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Unformatted text preview: Substance Use and
UCLA Psychology 127A
Professor Rena Repetti Substance Use and Abuse
Alcohol Use and Abuse
What is the most widely used
psychoactive substance in the world?
d. caffeine Recreational Use versus
Recurrent and Maladaptive Patterns of
Drug of abuse: a chemical substance that
alters a person’s mood, level of perception,
or brain functioning
abuse of/dependence on
several types of drugs Substance Dependence
⬧ Craving the person craves or has a very forceful urge to use the substance. ⬧ Compulsive use the individual plans and this becomes a constant
preoccupation. The substance is used to control how they are
feeling. Unsuccessful efforts to control use of drug. ⬧ Diminished control Diminished control is the first aspect of the DMS-5 criteria
for substance abuse.
Taken over a longer period of time or in larger amounts than
intended. Substance Dependence
⬧ Tolerance ⬧ Withdrawal DSM-5: Substance-Use Disorder
⬧ Measured on a continuum of mild to
⬧ Each specific substance is addressed as a
separate disorder (e.g., alcohol use
disorder, stimulant use disorder)
The diagnosis of substance use disorder but they are also given a severity rating of mild, moderate and severe.
See the dimension approach and categorical approach.
The DSM5 - each substance has a different disorder. Drugs of Abuse
⬧ Amphetamine and cocaine
⬧ Barbituates and benzodiazepines
⬧ Opiates morphine and codeine. heroine is a synthetic opiate. ⬧ Hallucinogens MDMA, PCP. can be naturally occurring or synthetic. ALCOHOL USE
(intoxication) affects every organ and every organ system in the
the amount of alcohol per unit per blood. - BAC
BAC and short term affects on the central nervous systems
have a strong correlation.
The rate which the individual becomes intoxicated vary
the short-term affects. Long-term Consequences
⬧ Disruption of relationships, job
performance, problems with legal
authorities ALCOHOL USE
Long-term Consequences cont’d
⬧ Multiple health problems
(including disruption of
organ system functions and
nutritional disturbance) ALCOHOL USE
Long-term Consequences cont’d
⬧ Memory impairment
⬧ Fetal Damage
⬧ Injury and premature death DSM-5: Alcohol-Use Disorder (AUD)
11 Features at least 2 of them for a mild alcohol use disorder. ⬧ Alcohol is often taken in larger amounts or
over a longer period than was intended.
this is diminished control. ^ ⬧ There is a persistent desire or unsuccessful
efforts to cut down or control alcohol use.
they try and cut down and they cant succeed. another example of diminished control. ⬧ A great deal of time is spent in activities
necessary to obtain alcohol, use alcohol,
or recover from its effects
compulsive use ^ DSM-5: Features of AUD, cont’d
⬧ Craving, or a strong desire or urge to use
alcohol. this is craving.
⬧ 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. DSM-5: Features of AUD, cont’d
⬧ 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.
⬧ 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. DSM-5: Features of AUD, cont’d
This is PHYSIOLOGICAL dependence and everything before was psychological. ⬧ Tolerance, as defined by either of the
a) A need for markedly increased amounts
of alcohol to achieve intoxication or
b) A markedly diminished effect with
continued use of the same amount of
alcohol DSM-5: Features of AUD, cont’d
Withdrawal, as manifested by either of the
a) The characteristic withdrawal syndrome
for alcohol (e.g. hand tremors, nausea,
b) Alcohol (or a closely related substance,
such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms. DSM-5: Severity of Alcohol-Use
⬧ 2 to 3 symptoms: Mild
⬧ 4 to 5 symptoms: Moderate
⬧ 6 or more symptoms: Severe
whatever substance use disorder is - same 11 features.
the withdrawal symptoms may change. Question
What does research indicate is the
lifetime prevalence rate for alcohol
use disorder in the US?
a) Less than 5%
c) About 30%
d) About 50%
Frequency and Prevalence
⬧ Two out of three males in Western
countries drink alcohol regularly (at least
less than 25% abstain completely among males in western culture
on a social basis). but
most people that use alcohol do NOT become alcoholics.
2/3 vs 30% ⬧ 30% lifetime prevalence rate for AUD
⬧ Age differences
older people drink less than younger people. early 20's is extremely high use of alcohol.
among people in their 30s - 22% abstain completely
about 47% of people abstain in their 60's.
over 80% - the people over the age of 80 will abstain.
Frequency and Prevalence
⬧ Risk factor for AUD: 14 drinking before age
early onset drinking is a problem. for both males and female
risk of males that start at age 14 - is double than males who start at
18. Initial use is not a sip of wine - its getting intoxicated.
its a risk factor - don't know if it actually causes. Women get drunk faster with less alcohol.
