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Unformatted text preview: Substance*Use*Disorders*
Cannabis, LSD, PCP, Mushrooms Text Diagnostic Issues
• The DSM-5 term substance-related disorders
include 11 symptoms that range from
relatively mild (e.g., substance use results in
a failure to fulfill major role obligations) to
more severe (e.g., occupational or
recreational activities are given up or reduced
because of substance use)
Don’t have to know how many • Substance-related disorders and anxiety and
mood disorders are highly prevalent 1.
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• Substance*is*o3en*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*substance*use.*
A*great*deal*of*Bme*is*spent*in*acBviBes*necessary*to*obtain*substance,*use*substance,*or*
recover*from*its*effects.*
Craving,*or*a*strong*desire*or*urge*to*use*substance.*
Recurrent*substance*use*resulBng*in*a*failure*to*fulfill*major*role*obligaBons*at*work,*
school,*or*home.*
ConBnued*substance*use*despite*having*persistent*or*recurrent*social*or*interpersonal*
problems*caused*or*exacerbated*by*the*effects*of*substance.*
Important*social,*occupaBonal,*or*recreaBonal*acBviBes*are*given*up*or*reduced*because*
of*substance*use.*
Recurrent*substance*use*in*situaBons*in*which*it*is*physically*hazardous.*
Substance*use*is*conBnued*despite*knowledge*of*having*a*persistent*or*recurrent*physical*
or*psychological*problem*that*is*likely*to*have*been*caused*or*exacerbated*by*substance.*
Tolerance,*as*defined*by*either*of*the*following:*
A*need*for*markedly*increased*amounts*of*substance*to*achieve*intoxicaBon*or*desired*
effect.*
A*markedly*diminished*effect*with*conBnued*use*of*the*same*amount*of*substance.*
Withdrawal,*as*manifested*by*either*of*the*following:*
The*characterisBc*withdrawal*syndrome*for*substance*(refer*to*Criteria*A*and*B*of*the*
criteria*set*for*substance*withdrawal).*
substance*(or*a*closely*related*substance,*such*as*a*benzodiazepine)*is*taken*to*relieve*or*
avoid*withdrawal*symptoms.* Five*Main*Categories*of*Substances**
1.Depressants* – Behavioral*sedaBon*(e.g.,*alcohol,*sedaBve,*anxiolyBc*drugs)* 2.SBmulants* Benzodiazepine – Increase*alertness*and*elevate*mood**
(e.g.,*cocaine,*nicoBne;*caffeine)** 3.*Opiates** – Produce*analgesia*and*euphoria*(e.g.,*heroin,*morphine,*
codeine)* 4.Hallucinogens** – Alter*sensory*percepBon*(e.g.,*marijuana,*LSD)* PCP 5.*Other*drugs*of*abuse* – Include*inhalants,*anabolic*steroids,*medicaBons* MDMA, Ketamine, E Depressants;*Alcohol*Use*Disorders*
(AUDs)*
• LifeBme*prevalence*(Kessler*et*al.,*1994)* – Abuse*`**17%*
– Dependence*–*12%*
– Both*higher*for*men*than*women*(20%*vs*8%)* Data is based on before DSM 5, that’s
why there is difference between A & D • Binge*drinking* – 5*drinks*(4*for*women)*in*short*period*
– 43.5%*past`month*prevalence*among*college*students* • Heavy*use*drinking*
– 5*drinks,*5*or*more*Bmes*in*a*30*day*period*
• 17.6%*prevalence*among*college*students* • Comorbidity*is*extremely*common*`*21.3%*with*AUD*also*have*at*
least*1*psychological*disorder* Common w/ Anxiety, Depression, Anti-Social Behavior Race/Ethnic*Differences*in*AUD*
highest on current use for white,
binge in Native American/Alaska Native; Native Hawaiian
Lowest in Asian; don’t have the gene to stomach it Alcohol*
• Enters*the*bloodstream*through*small*
intesBne*
