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Lecture 5

PSY333H1 Lecture Notes - Lecture 5: Major Depressive Disorder, Coronary Artery Disease, Bipolar Disorder

Course Code
Nevena Simic

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Health- Compromising Behaviours- Chapter 5 May 30, 2012
Health comprising behaviours
Behaviours practiced by people that undermine or harm their current or future
- Abusing alcohol
- Smoking
- Illicit drug use
- Unsafe sex
- Risk-taking behaviour
Substance Dependence:
Dependent on a substance if repeatedly self-administer it, resulting in tolerance,
withdrawal, compulsive behaviour.
Physical dependence: state that occurs when body adjusts to substance and
incorporates the use of it into normal function of body’s tissues
- Often involves tolerance: body increasingly adapts to use of substance,
requiring increased doses to achieve same effect
- Craving: strong desire to engage in a behaviour or consume a substance.
Addiction: occurs when a person becomes physically or psychologically dependent
on a substance following use over time.
Withdrawal: unpleasant symptoms experienced when stop taking substance on
which one has become dependent
- Anxiety, irritability, intense cravings, nausea, headaches, shaking,
Substance Abuse:
Costs to Canadians (2002)
- $39.8 billion health care resources, law enforcement, loss of productivity at
- Smoking accounted for most of this cost (43%)
- Alcohol accounted for 37%
- Substance abuse= 20%
Harm reduction: intervention strategy
- Public health response to substance abuse problem
- “Approach that focuses on the risks and consequences of substance use
rather than on the use itself”
- Ex) methadone clinics, needle exchange programs
Substance Abuse vs. Dependence
A maladaptive pattern of substance use leading to clinically significant impairment
or distress, as manifested by one (or more) of the following, occurring within a 12-
month period:

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1. Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, home
- E.g., repeated absences or poor work performance related to substance use
- Substance-related absences, suspensions, or expulsions from school
- Neglect of children or household
2. Recurrent substance use in situations in which is physically hazardous
- E.g., driving an automobile or operating a machine when impaired by
substance use
3. Recurrent substance-related legal problems
- E.g., arrests for substance-related disorderly conduct
4. Continued substance use despite having persistent or recurrent social or
interpersonal problems cause or exacerbated by the effects of the substance
- E.g., arguments with spouse about consequences of intoxication
- Physical fights
Substance abuse vs. dependence :
1. Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the substance to achieve
intoxication or desired effect
- Markedly diminished effect with continued use of the same amount of
2. Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for the substance
- The same (or a closely related) substance is taken to relieve or avoid
withdrawal symptoms
3. Substance is often taken in larger amounts or over a longer period than was
4. There is a persistent desire or unsuccessful efforts to cut down or control substance
5. A great deal of time is spent in activities to obtain the substance, use the substance,
or recover from its effects
6. Important social, occupational or recreational activities are given up or reduced
because of substance use
7. Substance use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated
by the substance (e.g., continued drinking despite recognition that an ulcer was
made worse by alcohol consumption)
How does alcohol abuse compromise health?
Alcohol-related deaths= 8000/year
Linked to a number of disorders:
- High blood pressure

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- Stroke cirrhosis of the liver
- Some forms of cancer
- Fetal alcohol spectrum disorder
- Major sleep disorders
- Cognitive impairments (irreversible often)
Economically, costs Canadians $14.6 billion in loss productivity, treatments,
accidents, fire, and crime
- $463/Canadian/year
Nearly 20% of Canadians drink at levels that exceed government recommendations
Low-Risk Drinking Guidelines (CAMH)
Maximize life, Minimize risk
- 0: Zero drinks= lowest risk of an alcohol-related problem
- 2: No more than 2 standard drinks on any one day
- 9: Women: up to 9 standard drinks a week
- 14: Men: up to 14 standard drinks a week
One standard drink= 13.6 g of alcohol
- 5oz/142 mL of wine (12% alcohol)
- 1.5 oz/43 mL of spirits (40% alcohol)
- 12 oz/341 mL of regular strength beer (5% alcohol)
People find it difficult to elicit the standard amount.
How does alcohol abuse compromise health?
- Genetic factors (twin studies), M>F
- Socio-demographic factors (low SES)
Overall, a gradual process involving physiological, behavioural, and socio-cultural
variables induces alcohol use (parents and peers shape behaviours)
- Stress buffer
- Social event= learned early
Appears to be TWO windows of vulnerability
- Chemical dependence usually starts between 12&21; peaks 18 to 25
- Late middle age; coping method for managing stress
Treatment of alcohol abuse:
10-20% of alcoholics stop drinking on their own
32% stop with minimal help
- “Maturing out”; later years of life!
Cognitive behavioural modification programs
- BUT 60% dropout rate
Alcoholics from high SES & are in highly socially stable environments do better in
treatment programs
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