Chapter11 - Chapter 11 Chapter 11 Substance­Related...

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Unformatted text preview: Chapter 11 Chapter 11 Substance­Related Disorders Substance Related Disorders 0. Addictive disorders are one of the most pervasive and intransigent mental health problems facing our society today 1. Related to stress 0. Stress – feel bad 1. Drugs – feel good Substance Related Disorders 2. Substances are drugs that effect mental functioning – psychoactive drugs 3. Some legal, some medical, some illegal Substance Related Disorders 4. Two major categories of substance related disorders 2. Conditions that involve organic impairment resulting from prolonged and excessive ingestion of psychoactive substance (alcohol abuse dementia) 3. Conditions that stem from toxicity of a substance (alcohol intoxication) Substance Related Disorders 5. Addictive disorders deal with maladaptive behavior 5. resulting from regular and constant use of a substance 4. Substance dependence disorder 0. Marked physiological need for increasing amounts to achieve desired effect 5. Substance abuse disorder 1. Pathological use resulting in maladaptive behavior and other problems Substance Related Disorders 6. Addictive behavior – behavior based on the pathological need for substance or activity – may involve the abuse of substances such as 6. Nicotine 7. Alcohol 8. Cocaine 9. Heroin 10. Marijuana Alcohol Abuse and Dependence Alcohol Abuse and Dependence: Definitions 7. Alcoholic – a person with a serious drinking problem whose drinking impairs his or her health, personal relationships, and occupational functioning 8. Alcoholism – 8. a dependence on alcohol that seriously interferes with life adjustment Alcohol Abuse and Dependence: History 9. Excessive use of alcohol goes back almost as far as recorded history 11. 3000 BC beer made in Egypt 12. 150 BC wine­making in Italy 13. 800 AD distillation developed Alcohol Abuse and Dependence: Consequences (I) 10.Associated with 14. 15. 16. 17. 18. Vulnerability to injury Partner violence Shorter lifespan (12 years) Lower performance on cognitive tasks Brain shrinkage Alcohol Abuse and Dependence: Consequences (II) 11.Associated with: 19. 20. 21. 22. 23. Coexisting mental disorders (depression) Suicide risk 50% death and injury in automobile accidents 50% murders and rapes 75% arrests 24. 43% violent encounters with police 24. Alcohol Abuse and Dependence: Prevalence (I) 12.One in seven people meet the criteria for alcohol abuse 13.More than 37% of alcohol abusers suffer from at least one coexisting mental disorder Alcohol Abuse and Dependence: Prevalence (II) 14.Alcohol abuse cuts across all age, educational, occupational, and socioeconomic boundaries 25. Alcohol abuse is a problem in the military, among professionals 26. Five times more frequent in men than women 27. 10% of men over 65 are heavy drinkers Fact or Fiction? Are the following statements about alcohol true or false? The Clinical Picture of Alcohol Abuse and Dependence: Levels 15.Alcohol has complex and often contradictory effects on the brain: 16.At lower levels, alcohol stimulates certain brain cells and activates the brain’s “pleasure areas” The Clinical Picture of Alcohol Abuse and The Clinical Picture of Alcohol Abuse and Dependence: Levels 17.Alcohol has complex and often contradictory effects on the brain: 18.At higher levels, alcohol depresses brain functioning 28. Inhibits glutamate; slows activity of the brain; creates impaired learning and higher order functioning The Clinical Picture of Alcohol Abuse and Dependence: Levels 19.At higher levels, alcohol: 29. 30. 31. 32. Lowers self­control Reduces motor coordination Dulls discrimination of perception of pain Creates sense of well­being 33. 34. 