– metabolized*by*the*liver* Can die from Cirrhosis • Interacts*with*several*neural*systems*
– SBmulates*GABA*receptors*
– SBmulates*endogenous*opioids*
– Increases*dopamine*and*serotonin*
– Inhibits*glutamate*receptors* Biphasic effect
At*higher*levels,*alcohol*
depresses*brain*funcBoning*
(lessen*judgment,*learning,*
self`control)*
Higher Level—Pass out, depresses
brain functioning
Lower Level/Beginning— Stimulant/
relaxing, euphoria At*lower*levels,*alcohol*
sBmulates*certain*brain*cells*
and*acBvates*brain’s*
“pleasure*areas”* When ingested in large amounts
Depression*
and*
withdrawal* Poor*
coordinaBon
Impaired*
/loss*of*
speech*and*
balance*
vision*
Interference*
in*complex*
thought*
processes* When they drink alcohol they have severe withdrawal symptoms, life threatening Clinical'picture'for'
excessive'drinkers' Long-term consequences of heavy
alcohol use
Baby has facial abnormalities,
intellectual impairment/disability This is characterized by problems
in memory, not recognizing
familiar people; substance
induced neurocognitive disorder Associated*brain*
condiBons*–*
demenBa*and*
Wernicke s*
disease* Fetal*alcohol*
syndrome** Do no eat a healthy diet Vitamin/
nutriBonal*
deficiency* Aggression, lack of parenting DisrupBon*of*
relaBonships,*job*
performance,*
problems*with*
legal*authoriBes** Long`term*
consequences* MulBple*health*
problems*
(e.g.Cirrhosis*of*
the*liver)** Opioids:*An*Overview*
• The*nature*of*opiates*and*opioids*
– Opiate*–*natural*chemical*in*the*opium*poppy*
with*narcoBc*effects**
– Opioids*–*natural*and*syntheBc*substances*with*
narcoBc*effects*
– O3en*referred*to*as*analgesics** Opium and Its Derivatives
(Narcotics)=Opium, Morphine,
Heroin
AlleviaBon*of*physical*pain*
PosiBve*
effects*
last*for*
4`6*hrs* Immediate*effects*of*
narcoBcs* RelaxaBon,*anxiety*
reducing,*pleasant*feelings* Slowed*breathing** *Injected,*snorted,*smoked* Drowsiness,*impaired*
coordinaBon,*dizziness,*
confusion* Opium and Its Derivatives
(Narcotics)
Sam,*a*15`year`old*addict:*“When%you%first%shoot%up,%
you%will%most%likely%puke%and%feel%repelled,%but%soon%
you’ll%try%it%again.%It%will%cling%to%you%like%an%obsessed%
lover.%The%rush%of%the%hit%and%the%way%you’ll%want%
more,%as%if%you%were%being%deprived%of%air—that’s%
how%it%will%trap%you.”*
Long`term*effects* Your%whole%day%is%spent%finding%or%taking%drugs.%
You%get%high%all%a6ernoon.%At%night,%you%put%
yourself%to%sleep%with%heroin.%And%you%live%only%
for%that.%You%are%in%a%prison.%You%beat%your%
head%against%a%wall,%nonstop,%but%you%don’t%get%
anywhere.%In%the%end,%your%prison%becomes%
your%tomb.”*—Sabrina* Physiological*craving*for*the*
drug`tolerance*develops*rapidly* Withdrawal*symptoms*can*be*
severe*(within*8*hours*for*
heroin)* Mortality*rates*are*high*for*
opioid*addicts*
``High*risk*for*HIV*infecBon*and*
high*doses*result*in*death* SBmulants:*An*Overview*
• Nature*of*sBmulants*
– Most*widely*consumed*drug*in*the*United*States*
– Such*drugs*increase*alertness*and*increase*energy*
– Examples*include*amphetamines,*cocaine,*
nicoBne,*and*caffeine**
Most commonly used drug category, increased heart rate, irritability/ anxiety -> hemmorages, panic attack Cocaine and Amphetamines
(Stimulants) Cocaine*and*
amphetamines*
(methamphetamine)* Increase*feelings*of*
alertness*and*
confidence* Decrease*feelings*of*
faBgue* Euphoric*state*lasts*
4`6*hours* SBmulate*sexual*drive* Increased*heart*rate,*
