Lecture 11 - Substance*Use*Disorders Cannabis LSD PCP Mushrooms Text Diagnostic Issues The DSM-5 term substance-related disorders include 11 symptoms

Lecture 11 - Substance*Use*Disorders Cannabis LSD PCP...

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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.  2.  3.  4.  5.  6.  7.  8.  9.  10.  •  •  11.  •  •  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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  • Spring '14
  • Cannabinoid receptor, term substance-related disorders, •  Controlled

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