35. Decreased social inhibitions Blackouts – loss of memory Hangovers – headaches 20.Psychological effects of alcohol The Clinical Picture of Alcohol Abuse and Dependence: Levels 21.At blood level of .08% = intoxication 36. Lower muscle coordination 37. Impairment of speech and vision 22.At blood level of .5% 38. Entire neural balance is upset and person passes 38. out 23.At blood level above .55% = lethal Levels The Clinical Picture of Alcohol Abuse and Dependence 24.Concentration determines intoxication 39. Not amount consumed 40. Food, duration of drinking, metabolism 41. In women, metabolism is less effective and thus they become intoxicated on lower quantities The Clinical Picture of Alcohol Abuse and Dependence 25.Excessive drinking can be viewed as progressing from early­ to middle­ to late­stage alcohol abuse disorder The Clinical Picture of Alcohol Abuse and Dependence 26.For individuals who drink to excess, the clinical picture is highly unfavorable and may include: 27.Cirrhosis of the liver (assimilates alcohol) 42. Irreversible (30% of heavy drinkers have this) 28.Malnutrition (alcohol reduces appetite) The Clinical Picture of Alcohol Abuse and The Clinical Picture of Alcohol Abuse and Dependence 29.Psychosocial effects of alcohol abuse and dependence include: 30.Chronic fatigue, Oversensitivity, Depression 31.Initially alcohol may appear to help deal with stresses of life, but it becomes counter­productive The Clinical Picture of Alcohol Abuse and Dependence 32.Psychosocial effects of alcohol abuse and dependence include: 43. Creates impaired reasoning, poor judgment and personality deterioration 44. Inability to cope; to maintain employment 45. Marital difficulties and deterioration The Clinical Picture of Alcohol Abuse and Dependence 33.Several acute psychotic reactions fit the diagnostic classification of substance­induced disorders: 46. Persons drinking excessively over long period ­ develop brain lesions 47. Alcoholic psychosis ­ delusions 48. Alcohol amnesia ­ memory deficits 49. Delirium, delusions, disorientation 50. Hallucinations, disorganization, other cognitive impairments Biological Factors Biological Factors 34.The mesocorticolimbic dopamine pathway (MCLP) is the center of psychoactive drug activation in the brain (pleasure pathway) Biological Factors 35.MCLP – controls emotions, memory, gratification 51. Middle portion of brain 36.Alcohol stimulates MCLP and produces feelings of pleasure Biological Factors 37.Genetics probably play an important role in developing sensitivity to the addictive power of drugs like alcohol 52. Stronger effects produce stronger conditioning Biological Factors 38.Learning factors appear to play an important role in the development of substance abuse 53. Note that the majority of children of alcoholics do not become alcoholics 39.In alcoholic families, combination of genetics and modeling increase risk Psychosocial Causal Factors 40.Potential alcohol abusers (alcoholic personality) tend to: 54. Be emotionally immature 55. Expect a great deal of the world 56. Require an inordinate amount of praise and 56. appreciation 57. React to failure with marked feelings of hurt and inferiority Psychosocial Causal Factors 41.Potential alcohol abusers (alcoholic personality) tend to: 58. Have low frustration tolerance 59. Feel inadequate and unsure of their abilities to fulfill expected male or female roles 60. Are more impulsive and aggressive than others Psychosocial Causal Factors 61. Alcohol abusers also tend to be unable or unwilling totolerate tension and stress 62. Many people expect that alcohol use will lower tension and anxiety and increase sexual desire and pleasure in life 63. Adults with less intimate and supportive relationships tend to show greater drinking following sadness or hostility 64. All of the above make alcohol consumption reinforcing due to its effects Psychosocial Causal Factors 42.Drinking in marital relationships 65. Relationships can facilitate excessive drinking by generating the expectations and accommodations for drinking 66. Drinking is frequently involved in marital problems and is the most frequent cause for divorce Sociocultural Factors Sociocultural Factors Sociocultural Factors 43.Alcohol use is pervasive component in social life of western civilization 44.Social events revolve around alcohol use 45.Alcohol serves as a social lubricant to reduce social anxiety and tension Treatment of Alcoholism 46.Treatment is difficult due to refusal to admit problem before ‘hitting bottom’ 47.Generally multidisciplinary approach is best 48.Detoxification – physical rehabilitation – behavioral control 49.Relapse is common Treatment of Alcoholism 50.Biological approaches include: 51.Medications to lower the side effects of acute withdrawal: 67. 