psych chapter 11

drugs most associated with abuse

(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

Alcoholics Anonymous

A practical approach to alcoholism that has become very popular around the world is that of Alcoholics Anonymous (AA). 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. To ensure anonymity, only first names are used. Meetings are devoted partly to social activities, but they consist mainly of discussions of the participants' problems with alcohol, often with testimonials from those who have stopped drinking. Such members usually contrast their lives before they broke their alcohol dependence with the lives they now live without alcohol. We should point out here that the term alcoholic is used by AA and its affiliates to refer either to persons who currently are drinking excessively or to people who have stopped drinking but must, according to AA philosophy, continue to abstain from alcohol consumption in the future. That is, in the AA view, one is an alcoholic for life, whether or not one is drinking; one is never "cured" of alcoholism but is instead "in recovery." 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. The reported success of Alcoholics Anonymous is based primarily on anecdotal information rather than on objective study of treatment outcomes because AA does not directly participate in external comparative research efforts. Comprehensive reviews aimed at determining the effectiveness of AA's 12-step approach have been inconclusive. AA has not been shown to be any more effective than other treatment approaches

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 amnestic disorder

A second alcohol-related psychosis is alcohol amnestic disorder (formerly known as Korsakoff's syndrome). This condition was first described by the Russian psychiatrist Korsakoff in 1887 and is one of the most severe alcohol-related disorders. The primary symptom is a memory defect (particularly with regard to recent events), which is sometimes accompanied by falsification of events (confabulation). People with this disorder may not recognize pictures, faces, rooms, and other objects that they have just seen, although they may feel that these people or objects are familiar. Such people increasingly tend to fill in their memory gaps with confabulations that lead to unconnected and distorted associations. These individuals may appear to be delirious, delusional, and disoriented for time and place, but ordinarily their confusion and disordered actions are closely related to their attempts to fill in memory gaps. The memory disturbance itself seems related to an inability to form new associations in a manner that renders them readily retrievable. Such a reaction usually occurs in long-time alcohol abusers after many years of excessive drinking. These patients have also been observed to show other cognitive impairments such as planning deficits, , intellectual decline, emotional deficits. bad judgements, and cortical lesions. The symptoms of alcohol amnestic disorder result from malnutrition, specifically the lack of vitamin B (thiamine). If symptoms are correctly diagnosed within the first 48 to 72 hours, treatment with thiamine leads to a reversal of this condition and memory functioning appears to be restored with prolonged abstinence. However, if undiagnosed and with disease progression beyond several days, the brain damage causing this condition becomes irreversible

prevelance of drug abuse

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 Although they may occur at any age, drug abuse and dependence are most common during adolescence and young adulthood Among people who abuse drugs, behavior patterns vary markedly depending on the type, amount, and duration of drug use; on the physiological and psychological makeup of the individual; and, in some instances, on the social setting in which the drug experience occurs.

Marital and Other Intimate Relationships-alcoholism

Adults with less supportive relationships tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships Excessive drinking often begins during crisis periods in marital or other intimate personal relationships, particularly crises that lead to hurt and self-devaluation. The marital relationship may actually serve to maintain the pattern of excessive drinking. Marital partners may behave toward each other in ways that promote or enable a spouse's excessive drinking. For example, 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. These expectations, in turn, may make the drinking behavior more likely. Eventually an entire marriage may center on the drinking of a substance-abusing spouse. In some instances, the husband or wife may also begin to drink excessively. Thus, one important concern in many treatment programs today involves identifying the personality or lifestyle factors in a relationship that tend to foster the drinking in the alcohol-abusing person. Of course, such relationships are not restricted to marital partners but may also occur in those involved in love affairs or close friendships. Excessive use of alcohol is one of the most frequent causes of divorce in the United States and is often a hidden factor in the two most common causes—financial and sexual problems. The deterioration in interpersonal relationships of the alcohol abuser or dependent, of course, further augments the stress and disorganization in her or his life. The breakdown of marital relationships can be a highly stressful situation for many people. The stress of divorce and the often erratic adjustment period that follows can lead to increased substance abuse. six family relationship factors that were significantly associated with the development of alcoholism in the individuals they studied. 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.

Alcohol abuse and alcohol dependence prevelance

Alcohol abuse and alcohol dependence are major problems around the world and are among the most destructive of the psychiatric disorders because of the impact excessive alcohol use can have on users' lives and those of their families 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 Specifically, in 2013, more than half (52.2 percent) of Americans ages 12 or older reported that they currently (i.e., in the past 30 days) drink alcohol, approximately a quarter (22.9 percent) report binge drinking (i.e., having at least five drinks on one occasion in the past month), and 6.3 percent report being heavy drinkers (i.e., having at least five drinks at least five times in the past month)

who are alcoholics?

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 Historically, most problem drinkers—people experiencing life problems as a result of alcohol abuse—have been men; for example, men become problem drinkers at about five times the frequency of women-but this gap has been narrowed. There do not seem to be important differences in rates of alcohol abuse between black and white Americans, although 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. Surveys of alcoholism rates across different cultural groups around the world have found varying rates of the disorder across diverse cultural samples

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 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. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out and the drinker's feelings of self-esteem and adequacy rise. Casual acquaintances become the best and most understanding of friends and the drinker enters a generally pleasant world of unreality in which worries are temporarily left behind. In most U.S. states, when the alcohol content of the bloodstream reaches 0.08 percent, the individual is considered intoxicated, at least with respect to driving a vehicle. Muscular coordination, speech, and vision are impaired and thought processes are confused. Even before this level of intoxication is reached, however, judgment becomes impaired to such an extent that the person misjudges his or her condition. For example, drinkers tend to express confidence in their ability to drive safely long after such actions are in fact quite unsafe. When the blood alcohol level reaches approximately 0.5 percent (the level differs somewhat among individuals), the entire neural balance is upset and the individual passes out. Unconsciousness apparently acts as a safety device because concentrations above 0.55 percent are usually lethal. In general, it is the amount of alcohol actually concentrated in the bodily fluids, not the amount consumed, that determines intoxication. The effects of alcohol vary for different drinkers, depending on their physical condition, the amount of food in their stomach, and the duration of their drinking. In addition, alcohol users may gradually build up a tolerance for the drug so that ever-increasing amounts may be needed to produce the desired effects. Women metabolize alcohol less effectively than men and thus become intoxicated on lesser amounts The effects of alcohol do not stop at intoxication—a state of being affected by one or more psychoactive drugs. Another phenomenon associated with excessive alcohol consumption is the alcohol "hangover," in which a person experiences symptoms of headache, nausea, fatigue and cognitive impairment for 8 to 24 hours after consuming alcohol. Researchers are still trying to understand what causes alcohol hangovers, with leading theories focusing on dehydration along with the buildup of alcohol metabolites such as acetaldehyde, and the triggering of the body's immune response. Despite the lack of understanding of the causes of hangovers, it is clear that beyond being unpleasant, they can be dangerous, leading to problems like impairment while driving an automobile

The Physical Effects of Chronic Alcohol Use

Alcohol that is taken in must be assimilated by the body, except for the approximately 5 to 10 percent that is eliminated through breath, urine, and perspiration. The work of alcohol metabolism is done by the liver, but when large amounts of alcohol are ingested, the liver may be seriously overworked and eventually suffer irreversible damage. In fact, from 15 to 30 percent of heavy drinkers develop cirrhosis of the liver, a disorder that involves extensive stiffening of the blood vessels. Many of the 36,000 annual cirrhosis deaths every year are alcohol related Alcohol is also a high-calorie drug. Thus, consumption of alcohol reduces a drinker's appetite for other food. Because alcohol has no nutritional value, the excessive drinker can suffer from malnutrition. Furthermore, heavy drinking impairs the body's ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Many people who abuse alcohol also experience increased gastrointestinal symptoms such as stomach pains

Sociocultural Causal Factors of alcoholism

Alcohol use is a pervasive component in the social life of Western civilization. Social events often revolve around it, and alcohol use before and during meals is commonplace. Alcohol is often seen as a "social lubricant" or tension reducer that enhances social events. Thus, investigators have pointed to the role of sociocultural as well as biological and psychological factors in the high rate of alcohol abuse and dependence among Americans. 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. The incidence of alcoholism among these groups is minimal. In comparison, the incidence of alcoholism is high among Europeans. in a study of alcohol-related behavior in eight countries, found that most people expressed the view that aggressive behavior frequently follows their drinking "many" drinks. However, the expectation that alcohol leads to aggression is related to cultural traditions and early exposure to violent or aggressive behavior.

