Chapter 11 Substance-Related Disorder custom study set

Quiz Chapter 11 Substance-Related Disorders In most U.S. states, a person is considered legally intoxicated for driving when the concentration of alcohol in the bloodstream reaches ________.

0.08

Treatment of Nicotine Withdrawal

Available programs use many different methods including social support groups; various pharmacological agents that replace cigarette consumption with safer forms of nicotine such as candy, gum, or patches; self-directed change that involves giving individuals guidance in changing their own behaviors; and professional treatment using psychological procedures such as behavioral or cognitive-behavioral interventions

Men vs Women in alcohol dependence

Men drinks five times more than women

Quiz 11.6 Stimulants ________ may have an anti-anxiety property; its use has been noted to be highly prevalent among those with anxiety disorders.

Nicotine

Psychosocial Causal Factors in Alcohol Abuse and Dependence

Not only do people who abuse alcohol become physiologically dependent on it, they develop a powerful psychological dependence as well—they become socially dependent on the drug to help them enjoy social situations.

Since the passage of the Controlled Substance Act of 1970, amphetamines have been classified as a __________ drug, which means _____________.

Schedule II; these drugs have a high abuse potential and require a prescription for each purchase

Cocaine

Stimulating and pain-reducing psychoactive drug

Synthetic Cannabinoids

Substances that mimic the effects of THC.

hallucinogens drugs

The major drugs in this category are LSD (lysergic acid diethylamide) or "acid," mescaline, psilocybin, Ecstasy, and marijuana.

Nicotine and general population

The use of tobacco is a significant problem in the general population. The number of Americans ages 12 and older who use some form of tobacco is estimated at 70.9 million people, or about 28.4 percent of the population (SAMHSA, 2009). However, an estimated 63 percent of women and 53 percent of men have never smoked (Pleis et al., 2009). The DSM-5 contains a diagnostic category for nicotine abuse. The criteria for tobacco use disorder are the same for other addictive disorders.

tobacco quit success

They average only about a 20 to 25 percent success rate,

Morphine

addictive drug derived from opium that can serve as a powerful sedative and pain reliever

Genetic Vulnerability

heredity plays an important role Adoption studies also provide evidence for a genetic vulnerability for alcohol problems. twice as likely to have alcohol problems by their late 20s

The number of pathological gamblers in the United States has been

increasing

study prealcoholic personalities

individuals who are at high risk for substance abuse but who are not yet affected by alcohol An alcohol-risk personality has been described as an individual who has an inherited predisposition toward alcohol abuse and who is impulsive, prefers taking high risks, and is emotionally unstable. (BPD?)

Compared to opiate withdrawal, barbiturate withdrawal

is more dangerous, severe, and long-lasting.

A short-range effect associated with marijuana use is

memory dysfunction and a slowing of information processing.

The ___________ is central to the release of the neurotransmitter dopamine and in mediating the rewarding properties of drugs.

mesocoricolimbic pathway

Genetic Influences and Learning

peer pressure, parental example, and advertising The development of alcohol-related problems involves living in an environment that promotes initial as well as continuing use of the substance. People become conditioned to stimuli and tend to respond in particular ways as a result of learning. Learning appears to play an important part in the development of substance abuse and antisocial personality disorders.

Quiz 11.8 Hallucinogens A group of substances that mimic the effects of amphetamines and cocaine by activating the body's monoamine system are known as

synthetic cathinones.

With aversive conditioning therapy,

the patient experiences the presentation of a wide range of noxious stimuli paired with alcohol consumption in order to suppress drinking behavior.

Tolerance for barbiturates follows a different pattern than opiate tolerance in that

tolerance for barbiturates does not increase the amount of drug needed to cause death.

Treatments and Outcomes

treatment focuses on helping the person make an adequate adjustment to his or her community and abstain from the further use of opiates

According to SAMHSA, how many Americans aged 12 years or older report using at least one illicit drug during the past year?

21.6 million

According to the Monitoring the Future Study, the annual prevalence rate of using any illicit drug is ______ for 12th graders.

37 percent

Ecstasy MDMA (3,4-methylenedioxymethylamphetamine)

A human manufactured drug that is taken orally and acts as both a stimulant and a hallucinogen. The drug effects include feelings of mental stimulation, emotional warmth, enhance sensory perception, and increased physical energy. is both a hallucinogen and a stimulant that is popular as a party drug among young adults

Sociocultural Causal Factors

Alcohol is often seen as a "social lubricant" or tension reducer that enhances social events

Psychological Treatment Approaches

Although individual psychotherapy is sometimes effective, the focus of psychosocial measures in the treatment of alcohol-related problems often involves group therapy, environmental intervention, behavior therapy, and the approach used by Alcoholics Anonymous and family groups such as Al-Anon and Alateen.

Behavioral and Cognitive-Behavioral Therapy

An interesting and often effective form of treatment for alcohol-related disorders is behavioral therapy One is aversive conditioning therapy, which involves the presentation of a wide range of noxious stimuli with alcohol consumption in order to suppress drinking behavior. This approach combines cognitive-behavioral strategies of intervention with social-learning theory and modeling of behavior. The approach, often referred to as a "skills training procedure," is usually aimed at younger problem drinkers who are considered to be at risk for developing more severe drinking problems because of an alcohol abuse history in their family or their current heavy consumption Self-control training techniques, such as the BMI procedure noted earlier, in which the goal of therapy is to get alcoholics to reduce alcohol intake without necessarily abstaining altogether, have a great deal of appeal for some drinkers. one approach to improve drinking outcomes by altering the drinker's social networks was found to be successful (Litt et al., 2007), and motivational interviewing with adolescents was found to be promising in decreasing substance use (Macgowan & Engle, 2010)

History of Marijuana

Ancient history by Chinese Emperor Shen nung written about 2737 B.C.E ] Today, marijuana is the most frequently used illicit drug. In the United States, 7.5 percent of those 12 years and older report having used marijuana in the past month

Ecstasy used by among college students and young adults

As party enhancement or "rave" drug at dances.

Effects of Barbiturates

Barbiturates were once widely used by physicians to calm patients and induce sleep depressants Shortly after taking a barbiturate, or "downer," an individual experiences a feeling of relaxation in which tensions seem to disappear, followed by a physical and intellectual lassitude and a tendency toward drowsiness and sleep—the intensity of such feelings depends on the type and amount of barbiturate taken

Use of Medications in Treating Alcohol Abuse and Dependency

Biological approaches include a variety of treatment measures such as medications to reduce cravings, to ease the detoxification process, and to treat co-occurring health (National Institutes of Health, 2001) and mental health problems that may underlie the drinking behavior.

___________ is a drug used in the treatment of heroin addiction. It is a partial antagonist drug that produces the same feeling of contentment found in heroin but without the physical dependence found with heroin use.

Buprenorphine

Caffeine and Nicotine Two Legal available and widely used substances

Caffeine: a drug of dependence found in many commonly available drinks and food Nicotine: Addictive alkaloid that is the chief active ingredient in tobacco and a drug of dependence.

mesocorticolimbic dopamine pathway (MCLP)

Center of psychoactive drug activation in the brain. This area is involved in the release of dopamine and in mediating the rewarding properties of drugs. located middle area of the brain; ventral tegmental area involving control of emotions, memory, and gratification

Psychosocial Effects of Alcohol Abuse and Dependence

Chronic fatigue, oversensitivity, and depression Becomes counterproductive, impaired reasoning and judgement and gradual personality deterioration. Less responsibility, loses pride in personal appearance, neglects spouse and family, and becomes irritable and unwilling to discuss the problem. can lead to unable to hold a job. loss of employment and marital breakup. brain and liver damage can occur. memory and problem solving is affected

How does cocaine affect the brain?