68. 69. Important for getting off alcohol Valium ­ lowers motor excitement Problem is that it can become addictive Treatment of Alcoholism 52.Biological approaches include: 53.Medications to block the desire to drink: 70. Antabuse ­ causes vomiting with alcohol 71. Generally not effective since self­administered 72. Naltrexone ­ blocks 'craving' 72. Treatment of Alcoholism 54.Psychological treatment approaches include: 55.Group therapy: 73. Give and take; forcing facing of problem (AA) 56.Environmental intervention 74. Help alcoholic get job, support, etc Treatment of Alcoholism 57.Psychological treatment approaches include: 58.Behavior therapy 75. Aversive conditioning (shock, antabuse) 76. Cognitive behaviorism (skills training ­ coping) Treatment of Alcoholism 59.Several approaches stress controlled drinking rather than abstinence 77. May work with persons with less severe problem Treatment of Alcoholism 60.Alcoholics Anonymous (AA) has reportedly met with considerable success 78. 79. 80. 81. 82. Self­help Discussion of problems Alcoholic for life 51,000 groups in US High drop­out Twelve Steps Treatment of Alcoholism 0. Success of alcoholism treatments range from low rates for 0. hard­core substance abusers to rates of 70–90% where modern treatment procedures are used 1. Treatment is effective when person realizes they need help and treatment is available Treatment of Alcoholism 61.Project MATCH found equal success rates among the following treatments: 83. 84. 85. A 12­step program A CBT program Motivational enhancement therapy Treatment of Alcoholism 62.Relapse prevention programs attempt to maintain abstinence once the behavioral excesses have been checked 86. Biggest problem is relapse (falling off wagon) 87. Problem beings with gradual slippage in effort 88. Abstinence violation effect ­ one slip and give up Substance Related Disorders Drug Abuse and Dependence: Varieties 63.Aside from alcohol, the psychoactive drugs most commonly associated with abuse and dependence are 89. Narcotics: opium & its derivatives 90. Sedatives: barbiturates 91. Stimulants: cocaine and amphetamines 92. Hallucinogens: LSD, PCP 92. 93. Anti­anxiety drugs: benzodiazepines 94. Caffeine and nicotine: drugs of dependence Drug Abuse and Dependence: Prevalence 64.28 million world wide use psychoactive substances other than alcohol and nicotine 65.Most common among adolescents and young adults and lower SES 66.Type, amount and duration vary widely based on person and drug Narcotics: Types 67.Narcotics include 95. 96. 97. Opium – mixture of 18 alkaloids Morphine – found in opium; sedative Heroin – morphine treated with acetic anhydride 68.These drugs were originally praised for their medical uses, but they are dangerously addictive Narcotics: Immediate Effects 69.The immediate effects of narcotics include 98. Alleviation of physical pain 99. Relaxation and pleasant reverie 100. Alleviation of anxiety and tension 101. 101. Euphoric spasm 102. Oxycontin, darvon 70.Effect may last 4­6 hours 71.Other pain killers Narcotics: Long­term Effects 72.Long­term effects include 103. 104. 105. Physiological craving for the drug 2. (development of tolerance) Gradual deterioration of well­being 3. (maladaptive lifestyle) 4. (disrupted immune system) 5. (overdose; dirty needles) Withdrawal symptoms 6. (need another dose within 8 hours) Narcotics: Withdrawal 73.Withdrawal characterized by 106. 107. 