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 Miller and colleagues (1986) evaluated the results of four long-term follow-up studies of controlled-drinking treatment programs. Although they found a clear trend of increased numbers of abstainers and relapsed cases at long-term follow-up, they also found that a consistent percentage (15 percent) of subjects across the four studies controlled their drinking. The researchers concluded that controlled drinking was more likely to be successful in persons with less severe alcohol problems. Many people in the field have rejected the idea that people who abuse alcohol can learn to control their drinking, and some groups, such as Alcoholics Anonymous, are adamant in their opposition to programs aimed at controlled drinking for alcohol-dependent individuals.

Causal Factors in Barbiturate Abuse and Dependence

Although many young people experiment with barbiturates, most do not become dependent. In fact, the people who do become dependent on barbiturates tend to be middle-aged and older people who often rely on them as "sleeping pills" and who do not commonly use other classes of drugs (except possibly alcohol and minor tranquilizers). 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. 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.

reward deficiency syndrome

Although much remains to be learned about the addiction process, several additional pieces of the puzzle have been recently discovered and are fairly well agreed on by researchers. First, if substances and experiences that lead to pleasurable internal states were the whole story, then exposure to these things would explain addiction. However, it is clear that people differ in their vulnerability to addiction—some of us can have one drink and then stop, whereas others of us have a strong urge to keep drinking over and over again. The 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 Significant evidence has emerged to support the reward deficiency syndrome hypothesis during the past several decades (see the following video on dopamine and addiction); however, with this supportive evidence has come the further realization that understanding addiction does not come down to pinpointing a specific, deficient gene, but in understanding how genetic, neural, and environmental factors interact to lead to addictive behavior Second, researchers have come to understand that there is not a simple, single "pleasure pathway" in the brain. For instance, although dopaminergic pathways play a primary role in the "wanting" or anticipation of reward, it is the opioid system that seems to play a primary role in the "liking" or consumption of rewarding stimuli. indings such as these highlight that dopamine plays an important role in the neural understanding of addiction, but that other neurotransmitters, and other explanations altogether, may be needed to fully understand how and why people become addicted to substance use and other behaviors.

pathological gambling, prevelance

Although pathological gambling does not involve a chemically addictive substance, it is considered by many to be an addictive disorder because of the personality factors that tend to characterize compulsive gamblers. Like the substance abuse disorders, pathological gambling involves behavior maintained by short-term gains despite long-term disruption of an individual's life. There is a high comorbidity between pathological gambling and alcohol abuse 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.. Estimates place the number of pathological gamblers worldwide at between 1 and 2 percent of the adult population. Both men and women appear to be vulnerable to pathological gambling. However, rates differ by subpopulation; for example, in some high-risk populations, such as alcoholics, the rates are higher. One study of elderly African Americans from two senior citizen centers documented the extent of gambling problems in this population; 17 percent were found to be people with gambling disorders. Pietrzak and colleagues (2007) found that older, disordered gamblers were significantly more likely than nongambling older adults to have alcohol abuse problems, nicotine addiction, and health problems. Cultural factors also appear to be important in the development of gambling problems. Pathological gambling is a particular problem among some cultural groups (e.g., Chinese, Jewish) and among ethnic minorities and indigenous groups (e.g., Native Americans), perhaps due to the availability and acceptability of gambling behavior 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. Whatever an individual gambler's situation, compulsive gambling significantly affects the social, psychological, and economic well-being of the gambler's family. In fact, studies have found that a high proportion of pathological gamblers commit crimes that are related to gambling, family violence, and other crimes of agression.

Biological Causal Factors in Alcohol Abuse and Dependence

Although the exact mechanisms are not fully agreed on by experts in the field, two important factors are clearly involved. 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. The development of an alcohol addiction is a complex process involving many elements: constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

alcohol withdrawal delirium

Among those who drink excessively for a long time, a reaction called alcohol withdrawal delirium (formerly known as delirium tremens) may occur. This reaction usually happens following a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or suddenly moving objects may cause considerable excitement and agitation. The full-blown symptoms include (1) disorientation for time and place, in which, for example, a person may mistake the hospital for a church or jail, no longer recognize friends, or identify hospital attendants as old acquaintances; (2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches; (3) acute fear, in which these animals may change in form, size, or color in terrifying ways; (4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested; (5) marked tremors of the hands, tongue, and lips; and (6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath. The delirium typically lasts from 3 to 6 days and is generally followed by a deep sleep. When a person awakens, few symptoms remain, but frequently the individual is scared and may not resume drinking for several weeks or months. It has been estimated that 5 to 25 percent of patients with alcohol withdrawal delirium die as a result of convulsions, heart failure, and other complications. Drugs such as chlordiazepoxide (Librium), however, have demonstrated the ability to decrease withdrawal symptoms and with it the risk of death as a result of withdrawal

Behavioral and Cognitive-Behavioral Therapy

An interesting and often effective form of treatment for alcohol-related disorders is behavioral therapy, of which several types exist. 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. For example, the ingestion of alcohol might be paired with an electric shock or a drug that produces nausea. A variety of pharmacological and other deterrent measures can be used in behavioral therapy after detoxification. One approach involves an intramuscular injection of emetine hydrochloride, an emetic. Before experiencing the nausea that results from the injection, a patient is given alcohol, so that the sight, smell, and taste of the beverage become associated with severe retching and vomiting. That is, a conditioned aversion to the taste and smell of alcohol develops. With repetition, this classical conditioning procedure acts as a strong deterrent to further drinking—probably in part because it adds an immediate and unpleasant physiological consequence to the more general socially aversive consequences of excessive drinking. 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. This approach relies on such techniques as imparting specific knowledge about alcohol, developing coping skills in situations associated with increased risk of alcohol use, modifying cognitions and expectancies, acquiring stress management skills, and providing training in life skills. Although CBT is a widely used treatment for many psychological conditions, it has so far shown only modest effects in the treatment of alcohol problems 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. For example, one approach to improve drinking outcomes by altering the drinker's social networks was found to be successful. and motivational interviewing with adolescents was found to be promising in decreasing substance use. It is difficult, of course, for individuals who are extremely dependent on the effects of alcohol to abstain totally from drinking. Thus, many alcoholics fail to complete traditional treatment programs.

