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Lecture 9

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University of Toronto Scarborough
Konstantine Zakzanis

PSYB32- Lecture 9 Substance-Related Disorders  Drugs are usually initially pleasing, thus people do more, and eventually become dependent, encountering all sorts of problems  In a study done by an Oxford psychiatrist, the prevalence of recreational substance abuse and dependence skyrockets through teen and young adult years; this type of behaviour typically stops at 30 years-old  Substance dependence is characterized by any three of the following symptoms: o Tolerance is indicated when larger doses of the substance are needed to produce the desired effect; also the effects of the drugs become markedly less if the usual amount is taken o Withdrawal are the negative physiological or psychological symptoms that develop when the person suddenly stops taking the substance or reduces the amount; also defined by a person who uses the substance to avoid the withdrawal symptoms o Person uses more of the substance or uses it for a longer time than intended o Person recognizes excessive use of substance; problem with this criteria is that most people with substance problem will not admit it quite readily; typically the first step with rehab programs o Much of the person’s time is spent trying to obtain substance or recover from its effects o Substance use continues despite problems o Person gives up or cuts back participating in many activities because of substance; person has limited social circle, person gets high or drunk at home alone as well o Also add the qualifier of addiction when the substance dependence is accompanied by either tolerance or withdrawal  Physiological tolerance typically means two things: greater problems and it is much more difficult to treat  Substance abuse is characterized by at least one of the following: o Failure to fulfill major obligations; inability to go to work every morning o Exposure to physical dangers; drinking and driving o Legal problems; trafficking drugs o Persistent social or interpersonal problems; being violently abusive of spouse or children o No withdrawal or tolerance with substance abuse o Another possible diagnostic entity is substance intoxication; would be acute effects of what a drug or alcohol might cause; brought into emergency room with hallucinations, violent behaviour  Alcohol abuse and dependence o Alcoholism is the fourth leading cause of disability worldwide; not culture specific and costs are high in terms of a burden on health care o Somebody who is dependent on alcohol will have more disability with respect to the activities of daily living and will have evidence of tolerance or withdrawal o When someone is withdrawing from alcohol with a sudden drop of blood-alcohol level they will suffer from Delirium tremens (DTs); DTs is an almost psychotic-like state when someone’s blood-alcohol suddenly drops; symptoms of DTs are disorientation, memory problems, terrified because of hallucinations; all of these symptoms are transient (temporary) o Polydrug abuse is when the person abuses more than just one drug; 80-85% of those who suffer from alcohol abuse or dependence will also smoke cigarettes because they are synergistic o Prevalence of alcohol abuse- lifetime is 17.8%, twelve months is 4.7%; prevalence of dependence is lower- lifetime is 12.5%, twelve months is 3.8% o Prototypical alcoholics appear to be men, younger adults, Caucasians, single (typically not married), well off financially o Course of the disorder- there no single pattern of abuse or dependence; abuse does not necessarily lead to dependence o Short-term effects of alcohol- more social, little less anxious in surrounding, louder, dizzy, increased confident; alcohol is biphasic- acts as a stimulant at first, but when blood-alcohol level stops rising and decreases, it becomes a depressant; short-term effects of alcohol are dependent on five factors: level of concentration in the blood stream, amount ingested in a particular period of time, presence or absence of food in stomach (reduces absorption rate of alcohol), size of the person or how much they weigh, efficacy of liver (how well liver can break down enzymes) o Long-term effects of prolonged alcohol abuse are malnutrition, Korsakov syndrome (alcohol induced dementia characterized by anterograde amnesia), psoriasis of liver, hypertension, capillary haemorrhages  Marijuana  Psychological effects- paranoia, fragment thoughts  Somatic effects- increased hunger, bloodshot, itchy eyes, dry mouth, increased blood pressure, decreased lung function  Therapeutic effects- helps with pain, helps chemotherapy patients with nausea and loss of appetite, multiple sclerosis, epilepsy, HIV/AIDS  Sedatives- used with respect to slowing down the body’s activity and responsiveness which is important when trying to alleviate a person’s perception of pain o Comes from the opium plant; morphine, heroin, codeine o Morphine induces sleep and reduces pain; feeling of euphoria, drowsiness, lack of coordination, hallucinations, vivid nightmares o Heroin is described subjectively by users as not only bringing on those psychological effects, but also a rush of warmth, a sense of ecstasy, a feeling of shedding all worries, guilt, negative feelings, and gives a person great self-confidence; incredibly addictive; tolerance and withdrawal are immediate and can happen after a single usage; appealing symptoms last about 4-6 hours, followed by a vicious period of withdrawal within about 8 hours that can be best characterized as the worst flu one has ever experienced in one’s life; gives way to 5-10 days of twitches, cramps, chills, etc.; users often become homeless  Stimulants- complete opposite of sedatives; substances that will increase alertness, motor activity, reduce appetite, make the person feel outgoing, make them feel like they have boundless energy, incredible feelings of self-confidence; incredibly addictive, tolerance builds up incredibly fast; o Cocaine- effect of drug, increase of sexual desire, endless energy, etc. do not last long; users are always chasing their next line; when someone overdoses it can be life threatening, experience chills, nausea, insomnia, and other symptoms that characterize withdrawals from sedatives but with two additional symptoms which are hallucinations and delusions; delusions are characterized by severe paranoid state; different substances that increase dopamine in the brain can cause schizophrenic like states (cocaine is one of these) o Chronic users will experience a change in personality, typically characterized by disexecutive functioning, hard time planning, problem solving, using judgements, more irritable, impaired social skills, fatigue, and mainly cognitive impairment o Cocaine was used in the past for toothache drops, by teachers and preachers to smooth the voice  LSD and other Hallucinogens- drug common in the 60s; increases dopamine in the brain and thus produces vivid hallucinations  Ecstasy has become the second most used recreational drug after marijuana o First created as an appetite suppressant during WWI; also was used in couples therapies by psychiatrists; became popular at raves o Ecstasy has short-term and long-term effects on the brain; short term- changes in brain chemistry, behaviour; long term- changes brain structure, behaviour o What happens in the brain? Brings a rush of serotonin into the brain and blocks reuptake; when brain is no longer flushed with serotonin, the brain is no longer to make as much natural serotonin; in chronic users, the level never gets back to baseline o One of the biggest limitations to research is that when people thin
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