Cocaine blocks the presynaptic dopamine transporter, thus increasing the availability of dopamine in the synapse and increasing the activation of the receiving cells.

Expectations of Social Success

Cognitive expectation of their peers Adolescents begin drinking as results of expectations that using alcohol will increase their popularity and acceptance by their peers.

Medications to Block the Desire to Drink

Disulfiram (Antabuse), a drug that causes violent vomiting when followed by ingestion of alcohol, may be administered to prevent an immediate return to drinking However, such deterrent therapy is seldom advocated as the sole approach because an alcohol-dependent person may simply discontinue the use of Antabuse when he or she is released from a hospital or clinic and begins to drink again Moreover, the cost of Antabuse treatment, which requires careful medical maintenance, is higher than that for many other, more effective treatments. naltrexone, an opiate antagonist that helps reduce the craving for alcohol by blocking the pleasure-producing effects of alcohol, and acamprosate, a drug whose properties are still being studied

Amphetamines

Drug that produces a psychologically stimulating and energizing effect

_________ is considered both a hallucinogen and a stimulant.

Ecstasy

Environmental Intervention

Environmental support has been shown to be an important ingredient of an alcohol abuser's recovery. People often become estranged from family and friends because of their drinking and either lose or jeopardize their jobs. As a result, they are often lonely and live in impoverished neighborhoods. For those who have been hospitalized, halfway houses—designed to assist them in their return to family and community—are often important adjuncts to their total treatment program.

The Clinical Picture of Alcohol-Related Disorders

For instance, alcohol consumption decreases behavioral inhibition, impairs learning and memory, and negatively impacts judgment, decision making, and motor coordination.

alcohol amnestic disorder

Formerly known as Korsakoff's syndrome, is a condition characterized by a persisting memory deficit (particularly with regard to recent events) that is sometimes accompanied by falsification of events. This disorder is caused by malnutrition, lack of vitamin B (thiamine). Primary symptoms is memory defect Results from malnutrition.

Gambling takes in many forms

Gambling in our society takes many forms including casino gambling, betting on horse races or sports (legally or otherwise), Internet gaming, numbers games, lotteries, dice, bingo, and cards.

Group Therapy

Group therapy has been shown to be effective for many clinical problems In other situations, family treatment is itself the central focus of therapeutic efforts. family therapy in such cases involves a delicate balance of educating the drinker about the familial consequences of her or his drinking

Top 10 Alcohol-Related Consequences Among Dutch Students

Hangover 74.3% Less energy or felt tired 63.9% While drinking, i have said or done embarassing things 38% Felt very sick to my stomach or thrown up after drinking 34.1% Ended up drinking on nights when i planned not to drink 29.2% Not gone to work or missed classes at school 28.0% Blackouts 26.8% Taken foolish risks when i have been drinking 24.7% Quality of work or school has suffered because of my drinking 21.7% When drinking, i have done impulsive things i regretted later. 21.4%

illegal in the United States.

However, its value in this capacity was not supported. At present, this drug is considered a "dangerous" drug and is listed in the most restricted category by the U. S. Drug Enforcement Administration (DEA) (Murray, 2001). It is currently available in the United States only through illicit means.

The Physical Effects of Chronic Alcohol Use

In terms of excess drinking, Alcohol is eliminated through breath, urine, and perspiration. Majority of work is done by the liver. Liver may be overworked and eventually suffer irreversible damage. 15 to 30 percent heavy drinkers develop cirrhosis (5 to 6 drinks a day) Alcohol high in calories. Explains the weight gain Heavy drinking can impair the body's ability to utilize nutrients. Increased gastrointestinal symptoms

Withdrawal

Intellectual, emotional, or physical retreat. sweating, tremors, and tension that accompany abstinence from a drug.

mothers who abuse cocaine while pregnant

Many life problems experienced by cocaine abusers result in part from the considerable amounts of money that are required to support their habits. children of crack-using mothers are at risk of being maltreated as infants as well as of losing their mothers during infancy. They found that children who were regularly exposed to cocaine in utero were more likely to be mistreated (23 percent compared with only 4 percent of controls).

Methamphetamine

Methamphetamine, referred to on the streets as "crystal meth" or "ice" because of its appearance, is a highly addictive stimulant drug that can provide an immediate and long-lasting "high." However, it is one of the most dangerous illegal drugs Methamphetamine is a form of amphetamine that can be "cooked" in large quantities in makeshift laboratories (e.g., within peoples' own homes). his drug is relatively cheap to manufacture and is sometimes referred to as "poor people's cocaine." Like cocaine and heroin, it can be ingested in a variety of ways, through smoking, snorting, swallowing, or injecting.

Marijuana

Mild hallucinogenic drug derived from the hemp plant; often smoked in cigarettes called reefers or joints.

11.5 Opium and Its Derivatives Opium

Narcotic drug that leads to physiological dependence and the development of loerance; derivatives are morphine, heroin and codeine

Tolerance

Need for increased amounts of a substance to achieve the desired effects.

Neural Bases for Physiological Addiction

Opiate drugs work by binding to opiate receptors in specific parts of the brain that are involved in the regulation of pleasure, pain, and breathing

Addiction Associated with Psychopathology

Opioid abuse is associated with a dramatically increased risk of other forms of psychopathology, as well as a range of other negative outcomes. More specifically, approximately 70 percent of people who abuse opioids have other psychological diagnoses, 50 percent have other forms of substance abuse, and 36 percent have a history of trauma

Substance-related disorders

Pattern of maladaptive behavior centered on the regular use of a substance, such as a drug or alcohol.

Intoxication phenomenon is "hangover"

Person experiences symptoms of headache, nausea, fatigue and cognitive impairment for 8 to 24 hours after consuming alcohol. May caused by dehydration along with alcohol. Hangover can impairment while driving an automobile

Substance dependence

Severe form of substance use disorder involving physiological dependence on the substance, tolerance, withdrawal, and compulsive drug taking.

Development of Alcohol Dependence

Starts from excessive drinking Can lead to Fetal Alcohol syndrome (FAS) if excessive drinking during pregnancy and results in birth defects such as mental retardation.

Synthetic cathinones aka bath salts

Substances that mimic the effects of amphetamines and cocaine by activating hte body's monoamine system.

Which substance binds with CB1 receptors in the nervous system and can produce marijuana-like intoxication?

Synthetic cannabinoids

Biological Causal Factors in Alcohol Abuse and Dependence

The first is the ability of most, if not all, addictive substances to activate areas of the brain that produce intrinsic pleasure and sometimes immediate, powerful reward The second factor involves the person's biological makeup, or constitution, including his or her genetic inheritance and the environmental influences (learning factors) that enter into the need to seek mind-altering substances to an increasing degree as use continues.