Treatments and Outcomes with barbituates

As with many other drugs, it is often essential in treatment to distinguish between barbiturate intoxication, which results from the toxic effects of overdose, and the symptoms associated with drug withdrawal, because different procedures are required. With barbiturates, withdrawal symptoms are more dangerous, severe, and long lasting than in opiate withdrawal. A patient going through barbiturate withdrawal becomes anxious and apprehensive and manifests coarse tremors of the hands and face; additional symptoms commonly include insomnia, weakness, nausea, vomiting, abdominal cramps, rapid heart rate, elevated blood pressure, and loss of weight. An acute delirious psychosis may develop. For persons accustomed to taking large dosages, withdrawal symptoms may last for as long as a month, but usually they tend to abate by the end of the first week. Fortunately, the withdrawal symptoms in barbiturate addiction can be minimized by administering increasingly smaller doses of the barbiturate itself or another drug that produces similar effects. The withdrawal program is still a dangerous one, however, especially if barbiturate addiction is complicated by alcoholism or dependence on other drugs.

Environmental Intervention-alcoholism

As with other serious maladaptive behaviors, a total treatment program for alcohol abuse or dependency usually requires measures to alleviate a patient's aversive life situation. 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. Typically, the reaction of those around them is not as understanding or as supportive as it would be if the individual who abuses alcohol had a physical illness of comparable magnitude. Simply helping people with alcohol abuse problems learn more effective coping techniques may not be enough if their social environment remains hostile and threatening. 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.

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. One recent study provided smokers with ultrasound photographs of their carotid and femoral arteries along with quit-smoking counseling. This group showed higher quit rates than controls In general, tobacco dependence can be successfully treated, and most of the quit-smoking programs enjoy some success. They average only about a 20 to 25 percent success rate, however, although rates have been reported to be higher with treatment. This same level of success appears to result from the use of nicotine replacement therapy (NRT). Shiffman and colleagues (2006) point out that high-dose NRT reduces withdrawal symptoms. Treatment with active patches reduced withdrawal and craving during cessation and completely eliminated deprivation-related changes in affect or concentration. Recently, encouraging results have been reported on the use of the drug bupropion (Zyban) in preventing relapse for smokers trying to quit. The drug reduced relapse as long as the person was taking it, but relapse rates were similar to those of other treatments once the drug was discontinued The highest self-reported quit rates for smokers were reportedly among patients who were hospitalized for cancer (63 percent), cardiovascular disease (57 percent), or pulmonary disease

Effects of Barbiturates

Barbiturates were once widely used by physicians to calm patients and induce sleep. They act as depressants—somewhat like alcohol—to slow down the action of the CNS and significantly reduce performance on cognitive tasks. 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. Strong doses produce sleep almost immediately; excessive doses are lethal because they result in paralysis of the brain's respiratory centers. Impaired decision making and problem solving, sluggishness, slow speech, and sudden mood shifts are also common effects of barbiturates 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.

Effects of Amphetamine Abuse

Despite their legitimate medical uses, amphetamines are not a source of extra mental or physical energy. 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. 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. For a person who exceeds prescribed dosages, amphetamine consumption results in heightened blood pressure, enlarged pupils, unclear or rapid speech, profuse sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, 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.

Use of Medications in Treating Alcohol Abuse and Dependency

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. In fact, the primary value of drugs of this type seems to be their ability to interrupt the alcohol abuse cycle for a period of time during which therapy may be undertaken. Uncomfortable side effects may accompany the use of Antabuse; for example, alcohol-based aftershave lotion can be absorbed through the skin, resulting in illness. Moreover, the cost of Antabuse treatment, which requires careful medical maintenance, is higher than that for many other, more effective treatments. Other medications used to treat alcohol use are 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.

Neural Bases for Physiological Addiction- opiates

Drugs of abuse work by acting on different neural receptors in the brain. Receptor sites are found on specific nerve cells into which given psychoactive drugs fit like keys into locks. 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. The human body produces its own opium-like substances, called endorphins, in the central nervous system and pituitary gland. Heroin plugs into opiate receptors (taking the place of endorphins), but works much more quickly and intensely, producing the extreme euphoria described above. This intensely positive feeling leads some people to use heroin over and over again, sometimes multiple times per day, in order to reexperience that euphoric feeling. Over time, people build up tolerance in which more and more of the drug is required to produce the same high. Over repeated administrations, a person will also begin to experience withdrawal symptoms when the drug wears off, and so must either suffer through those symptoms or readminister the drug in order to stop the withdrawal symptoms and reexperience euphoria yet again. This can develop into a vicious cycle that is difficult for many to escape.

Synthetic Cannabinoids and Cathinones

During the past several years, drug developers have attempted to make and sell synthetic psychoactive substances that produce the same effects as naturally occurring drugs such as marijuana and cocaine, but do not contain the legally banned substance and so are not subject to prosecution. Two examples of this are synthetic cannabinoids and synthetic cathinones. Synthetic cannabinoids are substances that mimic the effects of tetrahydrocannabinol (THC), the active plant-derived substance in marijuana, and activate the human endocannabinoid system. Synthetic cannabinoids, sold under the names "Spice," "K2," "Blaze," and others, do contain some actual plants/herbs, but it is the synthetic chemical additive that causes the marijuana-like effects. Specifically, synthetic cannabinoids bind with CB1 receptors and produce marijuana-like intoxication. However, synthetic cannabinoids are much more likely than marijuana to have serious adverse side effects such as anxiety, tachycardia, hypertension, heart palpitations, seizures, and psychosis-like effects.In response to the recent rise in synthetic cannabinoids, and their dangerous side effects, in 2011 the DEA declared these chemicals to be illegal substances Synthetic cathinones are substances that mimic the effects of amphetamines and cocaine by activating the body's monoamine system. Synthetic cathinones, sold under the name "bath salts," first appeared in the illegal drug scene in 2010. Since then they have been examined in human epidemiologic and laboratory animal studies, and have been found to produce increased motor activity, agitation, violence, psychosis-like effects, and heart problems

Development of Alcohol Dependence

Excessive drinking can be viewed as progressing insidiously from early- to middle- to late-stage alcohol-related disorder, although some abusers do not follow this pattern. Many investigators have maintained that alcohol is a dangerous poison even in small amounts, but others believe that in moderate amounts it is not harmful to most people. For pregnant women, however, even moderate amounts are believed to be dangerous; in fact, no safe level has been established

Group Therapy-alcoholism

Group therapy has been shown to be effective for many clinical problems. In the confrontational give-and-take of group therapy, people who abuse alcohol are often forced (perhaps for the first time) to face their problems and their tendencies to deny or minimize them. These group situations can be extremely difficult for those who have been engrossed in denial of their own responsibilities, but such treatment also helps them see new possibilities for coping with circumstances that have led to their difficulties. Often this paves the way for them to learn more effective ways of coping and other positive steps toward dealing with their drinking problem. In some instances, the spouses of people who abuse alcohol and even their children may be invited to join in group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic efforts. Given that alcohol abuse and dependence can cause significant strains on family relationships, family therapy in such cases involves a delicate balance of educating the drinker about the familial consequences of her or his drinking, discussing any role that the family may have played in facilitating the drinking behavior (if any), and making plans for how the family can function most adaptively in the future.