blood*pressure,*
reduced*appeBte,*
irritability,*anxiety* Damage*blood*vessels*
in*brain,*aggressive*
behavior* Inhales, goes to brain, stimulates
neuron, blocks pre-synaptic
neurons from the recycling
process, leads it to cause more
dopamine to excite it There is a high and then there is
a crash phase when dopamine
is depleted Long term use: Cocaine and
Amphetamines (Stimulants)
I%had%no%more%future.%I%did%not%see%
how%I%could%escape%my%cocaine%
dependence.%I%was%lost.%I%was%
Long`term*use*
‘exploding’%and%unable%to%stop%
myself%from%conGnuing%to%seriously%
abuse%cocaine.%I%had%hallucinaGons%
that%animals%were%crawling%under%
May*result*in*brain*
my%skin.%I%felt%them%each%Gme%I%
Effects*followed*by*
damage*and*
shot%up%and%scraped%myself%with%
faBgue*and*
psychopathology*
the%point%of%my%syringe%unGl%I%
depression*(“crash”)*
started%bleeding%in%order%to%make%
them%leave.%I%was%once%bleeding%so%
heavily%from%this%I%had%to%be%taken% Feel like they have bugs crawling
Stroke,*hallucinaBons,*
to%the%hospital.”'—Susan*
on them depression,*sexual**
dysfuncBon,*
sleeplessness* Hallucinogens:*An*Overview*
• Nature*of*hallucinogens*
– Change*the*way*the*user*perceives*the*world*
– Cause*individual*to*see*or*hear*things*in*different*
and*unusual*ways*
– “expand*one’s*mind”*
– Feel*detached*from*one’s*body* Hallucinogens:
Marijuana, LSD and Related Drugs Hallucinogens' PCP* Cannabis*
(marijuana)* Psilocybin*
mushrooms* LSD** Mescaline*
peyote* Marijuana
5-15% of western use; easy access,
leading to higher use
Cannabinoid receptors in the brain; THC
binds to the receptors and produces
altered sensory perceptions Classified*as*
mild*
hallucinogen* Marijuana* • Derived*from*Cannabis*
saBva*(hemp*plant)*
• AcBve*ingredient*is*THC*
(tetrahydrocannibal)*
• Smoked*or*ingested*
• When*smoked*has*peak*
effect*within*30*minutes*
usually*lasts*1`3*hours* Effects of Marijuana
Pleasurable effects, medicinal use
prescribed for these symptoms Sleepiness,*
Increased*
appeBte,** Euphoria,*RelaxaBon,*
DistorBons*in*sense*of*Bme,*
vision,*hearing* Cannabinoid receptor normal function:
appetite, pain sensation, mood &
memory Slowed*reacBon*Bme,*
Loss*of*coordinaBon,*
Impaired*learning*and*
memory,*Paranoia,*
anxiety,*Panic*amacks,*
HallucinaBons,*Loss*
of*moBvaBon,*Heart*
rate*can*speed*up* Varied*Effects*
This is what will cause problems at
school/work, there are memory
problems; has the most variable effects
on people; anxiety, hallucinations,
motivational problems, lethargy
There is a withdrawal symptom: anger,
irritability, restlessness, anxiety Designer Drugs
Synthetically made; don’t belong to just one class
Ecstacy: Hallucinogens/Stimulant Ecstasy:'
hallucinogen'
and'
s=mulant' `Chemically*similar*to*
methamphetamine*
• Euphoria,*increased*energy,*Lowered*
inhibiBon,*mental*alertness*
• *Heighten*auditory*and*visual*
percepBon,*sense*of*taste/touch*
• Produce*tolerance*and*dependence*
As well as withdrawal
ex: MDMA, K, etc. EBology*of*SUDs:*GeneBc*Factors*
• RelaBves*and*children*of*problem*drinkers*have*higher`than`
expected*rates*of*alcohol*abuse*or*dependence* – Heritability*esBmates*~*40%*
! Rates*of*alcoholism*in*men*were*12.4%*(0),*29.5%*(1*
parent),*41.5%*(2*parents)* • Greater*concordance*in*MZ*than*DZ*twins*
– In*men*
• alcohol,*caffeine,*smoking,*marijuana,*&*drug*abuse*in*
general*
– In*women*
• Role*of*geneBcs*less*clear*