Social Effects of Morphine and Heroin

Typically, the life of a person addicted to opiates becomes increasingly centered on obtaining and using drugs, so the addiction usually leads to socially maladaptive behavior as the individual does whatever he or she can (e.g., lying, stealing) to maintain a supply of drugs. Many addicts resort to petty theft to support their habits, and some turn to prostitution as a means of financing their addictions.

Withdrawal

Withdrawal can, however, be an agonizing experience for some people, with symptoms including runny nose, tearing eyes, perspiration, restlessness, increased respiration rate, and an intensified desire for the drug.

Brief Motivational Intervention is

a therapy that attempts to encourage alcoholics to reduce alcohol intake without necessarily abstaining altogether.

11.4 Drug Abuse and Dependence Review questions Drug abuse and dependence are most common during

adolescence and young adulthood.

A high comorbidity has been noted between pathological gambling and

alcohol abuse and personality disorders.

tobacco withdrawal disorder

as it is called in DSM-5, results from ceasing or reducing the intake of nicotine-containing substances after an individual has developed physical dependence on them (1) the daily use of nicotine for at least several weeks, and (2) the presence of the following symptoms after nicotine ingestion is stopped or reduced: craving for nicotine; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain Several other physical concomitants are associated with withdrawal from nicotine including decreased metabolic rate, headaches, insomnia, tremors, increased coughing, and impairment of performance on tasks requiring attention

heavy episodic drinking

as the consumption of six or more alcoholic drinks on at least one occasion at least once per month

alcoholism

harmful use of alcohol

Methamphetamine operates

increasing the level of dopamine in the brain, but is metabolized more slowly than other drugs such as cocaine and produces a high for a longer period of time Prolonged use of methamphetamine produces structural changes in the brain (Chang, Alicata, et al., 2007), and the severity of psychiatric symptoms associated with the drug is related to the duration of use Moreover, discontinuing the drug after the person has become habituated can result in problems with learning, memory, and cognitive dysfunction (Cretzmeyer et al., 2003; Rothman et al., 2000) and severe mental health problems such as paranoid thinking and hallucinations When the drug wears off or when users "come down from the high," they are likely to feel extremely weak, lethargic, sleepy, and depressed.

11.2 Causal Factors in the Abuse of and Dependence on Alcohol Review questions The alcohol flush response is caused by a(n)

mutant enzyme that fails to break down alcohol molecules in the liver during the metabolic process.

Drugs such as ____________ have been used as part of psychological therapy in treating cocaine dependence as these drugs reduce cravings and increase the likelihood of treatment compliance.

naltrexone and methadone

Failures in parental guidance

negative socialization factors influence alcohol use, replicated findings that alcohol abuse in parents is associated with substance use in adolescent. In addition, stress and negative affect (more prevalent in families with an alcoholic parent) are associated with alcohol use in adolescents (Chassin et al., 1993). Extremely stressful childhood experiences such as physical abuse (Douglas et al., 2010; Kaufman et al., 2007) or child sexual abuse might also make a person vulnerable to later problems.

The Alcoholics Anonymous model believes that ____________, and thus one __________.

one is never cured of alcoholism; is always considered to be "in recovery."

Excessive doses of barbiturate can be lethal because barbiturates

paralyze the brain's respiratory centers.

Recreational use of Ecstasy associated personality

personality characteristics of impulsivity and poor judgment

The Neurobiology of Addiction

pleasure pathway. mesocorticolimbic dopamine pathway (MCLP)

Some detoxification clinics are concerned about the use of tranquilizers during the alcohol detoxification phase of treatment because

tranquilizers do not promote long-term recovery and may simply transfer the addiction to another substance.

nicotine-dependence syndrome

which nearly always begins during the adolescent years and may continue into adult life as a difficult-to-break and health-endangering habit.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that approximately _____ college students drink alcohol and ____ of students who drink engage in binge drinking.

4 out of 5; half

Hashish

Strongest drug derived from the hemp plant; a relative of marijuana that is usually smoked

Methadone

Synthetic narcotic related to heroin; used in the treatment of heroin addiction because it satisfies the craving for heroin without producing serious psychological impairment.

It is suggested that a ____________ in the brain plays a primary role in the 'wanting' or anticipation of reward; however, ______ seems to play a primary role in the 'liking' or consumption of rewarding stimuli.

dopaminergic pathway; the opioid system

When compared to heroin, methadone is

equally addictive in a physiological sense but produces less psychological impairment.

11.2 Causal Factors in the Abuse of and Dependence on Alcohol

genetic and biochemical factors psychosocial factors maladaptive pattern of adjustment to the stress of life sociocultural factors such as the availability of alcohol and social approval of excessive drinking Combination of patterns of biological, psychosocial, and sociocultural causal factors.

Abraham and Wolf (1988) compared subjects who had used LSD 2 years earlier with a matched group of control subjects. Compared to the controls, the subjects with the history of LSD use

had reduced visual sensitivity to light during dark adaptation and showed other visual problems.

The deficits of alcohol amnestic disorder are the result of _________, more specifically, a(n) ____________ deficiency.

malnutrition; thiamine

11.3 Treatment of Alcohol-Related Disorders The drug naltrexone is used to treat alcohol use by

reducing the craving for alcohol by blocking its pleasure-producing effects.

Barbiturates are classified as

sedatives

Content of alcohol in blood stream

0.08 percent, individual is intoxicated. coordination, speech and vision impaired and thought processes confused. judgement is impaired leads to misjudges It is the concentrated content of alcohol not the amount consumed. Effects vary..depends on physical condition and amount of food in their stomach. alcohol users build up tolerance for the drug women metabolize alcohol differently than men.

The Prevalence, Comorbidity, and Demographics of Alcohol Abuse and Dependence

Alcohol is so destructive that it affect the user's lives and family and friends Approximately 13 percent of people in the United States meet DSM criteria for alcohol abuse at some point in their lifetime and about 5 percent meet criteria for alcohol dependence Heavy drinking is associated with vulnerability to injury (Cherpitel, 1997), marital discord (Hornish & Leonard, 2007), and becoming involved in intimate partner violence The life span of the average person with alcohol dependence is about 12 years shorter than that of the average person without this disorder. Alcohol significantly lowers performance on cognitive tasks such as problem solving—and the more complex the task, the more the impairment (Pickworth et al., 1997). Organic impairment, including brain shrinkage, occurs in a high proportion of people with alcohol dependence (Gazdzinski et al., 2005), and alcohol abuse is associated with increased risk of a wide range of other negative health outcomes such as diabetes, stroke, and cardiovascular disease. Alcohol abuse is associated with over 40 percent of the deaths suffered in automobile accidents each year (Chou et al., 2006) and with about 40 to 50 percent of all murders (Bennett & Lehman, 1996), 40 percent of all assaults, and over 50 percent of all rapes (Abbey et al., 2001). About one of every three arrests in the United States is related to alcohol abuse, and over 43 percent of violent encounters with the police involve alcohol (McClelland & Teplin, 2001). Alcohol is more frequently associated with both violent and nonviolent crime than drugs such as marijuana, and people with violence-related injuries are more likely to have a positive Breathalyzer test (Cherpitel, 1997; Dawkins, 1997).

