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Lecture

Summarized and reformatted notes originally posted by the prof when she was sick. Works great to print 2 pages per side if paper =)

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Department
Psychology
Course Code
PSY240H1
Professor
S.Cassin

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1
PSY240 Lecture 9 Substance Use
Disorders
We live in a culture of socially sanctioned
addictions.
Canada = drug culture:
Wake up to coffee/tea
Drink more coffee/cola to say alert
throughout the day
Drink alcohol to relax and become more
social
Take aspirin to reduce pain
Many substances come from plants,
o used for medicinal, spiritual, and
endurance purposes for centuries
Opium - produced from the poppy plant,
used for hundreds of years to relieve
pain
Natives in the Andes - chewed coca
leaves to increase endurance
Coca leaves manufactured into
cocaine
Cocaine used in Europe and
America at the turn of the
century to relieve fatigue, used in
original coca-cola
Aztecs and other native groups in the
U.S. and Canada - chewed Peyote cactus
to experience visual hallucinations
Wide cultural variations in attitudes,
patterns of use, accessibility, physiological
reactions, prevalence of substance-related
disorders
Some groups forbid use of any drugs,
others accept or even encourage drug
use
Evaluation of an individuals pattern of
substance use must take these factors
into account
DSM-IV Disorders
Before 1980 and introduction of DSM-III,
discussion of alcoholism and drug abuse
considered part of sociopathic personality
disturbances
4 substance-related conditions recognized
by DSM-IV:
Substance intoxication
Substance abuse
Substance dependence
Substance withdrawal
Substance Intoxication
Development of reversible symptoms +
maladaptive behavioural or psychological
changes due to direct physiological effects of
a substance on the CNS
Perceptionex. LSD
Wakefulness—ex. Sedative
Attentionex. Marijuana
Thinkingex. Marijuana
Judgmentex. Alcohol
Mood labilityex. Cocaine
Psychomotor behaviourex.
Amphetamine
Interpersonal behaviour (ex.
belligerence)ex. Alcohol
Diagnosis only given when:
obehavioural + psychological changes
cause significant disruption in social
and family relationships, occupational
or financial problems, or place the
person at risk for adverse effects (ex.
accidents, medical ailments, legal
problems)
Factors Affecting Intoxication
Factors affecting intoxication:
Type of substance & route of
administration
Route of administration of a
substance = important factor in
determining effects + likelihood
of tolerance and withdrawal
Routes of administration that
produce more rapid and efficient
absorption into bloodstream (ex.
intravenous, smoking, snorting)
more intense high and greater
risk of dependence (ex. Crack)
These routes of administration
quickly deliver a large amount of
drug to brain, associated w/
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2
higher levels of substance
consumption and toxic effects
(over-dosing)
Dosage
History of use
Tolerance related to body size, gender,
history of use, drug metabolism
Expectations of use
ppl expecting marijuana to relax
them may experience relaxation,
ppl afraid of becoming dis-
inhibited may experience anxiety
Environment or setting in which
substance is ingested
a few drinks at a party leads to
greater gregariousness, a few
drinks at home lead to tiredness
or sadness, or a few regretted
phone calls or e-mails
Signs and symptoms may persist for hours
or day after the substance is detected in
body fluids
Substance Abuse
Diagnosis: persons recurrent use of a
substance results in significant harmful
consequences
4 categories of harmful consequences
suggesting SA in DSM-IV
Failure to fulfill major role obligations
(ex. repeated absences or poor
work/school performance; neglect of
children or household)
Use in situations in which it is
physically hazardous (ex. driving a car,
operating machinery, swimming, rock
climbing)
Legal problems (ex. arrests for
substance-related disorderly conduct)
Social or interpersonal problems caused
or worsened by substance
Need to meet at least 1 criterion w/in 1 year
period
Problem—a lot of ppl meet criteria using
this definition
Note: Unlikely to get a diagnosis of
substance abuse for many legal drugs (ex.
cigarettes, pain killers, diet pills), would not
meet criteria for substance abuse, but easily
qualify for a diagnosis of dependence.
Substance Dependence
Diagnosis of SD pre-empts the diagnosis of
substance abuse
oSince dependence is considered more
advanced condition
Diagnosis usually described as addiction
Presence of at least 3 in 1 year period:
Tolerance need to increase amount to
get same effect, or much less effect if use
the same amount
Degree to which tolerance
develops varies greatly across
substances
ex. very pronounced for
opioids, stimulants, alcohol
Withdrawal experience withdrawal
symptoms or take substance to relieve or
avoid withdrawal symptoms (ex. eye-
opener, hair of the dog)
Degree to which withdrawal is
experienced varies greatly across
substances
ex. absent for
hallucinogens; moderate
for amphetamines,
cocaine, nicotine, and
marijuana; severe for
alcohol, opioids, sedatives,
anxiolytics
Substance taken in larger amounts or
over longer period of time than intended
rare for marijuana because often
require less due to sensitivity
Persistent desire or unsuccessful efforts
to cut down or control use
Great deal of time in activities
necessary to obtain, use the substance,
or recover from effects