Psychosocial Effects of Alcohol Abuse and Dependence

In addition to physical and medical problems, heavy drinkers often suffer from chronic fatigue, oversensitivity, and depression. Initially, alcohol may seem to provide a useful crutch for dealing with the stresses of life, especially during periods of acute stress, by helping screen out intolerable realities and enhance the drinker's feelings of adequacy and worth. The excessive use of alcohol eventually becomes counterproductive, however, and can result in impaired reasoning, poor judgment, and gradual personality deterioration. Behavior typically becomes coarse and inappropriate, and the drinker often assumes increasingly less responsibility, loses pride in personal appearance, neglects spouse and family, and becomes irritable and unwilling to discuss the problem. As judgment becomes impaired, an excessive drinker may be unable to hold a job and generally becomes unqualified to cope with new demands that arise. General personality disorganization and deterioration may be reflected in loss of employment and marital breakup. The drinker's general health will eventually deteriorate, and brain and liver damage will occur. For example, there is evidence that an alcoholic's brain is accumulating diffuse organic damage even when no extreme organic symptoms are present. and even mild to moderate drinking can adversely affect memory and problem solving.

Medications to Reduce the Side Effects of Acute Withdrawal

In cases of acute intoxication, the initial focus is on detoxification (the elimination of alcoholic substances from an individual's body), on treatment of the withdrawal symptoms described earlier, and on a medical regimen for physical rehabilitation. One of the primary goals in treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches are the prevention of heart arrhythmias, seizures, delirium, and death. These steps can usually best be handled in a hospital or clinic, where 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 Concern is growing, however, that the use of tranquilizers—drugs that depress the CNS, resulting in calmness, relaxation, reduction of anxiety, and sleeping—does not promote long-term recovery and may simply transfer the addiction to another substance. Accordingly, some detoxification clinics are exploring alternative approaches including a gradual weaning from alcohol instead of a sudden cutoff. Maintenance doses of mild tranquilizers are sometimes given to patients withdrawing from alcohol to reduce anxiety and help them sleep. Such use of medications may be less effective than no treatment at all, however. Usually patients must learn to abstain from tranquilizers as well as from alcohol because they tend to misuse both. Further, under the influence of medications, patients may even return to alcohol use.

stimulants

In contrast to opiates, which depress (slow down) the action of the CNS, cocaine, amphetamines, methamphetamine, caffeine, and nicotine stimulate it

Psychological Vulnerability-alcoholism

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 Considerable research also has suggested that there is a relationship between depressive disorders and alcohol abuse, and there may be gender differences in the association between these disorders. For whatever reason they co-occur, the presence of other mental disorders in patients who abuse alcohol or drugs is a very important consideration when it comes to treatment, as discussed later in this chapter.

Binge Drinking in College

In spite of the fact that alcohol use is illegal for most undergraduates, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that approximately 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 What are the reasons for the widespread problem of binge drinking in college? Many factors can be cited, such as 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" a long-term follow-up of over 11 years has shown that the heavy drinking during college did not translate to heavy drinking during later years (Bartholow et al., 2003). These investigators found that heavy drinking that is associated with Greek society involvement does not generally lead to sustained heavy drinking in later life. Some institutions provide a psychological intervention in an effort to reduce the extent of drinking among college students. One recent study reported that a procedure referred to as Brief Motivational Intervention, or BMI, produced greater self-regulation among a sample of binging college students by providing skills for them to moderate their drinking behavior

Cocaine

Like opium, cocaine is 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. However, with more widespread availability and lowering of prices, the drug's use increased significantly in the United States during the 1980s and 1990s—to the point where its use was considered epidemic, especially among middle- and upper-income groups. "Crack" is the street name that is applied to cocaine that has been processed from cocaine hydrochloride to a free base for smoking. The name refers to the crackling sound emitted when the mixture is heated. Cocaine is still illegal; however, approximately 0.6 percent of those 12 years or older report having used cocaine in the past month

use of cocaine

Like the opiates, cocaine may be ingested by sniffing, swallowing, or injecting. However, cocaine affects the brain in a different way than alcohol or opioids. 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 Also like the opiates, the euphoric state resulting from cocaine use lasts for 4 to 6 hours, during which a user experiences feelings of confidence and contentment. However, this 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. Many people develop both acute and chronic tolerance to cocaine over time. Moreover, cognitive impairment associated with cocaine abuse is likely to be an important consideration in long-term effects of the drug. The psychological and life problems experienced by cocaine users are often great. 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. Women who use cocaine when they are pregnant place their babies at risk for both health and psychological problems. Although research has suggested that there is no "fetal crack syndrome" similar to the syndrome associated with mothers who abuse alcohol children of crack-using mothers are at risk of being maltreated as infants as well as of losing their mothers during infancy.

Genetic Vulnerability to alcoholism

Many experts agree that heredity plays an important role in a person's developing sensitivity to the addictive power of drugs like alcohol ikewise, a study of children of alcoholics found that for males, having one alcoholic parent increased the rate of alcoholism from 12.4 percent to 29.5 percent and having two alcoholic parents increased the rate to 41.2 percent. For females with no alcoholic parents, the rate was 5.0 percent; for those with one alcoholic parent, the rate was 9.5 percent; and for those with two alcoholic parents, it was 25.0 percent Adoption studies also provide evidence for a genetic vulnerability for alcohol problems. In these studies, researchers followed up with children of alcoholics and children of nonalcoholics who were all adopted by nonalcoholic families. Such studies have shown that the children of alcoholic parents who had been adopted by nonalcoholic foster parents were nearly twice as likely to have alcohol problems by their late 20s as the control group of adopted children whose biological parents were not alcoholics. Another approach to understanding the precursors to alcohol-related disorders is to 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. Research has shown that those who are genetically predisposed to developing drug or alcohol problems but who have not yet acquired the problem show different physiological patterns than nonalcoholic men in several respects. Those at risk tend to experience greater decreases in stress following alcohol ingestion, show different alpha wave patterns on EEGs, and have larger conditioned physiological responses to alcohol cues than individuals who were considered to have a low risk for alcoholism

Marijuana

Marijuana comes from the leaves and flowering tops of the hemp plant, Cannabis sativa, which grows in mild climates throughout the world. In its prepared state, marijuana consists chiefly of dried green leaves—hence, the colloquial name "grass." It is ordinarily smoked in the form of cigarettes (variously referred to as "pot," "reefers," "joints," "weed," etc.) or in pipes. In some cultures the leaves are steeped in hot water and the liquid is drunk, much as one might drink tea. Marijuana is related to a stronger drug, hashish, which is derived from the resin exuded by the cannabis plant and made into a gummy powder. Hashish, like marijuana, is usually smoked. Although marijuana can be considered a mild hallucinogen, there are significant differences between the nature, intensity, and duration of its effects and those induced by drugs like LSD, mescaline, and other major hallucinogens. Both marijuana use and hashish use can be traced far back into history. Cannabis was apparently known in ancient China and was listed in the herbal compendiums of the 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. Marijuana use is likely to show an increase in the future, given that it has been legalized in some states even though it is illegal according to federal legal standards. In a recent survey of drug-related visits to the ED, 18.5 percent were for marijuana abuse

Should Marijuana Be Marketed and Sold Openly as a Medication?