Controlled Drinking versus Abstinence

Although many people believe that abstinence is the only effective treatment of alcohol dependence, some feel that problem drinkers need not give up drinking altogether but rather can learn to drink moderately The researchers concluded that controlled drinking was more likely to be successful in persons with less severe alcohol problems. The finding that some individuals are able to maintain some control over their drinking after treatment

Some members of which of the following ethnic group are reported to have a hypersensitive reaction to alcohol including flushing of the skin, a drop in blood pressure, heart palpitations, and nausea?

Asian

alcohol flush reaction

Asians and Native Americans tendency to have a hypersensitive reaction including flushing of the skin, a drop in blood pressure, heart palpitations, and nausea following the ingestion of alcohol mutant enzyme that fails to break down alcohol molecules in the liver during the metabolic process

Addictive behavior

Behavior based on the pathological need for a substance or activity; it may involve the abuse of substances, such as nicotine, alcohol or cocaine, or gambling.

Cocaine on the brain

Cocaine has its primary effect by blocking the presynaptic dopamine transporter (whose job it is to retrieve excess dopamine from the synapse), thus increasing the availability of dopamine in the synapse and increasing the activation of the receiving cells. The increase of dopamine activity in the nucleus accumbens is believed to be especially important in cocaine addiction, because specific parts of this brain region have been suggested to be "hedonic hot spots" that have been consistently associated with the experience of reward and pleasure

11.8 Hallucinogens

Drugs know to induce hallucinations; often referred to as psychedelics.

psychoactive substances

Drugs that affect mental functioning alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, Ecstasy, and marijuana.

11.5 Opium and Its Derivatives __________ is an opium-like substance that is produced in the brain and pituitary gland.

Endorphin

Impact of drug among employed people

In an extensive survey of illegal drug use among 40,000 currently employed workers, researchers found the following rates of illicit drug use within the month prior to the survey: 19 percent for those 18 years of age or younger, 10.3 percent for those between 18 and 25 years, 7 percent for those between 26 and 34 years, 7 percent for those between 35 and 49 years, and 2.6 percent for those between 50 and 64 years (Larson et al., 2007). The overall frequency of illegal drug use in this work sample was 8.2 percent. The high rate of drug use in this population (many reported actually using drugs on the job) is problematic. For example, among those workers who reported current illicit drug use, 12.3 percent reported that they had worked for three or more employers in the past year, compared with 5.1 percent for nonabusing workers.

LSD

Lysergic acid diethylamide, or LSD, is the most potent of the hallucinogens. It is odorless, colorless and tasteless, and an amount smaller than a grain of salt can produce intoxication.

Substance abuse

Maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the use of the substance. 1. Potentially hazardous behavior such as driving while intoxicated. 2. Continued use despite a persistent social, psychological, occupational, or health problem.

________ is a hallucinogen that is derived from the small, disc-like growths at the top of the peyote cactus.

Mescaline

amphetamine psychosis

Methedrine can raise blood pressure enough to cause immediate death. In addition, chronic abuse of amphetamines can result in brain damage and a wide range of psychopathology, including a disorder known as "amphetamine psychosis," which appears similar to paranoid schizophrenia. Suicide, homicide, assault, and various other acts of violence are also associated with amphetamine abuse.

Ethnic groups associated with drinking

Native Americans tend to have higher rates of alcohol abuse, and Asian Americans tend to have lower usage. It appears that problem drinking may develop during any life period from early childhood through old age. About 10 percent of men over age 65 are found to be heavy drinkers (Breslow et al., 2003). Surveys of alcoholism rates across different cultural groups around the world have found varying rates of the disorder across diverse cultural samples (Hibell et al., 2000).

Stress, Tension Reduction, and Reinforcement

Studies on patients undergoing substance abuse treatment have shown high levels of trauma in their prior histories—about 25 to 50 percent of PTSD patients also have substance abuse disorders 98 percent of the American Indian adolescents in their substance abuse study reported having a history of trauma such as threat of personal injury, witnessing of injury, or sexual abuse. One recent controlled-treatment study of disaster workers who experienced PTSD following the September 11, 2001, terrorist attacks found that excessive alcohol use was associated with dropout from treatment (Difede et al., 2007). In addition, high exposure to threatening situations and atrocities among Iraq War veterans has been associated with a positive screen for alcohol abuse individual who abuses alcohol is discontented with his or her life and is unable or unwilling to tolerate tension and stress

Religion prohibit drinking

The effect of cultural attitudes toward drinking is well illustrated by Muslims and Mormons, whose religious values prohibit the use of alcohol, and by orthodox Jews, who have traditionally limited its use largely to religious rituals influence of alcohol also seems to be influenced by cultural factors

Caffiene and Nicotine cause mental health problems in society

These drugs are easy to abuse. It is easy to become addicted to them because they are widely used and most people are exposed to them early in life. These drugs are readily available to anyone who wants to use them; in fact, because of peer pressure, it is usually difficult to avoid using them in our society. Both caffeine and nicotine have clearly addictive properties; use of them promotes further use, until one craves a regular "fix" in one's daily life. It is difficult to quit using these drugs both because of their addictive properties and because they are so embedded in the social context. (Nicotine use, however, is falling out of favor in many settings.) The extreme difficulty most people have in dealing with the withdrawal symptoms when trying to "break the habit" often produces considerable frustration. The health problems and side effects of these drugs, particularly nicotine, have been widely noted for many years (U.S. Department of Health and Human Services, 1994). One in seven deaths in the United States is associated with cigarette consumption.

Effects of Ecstacy

Usually about 20 minutes after ingesting Ecstasy (typically in pill form), the person experiences a "rush" sensation followed by a feeling of calmness, energy, and well-being. The effects of Ecstasy can last for several hours. People who take the drug often report an intense experience of color and sound and mild Use of the drug is accompanied by a number of adverse consequences such as nausea, sweating, clenching of teeth, muscle cramps, blurred vision, and hallucinations (Parrott, 2001)

Treatment

When abstaining from marijuana use, some users report having uncomfortable withdrawal-like symptoms such as nervousness, tension, sleep problems, and appetite change

Best treatments for cocaine

both CBT (described earlier) and contingency management (CM) approaches are effective treatments for substance use disorders. CBT for cocaine dependence focuses on teaching patients cognitive and behavioral skills intended to help them navigate daily life and difficult situations without engaging in drug use. It has proven to be an effective method of decreasing cocaine use in those meeting the criteria for cocaine dependence, even when administered in a fully computerized form CM is based on the principles of operant conditioning and offers rewards or financial incentives for meeting agreed-on treatment targets Recent research has shown that CM is just as effective when it uses relatively low-cost reinforcers

Causal Factors in Opiate Abuse and Dependence

both genetic and environmental influences seem to play a role

Cocaine Cognitive impairment

effects long term Employment, family, psychological, and legal problems are all more likely to occur among cocaine and crack users than among nonusers. Many life problems experienced by cocaine abusers result in part from the considerable amounts of money that are required to support their habits.

Elaine's mother drank frequently during her pregnancy. At birth, Elaine's appearance was striking as she was noted to have a low nasal bridge, ear abnormalities, and a thin upper lip. What would Elaine most likely be diagnosed as having?

fetal alcohol syndrome

Drinking among college students

risky behavior and low academic motivation older students showed less expectation of the benefits of alcohol than beginning students

A change in the DSM-5 criteria for Attention Deficit Hyperactivity Disorder (ADHD) has resulted in expanding the population of patients who can receive this diagnosis to now include adults, which may lead to a much greater use of stimulants by adults. Concern has been expressed that

the expansion could lead to widespread misuse of stimulant drugs for performance enhancement and recreation use, adding to the already extensive problem of simulant abuse.

