CRM 200 Lecture Notes - Lecture 11: Impulse Control Disorder, Substance Intoxication, Problem Gambling
3 May 2018
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Chapter 11 - “UB“TANCE‐RELATED, ADDICTIVE, AND IMPUL“E‐
CONTROL DISORDERS
Lecture Outline
• Perspectives on Sustae‐Related ad Additie Disorders
• Depressants, stimulants, opioids, cannabis, hallucinogens, other
• Causes
• Treatment
• Gambling disorder
• Ipulse‐otrol disorders
Perspectives on “ustae‐Related ad Additie Disorders
Levels of involvement (physically) – midterm
◦ Substance use
◦ Just injection of drug– even coffee
◦ Does’t ea atuall hae a prole
◦ Substance intoxication
◦ When you have physiological physical reaction to the drug
◦ Alcohol – getting drunk
◦ Does’t ea atuall hae a prole
◦ Substance abuse
◦ How much the drug is interfering with someone's life
◦ Day to day functioning – not going to work/school
◦ Implies there is a problem: not enough to determine if have problem
◦ Substance dependence
◦ Addiction
◦ Your body needs/depends on the drug to function normally.
◦ When you withdrawal you get withdraw symptoms
◦ Could be psychological or physiological
Substance Use Disorders
The D“M‐5 = in order for a person to be diagnosed with a disorder due to a substance, they
must display 2 of the folloig syptos ithi ‐oths:
1. Consuming more alcohol or other substance than originally planned
2. Worrying about stoppig or osistetl failed efforts to otrol oe’s use
3. Spending a large amount of time using drugs/alcohol, or doing whatever is needed to
obtain them
o Stealing
o The more severe the more severe the action
4. Use of the sustae results i failure to fulfill ajor role oligatios suh as at hoe,
work, or school.
5. Craig the sustae alohol or drug
o Physiological or Psychological
6. Continuing the use of a substance despite health problems caused or worsened by it.
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o This can be in the domain of mental health (psychological problems may include
depressed mood, sleep disturae, aiet, or lakouts or phsial health.
7. Continuing the use of a substance despite its having negative effects in relationships
with others
o (for example, using even though it leads to fights or despite people’s ojetig to
it).
8. Repeated use of the substance in a dangerous situation
o (for example, when having to operate heavy machinery, when driving a car)
9. Giig up or reduig atiities i a perso’s life eause of the drug/alcohol use
10. Building up a tolerance to the alcohol or drug.
o Tolerae is defied the D“M‐5 as either needing to use noticeably larger
amounts over time to get the desired effect or noticing less of an effect over
time after repeated use of the sae aout.
o Need more and more to get to the effect
11. Experiencing withdrawal symptoms after stopping use.
o Withdrawal symptoms typically include, aordig to the D“M‐5:
o aiet, irritailit, fatigue, ausea/oitig, had treor or seizure i the case
of alohol.
In order to meet criteria, person only have to say yes to two
• 2-3 = mild
• 4-5 = moderate
• 6+ = severe
o Important to know so know how to treat it
Perspeties o “ustae‐ Related ad Additie Disorders
1. Physiological dependence
o Tolerance
o Withdrawal
2. Psychological dependence
3. Polysubstance use
4. Diagnostic Issues
1. Physiological dependence
Drug Tolerance and Withdrawal
• Tolerance
o the need to take higher and higher dosages of most drugs to achieve the same
effect
o Occurs because brain cells become less responsive to stimulation
• Withdrawal
o a syndrome that occurs once drug use is decreased or discontinued
o Could be Physiological or Psychological
2. Psychological dependence
Progression to Substance Use Disorder
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• Iitial pleasure fro sustaes is deried through rai’s reward system
o If you have a bad experience, youre less likely to develop a connection to it
• Operant conditioning
o If drug makes you feel good = positive reinforcement = more likely to consume
o Negative reinforcement = take away the bad = if drug takes away the bad
feelings
• Limited use to daily or compulsive use
o When limited use turns into daily use = more likely to developed
o Limited use can turn into compulsive use
o But doesn’t mean will hit the next steps.
• Withdrawal symptoms – also operant conditioning
o Positive punishment = withdraw symptoms = headaches = don’t want to
withdraw
• Neuroplastic changes
o When you start taking drugs, your brain starts to change
o Brain structure starts to change
o If you get certain chemicals from the drug, your brain will stop producing it
therefore when you stop taking the drug, you don’t feel the same way.
Therefore you don’t want to stop
• Influence of genetics PLUS environmental factors
o There has to be environmental factors. Genetic = pre factor
o It might be in your genes but if you're never exposed to it, you're not going to
get addiction to it
The Chaged “et Poit Model
• Drug use alters our aselies, or set poits
o Reward pathways are aturall set to release enough dopamine
o If exogenous substances are causing an increase in dopamine (i.e., through
reuptake inhibition), the body is going to reduce dopamine output
▪ Brain is set to release certain chemicals.
▪ That amount is the baseline/set point.
▪ If your bring in other chemicals/external factors, your brain will stop
producing that amount, and therefore the amount changes.
The Important Role of Stress
• Patients with SUDs are more vulnerable to stress
o SUD = substance use disorder
• Stressors trigger drug cravings
o Stress triggers hormones
• “tress ‐> ortisol ‐> trigger’s rai’s reward system
• Under stress = harmonies get released = need something to solve that = addiction to
something
3. Polysubstance use
Defining Multiple Substance Use
• Historically
o D“M‐IV: a perso ho has used three or ore sustaes
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