Marijuana is a Schedule I drug according to the 1970 Controlled Substances Act, and U.S. government drug control agencies have strongly opposed legalization of the drug however, substantial efforts have been made to broaden its use and availability. In recent years marijuana has been distributed for pain or nausea relief from medical conditions such as cancer, AIDS, glaucoma, multiple sclerosis, migraines, and epilepsy. Proponents of medical marijuana cite its value in the treatment of these conditions, and some have pointed out that medical marijuana treatment is consistent with participation in other forms of drug treatment and may not adversely affect the outcome. Marijuana does not cure any illness; it only reduces pain for which other medications exist Although many professional researchers and practitioners discourage the use of marijuana because of the ill effects, others, including mental health professionals, politicians, and laypersons, press society to change the rigid control over the drug and make it legal. States vary in how medical marijuana is made available to the public. Some locations, such as the District of Columbia, have approved medical marijuana use by a limited and controlled number of dispensaries. The ready access to marijuana has heightened concerns over the drug serving as an "entry-level" drug for more addictive and dangerous illicit substances. This problem has been a focus of the U.S. government's opposition to legalizing marijuana since it has become more widely available. A number of problems with the use of medical marijuana have been reported, in part because of the unregulated availability of the drug; for example, one can get a "prescription" for the drug by walking into one of the many "treatment centers" and talking with a salesperson. A number of people have lost jobs or have not been offered a position as a result of drug screening—a requirement for employment in many positions such as security personnel, police applicants, pilots, and even some corporations such as Walmart. Marijuana's short-range physiological effects include a moderate increase in heart rate, a slowing of reaction time, a slight contraction of pupil size, bloodshot and itchy eyes, a dry mouth, and increased appetite. Furthermore, marijuana induces memory dysfunction and a slowing of information processing. Continued use of high dosages over time tends to produce lethargy and passivity along with reduced life success. In such cases marijuana appears to have a depressant and a hallucinogenic effect. The effects of long-term and habitual marijuana use are still under investigation, although a number of possible adverse side effects have been found to be related to the prolonged, heavy use of marijuana. With higher dosages marijuana can produce extreme euphoria, hilarity, and overtalkativeness, but it can also produce intense anxiety and depression as well as delusions, hallucinations, and other psychotic-like experiences. Evidence suggests a strong relationship between daily marijuana use and the occurrence of psychotic symptoms.

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). It can be manufactured, for example, in a portable cooler with ingredients that can be legally obtained from any drugstore. This 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. Methamphetamine operates by 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 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 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. 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

Biological Effects of Morphine and Heroin (and withdrawl process)

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, which many addicts compare to a sexual orgasm. However, vomiting and nausea have also been known to be part of the immediate effects of heroin and morphine use. This rush is followed by a high, during which an addict typically is in a lethargic, withdrawn state in which bodily needs, including needs for food and sex, are markedly diminished; pleasant feelings of relaxation and euphoria tend to dominate. 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. The use of opiates over a period of time generally results in a physiological craving for the drug. The time required to establish the drug habit varies, but it has been estimated that continual use over a period of 30 days is sufficient. Users then find that they have become physiologically dependent on the drug in the sense that they feel physically ill when they do not take it. In addition, users of opiates gradually build up a tolerance to the drug so increasingly larger amounts are needed to achieve the desired effects. 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. Withdrawal from heroin is not always dangerous or even very painful. Many addicted people withdraw without assistance. 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. As time passes, the symptoms may become more severe. Typically, a feeling of chilliness alternates with flushing and excessive sweating, vomiting, diarrhea, abdominal cramps, pains in the back and extremities, severe headache, marked tremors, and varying degrees of insomnia. Beset by these discomforts, an individual refuses food and water, and this, coupled with the vomiting, sweating, and diarrhea, results in dehydration and weight loss. Occasionally, symptoms include delirium, hallucinations, and manic activity. Cardiovascular collapse may also occur and can result in death. If morphine is administered, the subjective distress experienced by an addict temporarily ends and physiological balance is quickly restored. Withdrawal symptoms usually decline by the third or fourth day and by the seventh or eighth day have disappeared. As the symptoms subside, the person resumes normal eating and drinking and rapidly regains lost weight. After withdrawal symptoms have ceased, the individual's former tolerance for the drug is reduced; as a result, there is a risk that taking the former large dosage might result in overdose.

Causal Factors in Opiate Abuse and Dependence

No single causal pattern fits all addictions to opiates, and both genetic and environmental influences seem to play a role. The three most frequently cited reasons that people given for beginning to use heroin are 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

Relapse Prevention-alcoholism

One of the greatest problems in the treatment of addictive disorders is maintaining abstinence or self-control once the behavioral excesses have been checked. Most alcohol treatment programs show high success rates in getting people to stop drinking for the time being, but many programs show lessening rates of abstinence or controlled drinking at various follow-up periods. That is, it is one thing to get someone to stop drinking for 30 days, but some have argued that many treatment programs do not pay enough attention to maintaining effective behavior and preventing relapse into previous maladaptive patterns Given that alcohol-dependent people are highly vulnerable to relapse, some researchers have focused on the need to help them remain abstinent. In one cognitive-behavioral approach, relapse behavior is a key factor in alcohol treatment The behaviors underlying relapse are seen as "indulgent behaviors" that are based on an individual's learning history. 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. In the cognitive-behavioral view, a person may, even while maintaining abstinence, inadvertently make a series of mini-decisions that begin a chain of behaviors that render relapse inevitable. Another type of relapse behavior involves the "abstinence violation effect," in which even minor transgressions are seen by the abstainer as having drastic significance. The effect works this way: An abstinent person may hold that she or he should not, under any circumstance, transgress or give in to the old habit. Abstinence-oriented treatment programs are particularly guided by this prohibitive rule. What happens, then, when an abstinent person becomes somewhat self-indulgent and takes a drink offered by an old friend or joins in a wedding toast? He or she may lose some of the sense of self-efficacy—confidence—needed to control his or her drinking. Feeling guilty about having technically violated the vow of abstinence, the person may rationalize that he or she "has blown it and become a drunk again, so why not go all the way? In relapse prevention treatment, clients are taught to recognize the apparently irrelevant decisions that serve as early warning signals of the possibility of relapse. High-risk situations such as parties or sports events are targeted, and the individuals learn to assess their own vulnerability to relapse. Clients are also trained not to become so discouraged that if they do relapse they lose their confidence. Some cognitive-behavioral therapists have even incorporated a "planned relapse" phase into the treatment. Research with relapse prevention strategies has shown them to be effective in providing continuing improvement over time

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. Moreover, people who abuse opioids are significantly more likely than nonabusers to use the full range of medical services (e.g., mental health visits, ED visits, hospital stays). The direction and causal associations of these comorbidities are not yet clear. It may be that psychological disorders like depression and anxiety lead people to use opiates as a way to escape from their negative thoughts and feelings. But it is also possible that the negative consequences of opiate use lead people to be depressed and anxious, or both. Either way, it is clear that opiate addiction is associated with a host of other problems that must be understood, assessed, and addressed in each case.

alcoholism and 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. It is also no surprise that many alcoholics die by suicide. In addition to the serious problems that excessive drinkers create for themselves, they also pose serious difficulties for others -Alcohol abuse co-occurs with high frequency with personality disorder as well

Increase in gambling

Pathological gambling is on the increase in the United States-particularly with the widely available gambling opportunities on the Internet Liberalized gambling legislation has permitted state-operated lotteries, horse racing, and gambling casinos in an effort to increase state tax revenues. In the context of this apparent environmental support and "official" sanction for gambling, it is likely that pathological gambling will increase substantially as more and more people "try their luck." Given that pathological gamblers are resistant to treatment, future efforts to develop more effective preventive and treatment approaches will need to be increased as this problem continues to grow.