DSM-5 Criteria for... Alcohol Use Disorder

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: Alcohol is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. Craving, or a strong desire or urge to use alcohol. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. Recurrent alcohol use in situations in which it is physically hazardous. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. Tolerance, as defined by either of the following: A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. A markedly diminished effect with continued use of the same amount of alcohol. Withdrawal, as manifested by either of the following: The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499-500). Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Alcohol withdrawal delirium

Acute delirium associated with withdrawal from alcohol after prolonged heavy consumption; characterized by intense anxiety, tremors, fever and sweating, and hallucinations. Symptoms: (1) disorientation (2) vivid hallucinations (3) acute fear (4) extreme suggestibility (5) marked tremors of the hands, tongue and lips; (6) fever,perspiration, rapid and weak heartbeat, coated toungue and foul breath.

Alcohol abuse and Alcohol dependence

Alcohol abuse and alcohol dependence in the United States cut across all age, educational, occupational, and socioeconomic boundaries. Alcohol abuse is found in priests, politicians, surgeons, law enforcement officers, and teenagers; the image of the alcohol-abusing person as an unkempt resident of skid row is clearly inaccurate. Recent research has shown that alcohol abuse has a strong presence in the workplace, with 15 percent of employees showing problem behaviors; many (1.7 percent, or 2.1 million people) actually drinking on the job; and 1.8 percent, or 2.3 million workers, drinking before they go to work (Frone, 2006).

Treatment of Alcohol-Related Disorders

Alcohol abuse and dependence are difficult to treat because many people who abuse alcohol refuse to admit that they have a problem before they "hit bottom," and many who do go into treatment leave before therapy is completed Addictions have been described as "diseases of denial" (DiClemente, 1993). Overall, less than one-third of those with alcohol use disorders receive treatment, and available treatments for alcohol-related disorders show modest effects a multidisciplinary approach to the treatment of drinking problems appears to be most effective because the problems are often complex, requiring flexibility and individualization of treatment procedure Treatment objectives usually include detoxification, physical rehabilitation, control over alcohol abuse behavior, and the individual's realizing that he or she can cope with the problems of living and lead a much more rewarding life without alcohol.

Alcohol's Effects on the Brain

Alcohol has complex effects on the brain. At lower levels, alcohol activates the brain's "pleasure areas," which release endogenous opioids that are stored in the body (Braun, 1996). At higher levels, alcohol depresses brain functioning, inhibiting one of the brain's excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain Inhibition of glutamate in the brain impairs the ability to learn and affects the higher brain centers, impairing judgment and other rational processes and lowering self-control. As behavioral restraints decline, a drinker may indulge in the satisfaction of impulses ordinarily held in check. A lack of motor coordination soon becomes apparent, and the drinker's discrimination and perception of cold, pain, and other discomforts are dulled.

Annual Prevalence

An estimated 21.6 million Americans ages 12 years or older report using at least one illicit drug during the past year (SAMHSA, 2014). According to the Monitoring the Future study, the annual prevalence rate of using any illicit drug is 37 percent for 12th graders, 35 percent for college students, and 34 percent for 19- to 28-year-olds (Johnston et al., 2009). Although they may occur at any age, drug abuse and dependence are most common during adolescence and young adulthood (Campbell, 2010).

Psychological Vulnerability

In recent years, substantial research has focused on the link between alcohol-related disorders and such other disorders as antisocial personality, depression, and schizophrenia to determine whether some individuals are more vulnerable to substance abuse disorders About half of those with schizophrenia have either alcohol or drug abuse or dependence as well In addition, antisocial personality disorder, alcohol, and aggression are strongly associated relationship between depressive disorders and alcohol abuse,

Amphetamines used by military and civilians

Initially these preparations were considered to be "wonder pills" that helped people stay alert and awake and function temporarily at a level beyond normal. During World War II, the military became interested in the stimulating effects of these drugs and they were used by soldiers to ward off fatigue Similarly, among civilians, amphetamines came to be widely used by night workers, long-distance truck drivers, students cramming for exams, and athletes striving to improve their performance. It was also discovered that amphetamines tend to suppress appetite, and they became popular with people trying to lose weight. In addition, they were often used to counteract the effects of barbiturates or other sleeping pills that had been taken the night before. As a result of their many uses, amphetamines were widely prescribed by doctors.

Effects of Amphetamine Abuse

Instead, they push users toward greater expenditures of their own resources—often to the point of hazardous fatigue. Amphetamines are psychologically and physically addictive, and the body rapidly builds up tolerance to them Amphetamines are psychologically and physically addictive, and the body rapidly builds up tolerance to them (Wise, 1996). Thus, habituated abusers may use the drugs in amounts that would be lethal to nonusers. In some instances, users inject the drug to get faster and more intense results.

An interesting and unusual phenomenon that may occur sometime following the use of LSD is flashback

Involuntary recurrence of perceptual distorations or hallucinations weeks or months after taking a drugl in posttraumatic stress, disorder, a dissociative state i nwhic hte person breifly relives the traumatic.

History of LSD

It is most often sold and consumed via tiny sheets of blotter paper containing a few micrograms of the drug, which is ingested by letting the paper dissolve on the tongue. It is a chemically synthesized substance first discovered by the Swiss chemist Albert Hofmann in 1938. Hofmann was not aware of the potent hallucinatory qualities of LSD until he swallowed a small amount.

Mescaline and Psilocybin

Mescaline: Hallucinogenic drug derived form the peyote cactus. Psilocybin: Hallucinogenic drug derived from a varied mushrooms. These drugs have been used for centuries in the ceremonial rites of Native peoples living in Mexico, the American Southwest, and Central and South America. In fact, they were used by the Aztecs for such purposes long before the Spanish invasion. Both drugs have mind-altering and hallucinogenic properties, but their principal effect appears to be enabling an individual to see, hear, and otherwise experience events in unaccustomed ways—transporting him or her into a realm of "nonordinary reality." As with LSD, no definite evidence shows that mescaline and psilocybin actually "expand consciousness" or create new ideas; rather, they mainly alter or distort experience.

Biological Effects of Morphine and Heroin

Morphine and heroin are commonly introduced into the body by smoking, snorting (inhaling the powder), eating, "skin popping," or "mainlining," the last two being methods of introducing the drug via hypodermic injection. Skin popping is injecting the liquefied drug just beneath the skin, while mainlining is injecting the drug directly into the bloodstream. Among the immediate effects of mainlined or snorted heroin is an intense feeling of euphoria (the rush) lasting 60 seconds or so These effects last from 4 to 6 hours and are followed—in addicts—by a negative phase that produces a desire for more of the drug. When people addicted to opiates do not get another dose of the drug within approximately 8 hours of their last dose, they start to experience withdrawal symptoms. The character and severity of these reactions depend on many factors including the amount of the narcotic habitually used, the intervals between doses, the duration of the addiction, and especially the addict's health and personality.

