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ch 12

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BLG 151
Margaret Buckby

Chapter 12: Substance-Related Disorders The pathological use of substances falls into 2 categories o Substance abuse o Substance dependence presence of at least 3 of the following The person develops tolerance, indicated by larger doses of the substance being needed to produce the desired effect or the effects of the drug becoming markedly less if the usual mount is taken Withdrawal symptoms (negative physical and psychological effects when they stop taking it) The person uses more of the substance or uses it for a longer time than intended The person recognizes excessive use of the substance, he/she may tried to reduce usage but has been unable to do so Much of the persons time is spent in efforts to obtain the substance or recover from its effects Substance use continues despite psychological or physiological problems caused or exacerbated by the drug The person gives up or cuts back participation in many activities Substance dependence is diagnosed as being accompanied by physiological dependence (aka addiction) if either tolerance or withdrawal is present For less serious diagnoses of substance abuse, the person must experience 1 of the following as a result of recurrent use of the drug o Failure to fulfill major obligations o Exposure to physical dangers o Legal problems o Persistent social or interpersonal problems Substance intoxication: ingestion of a substance affects the CNS and produces maladaptive cognitive and behavioural effects If a person addicted to a drug is denied it and then experiences withdrawal, the person receives a diagnoses of both substance dependence and substance withdrawal Alcohol Abuse and Dependence Alcoholic doesnt have a precise meaning Alcohol abuse: used to refer to both aspects of excessive and harmful use of alcohol Alcohol dependence: may include tolerance or withdrawal reactions (people who are physically dependent on alcohol) In withdrawal the person is often anxious, depressed, weak, restless and unable to sleep C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s Page 14 r s Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly the person has hallucinations (happens when a person has been drinking for a number of years). They may feel like spiders are crawling on them, feel feverish, disoriented and terrified The person who abuses alcohol, in contrast to the person physically dependent on it, experiences negative social and occupational effects from the drug but does not show tolerance, withdrawal, or the compulsive drinking patterns seen in the person who is alcohol dependent Alcohol abuse or dependence is often part of polydrug abuse using or abusing more than one drug at a time o Alcohol serves as a cue for smoking; smoking is 2x as frequent in situations where a person is also drinking o Comorbid with nicotine because nicotine can induce tolerance for the rewarding effects of alcohol and vise versa o These cause problem because drugs taken together are synergistic the effects of each combine to produce an especially strong reaction Prevalence of Alcohol Abuse and Comorbidity with other disorders Prevalence 20% for men and over 8% for women declines with age Problem drinking is comorbid with mood and anxiety disorders and with other drugs use and schizophrenia Its a factors in 25% of suicides Course of the Disorder The histories of alcohol dependent people do show a progression from alcohol abuse to alcohol dependence but data shows considerable fluctuations in drinking patterns from heavy drinking from some periods of time to abstinence or lighter drinking at others Heavy use of alcohol may be restricted to weekends or long periods of abstinence may be interspersed with binges of continual drinking for several weeks There is no single pattern of alcohol abuse This Jellineks account doesnt apply to women. For women the interval between the onset of heavy drinking and alcohol abuse is briefer than it is for men Women with drinking problems tend to be steady drinkers who drink alone and are more unlikely than men to binge Costs of Alcohol Abuse and Dependence Alcohol abuse is the 4 leading cause of worldwide disability than the use of tobacco or illegal drugs Problem drinkers use health services 4x more than do non abusers, and their medical expenses are twice as high as those of non drinkers Alcohol is associated with many problems, deaths, assaults and accidents Short-term effects of Alcohol Alcohol is metabolized by enzymes after being swallowed and reaching the stomach C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s oPage 14r s Most goes to the small intestines and is broken mostly by the liver (which can metabolize about 50%/hour) The excess quantities stay in the bloodstream Absorption of alcohol is rapid but removal is always slow The effects of the drug vary with the level of concentration of the drug in the bloodstream, which in turn depends on the amount ingested in a particular period of time, the presence or absence of food in the stomach to retain the alcohol and reduce its absorption rate, the size of a persons body and the efficiency of the liver It has biphasic effect which means the initial effect of alcohol is stimulating the drinker experiences an expansive feeling of sociability and well-being as the blood-alcohol levels rises- but after the blood- alcohol level peaks and begins to decline, alcohol acts as a depressant that may lead to negative emotions Motor coordination, balance, speech, and vision is also impaired Large doses can cause sedation, sleep and even death Alcohol stimulates GABA receptors, which may be responsible for reducing tension, it also increases the level of serotonin and dopamine (pleasurable effects) Alcohol also inhibits glutamate receptors; which may cause the cognitive effects of alcohol intoxication (slurred speech and memory loss) People who actually drink alcohol also report increased sexual arousal, even though alcohol actually lowers physiological arousal (which may be caused by cognition) Long-term effects of Prolonged Alcohol Abuse Almost every tissue and organ of the body is affected adversely by prolonged consumption of alcohol malnutrition may be severe In older chronic alcohol abusers, a deficiency of B-complex vitamins can cause amnestic syndrome, a severe loss of memory for both recent and long-past events Cirrhosis (some liver cells become engorged with fat and protein, impeding their function; some cells die- triggering the inflammatory process) of the liver is caused by prolonged alcohol use with reduced protein Damage to the endocrine glands and pancreases, heart failure, hypertension, stroke, and capillary haemorrhages, which are responsible for the swelling and redness in the face (nose) Prolonged use of alcohol appears to destroy brain cells Reduces effectiveness of the immune system and increases susceptibility to infection and cancer Womens risk of breast cancer increases steadily with drinking Heavy alcohol during pregnancy causes mental retardation (the growth of the fetus is slowed, and cranial ,facial and limb abnormality are produced) -- fetal alcohol syndrome Some say that light amounts of alcohol may actually have its physiological gains but its still a controversy C h a p t e r 1 2 : S u b s t a n c e R e l a t e d D i s o Page 14 s
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