Pathological gambling development

Pathological gambling seems to be a learned pattern that is highly resistant to extinction. Some research suggests that control over gambling is related to duration and frequency of playing. However, many people who become pathological gamblers won a substantial sum of money the first time they gambled; chance alone would dictate that a certain percentage of people would have such "beginner's luck." The reinforcement a person receives during this introductory phase may be a significant factor in later pathological gambling. Because everyone is likely to win from time to time, the principles of intermittent reinforcement—the most potent reinforcement schedule for operant conditioning—could explain an addict's continued gambling despite excessive losses. Those with co-occurring substance abuse disorders typically have the most severe gambling problems. The causes of impulse-driven behavior in pathological gambling are complex. Some research has suggested that early trauma might contribute to the development of compulsive gambling. Although learning undoubtedly plays an important part in the development of personality factors underlying the "compulsive" gambler, recent research on brain mechanisms that are involved in motivation, reward, and decision making indicates that these mechanisms could influence the underlying impulsivity in personality. These investigators have suggested that important neurodevelopmental events during adolescence occur in brain regions associated with motivation and impulsive behavior. Recent research has also suggested that genetic factors might play a part in developing pathological gambling habits

history of alcohol and alcoholism

People of many ancient cultures, including the Egyptians, Greeks, Romans, and Israelites, made extensive and often excessive use of alcohol (and other substances). Beer was first made in Egypt around 3000 b.c.e. The oldest surviving wine-making formulas were recorded by Marcus Cato in Italy almost a century and a half before the birth of Christ. About a.d. 800, the process of distillation was developed by an Arabian alchemist, thus making possible an increase in both the range and the potency of alcoholic beverages. Problems with excessive use of alcohol were observed almost as early as its use began. Cambyses, King of Persia in the sixth century b.c.e., has the dubious distinction of being one of the early alcohol abusers on record.

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.

Fetal Alcohol Syndrome

Research indicates that heavy drinking by expectant mothers can affect the health of unborn babies, particularly binge drinking and heavy drinking during the early days of pregnancy Newborn infants whose mothers drank heavily during pregnancy have been found to have frequent physical and behavioral abnormalities, including growth deficiencies, facial and limb irregularities, damage to the CNS, and impairment in cognitive and motor functioning Neuroimaging research has shown that there is an overall reduction of brain size and prominent brain shape abnormalities, with narrowing in the parietal region along with reduced brain growth in portions of the frontal lobe. Moreover, children with FAS often show significant working memory deficits and altered activation patterns in some brain regions.

Treatments and Outcomes for amphetimines

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. Moreover, abrupt abstinence commonly results in feelings of weariness and depression. 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. Mild feelings of depression and lassitude may persist for weeks or even months. If brain damage has occurred, the residual effects may include impaired ability to concentrate, learn, and remember, with resulting social, economic, and personality deterioration.

Caffeine and Nicotine- why are they so popular?

SM-5 includes addictions to two legally available and widely used substances: caffeine and nicotine. Although these substances do not involve the extensive and self-destructive problems found in alcohol and drug use disorders, they can create important physical and mental health problems in our society for several reasons: 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.

Expectations of Social Success-alcoholism

Some research has explored the idea that cognitive expectation may play an important role both in the initiation of drinking and in the maintenance of drinking behavior once the person has begun to use alcohol. According to the reciprocal-influence model, adolescents begin drinking as a result of expectations that using alcohol will increase their popularity and acceptance by their peers. This view gives professionals an important and potentially powerful means of deterring drinking among young people or at least delaying its onset. From this perspective, alcohol use in teenagers can be countered by providing young people with more effective social tools and with ways of altering these expectancies before drinking begins. Some researchers have suggested that prevention efforts should be targeted at children before they begin to drink so that the positive feedback cycle of reciprocal reinforcement between expectancy and drinking will never be established Time and experience do have moderating influences on these alcohol expectancies, although heavy drinking in early college years can result in risky behavior and low academic motivation

alcoholism in ethnic groups- alcohol flush syndrome

Some research suggests that certain ethnic groups, particularly Asians and Native Americans, have abnormal physiological reactions to alcohol—a phenomenon referred to as "alcohol flush reaction." Asian and Eskimo subjects have shown a 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 This physiological reaction is found in roughly half of all Asians and results from a mutant enzyme that fails to break down alcohol molecules in the liver during the metabolic process Although cultural factors may also play a role, the relatively lower rates of alcoholism among Asian groups might be related to the extreme discomfort associated with the alcohol flush reaction

Failures in Parental Guidance-alcoholism

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 They found that parenting skills or parental behavior was associated with substance use in adolescents. Specifically, alcohol-abusing parents are less likely to keep track of what their children are doing, and this lack of monitoring often leads to the adolescents' affiliation with drug-using peers. In addition, stress and negative affect (more prevalent in families with an alcoholic parent) are associated with alcohol use in adolescents.

Stress, Tension Reduction, and Reinforcement-alcoholism

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 A number of investigators have pointed out that the typical individual who abuses alcohol is discontented with his or her life and is unable or unwilling to tolerate tension and stress. high degree of association between alcohol consumption and negative affectivity such as anxiety and somatic complaints. In other words, many alcoholics drink to relax. In this view, anyone who finds alcohol tension reducing is in danger of abusing alcohol, even without an especially stressful life situation. However, the tension-reduction causal model is difficult to accept as a sole explanatory hypothesis. If this process were a main cause, we would expect substance abuse disorder to be far more common than it is because alcohol tends to reduce tension for most people who use it. In addition, this model does not explain why some excessive drinkers are able to maintain control over their drinking and continue to function in society, whereas others are not.

"tobacco withdrawal disorder

The "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. The diagnostic criteria for nicotine withdrawal include (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. These withdrawal symptoms usually continue for several days to several weeks, depending on the extent of the nicotine habit. Some individuals report a desire for nicotine continuing for several months after they quit smoking. In general, nicotine withdrawal symptoms operate in a manner similar to those of withdrawal from other addictions—they are time limited and are reduced over time as the drug intake stops

Caffeine

The chemical compound caffeine is found in many commonly available drinks and foods. Although the consumption of caffeine is widely practiced and socially promoted in contemporary society, problems can result from excessive caffeine intake. 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.

dopamine theory of addiction

The dopamine theory of addiction suggests that addiction is the result of a dysfunction of the dopamine reward pathway. This pathway, also called the "pleasure pathway," as mentioned earlier in our discussion of alcohol addiction, was first discovered in seminal work by Olds and Milner (1954), who found that rats would repeatedly press a lever to self-stimulate certain areas of their brain (via electrodes placed there) instead of engaging in any other activity. Researchers later realized that what Olds and Milner had stumbled upon was the dopamine reward pathway, which stretches from the ventral tegmental area to the nucleus accumbens. which in turn connects with other parts of the brain such as the amygdala and prefrontal cortex. 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. Several decades of research, however, have demonstrated that the picture appears to be much more complex than that, and the pleasure experienced in response to drug use is not simply the result of elevated levels of dopamine.

