Lecture7:8 - Substance Use and Abuse UCLA Psychology 127A Professor Rena Repetti Substance Use and Abuse Lecture Outline Introduction Alcohol Use and

Lecture7:8 - Substance Use and Abuse UCLA Psychology 127A...

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Unformatted text preview: Substance Use and 
 Abuse UCLA Psychology 127A Professor Rena Repetti Substance Use and Abuse Lecture Outline Introduction Alcohol Use and Abuse Description Causal Factors Treatment Question What is the most widely used psychoactive substance in the world? a. nicotine b. alcohol c. marijuana d. caffeine Recreational Use versus Dependence/Abuse Recurrent and Maladaptive Patterns of Use Drug of abuse: a chemical substance that alters a person’s mood, level of perception, or brain functioning Polysubstance abuse: abuse of/dependence on several types of drugs Substance Dependence Psychological 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 Physiological Dependence ⬧ Tolerance ⬧ Withdrawal DSM-5: Substance-Use Disorder ⬧ Measured on a continuum of mild to severe ⬧ 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 ⬧ Nicotine ⬧ Alcohol ⬧ Cannabis ⬧ 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 Short-term Effects (intoxication) affects every organ and every organ system in the body. 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 following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect 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 following: a) The characteristic withdrawal syndrome for alcohol (e.g. hand tremors, nausea, insomnia, hallucinations) 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 Disorder (AUD) ⬧ 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% b) 10-15% 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 of men. a) one-quarter b) one-third c) half d) the same as e) two times AUD Associated Problems ⬧ Anxiety ⬧ 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) ⬧ Aggression 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 Personality Traits (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 Neurochemical Mechanisms Endorphins (endogenous opioids) Similarity to morphine: effects on pain, tolerance & withdrawal symptoms Endorphins disinhibit dopamine pathways ! reward pathways in the brain are activated 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 activity along dopamine (reward) pathways Endogenous Opioids Possible role in brain’s response to alcohol ⬧ Opioid system response in people who seem predisposed to consume high levels of alcohol ⬧ Effects of receptor antagonists on lab animals (reduction in self-administration of alcohol) ⬧ Effects of Naltrexone on alcoholic patients Naltrexone is an antagonist of (blocks receptors for) endorphins and opiates Alcohol Release of endorphins Naltrexone Increased activity along dopamine (reward) pathways, due to 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 pathways). d) It reduces the pleasurable effects of alcohol. e) All of the above statements are true. TEXTBOOOOOK! Psychological Factors ⬧ Expectations people have beliefs that alcohol will increase their pleasure. improve mood decrease tension. 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 alcohol. Question
 Approximately what percent of people in the US who are dependent on alcohol receive treatment for the disorder? a) 3% b) 24% c) 48% d) 73% Treatment of AUD ⬧ Acknowledgement of Problem ⬧ Motivation ⬧ Treatment Compliance ⬧ Abstinence ⬧ Relapse Interventions for AUD Detoxification (“detox”) ⬧ Benzodiazepines ⬧ 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 Detoxification (“detox”) Alcohol Withdrawal Delirium (“delirium tremens,” DTs): Symptoms may include visual and tactile hallucinations Interventions for AUD Pharmacotherapy ⬧ 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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