Important social, occupational, or
recreational activities given up or
reduced because of use
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Use is continued despite knowledge of
having persistent or recurrent physical
or psychological problem that is caused
or worsened by substance
ex. depression w/ cocaine, ulcer w/
alcohol
W/ or w/o physiological dependence (ex.
tolerance and/or withdrawal)
oNot required for diagnosis
Clinical course more severe if
physiologically dependent
Can be constant craving for the substance
will do anything to get it psychological
dependence
Substance Withdrawal
Set of maladaptive physiological +
behavioural symptoms
Result when prolonged heavy users stop
Can begin a few hours after person stops
ingesting substance that breaks down
quickly in body
ex. Alcohol, heroin
More intense symptoms usually end w/in
few days to few weeks
Some, including seizures, may develop from
elimination of high doses, such as the
reduction of anxiolytics
Other symptoms: chills, fever, diarrhea,
nausea, and vomiting
Alcohol Intoxication
Alcohol = CNS depressant
Immediate physical effects occur in stages:
Frontal lobes reasoning, memory,
judgment, behavioural inhibition
Initially has a stimulating effect since
decreases inhibitions.
Cerebellum motor + muscle control,
coordination, balance, speech, motor
functioning clumsy
Spinal cord and medulla respiration,
body temperature, heart rate
Sedating effect can be life-threatening if
a lot consumed
(particularly if blood alcohol level > 0.5%
1/3 of deaths from respiratory
paralysis, legal limit = .08%)
Cognitive Effects often forget what
occurred drinking due to state-dependent
learning, more likely to recall it when you
are back in that state than when you are
sober
Empty stomach alcohol more quickly
delivered from stomach to small intestine,
where absorbed
oFrance alcohol usually
consumed w/ meals lower
rates of alcohol-related disorders
in the U.S, where alcohol usually
consumed on empty stomachs
Alcohol Abuse and Dependence
AA uses alcohol in dangerous situations,
fails to meet obligations at work or home
due to use, and/or recurrent legal or social
problems as result of use
AD physiological or psychological
dependence, physiological tolerance, spends
a lot of time intoxicated or in withdrawal, or
continues to drink despite significant legal,
social, medical, or occupational problems
that result
3 distinct patterns of use
Drink large amount every day
Abstinence followed by binges that last
for days or weeks
Sober during weekdays, drink heavily
during evenings or sometimes only on
weekends
Alcohol Withdrawal
Heavy and prolonged users can show severe
withdrawal symptoms in 3 stages:
1 few hours after drinking stopped
tremors, weakness, profuse
perspiration at moderate levels of
dependence may experience for a few
days
2 convulsive seizures which may occur
btwn 2nd and 3rd day
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Description
1 PSY240 Lecture 9 Substance Use Substance intoxication Disorders Substance abuse Substance dependence We live in a culture of socially sanctioned Substance withdrawal addictions. Canada = drug culture: Substance Intoxication Wake up to coffeetea Development of reversible symptoms + Drink more coffeecola to say alert maladaptive behavioural or psychological throughout the day changes due to direct physiological effects of a substance on the CNS Drink alcohol to relax and become more social Perceptionex. LSD Take aspirin to reduce pain Wakefulnessex. Sedative Many substances come from plants, Attentionex. Marijuana o used for medicinal, spiritual, and Thinkingex. Marijuana endurance purposes for centuries Judgmentex. Alcohol Opium - produced from the poppy plant, Mood labilityex. Cocaine used for hundreds of years to relieve Psychomotor behaviourex. pain Amphetamine Natives in the Andes - chewed coca Interpersonal behaviour (ex. leaves to increase endurance belligerence)ex. Alcohol Coca leaves manufactured into Diagnosis only given when: cocaine o behavioural + psychological changes Cocaine used in Europe and cause significant disruption in social America at the turn of the and family relationships, occupational century to relieve fatigue, used in or financial problems, or place the original coca-cola person at risk for adverse effects (ex. Aztecs and other native groups in the accidents, medical ailments, legal U.S. and Canada - chewed Peyote cactus problems) to experience visual hallucinations Wide cultural variations in attitudes, Factors Affecting Intoxication patterns of use, accessibility, physiological Factors affecting intoxication: reactions, prevalence of substance-related Type of substance & route of disorders administration Some groups forbid use of any drugs, Route of administration of a others accept or even encourage drug substance = important factor in use determining effects + likelihood Evaluation of an individuals pattern of of tolerance and withdrawal substance use must take these factors Routes of administration that into account produce more rapid and efficient absorption into bloodstream (ex. DSM-IV Disorders intravenous, smoking, snorting) Before 1980 and introduction of DSM-III, more intense high and greater discussion of alcoholism and drug abuse risk of dependence (ex. Crack) considered part of sociopathic personality These routes of administration disturbances quickly deliver a large amount of 4 substance-related conditions recognized drug to brain, associated w by DSM-IV: www.notesolution.com
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