• Fewer*available*studies* GeneBcs:*SubjecBve*Response*
• GeneBc*factors*contribute*to*development*of*
SUDs*by*altering*drug*response.**
• Example*from*Ray*et*al.*2010*
• OPRM1*G*allele*associated*with*rewarding*
effects*of*alcohol*when*drinking*
• DRD4*Long*allele*associated*with*alcohol*
craving.* The*Brain’s*Reward*System*
Reward Pathway that gets
excited by pleasurable
things; related to production
of dopamine
when there is a surplus of
dopamine, there is a
euphoric feeling. if it
happens all the time, your
brain detects a surplus and
decreases the amount of
dopamine and depletes
dopamine — creating
withdrawal
Brain altered w/ use MesocorBcolimbic*dopamine*pathway`
pleasure*pathway*controls*emoBons,*
memories,*and*graBficaBon** Decrease in dopamine leads to not pleasurable
to do things they once liked Neurobiological Influences Neurotran
smimers* Glutamate + Dopamine makes it harder to quit because the memory of the pleasure it still there HypofuncBoning*Reward*System*
Due to Dopamine Chemistry*of*AddicBon**
• VIDEO*
hmps:// *
Still at risk because you still have the good memories; triggered when around things that remind you of it Causes:*Psychological*Dimensions*
• Role*of*posiBve*and*negaBve*reinforcement**
– Substance*abuse*as*a*means*to*cope*with*negaBve*
affect*
• The*self`medicaBon*and*the*tension*reducBon*
Positive: make you feel better
hypotheses*
Negative: take away the bad feeling • CogniBve*factors*
and positive
– Role*of*expectancy*effects** Both negativeyou also haverewards effects
Using drugs,
expectancy
– Expectancies*influence*drug*use*and*relapse* Problem is still there/worse when they try to stop; so they have to use again, maybe more EBology:*Sociocultural*factors*
• Family*factors* possibly do to heritability, chaos in the family,
social learning, lack of parental monitoring,
access more easily – Parental*substance*use*(Hawkins*et*al.,*1997)*
– Psychiatric,*marital,*or*legal*problems*in*the*family*and*
Lack*of*emoBonal*support*from*parents*increases*use*of*
cigaremes,*marijuana,*and*alcohol*(Cadoret*et*la.,*1995a)*
– Lack*of*parental*monitoring*linked*to*higher*drug*usage*
(Chassin*et*al.,*1996;*Thomas*et*al.,*2000)* EBology:*Psychopathology*and*
Personality*
• Personality*factors*that*predict*onset*of*alcohol*related*
disorders:*
– NegaBve*emoBonality* negative affect, insecurity, self medicating
– Desire*for*increased*arousal*and*posiBve*affect*
– Constraint*reduces*risk* don’t get the same amount of pleasure for normal things
• Harm*avoidance,*conservaBve*moral*values,*&*cauBous*
behavior* An Integrative Model
drug use is a good thing, positive drug use Changes in brain/body leads to drug
dependence, when you have higher
tolerance Treatment*Sevngs*
Level'of'Care' Indicators'
intensive treatment for acute intoxication/ Medical*hospitalizaBon*withdrawals Seizures,*delirium,*serious*med*problems* InpaBent*detox* Dependence,*withdrawal,*seizure,*medical*
problems,*serious*psychiatric*problems* When you don’t have social support OutpaBent*detox* good when don’t have comorbidity/ have
family to support! Dependence,*no*complicaBng*condiBons,*
social*supports*for*stopping* InpaBent*treatment/no*detox*needed* Hx*of*dropping*out*of*tx,*poor*social*
supports,*cogniBve*deficits,*suicidal,*lack*
of*insurance,*lack*of*transportaBon* ParBal*hospital/day*treatment* Hx*of*dropping*out*of*tx,*relapse*a3er*
