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Unformatted text preview: Chapter 11
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
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 –
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)
18. Vulnerability to injury
Shorter lifespan (12 years)
Lower performance on cognitive tasks
Brain shrinkage Alcohol Abuse and Dependence: Consequences (II)
11.Associated with: 19.
23. Coexisting mental disorders (depression)
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
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:
32. Lowers selfcontrol
Reduces motor coordination
Dulls discrimination of perception of pain
Creates sense of wellbeing 33.
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.
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 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:
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
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:
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
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
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
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
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
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)
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:
Build up physiologically and psychologically
After withdrawal, assist in adjustment to society Narcotics: Treatments and Outcomes 115.
Methadone and buprenorphine are often used in conjunction with a rehabilitation program:
Dealing with craving without producing serious impairment
Buprenorphine is antagonist to heroine creating positive feelings Sedatives: Barbiturates 74.Barbiturates were once widely used to induce sleep and calm patients:
119. Developed in 1930's to calm patients
Depressants like alcohol 75.They are dangerous drugs commonly associated with 120.
Physiological and psychological dependence
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)
Decrease feelings of fatigue (alertness) 79.Over the longterm amphetamines 127.
Are psychologically and physically addictive
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
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)
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)
6. Marijuana Euphoria
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
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
93.Video game addictions
95.Financial addictions 96.Gustatory addictions
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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- Spring '08
- Abnormal Psychology