Ecstasy

The drug Ecstasy, or MDMA (3,4-methylenedioxymethylamphetamine), is both a hallucinogen and a stimulant that is popular as a party drug among young adults. The 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. 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 Ecstasy is chemically similar to methamphetamine and to the hallucinogen mescaline and produces effects similar to those of other stimulants. 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 hallucinations in addition to the high levels of energy and excitement that are produced. The drug MDMA is an addictive substance, but it is not thought to be as addictive as cocaine. 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 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. As with many other illicit drugs, the recreational use of Ecstasy has been associated with personality characteristics of impulsivity and poor judgment. Ecstasy users have been found to be more likely to use marijuana, engage in binge drinking, smoke cigarettes, and have multiple sexual partners. However, Ecstasy use is also found among naïve partygoers who are provided the drug as a means of staying awake while socializing

Amphetamines

The earliest amphetamine to be introduced—Benzedrine, or amphetamine sulfate—was first synthesized in 1927 and became available in drugstores in the early 1930s as an inhalant to relieve stuffy noses. However, the manufacturers soon learned that some customers were chewing the wicks in the inhalers for "kicks." Thus, the stimulating effects of amphetamine sulfate were discovered by the public before the drug was formally prescribed as a stimulant by physicians. In the late 1930s, two newer amphetamines were introduced: Dexedrine (dextroamphetamine) and Methedrine (methamphetamine hydrochloride, also known as "speed"). The latter preparation is a far more potent stimulant of the CNS than either Benzedrine or Dexedrine and hence is considered more dangerous. In fact, its abuse can be lethal. 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. Today amphetamines are 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. Since the passage of the 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

Hallucinogens (effects and types)

The hallucinogens are drugs that are thought to induce hallucinations. However, these preparations usually do not in fact "create" sensory images but distort them so that an individual sees or hears things in different and unusual ways. These drugs are often referred to as psychedelics. The major drugs in this category are LSD (lysergic acid diethylamide) or "acid," mescaline, psilocybin, Ecstasy, and marijuana.

psychoactive substances

The most commonly used problem substances are those that affect mental functioning in the central nervous system (CNS)—psychoactive substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, Ecstasy, and marijuana. Some of these substances, such as alcohol and nicotine, can be purchased legally by adults; others, such as barbiturates or pain medications like OxyContin, can be used legally under medical supervision; still others, such as heroin, Ecstasy, and methamphetamine, are illegal.

LSD

The most potent of the hallucinogens, the odorless, colorless, and tasteless drug LSD can produce intoxication with an amount smaller than a grain of salt. 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. Researchers thought LSD might be useful for the induction and study of hallucinogenic states or "model psychoses," which were thought to be related to schizophrenia. About 1950, LSD was introduced into the United States for the purposes of such research and to ascertain whether it might have medical or therapeutic uses. Despite considerable research, however, LSD did not prove to be therapeutically useful. After taking LSD, a person typically goes through about 8 hours of changes in sensory perception, mood swings, and feelings of depersonalization and detachment. The LSD experience is not always pleasant. It can be extremely traumatic, and the distorted objects and sounds, the illusory colors, and the new thoughts can be menacing and terrifying. An interesting and unusual phenomenon that may occur sometime following the use of LSD is the flashback, an involuntary recurrence of perceptual distortions or hallucinations weeks or even months after an individual has taken the drug. Flashbacks appear to be relatively rare among people who have taken LSD only once—although they do sometimes occur. Even if no flashbacks occur, one study found that continued effects on visual function were apparent at least 2 years after LSD use-individuals who had used LSD for a week had reduced visual sensitivity to light during dark adaptation and showed other visual problems compared with controls.

Problems associated with ecstasy

The negative psychological and health consequences (including death) of using Ecstasy have been widely reported in the literature. 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.

Outcome Studies and Issues in Treatment

The outcome of treatment for alcohol-related disorders 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. 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. Instead, in MI the 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. For instance, one recent study found that adolescents visiting an emergency department (ED) with alcohol problems and aggression who were randomly assigned to receive a brief MI-focused intervention via a clinician or computer (compared to those who received no such intervention) showed significant reductions in their drinking and aggression up to 6 months after this brief intervention Some researchers have maintained that treatment for alcohol use and abuse disorders would be more effective if important patient characteristics (e.g., personality characteristics, degrees of severity) were considered. This view was evaluated in a study of patient-treatment matching (referred to as "Project MATCH") that was sponsored by the NIAAA (1997). This extensive study, initiated in 1989, involved 1,726 patients who were treated in 26 alcohol treatment programs in the United States by 80 different therapists representing three treatment approaches. The research design included both inpatient and outpatient treatment components. The results of this study were unexpected: Matching the patients to particular treatments did not appear to be important to having an effective outcome because the treatments studied all had equal outcomes.

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. 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. However, an estimated 63 percent of women and 53 percent of men have never smoked The DSM-5 contains a diagnostic category for nicotine abuse. The criteria for tobacco use disorder are the same for other addictive disorders.

Aspects linked to alcoholism (physical and social)

The potentially detrimental effects of excessive alcohol use are enormous. Heavy drinking is associated with vulnerability to injury, marital discord, 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. Organic impairment, including brain shrinkage, occurs in a high proportion of people with alcohol dependence. 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 and with about 40 to 50 percent of all murders, 40 percent of all assaults, and over 50 percent of all rapes 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

Effects of Marijuana

The specific effects of marijuana vary greatly, depending on the quality and dosage of the drug, the personality and mood of the user, the user's past experiences with the drug, the social setting, and the user's expectations. However, considerable consensus exists among regular users that when marijuana is smoked and inhaled, a state of slight intoxication results. 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

alcohol-induced psychotic disorders

These reactions may develop in people who have been drinking excessively over long periods of time. Such acute reactions usually last only a short time and generally consist of confusion, excitement, and delirium. These disorders are often called alcohol-induced psychotic disorders because they are marked by a temporary loss of contact with reality

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. The feelings of tension and depression that accompany absence of the drug have to be dealt with during the immediate withdrawal period. Despite cocaine's addictive potential, psychological interventions have proven to be quite effective in successfully treating cocaine dependence. A recent review of 34 studies testing psychological treatments for substance use disorders evaluated in randomized controlled trials reported that 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. CM is based on the principles of operant conditioning and offers rewards or financial incentives for meeting agreed-on treatment targets (e.g., drug-free urine). CM has been shown to be slightly more effective than CBT for cocaine dependence Importantly, recent research has shown that psychological treatments for cocaine dependence are associated with decreases not just in cocaine use but in a range of other problems in both men, women, and prisoners.

alcohol substance disorder treatment

Traditional treatment programs usually have as their goal abstinence from alcohol. However, some programs attempt to promote controlled drinking as a treatment goal for problem drinkers. For example, the BMI procedure discussed earlier attempts to modify clients' behavior through providing information and advice about the consequences of the substance use in an effort to challenge the users about their use—but leaves the responsibility to the individual. No matter what the treatment method, relapse is common, and many in the field see relapse as a factor that must be addressed in the treatment and recovery process. 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. Overall, less than one-third of those with alcohol use disorders receive treatment, and available treatments for alcohol-related disorders show modest effects. . In general, 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 procedures. Also, a substance abuser's needs change as treatment progresses. 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.

Treatments and Outcomes of opiod addictions

Treatment for opiate addiction is initially similar to that for alcoholism in that it involves restoring physical and psychological health and providing help through the withdrawal period. Addicts often dread the discomfort of withdrawal, but in a hospital setting it is less abrupt and usually involves the administration of medication that eases the distress. After physical withdrawal has been completed, treatment focuses on helping the person make an adequate adjustment to his or her community and abstain from the further use of opiates. Traditionally, however, the prognosis has been unfavorable, with many clients dropping out of treatment. Withdrawal from heroin does not remove the craving for the drug. Thus, a key target in treatment of heroin addiction must be the alleviation of this craving. One approach to dealing with the physiological craving for heroin was pioneered by a research team at Rockefeller University in New York. It involved the use of the drug methadone in conjunction with a rehabilitation program (counseling, group therapy, and other procedures) directed toward the "total resocialization" of addicts. Methadone hydrochloride is a synthetic narcotic that is related to heroin and is equally addictive physiologically. Its usefulness in treatment lies in the fact that it satisfies an addict's craving for heroin without producing serious psychological impairment, if only because it is administered as a "treatment" in a formal clinical context and can result in reduced drug use and improved cognitive performance Other medications, such as 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. It operates as a partial antagonist to heroin and produces the feelings of contentment associated with heroin use. Yet the drug does not produce the physical dependence that is characteristic of heroin and can be discontinued without severe withdrawal symptoms. Like methadone, buprenorphine appears to work best at maintaining abstinence if it is provided along with behavior therapy.