Social disapproval stops women from drinking. ⬧ Gender differences The number of women that use alcohol is about half
the number of men.
about 60% of women drink alcohol at least
occasionally. The difference is decreasing over time. Question
Among people in the US with AUD, the
number of women is about ___ the number
d) the same as
e) two times AUD Associated Problems
⬧ Depression often find that people who have alcohol use disorders are
suffering from Anxiety and depression.
Is the anxiety and depression causing alcohol use or is the
alcohol use causing anxiety and depression?
Alcohol can relieve symptoms for short term
All the consequences of alcohol abuse can cause anxiety
and depression. AUD Associated Problems
⬧ Antisocial Personality Disorder
⬧ Conduct Disorder (in adolescence)
these are personality characteristics
that we see in people that give them a
higher risk and have been more highly
correlated with alcohol use disorder. Biological Factors
Genetics of alcoholism
⬧ Family Studies
⬧ Twin Studies
concordance rates MZ vs DZ twins
17% Males: 56% vs 33%; Females: 30% vs ⬧ Adoption Studies Possible Genetic Mechanisms
(e.g., sensation seeking, binge drinking?)
Personality traits that relate to alcohol use. Impulsive behaviors are associated with the vulnerability to problem with
drinking. Alcohol Metabolism
Everyone metabolizes alcohol is different ways. Some individuals are more prone to alcohol use disorder than others. Possible Genetic Mechanisms
Endorphins (endogenous opioids)
Similarity to morphine:
effects on pain,
symptoms Endorphins disinhibit dopamine pathways ! reward pathways in the brain
When they are active they are associated with reward. Dopamine pathways are active when we are processing
reward. Endorphins inhibit dopamine pathways. There are inhibitory neurons in the brain that inhibit transmissions in
the brain including in the dopamine pathways. Don't want use to feel pleasure excessively.
Endorphins help the dopamine pathways to be active. When endorphins are released we have pleasure.
Lab animals develop tolerance to the endorphins.
Endorphins may be more highly activated with response to alcohol in respects to people. Some people may have a
more activated response in the endogenous opioid system when drinking. Alcohol Release of
endorphins some people dont get pleasure out of alcohol - don't want to drink. Increased
pathways Endogenous Opioids
Possible role in brain’s response to alcohol
⬧ Opioid system response in people who seem
predisposed to consume high levels of
⬧ Effects of receptor antagonists on lab
animals (reduction in self-administration of
⬧ Effects of Naltrexone on alcoholic patients Naltrexone is an antagonist of (blocks receptors for) endorphins and opiates Alcohol Release of
endorphins Naltrexone Increased
disinhibition << this is after the release of endorphins.
Naltrexone inhibits endorphins and then
we see a reduction in the enjoyment and
intake of alcohol use. Question
Which of the following statements about
Naltrexone is/are true?
a) It blocks the effects of endorphins.
b) It blocks the effects of opiates.
c) It inhibits dopamine pathways (i.e.,
interferes with the disinhibition of dopamine
d) It reduces the pleasurable effects of
e) All of the above statements are true. TEXTBOOOOOK! Psychological Factors
people have beliefs that
alcohol will increase their
media increases expectations. ⬧ Desire for peer acceptance
want to act like peers and be accepted by their peer groups. ⬧ Pressure for social performance substances like alcohol can act like avenues for social acceptance. and a temporary escape from anxiety
and stress. especially among kids with deficits in social skills. can facilitate their social interactions. Psychological Factors
⬧ Binge Drinking: sensation seeking and
impulsivity ⬧ Self-medication
see higher levels of sensation seeking with kids that drink
Approximately what percent of people
in the US who are dependent on
alcohol receive treatment for the
d) 73% Treatment of AUD
⬧ Acknowledgement of Problem
⬧ Treatment Compliance
⬧ Relapse Interventions for AUD
⬧ Alcohol Withdrawal
• hand tremors, sweating,
nausea, anxiety, insomnia
• convulsions and hallucinations
In the US most people develop some withdrawal symptoms but not significant ones. Only 5% of half of the
alcoholics go to DTs (Delirium tremens) worst withdrawal symptoms.
Include diarrhea, agitations, Interventions for AUD
Alcohol Withdrawal Delirium (“delirium
hallucinations Interventions for AUD
⬧ Disulfiram (Antabuse)
⬧ Naltrexone ⬧ SSRIs Interventions for AUD
AA/self-help Interventions for AUD
Cognitive Behavioral Approaches
Motivational Interviewing Interventions for AUD
Cognitive Behavioral Approaches
• Recognize and respond to precipitating
situations (Coping Skills)
this is the S in the SORC model and learn to deal with the R
portion. ex. don't go into a bar or restaurant.
Need coping skill training to identify situations that lead to drinking. • Relapse prevention ...
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