108. Chills, sweats, vomiting, cramps Pain, headaches, tremors Can last up to 30 days Narcotics: Abuse and Dependence 109. Some investigators have suspected that endorphins play a role (underproduction) 110. A high incidence of antisocial personality has been found among heroin addicts 7. Impulsivity, inability to delay gratification 111. In our country, addiction is associated with a narcotics subculture 8. Undereducated, unemployed 9. Withdrawal from broader culture 10. Belonging to addict milieu 10. Narcotics: Treatments and Outcomes 112. Treatment for narcotics addiction is initially similar to that for alcohol addiction: 113. Build up physiologically and psychologically 114. After withdrawal, assist in adjustment to society Narcotics: Treatments and Outcomes 115. Methadone and buprenorphine are often used in conjunction with a rehabilitation program: 116. Dealing with craving without producing serious impairment 117. Buprenorphine is antagonist to heroine creating positive feelings Sedatives: Barbiturates 74.Barbiturates were once widely used to induce sleep and calm patients: 118. 119. Developed in 1930's to calm patients Depressants like alcohol 75.They are dangerous drugs commonly associated with 120. Physiological and psychological dependence 121. Lethal overdoses (tolerance does not increase amount needed to cause death) Sedatives: Barbiturates 76.Those who become dependent on barbiturates tend to be middle­aged people who rely on them as sleeping aids 122. 122. When used with alcohol can cause death 123. 124. More severe and longer than for opiates Analogous to alcohol withdrawal, but worse 77.Withdrawal is a key issue in treatment Stimulants: Cocaine and Amphetamines 78.Cocaine and amphetamines – short­term 125. Increase feelings of alertness and confidence (euphoric state) 126. Decrease feelings of fatigue (alertness) 79.Over the long­term amphetamines 127. Are psychologically and physically addictive 128. May result in brain damage and psychopathology 11. Stimulation of ANS; increased blood pressure Stimulants: Cocaine 80.Cocaine is a plant product (poppies) 81.2.3 million users in US 82.Crack is processed from cocaine for smoking 83.Long­term use of cocaine can produce social, financial and psychological problems 84.Treatment is similar to narcotic treatment Stimulants: Amphetamines 85.Amphetamines introduced in 1920's 129. 130. Benzedrine was first created in 1927 In 1930's dexedrine and methadrine 86.Currently usedfor treatment of ADHD 87.Recreational use common 88.Can produce psychosis and psychological 88. dependence Hallucinogens: LSD and Related Drugs 131. Hallucinogens cause an individual to see or hear things in different and unusual ways (distortion of sensory processes) 132. This category includes 12. LSD: potent; up to 8 hours of effect; effect may be pleasant or traumatic; problem of flashbacks 13. Mescaline: from cactus 14. Psilocybin: from mushrooms 15. PCP: both stimulant and hallucinogen 16. Ecstasy: MDMA; original diet pill; produces energy and excitement; also addictive Hallucinogens: Marijuana 2. Marijuana may be classified as a mild hallucinogen (5000 years old; hemp) 3. The effects of marijuana vary but may include (depend on personality, mood) 0. 1. 2. 3. 4. 5. 6. Marijuana Euphoria Hilarity Hyper­talkativeness Anxiety Depression Hallucination Memory dysfunction 89.Marijuana is not strongly physiologically addictive, 89. but it may be psychologically addictive for some people 90.Psychological treatment methods have been shown to be effective in reducing use in dependent adults 133. Depends on underlying pathology Other Potentially Addictive Behaviors: Pathological Gambling 134. Although pathological gambling does not involve a chemically addictive substance it is similar in the following ways: 17. The personality factors (Axis II) that tend to characterize addictive gamblers 18. The difficulties attributable to compulsive gambling (resistant to extinction) 19. Increase availability of opportunities 0. Casinos, number games, lotteries, cards 20. The treatment problems involved 1. Like other addictions: denial, relapse Other Potentially Addictive Behaviors: Range 91.Sexual addictions 92.Sports addictions 93.Video game addictions 94.Work addictions 95.Financial addictions 96.Gustatory addictions 96. 97.Health and fitness addictions Unresolved Issues 98.Is the use of methadone effective, or does it simply exchange one addiction for another? End of Chapter 11 ...
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