Relapse Prevention

One of the greatest problems in the treatment of addictive disorders is maintaining abstinence or self-control once the behavioral excesses have been checked In one cognitive-behavioral approach, relapse behavior is a key factor in alcohol treatment (Witkiewitz & Marlatt, 2007). One recent study (Nattala et al., 2010) found that relapse prevention treatment worked most effectively when family members were involved in the treatment. When an individual is abstinent or has an addiction under control, she or he gains a sense of personal control over the indulgent behavior. The longer the person is able to maintain this control, the greater the sense of achievement—the self-efficacy or confidence—and the greater the chance that she or he will be able to cope with the addiction and maintain control. However, a person may violate this rule of abstinence through a gradual, perhaps unconscious, process rather than through the sudden "falling off the wagon" that constitutes the traditional view of craving and relapse.

Ecstasy negative psychological and health consequences

One study reported on the case of a 21-year-old man who developed panic disorder after taking Ecstasy (Windhaber et al., 1998); in another case study, an 18-year-old woman reportedly developed a prolonged psychosis after a single recreational use of Ecstasy (Van Kampen & Katz, 2001). The use of Ecstasy has also been found to be associated with memory impairment (Parrott et al., 1998) and obstructive sleep apnea (Chamberlin & Saper, 2009; McCann et al. 2009). Severe organic brain problems have also been reported. Granato and colleagues (1997) describe a case in which a 20-year-old male suffered from cerebrovascular injury after taking Ecstasy. The youth went into a coma about a minute or so after taking the drug. Upon awakening, he was found to have dissociation, delirium, visual hallucinations, and poor memory for past events. Subsequent examination showed damage to his frontal lobes and his right temporal lobe. Ecstasy users have consistently shown memory deficits (Roberts et al., 2009). A recent study by Schilt and colleagues (2010) found long-term harmful neurological effects in middle-aged Ecstasy users. Moderate to heavy Ecstasy users showed moderate memory loss compared to controls.

Alcohol comorbidity

Over 37 percent of people who abuse alcohol experience at least one coexisting mental disorder. Not surprisingly, given that alcohol is a depressant, depression ranks high among the mental disorders often comorbid with alcoholism. There is a high comorbidity of substance abuse disorders and eating disorders (Harrop & Marlatt, 2009). It is also no surprise that many alcoholics die by suicide (McCloud et al., 2004). In addition to the serious problems that excessive drinkers create for themselves, they also pose serious difficulties for others (Gortner et al., 1997). Alcohol abuse co-occurs with high frequency with personality disorder as well (Grant, Stinson, et al., 2004).

high comorbidity between pathological gambling and alcohol abuse disorders and with personality disorders

Pathological gambling, also known as "compulsive gambling" or disordered gambling, is a progressive disorder characterized by continuous loss of control over gambling, a preoccupation with gambling and with obtaining money for gambling, and continuation of the gambling behavior in spite of adverse consequences.

There is some evidence that people become more quickly addicted to methamphetamine and require treatment sooner than those using cocaine

People who are addicted to methamphetamine are highly resistant to treatment, and posttreatment relapse is common, with approximately one-third relapsing within 6 months after treatment and half relapsing during the next 3 years (Brecht et al., 2000).

DSM-5 Criteria for... Gambling Disorder

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: Needs to gamble with increasing amounts of money in order to achieve the desired excitement. Is restless or irritable when attempting to cut down or stop gambling. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). After losing money gambling, often returns another day to get even ("chasing" one's losses). Lies to conceal the extent of involvement with gambling. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. Relies on others to provide money to relieve desperate financial situations caused by gambling. The gambling behavior is not better explained by a manic episode.

Heroin

Powerful psychoactive drug chemically derived from morphine, that relieves pain but is even more intense and addictive than morphine Leading scientists of his time agreed on the merits of heroin, and the drug came to be widely prescribed in place of morphine for pain relief and related medicinal purposes. Unfortunately, heroin proved to be an even more dangerous drug than morphine, acting more rapidly and more intensely and being equally, if not more, addictive. Eventually, heroin was removed from use in medical practice.

Pathological gambling

Progressive disorder characterized by loss of control over gambling, preoccupation with gambling and obtaining money for gambling and irrational gambling behavior in spite of adverse consequences.

Treatments and Outcomes

Research on the effectiveness of various treatments for withdrawing patients from amphetamines is scarce Although withdrawal from amphetamines is usually safe, some evidence suggests that physiological dependence on the drug is an important factor to consider in treatment In some instances, abrupt withdrawal from the chronic, excessive use of amphetamines can result in cramping, nausea, diarrhea, and even convulsions. The depression usually peaks in 48 to 72 hours, often remains intense for a day or two, and then tends to lessen gradually over a period of several days.

Psychoses Associated with Severe Alcohol Abuse

Severe mental health problems Confusion, excitement and delirium (alcohol-induced psychotic disorders) temporary loss of contact with reality.

Genetics—the Whole Story?

Social circumstances are still considered powerful forces in providing both the availability and the motivation to use alcohol and other drugs.

Failures in Parental Guidance

Stable family relationships and parental guidance are extremely important molding influences for children and this stability is often lacking in families of substance abusers. Children who have parents who are extensive alcohol or drug abusers are vulnerable to developing substance abuse and related problems The experiences and lessons we learn from important figures in our early years have a significant impact on us as adults. Children who are exposed to negative role models and family dysfunction early in their lives or experience other negative circumstances because the adults around them provide limited guidance often falter on the difficult steps they must take in life (Fischer et al., 2005). These formative experiences can have a direct influence on whether a young person becomes involved in maladaptive behavior such as alcohol or drug abuse.

Nicotine

The poisonous alkaloid nicotine is the chief active ingredient in tobacco; it is found in such items as cigarettes, chewing tobacco, and cigars, and it is even used as an insecticide.

Dopamine theory of addiction

Theory suggesting that addiction is the result of a dysfunction of the dopamine reward pathway. Early versions of the dopamine theory of addiction suggested that all addictive drugs (e.g., alcohol, opiates, cocaine) and behaviors (e.g., gambling) activate the dopamine reward pathway, thus causing pleasure and increasing the likelihood of drug use and engagement in addictive behavior.

Causal Factors in Barbiturate Abuse and Dependence

These people have been referred to as "silent abusers" because they take the drugs in the privacy of their homes and ordinarily do not become public nuisances. middle-aged and older people uses not young people Barbiturates are often used with alcohol. Some users claim they can achieve an intense high by combining barbiturates, amphetamines, and alcohol. However, one possible effect of combining barbiturates and alcohol is death because each drug potentiates (increases the action of) the other.