Treatment of pathological gamblers

Treatment of pathological gamblers has tended to parallel that of other addictive disorders. The most extensive treatment approach used with pathological gamblers is cognitive-behavioral therapy. In a study of 231 gamblers (Petry et al., 2006), some improved when receiving CBT and when attending Gambler's Anonymous (GA) meetings, an organization modeled after Alcoholics Anonymous, or when attending GA and receiving a workbook. The patients tended not to remain abstinent, although incidents were fewer than they usually reported. Most participants reported some gambling during the follow-up period. More positive outcomes in treating pathological gambling have been found when family relationship problems are addressed in the treatment

Mescaline and Psilocybin

Two other hallucinogens are mescaline, which is derived from the small, disk-like growths (mescal buttons) at the top of the peyote cactus, and psilocybin, which is obtained from a variety of "sacred" Mexican mushrooms known as Psilocybe mexicana. 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.

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. Along with the lowering of ethical and moral restraints, addiction has adverse physical effects on an individual's well-being—for example, disruption of the immune system. 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. and transmission of the AIDS virus. In addition, the use of such a 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. The most common drug-related deaths in the United States involve combinations of heroin, cocaine, and alcohol. Women who use heroin during pregnancy subject their unborn children to the risk of dire consequences. One tragic outcome is premature babies who are themselves addicted to heroin and vulnerable to a number of diseases. The ill health and general personality degeneration often found in opiate addiction do not always result directly from the pharmacological effects of the drug, however; rather, they are often products of the sacrifices of money, proper diet, social position, and self-respect as an addict becomes more desperate to procure the required daily dosage.

Treatment of Marijuana abuse

When abstaining from marijuana use, some users report having uncomfortable withdrawal-like symptoms such as nervousness, tension, sleep problems, and appetite change. Psychological treatment methods have been shown to be effective in reducing marijuana use in adults who are dependent on the drug and no specific treatment approach has been found to be more effective than the others. No pharmacotherapy treatment for cannabis dependency has been shown to be very effective- however, one recent study using buspirone for treatment of marijuana dependency showed slight improvement over a placebo group

Genetic Influences and Learning in alcoholism

When we talk about familial or constitutional differences, we are not strictly limiting our explanation to genetic inheritance. Rather, learning factors appear to play an important part in the development of predetermined tendencies to behave in particular ways. Having a genetic predisposition or biological vulnerability to substance abuse, of course, is not a sufficient cause of the disorder. The person must be exposed to the substance to a sufficient degree for the addictive behavior to appear. In the case of alcohol, almost everyone in America is exposed to the drug to some extent—in most cases through 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. There clearly are numerous reinforcements for using alcohol in our everyday lives. However, research has also shown that psychoactive drugs such as alcohol contain intrinsic rewarding properties—apart from the social context or the drug's operation to diminish worry or frustration.

Opium (history and 2 types)

a mixture of about 18 chemical substances known as alkaloids. In 1805, the alkaloid present in the largest amount (10-15 percent) was found to be a bitter-tasting powder that could serve as a powerful sedative and pain reliever; it was named morphine after Morpheus, the god of sleep in Greek mythology. The hypodermic needle was introduced in America around 1856, allowing morphine to be widely administered to soldiers during the Civil War—not only to those wounded in battle but also to those suffering from dysentery (an illness with symptoms including abdominal pain and diarrhea with blood). As a consequence, many Civil War veterans returned to civilian life addicted to the drug, a condition euphemistically referred to as "soldier's illness." Scientists concerned with the addictive properties of morphine hypothesized that one part of the morphine molecule might be responsible for its analgesic properties (that is, its ability to eliminate pain without a loss of consciousness) and another for its addictiveness. At about the turn of the century, it was discovered that if morphine was treated with an inexpensive and readily available chemical called acetic anhydride, it would be converted into another powerful analgesic called heroin. Heroin was hailed enthusiastically by its discoverer, Heinrich Dreser (Boehm, 1968). 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. As it became apparent that opium and its derivatives—including codeine, which is used in some cough syrups—were extremely addictive, the U.S. Congress enacted the Harrison Act in 1914. Under this and later legislation, the unauthorized sale and distribution of certain drugs became a federal offense; physicians and pharmacists were held accountable for each dose they dispensed. Thus, overnight, the role of a chronic narcotic user changed from that of addict—whose addiction was considered a vice, but was tolerated—to that of criminal. Unable to obtain drugs through legal sources, many turned to illegal channels, and eventually to other criminal acts, as a means of maintaining their suddenly expensive drug supply. In 2011, heroin use accounted for approximately 20 percent of all drug-abuse-related ED admissions

Addictive behavior

behavior based on the pathological need for a substance—may involve the abuse of substances such as nicotine, alcohol, Ecstasy, or cocaine. Addictive behavior is one of the most prevalent and difficult-to-treat mental health problems facing our society today.

Substance abuse

generally involves an excessive use of a substance resulting in (1) potentially hazardous behavior such as driving while intoxicated or (2) continued use despite a persistent social, psychological, occupational, or health problem.

Substance dependence

includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing amounts of a substance to achieve the desired effects. Dependence in these disorders means that an individual will show a tolerance for a drug and/or experience withdrawal symptoms when the drug is unavailable.

nicotine-dependence syndrome

nearly always begins during the adolescent years and may continue into adult life as a difficult-to-break and health-endangering habit. Supporting the finding that nicotine may have an antianxiety property, nicotine use has been observed as being highly prevalent among those with anxiety disorders Recent evidence from stroke-related brain injury suggests that nicotine addiction might be controlled by a portion of the brain near the ear called the insula. A stroke patient with damage to that area of the brain reported that his craving for cigarettes vanished. This result suggests that the insula might be an important center for addiction to smoking, but more research is needed to support this conclusion.

Withdrawal

refers to physical symptoms such as sweating, tremors, and tension that accompany abstinence from a drug.

The mesocorticolimbic dopamine pathway (MCLP)

the center of psychoactive drug activation in the brain. The MCLP is made up of neuronal cells in the middle portion of the brain known as the ventral tegmental area and connects to other brain centers such as the nucleus accumbens and then to the prefrontal cortex. This neuronal system is involved in such functions as control of emotions, memory, and gratification. Alcohol produces euphoria by stimulating this area in the brain. Research has shown that direct electrical stimulation of the MCLP produces great pleasure and has strong reinforcing properties Other psychoactive drugs also operate to change the brain's normal functioning and to activate the pleasure pathway, as we discuss in more detail later. Drug ingestion or behaviors that lead to activation of the brain reward system are reinforced, so further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure and results in a number of behavioral effects. With continued use of the drug, neuroadaptation to or tolerance and dependence on the substance develop.

heavy episodic drinking

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

Tolerance

the need for increased amounts of a substance to achieve the desired effects—results from biochemical changes in the body that affect the rate of metabolism and elimination of the substance from the body.