psych 350 - Substance-Related and ImpulseSubstance-Related...

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Unformatted text preview: Substance-Related and ImpulseSubstance-Related Control Disorders Substance-Related Disorders Substance-Related Use and abuse of psychoactive substances that Use alter mood and/or behavior Wide-ranging psychophysiological and behavioral effects behavioral – – – – – Associated with significant impairment and costs resulting in a failure to fulfill major role obligations at resulting work, school, or home work, In situations in which it is physically hazardous Causing legal problems Despite persistent or recurrent social/interpersonal Despite problems caused or exacerbated by the substance use problems Substance abuse: Recurrent use Substance-Related Disorders Substance dependence: 3 or more Substance – 1) Tolerance A) need for increased amounts to achieve intoxication/desired effect A) B) diminished effect with continued use of same amount B) – 2) Withdrawal A) characteristic withdrawal syndrome for the substance B) same or related substance used to relieve or avoid symptoms – – – 3) taken in larger amounts or longer than intended 4) desire or unsuccessful effort to cut down or control use 5) a great deal of time spent in activities necessary to obtain substance 5) or recover effects or – 6) important social/occupational/recreational activities are given up or 6) reduced because of the substance reduced – 7) substance use is continued despite knowledge of having a persistent 7) or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use caused With or without physiological dependence Substance-Related Disorders Five Main Categories of Substances Five – Depressants – Result in behavioral sedation Alcohol, Sedatives, Hypnotics, Anxiolytics – Stimulants – Increase alertness & elevate mood Stimulants Amphetamines, Cocaine, Nicotine, Caffeine – Opiates – Primarily produce analgesia & euphoria Heroin, Opium, Codeine, Morphine – Hallucinogens – Alter sensory perception Marijuana, LSD Marijuana, – Other drugs of abuse Inhalants, Anabolic steroids, Medications Alcohol Use Disorders Alcohol Psychological and Physiological Effects – Central Nervous System depressant – reduces Central physiological arousal – Feels like a stimulant (initially) because it slows down Feels our inhibitory centers. – Affects several neurotransmitter systems – more Affects complex than other drugs (GABA, glutamate, serotonin) serotonin) Alcohol Use Disorders Effects of Alcohol Use Effects – Intoxication Clinically significant maladaptive behavioral or psychological Clinically changes that developed as a result of alcohol use changes 1 or more: Slurred speech, incoordination, unsteady gait, or nystagmus, memory or attention impairment, stupor or coma nystagmus, – Withdrawal Autonomic hyperactivity, hand tremor, insomnia, nausea, Autonomic transient hallucinations, psychomotor agitation, anxiety, seizures transient – Associated conditions Associated Dementia: loss of intellectual abilities Wernicke’s disease (may be due thiamine deficiency) Wernicke’s Fetal alcohol syndrome – retards growth, cognitive deficits, Fetal behavior problems, characteristic appearance behavior Alcohol Use Disorders Epidemiology Epidemiology – Most adults are “light drinkers” or “abstainers” – Over 50% of the U.S. (> 12 years) report current use – 23% report binge drinking in the past month College binge drinking? – 42% – fraternity and sororities report highest levels – – – – Rates highest among Caucasian & Native Americans Males use and abuse alcohol more than females Violence is associated with alcohol Alcohol alone does not cause aggression Sedative/Hypnotic/Anxiolytic Sedative/Hypnotic/Anxiolytic Substance Use Disorders The Drugs – Sedatives – Calming – Hypnotic – Sleep inducing Hypnotic – Anxiolytic – Anxiety reducing Effects Are Similar to Large Doses of Alcohol Effects – Combining such drugs with alcohol is synergistic All Influence the GABA Neurotransmitter System All Amphetamine Use Disorders Amphetamine Amphetamine Intoxication – Tachycardia or bradycardia, pupillary dilation, blood Tachycardia pressure change, perspiration/chills, nausea or vomiting, evidence of weight loss, psychomotor agitation or retardation, muscle weakness, respiratory depression, chest pain, cardiac arrhythmias chest Effects of Amphetamines – – Produce elation, vigor, reduce fatigue, reduce appetite Effects are followed by extreme fatigue and depression All are laboratory made Amphetamines stimulate CNS by Amphetamines – Enhancing release of norepinephrine and dopamine – Reuptake is subsequently blocked Too much can lead to hallucinations and delusions Cocaine Use Disorders Cocaine Effects of Cocaine – Short lived (15-30 minutes) sensations of elation, vigor, Short alertness, reduces fatigue, causes insomnia and loss of appetite appetite – Individuals often feel more powerful and confident; Individuals paranoia common paranoia – Blocks reuptake of dopamine – Highly addictive, but addiction develops slowly – Can cause cardiac difficulties Cocaine Intoxication (same as Amphetamine) Cocaine Withdrawal (dysphoric mood) and: – Fatigue, vivid/unpleasant dreams, insomnia or Fatigue, hypersomnia, increased appetite, psychomotor agitation or retardation retardation Nicotine Use Disorders Nicotine Effects of Nicotine – Stimulates nicotinic acetylcholine receptors – Results in sensations of relaxation, wellness, pleasure; may diminish Results negative affect negative – Nicotine is highly addictive – Relapse rates equal those for alcohol and heroin users Nicotine Withdrawal Only Nicotine Only – Psychological symptoms Dysphoria Dysphoria Anxiety Irritability Restlessness – Physiological symptoms (insomnia, difficulty concentrating, decreased Physiological heart rate, increased appetite or weight gain) heart Caffeine Use Disorders Caffeine Effects of Caffeine – – – – Found in tea, coffee, cola drinks, and cocoa products Blocks the reuptake of the neurotransmitter -adenosine Small doses elevate mood and reduce fatigue Half life of 3 to 6 hours 13 for women on oral contraceptives 18-20 hours for pregnant women – Used by over 90% of Americans – Regular use can result in tolerance and dependence Caffeine Intoxication – Recent consumption of caffeine (usually in excess of Recent 250 mg) 250 – 5 or more of the following or Restlessness, Nervousness, Excitement, Insomnia, Flushed face, Diuresis, Gastrointestinal disturbance, Muscle twitching, Rambling flow of thought or speech, Tachycardia or cardia arrhythmia, Periods of inexhaustibility, Psychomotor agitation agitation FYI Coffee, grande (16 oz.) Starbucks Coffee, tall (12 oz.) Starbucks Coffee, Coffee, short (8 oz.) Starbucks NoDoz, Maximum Strength (1) NoDoz, Regular Strength (1) 100 Coffee, non-gourmet (8 oz.) Coffee, instant (8 oz.) Cola (20 oz.) Mountain Dew (12 oz.) 550 550 375 375 250 200 135 95 60 55 55 Opiate – Narcotic like chemical in the opium poppy Opiate Analgesic and sedative effects Analgesic Opioids Opioids Opioids – Substances that produce narcotic effects Includes natural and synthetic variants Examples include heroin, opium, codeine, and morphine Effects of Opioids – – – – Activate endorphins Low doses – Euphoria, drowsiness, and slow breathing High doses can be fatal Withdrawal symptoms can be lasting (1 week) and severe Nausea/vomiting, chills, muscle aches, diarrhea, insomnia Associated Features – Mortality rates are high for addicts via overdose, suicide, homicide Many die at young age New fad (mixing heroin with Fentanyl) New – Users at increased risk for HIV infection Hallucinogens Hallucinogens Hallucinogens Hallucinogens – alter perceptions of the world – Produce delusions, paranoia, hallucinations, and/or altered Produce sensory perception sensory – Examples: marijuana, LSD, mushrooms, PCP Marijuana – Most widely used illicit substance (32% tried it) – Active chemical is tetrahydrocannabinol (THC) – Effects Euphoria, relaxation, perception of increased sensory Euphoria, sensitivity Mood swings, paranoia, hallucinations (higher doses) Mood Reactions appear to be quite individual – Impairment in motivation is not uncommon Impairment – Withdrawal and dependence are uncommon Hallucinogens Hallucinogens LSD and Other Hallucinogens – LSD is most common form of hallucinogenic drug – Disrupts serotonin functioning; impacts areas of the Disrupts brain dealing with mood, cognition, perception brain – Effects can last up to 12 hours – Tolerance tends to be rapid – Withdrawal symptoms are uncommon – Can produce psychotic delusions & hallucinations Inhalants – – – – – Inhalants Inhalants – – Found in volatile solvents Found Breathed into the lungs directly Examples: spray paint, hair spray, paint thinner, Examples: gasoline, nitrous Such drugs are rapidly absorbed Effects similar to alcohol intoxication Increases heart rate to get blood to the brain. Feel Increases stimulated, disinhibited; Distorted perceptual experiences experiences Serious health consequences (lung, liver damage; Serious brain damage) brain Produce tolerance/prolonged withdrawal symptoms (grand mal seizures, hallucinations, nausea, anxiety) (grand Most common in boys (ages 13-15) Anabolic Steroids Anabolic Anabolic-Androgenic Steroids Anabolic-Androgenic – – – – – Derived or synthesized from testosterone Used medicinally or to increase body mass Users may engage in cycling or stacking Users Steroids do not produce a high Long-term mood disturbances Depression Anxiety Irritability/Aggression – Physical problems – liver problems, cancer, cholesterol Physical problems problems men — shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer cancer women — growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice deepened Designer Drugs Designer Designer Drugs – Produced by pharmaceutical companies for diseases – Examples: Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), Examples: ketamine (“special K”) ketamine – All heighten auditory and visual perception; can cause a All sense of detachment and lack of awareness sense – Popular in nightclubs, raves, or large social gatherings – All can produce tolerance and dependence – Brain scans have shown signs of serious damage – Brain particularly to serotonin related cells particularly Family and Genetic Influences Family Results of Family, Twin, and Adoption Studies – – – Substance abuse has a genetic component Much of the focus has been on alcoholism Common genetic factors for the use of all drugs Specific drugs are used may be environmentally determined – Multiple genes are involved in substance abuse Multiple Neurobiological Influences Neurobiological Neurobiological Research Neurobiological – Drugs affect the pleasure or reward centers in Drugs the brain – The pleasure center – Dopamine Begin in midbrain and travel towards frontal cortex – Some work directly on dopamine (e.g., Some cocaine, amphetamines), others more indirectly (opioids inhibit GABA) indirectly – GABA turns off reward-pleasure system – May deactivate systems related to anxiety May and pain