Alcoholics Anonymous

This organization was started in 1935 by two men, Dr. Bob and Bill W., in Akron, Ohio. Bill W. recovered from alcoholism through a "fundamental spiritual change" and immediately sought out Dr. Bob, who, with Bill's assistance, also achieved recovery. They in turn began to help other alcoholics. Since that time, AA has grown to over 2 million members participating in more than 100,000 AA groups around the world Alcoholics Anonymous operates primarily as a self-help counseling program in which both person-to-person and group relationships are emphasized. AA accepts both teenagers and adults with drinking problems, has no dues or fees, does not keep records or case histories, does not participate in political causes, and is not affiliated with any religious sect, although spiritual development is a key aspect of its treatment approach An important aspect of AA's rehabilitation program is that it appears to lift the burden of personal responsibility by helping alcoholics accept that alcoholism, like many other problems, is bigger than they are. Henceforth, they can see themselves not as weak willed or lacking in moral strength but rather simply as having an affliction—they cannot drink—just as other people may not be able to tolerate certain types of medication. Through mutual help and reassurance from group members who have had similar experiences, many alcoholics acquire insight into their problems, a new sense of purpose, greater ego strength, and more effective coping techniques. Continued participation in the group, of course, can help prevent the crisis of a relapse. Affiliated movements such as Al-Anon family groups and Alateen are designed to bring family members together to share experiences and problems, to gain understanding of the nature of alcoholism, and to learn techniques for dealing with their own problems living in a family with one or more affected individuals.

Effects of Marijuana

This state is one of mild euphoria distinguished by increased feelings of well-being, heightened perceptual acuity, and pleasant relaxation, often accompanied by a sensation of drifting or floating away. Sensory inputs are intensified. Marijuana has the effect on the brain of altering one's internal clock Often a person's sense of time is stretched or distorted so that an event that lasts only a few seconds may seem to cover a much longer span. Short-term memory may also be affected, as when one notices that a bite has been taken out of a sandwich but does not remember having taken it. For most users, pleasurable experiences, including sexual intercourse, are reportedly enhanced. When smoked, marijuana is rapidly absorbed, and its effects appear within seconds to minutes but seldom last more than 2 to 3 hours. Marijuana has also been used to relieve pain or nausea; see the World around Us box for a discussion of the controversy over medical marijuana.

Treatments and Outcomes for Cocaine

To reduce cravings as part of psychological therapy and to ensure treatment compliance, drugs such as naltrexone and methadone have been used to reduce cocaine use

History of Cocaine

a plant product discovered in ancient times and used ever since. It was widely used in the pre-Columbian world of Mexico and Peru, where leaves of the coca plant were wrapped around lime and placed inside the cheek to provide a slow release— allowing workers to decrease their hunger and elevate their mood and energy so they could work long hours. Cocaine later gained popularity in the 1880s when Sigmund Freud came to see it as a wonderful treatment for depression, indigestion, and a range of other maladies Arthur Conan Doyle described how his fictional character—Sherlock Holmes—enjoyed the drug, and entrepreneur John Pemberton included it as a key ingredient in his new soft drink: Coca-Cola As the dangers of cocaine became apparent in the early 1900s, it was made illegal and its use decreased dramatically. When banned in the United States, it became very costly to obtain and was considered as the "high" for the affluent "Crack" is the street name

Barney, age 50, had been drinking heavily for the past 30 years. He has been sober for one year. Since being sober, he has shown difficulty with remembering recent conversations with family and coworkers, cannot recall the names of people he has met in the past six months, and appears confused and disoriented. What DSM-5 alcohol-related disorder is consistent with these observations about Barney?

alcohol amnestic disorder

Bob, after going on a week-long alcohol binge, has not had anything to drink in the last 24 hours. He states there are rats running across the floor (though no one else sees the rats), exhibits trembling in his hands, and cannot identify where he is when taken to the hospital. Bob is likely to be experiencing

alcohol withdrawal delirium.

Controlled Substance Act of 1970 (Drug Enforcement Administration, 1979),

amphetamines have been classified as Schedule II controlled substances—that is, drugs with high abuse potential that require a prescription for each purchase. As a result, medical use of amphetamines has declined in the United States in recent years and they are more difficult to obtain legally However, it is often possible to find illegal sources of amphetamines, which thus remain among the most widely abused drugs. Amphetamines are among the most widely used illicit drugs in other countries as well (Lintzeris et al., 1996). Approximately 7 percent of drug-related ED visits involve amphetamines or methamphetamines (SAMHSA, 2013).

The tension-reduction causal model is difficult to accept as a sole explanatory hypothesis for alcohol use

because if tension-reduction was the main factor, one would expect substance-abuse disorder to be far more common since alcohol tends to reduce tension for most people who use it.

Other medications to treat heroin addiction

buprenorphine, have also been used to treat heroin addiction Buprenorphine promises to be as effective a substitute for heroin as methadone but with fewer side effects

Endorphins (produced by the body)

central nervous system and pituitary gland

Which of the following forms of psychological treatment has demonstrated effectiveness for the treatment of cocaine abusers?

cognitive behavioral therapy and contingency management

The "skills training procedure," usually aimed at younger problem drinkers, is comprised of

cognitive-behavioral strategies of intervention with social-learning theory.

The most common drug-related deaths in the United States

combinations of heroin, cocaine, and alcohol.

addiction has adverse physical effects on an individual's well-being

disruption of the immune system (Theodorou & Haber, 2005). Lifestyle factors can lead to further problems; an inadequate diet, for example, may lead to ill health and increased susceptibility to a variety of physical ailments. The use of unsterile equipment may also lead to various problems including liver damage from hepatitis (Lucey et al., 2009) and transmission of the AIDS virus. potent drug without medical supervision and government controls to ensure its strength and purity can result in fatal overdose. Injection of too much heroin can cause coma and death.

Medications to Reduce the Side Effects of Acute Withdrawal

drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome motor excitement, nausea, and vomiting; prevent withdrawal delirium and convulsions; and help alleviate the tension and anxiety associated with withdrawal. Pharmacological treatments with long-lasting benzodiazepines, such as diazepam, which reduce the severity of withdrawal symptoms, have been shown to be effective (Malcolm, 2003).

Cocaine effects and sideffects

euphoric state resulting from cocaine use lasts for 4 to 6 hours, during which a user experiences feelings of confidence and contentment blissful state may be followed by headache, dizziness, and restlessness. When cocaine is chronically abused, acute toxic psychotic symptoms may occur, including frightening visual, auditory, and tactile hallucinations similar to those in acute schizophrenia.

The reciprocal-influence model suggests that adolescents begin drinking as a result of

expectations that using alcohol will increase their popularity and acceptance by their peers.

History of amphetamines

first synthesized in 1927 and became available in drugstores in the early 1930s as an inhalant to relieve stuffy noses Dexedrine (dextroamphetamine) and Methedrine (methamphetamine hydrochloride, also known as "speed")

Caffeine

found in many commonly available drinks and foods. The negative effects of caffeine involve intoxication rather than withdrawal. Unlike addiction to drugs such as alcohol or nicotine, withdrawal from caffeine does not produce severe symptoms, except for headache, which is usually mild. As described in DSM-5 caffeine-related disorder involves symptoms of restlessness, nervousness, excitement, insomnia, muscle twitching, and gastrointestinal complaints. It follows the ingestion of caffeine-containing substances such as coffee, tea, cola, and chocolate. The amount of caffeine that results in intoxication differs among individuals.

Strote and colleagues (2002)

found that between 1997 and 1999, Ecstasy use increased 69 percent, from 2.8 to 4.7 percent. Ecstasy reportedly grew in use among 8th, 10th, and 12th graders, as noted by the Monitoring the Future study, in which nearly 5 percent of 10th and 12th graders and about 2 percent of 8th graders reportedly had used MDMA in the past year

the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates

four out of five college students drink alcohol and half of students who drink engage in binge drinking (NIAAA, 2015). Moreover, approximately 25 percent of college students experience academic problems as a result of drinking such as missing classes and receiving poor grades (NIAAA, 2015).

