman's chances of becoming pregnant and slows the growth of the fetus - Research is mixed on whether caffeine increases the risk of miscarriage • Heart disease: High intake of caffeine may increase the risk of heart attack, particularly in people with other risk factors • Caffeinism (excessive use of caffeine) - Toxicity is relatively low - It would require about 100 cups of coffee to receive a fatal dose from oral caffeine Unpleasant symptoms do occur: (Nervousness Irritability Tremors Muscle twitching Insomnia flushed appearance)

History of Opioids: patterns of abuse

• Three types of opioid dependence developed in the U.S. in the second half of the 19th century • Oral intake increased as patent medicines spread. • Opium smoking increased after 1850, as Chinese laborers arrived in the U.S. • Injection of morphine—the most dangerous form of use. • Number and proportion of Americans dependent on opioids peaked at the start of the 20th century • Possibly as high as 1 percent of the population • Drugs purchased legally in patent medicines. • High drugs levels in patent medicines meant that withdrawal symptoms were severe and relieved only by taking more

Informal treatment strategies for Internet Addiction s.36

• Treatment strategies which are already known from the cognitive-behavioral approach: 1. practice opposite time of Internet use (identify patterns of Internet use and disrupt these patterns by suggesting new schedules) 2. use external stoppers (real events or activities prompting the patient to log off) 3. set goals (with regard to the amount of time) 4. abstain from a particular application (that your are unable to control), 5. use reminder cards (cues that remind the patient of the costs of IAD and benefits of breaking it) 6. develop a personal inventory (shows all the activities that the you used to engage in or can't find the time due to IAD) 7. enter a support group (compensates for a lack of social support) 8. engage in family therapy (addresses relational problems in the family).

Cons of decriminalization of drugs

• decriminalize doesn't get rid of drug dealers or drugs coming in • individuals with a biological predisposition toward addiction may more likely experiment with drugs if they do not fear legal prosecution • may lead to more drugs on the street, prices will fall and more people will be tempted

pros of legalization of drugs

• drug use continues. Not everyone automatically becomes an addict • the budgetary impact of ending the war on drugs • the ability of addicts to seek treatment without risking jail time • the end of the corruption of some on the police force produced by the war on drugs • a reduction in the scope and source of income for organized-crime organizations • the positive impact on the criminal-justice system • a transformation of the outlook of cities • reduction in incarceration • the end of an illegal market whose violence spills far beyond our borders • an expansion of personal freedom • s.17 Analogy to Gasoline Video: Legalize All Drugs: free society let people cosume whatever they want to do (freedom) -trying to discourage of use of drugs we lead worse outcomes and costs -consequences: we don't eliminate drug market-goes underground which is unsafe and violent, terrorists profit by selling their protection services to drug traffickers - Fully legal markets would be like alcohol or caffeine (some abuse most don't) - Restrictions (age, using while driving) Consumption may increase but lots of evidence does not support it will

Stimulants

• for ADHD and narcolepsy). stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulants taken repeatedly or in high doses, can cause anxiety, paranoia, dangerously high body temperatures, irregular heartbeat, or seizures • Dextroamphetamine (Dexedrine®), Methylphenidate (Ritalin® and Concerta®), Amphetamines (Adderall®)

Central nervous system depressants

• for anxiety and sleep disorders), Central nervous system depressants slow down brain function; if combined with other medications that cause drowsiness or with alcohol, heart rate and respiration can slow down dangerously. • sometimes referred to as sedatives and tranquilizers, are substances that can slow brain activity. This property makes them useful for treating anxiety and sleep disorders • Central nervous system depressants include barbiturates such as pentobarbital sodium (Nembutal®), and benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax®). And non-benzodiazepines such as Ambien and Lunesta

Term "Iatrogenic"

• induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures (doctor induced)

Opioids

• opioids (for pain), Opioids can produce drowsiness, constipation and, depending on amount taken, can depress breathing. • Opioids include hydrocodone (Vicodin®), oxycodone (OxyContin®), propoxyphene (Darvon®), hydromorphone (Dilaudid®), meperidine (Demerol®), and diphenoxylate (Lomotil®). • Opiods vs. opiates (s.9)