and Psychological Dimensions Psychological Positive Reinforcement: behavior is strengthened by the Positive consequence of experiencing a positive condition consequence – Most drugs result in some pleasurable effects – Animal research Negative Reinforcement: behavior is strengthened by the Negative consequence of stopping or avoiding a negative condition consequence – The self-medication and the tension reduction hypotheses Substance abuse as a means to cope with negative affect – Feel less depressed, less anxious, more confident – May be specifically likely to abuse drugs that “treat” problems Withdrawal is a negative condition Cognitive Factors Cognitive Response expectancies – Two Types Positive – – – – – – Global Positive Effects Physical/Social Pleasure Enhanced Sexuality Increased Social Assertiveness Relaxation and Tension Reduction Arousal/Power Arousal/Power Negative Negative – Negative Affective change – Loss of control – Develop early in life; influenced by parent/peer attitudes; Develop cultural influences; predict future substance use cultural Cravings – can make it difficult to lessen or end Cravings substance use substance – Physical and psychological triggers Social and Cultural Influences Social Exposure is prerequisite for Use of Drugs Exposure – Media, family, peers – Parents and family appear critical Children between age of 3 and 6 can often identify different Children types of alcohol by smell. types Substance-abusing parents monitor children less carefully, Substance-abusing giving them more opportunities to start their own use giving Societal Views About Drug Abuse Societal – Sign of moral weakness – Failure of self-control – Sign of a disease – Caused by underlying processes No different than other medical disease – biologically oriented The Role of Cultural Factors The – Influence the manifestation of substance abuse Prevalence, type of substance, “meaning” An Integrative Model An Exposure or Access to a Drug Exposure – necessary but not sufficient for abuse and addiction Drug Use Depends on Social and Cultural Expectations Drugs Are Used Because of their Pleasurable Effects Drugs Are Abused for Reasons that are More Complex – Equifinality – Stress may interact with psychological, genetic, Stress social, and learning factors social, Biological Treatment Biological Agonist Substitution – Substitute safer drug Substitute – Examples: methadone and nicotine gum or patch Antagonistic Treatment – – – Block or counteract pleasurable drug effects Examples: naltrexone Examples: Mixed success Aversive Treatment – Make use of drugs extremely unpleasant – Examples: Antabuse and silver nitrate Examples: – Limited success Efficacy of Biological Treatment – Generally ineffective when used alone – Better when paired with social support and/or psychotherapy Psychosocial Treatment Psychosocial Inpatient vs. Outpatient Inpatient – Overall efficacy is comparable – Inpatient much more expensive Community Support Programs – – – – Alcoholics Anonymous and related groups Seem helpful and are strongly encouraged Disease model and complete abstinence Invokes need to look to “higher power” Controlled Use vs. Complete Abstinence Controlled – Controlled use – very controversial. – Appears to work as well as complete abstinence Psychosocial Treatment Psychosocial Comprehensive Treatment/Prevention Programs – – – – – Individual and group therapy Aversion therapy and covert sensitization Contingency management Community reinforcement Relapse prevention Help people deal with ambivalence about stopping Confront costs of use Identify relapse triggers and coping mechanisms – Preventative efforts via education DARE Skills training approaches – Cultural changes Impulse-Control Disorders Impulse-Control Many disorders involve impulse control problems – Only diagnose if they are not better characterized by other disorders Only – Failure to resist an impulse, drive, or temptation to perform an act that Failure is harmful to the individual. is DSM-IV-TR DSM-IV-TR – – – – – Intermittent explosive disorder Kleptomania Pyromania Pathological gambling Trichotillomania Characterized by Characterized – Increased tension/anxiety prior to the act – A sense of relief following the act – Impairment of social and occupational functioning Impulse-Control Disorders Intermittent Explosive Disorder Intermittent – – – – – Rare condition Frequent aggressive outbursts Leads to injury and/or destruction of property Aggressiveness is out of proportion to precipitating factor Few controlled treatment studies exist serotonin and norephinephrine and testosterone Kleptomania – Failure to resist urge to steal unnecessary items – Not stealing for need and views the act as wrong and/or Not senseless senseless – Comorbid with mood disorders, substance use, and OCD Impulse-Control Disorders Pyromania Pyromania – Involves having an irresistible urge to set fires – Diagnosed in less than 4% of arsonists – Little etiological and treatment research Pathological Gambling – – – – – – Estimated to affect 3-5% adult Americans Treatment is similar to that for substance dependence Treatment studies are currently underway Inability to resist the urge to pull hair Observed in 1-5% of college students, mostly female Tricyclic antidepressants and CBT Trichotillomania ...
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This note was uploaded on 02/14/2011 for the course PSYCH 350 taught by Professor Conger during the Spring '10 term at Purdue.

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