History of Ecstasy

he drug was originally patented in 1914 by the pharmaceutical company Merck, supposedly to be sold as a diet pill, but the company decided against marketing the drug because of its side effects. The drug was further evaluated and tested during the 1970s and 1980s as a potential medication for use in psychological treatment for a wide range of conditions such as posttraumatic stress, phobias, psychosomatic disorders, depression, suicidality, drug addiction, and relationship difficulties (Grob, 2000)

If morphine is treated with the chemical acetic anhydride, it can be converted into another powerful analgesic called

heroin

reward deficiency syndrome

hypothesis suggests that addiction is much more likely to occur in individuals who have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards (e.g., from food, sex, drugs, and other pleasurable activities), which in turn leads them to overuse drugs and related experiences as a way to adequately stimulate their reward pathway

Quiz 11.9 Gambling Operant learning principles may explain why pathological gamblers, who may have experienced positive reinforcement with early wins, will continue to gamble in the face of loss. The gambling persistence may be sustained due to the influence of a(n) ________ schedule of reinforcement.

intermittent

Motivational interviewing (MI)

is a brief intervention that was designed to be a major departure from earlier confrontational approaches in which a clinician suggested that the drinker stop consuming so much alcohol. clinician guides the patient through a collaborative conversation in which the patient articulates the pros and cons of drinking and ultimately makes a decision about whether she or he is motivated to change One great strength of MI is that it can administered in one brief (35-minute) session, and still have positive effects.

An alcohol-risk personality has been described as an individual who has an inherited predisposition toward alcohol abuse, and who

is impulsive, prefers taking high risks, and is emotionally unstable.

delirium

lasts from 3 to 6 days . followed by deep sleep. 5 to 24 percent of patients with alcohol withdrawal delirium die as a result of convulsions, heart failure, and other complications

Excessive use of barbiturates

leads to increased tolerance as well as to physiological and psychological dependence It can also lead to brain damage and personality deterioration. Unlike tolerance for opiates, tolerance for barbiturates does not increase the amount needed to cause death This means that users can easily ingest fatal overdoses, either intentionally or accidentally.

Marital and Other Intimate Relationships

less supportive relationships tend to show greater drinking following sadness or hostility Excessive drinking often begins during crisis periods in marital or other intimate personal relationships, particularly crises that lead to hurt and self-devaluation. a husband who lives with a wife who abuses alcohol is often unaware of the fact that, gradually and inevitably, many of the decisions he makes every day are based on the expectation that his wife will be drinking. Excessive use of alcohol is one of the most frequent causes of divorce in the United States (Perreira & Sloan, 2001) and is often a hidden factor in the two most common causes—financial and sexual problems Family relationship problems have also been found to be central to the development of alcoholism The most important family variables that were considered to predispose an individual to substance use problems were the presence of an alcoholic father, acute marital conflict, lax maternal supervision and inconsistent discipline, many moves during the family's early years, lack of "attachment" to the father, and lack of family cohesiveness.

Which of the following is sometimes referred to as "poor people's cocaine"?

methamphetamine

Ecstasy is chemically similar to

methamphetamine and mescaline

11.7 Sedatives The individuals who are most likely to develop barbiturate dependency are

middle-aged and older adults.

For a person who exceeds prescribed dosage

mphetamine consumption results in heightened blood pressure, enlarged pupils, unclear or rapid speech, profuse sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness.

Amphetamines used today

occasionally used medically for curbing appetite when weight reduction is desirable; for treating individuals suffering from narcolepsy, a disorder in which people cannot prevent themselves from continually falling asleep during the day; and for treating hyperactive children. Curiously enough, amphetamines have a calming rather than a stimulating effect on those with ADHD. Amphetamines also are sometimes prescribed for alleviating mild feelings of depression, relieving fatigue, and maintaining alertness for sustained periods of time.

11.6 Stimulants CNS, cocaine, amphetamines, methamphetamine, caffeine, and nicotine

opposite of opiates (slow down) they stimulate and speed it up.

he three most frequently cited reasons that people given for beginning to use heroin

pleasure, curiosity, and peer pressure Pleasure is, by far, the single most widespread reason—given by 81 percent of addicts. Other reasons such as a desire to escape life stress, personal maladjustment, and sociocultural conditions also play a part. It also has been suggested that various forms of substance abuse such as smoking, drinking, and the use of drugs are all related to a personality characteristic referred to as "sensation seeking," which is itself thought to be mediated through genetic and biological mechanisms as well as through peer influences (Zuckerman, 2007).

In relapse prevention treatment, participants are taught to

recognize the apparently irrelevant decisions that serve as early warning signals of the possibility of relapse.

Researchers note that some people have difficulty experiencing pleasure from naturally occurring rewards that, to most people, are satisfying. Consequently, these individuals are compelled to seek out additional sources of pleasure through activities such as drug use. This hypothesis is called the

reward deficiency syndrome hypothesis.

extensive drinking in college, even among the heaviest drinkers from sororities and fraternities

situational events, factors that change with graduation. In a follow-up study of drinking behavior a year after graduation, Sher, Bartholow, and Nanda (2001) reported that being a member of a fraternity or sorority did not predict postcollege drinking.

widespread problem of binge drinking in college

students' expressing independence from parental influence (Turrisi et al., 2000); peer group and situational influences (Read et al., 2003); developing and asserting gender roles, particularly for men adopting a "macho" role (Capraro, 2000); and holding beliefs that alcohol can help make positive transformations, such as "having a few drinks to celebrate special occasions" (Turrisi, 1999).

barbiturates

synthetic drugs that act as depressants to calm the individual and induce sleep. Although barbiturates have legitimate medical uses, they are extremely dangerous drugs commonly associated with both physiological and psychological dependence and lethal overdoses.

11.1 Alcohol-Related Disorders The World Health Organization (WHO) defines heavy episodic drinking as

the consumption of six or more alcoholic drinks on at least one occasion at least once per month.

Drug Abuse and Dependence

the psychoactive drugs most commonly associated with abuse and dependence in our society appear to be: (1) opiates, including opium and heroin; (2) stimulants such as cocaine and amphetamines as well as caffeine and nicotine (disorders associated with tobacco withdrawal and caffeine intoxication are included in the DSM-5 diagnostic classification system); (3) sedatives such as barbiturates; (4) hallucinogens such as LSD; (5) antianxiety drugs such as benzodiazepines; and (6) pain medications such as OxyContin (Whoriskey, 2013)

Martin began drinking alcohol during college. He drinks daily. Initially, he drank a couple of beers each evening. He now consumes 6-12 bottles of beer each evening. When asked why he drinks so much, Martin replied, "It takes at least a six-pack to feel anything." Martin's increased need for alcohol to achieve the same effects is an example of

tolerance.

Outcome Studies and Issues in Treatment

varies considerably, depending on the population studied and on the treatment facilities and procedures employed. Results range from low rates of success for hard-core substance abusers to recovery rates of 70 to 90 percent when modern treatment and aftercare procedures are used Treatment is most likely to be effective when an individual realizes that she or he needs help, when adequate treatment facilities are available, and when the individual attends treatment regularly