inpaBent*tx,*fair*social*supports,*
ambivalence*about*tx*to*change,*lack*child*
care,*etc.* OutpaBent*tx* Hx*of*good*use*of*outpaBent*tx,*previous*
successful*quit*amempts,*good*social*
support,*lack*of*resources*for*more*
intensive*treatment,*work,*childcare*etc.** Treatment*ModaliBes*
! MoBvaBon*enhancement*therapy*
! CBT*(individual,*group,*family)*
! Twelve`step*approaches*–absBnence* MoBvaBon*Enhancement*Therapy:*
Stages*of*Change*
Yes, I want to change This isn’t a problem! Maybe it’s a
problem/I have
a problem Can’t put them into a treatment too quickly when the motivation isn’t there, they need to realize that changing is
the good thing CBT$SKills$
`
`
`
` FuncBonal*Analysis*
Help understand why, triggers, consequences, interrupt the chain SBmulus*Control* Environmental cues, location, surroundings, people CogniBve*DistorBons*about*substance** Not addicted, makes me cool, help me cope, can’t live without it AlternaBve*distracBng*behaviors*
Exercise,etc. `
`
` AsserBveness:*Refusal*Skills*
Teach them how to say no Dealing*with*NegaBve*affect**
How to deal with negative emotions New*social*systems*and*support*for*not*drinking*
Need a new social system, friends, support Functional$Analysis$ Trigger* Mom*
calls*to*
complain* Thoughts*
and*
Feelings* Tense,*
annoyed,*
I’m*a*bad*
daughter* Open*
Behavior* bomle*of*
wine* PosiBve*
Conseque
nces* Using*
alcohol*
NegaB
to*cope,*
Feel*less*
ve*
annoyed,* Conse sBll*upset*
forget,* quenc the*next*
calming*
day,*
es*
annoyed*
with*self* Help understand why, triggers, consequences, interrupt the chain Self*Help*Groups* Learning from peers at different stages of
recovery process, first names, no notes,
useful for some, used in conjunction,
sponsors— some people resist/drop out Prayer component! Similar in response rates, no certain
personality fits with a treatment
Hard to study because of confidentiality Treatment of Alcohol-Related
Disorders
Success*rates*of*
alcoholism*treatments**
• “Project*MATCH”*equal*
success*rates**
• MoBvaBonal*enhancement*
• CBT*
• 12*step*program* Treatment of SubstanceRelated Disorders
Psychosocial • Controlled use – Controlled drinking
– Moderation
– Possible benefits
– Limited research 20%-30% effective, not stop, just moderation Biological*Treatment*of*Substance`Related*
Disorders*
" Agonist*subsBtuBon* cigarettes
" Safe*drug*with*a*similar*chemical*composiBon*as*the*
abused*drug*
" Examples*include*methadone*and*nicoBne*gum*or*
patch* Need to be weened off more slowly
Methadon for heroin nicotine patch for " AntagonisBc*treatment*
" Drugs*that*block*or*counteract*the*posiBve*effects*of*
substances*
" Examples*include*naltrexone*for*opiate*and*alcohol*
problems*
Doesn’t let you get the same pleasurable feeling/response so easier to let go Biological*Treatment*of*Substance`Related*
Disorders*
Take in the morning, unpleasant side effects, non-compliance " Aversive*treatment*
" Drugs*that*make*use*of*substances*extremely*
unpleasant*
" Examples*include*antabuse*and*silver*nitrate*
" Efficacy*of*biological*treatment*
" Generally*ineffecBve*when*used*alone*
" Used*to*help*with*withdrawal*symptoms*
to manage everything when they can’t do it alone. used in conjunction to other treatments ...
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Full Document
- Spring '14
- Cannabinoid receptor, term substance-related disorders, • Controlled
