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M.Mc Kay (9)
Lecture 7

PSY240 Lecture 7

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M.Mc Kay

PSY240 Lecture 7 June 13: Substance Abuse Disorders (Chapter 17) Substance is any natural or synthesized product that has psychoactive effects it changes perceptions, thoughts, emotions, behaviours The societal cost of substance abuse Nearly half of the U.S. population have tried an illegal substance; 15% have used one in the past year Similar patterns run across the U.S. and Canada, thought Canadians use less cocaine and more LSD than do Americans Illicit drug use higher in males than females; once women begin to use substance, they are as likely to become dependent, and may suffer greater physiological damage from some substances than men Stats Canada; Canadian Alcohol and Drug Use Monitoring Survey 2010 Among 15 years and older, prevalence of cannabis use decreased from 14.1% (2004) to 10.7% Among 15 years and older, prevalence of cocaine/crack decreased from 1.9% (2004) to 1.2% Hallucinogens (.0%), ecstasy (.7%) and speech (.5%) remained the same Alcohol use (77%) remained the same Rates of psychoactive pharmaceutical use remains the same (26% use, .3% use to get high) Drug use and abuse across cultures: o Muslim cultures may impose strict sanctions for the use of any drugs; China certainly did at the time of the cultural revolution communists in 1940s made it major goal to eradicate use of opium, executed traffickers, sent users to countryside for rehab/education o In the UK, drug abuse is viewed as medical problem, people who abuse substances/dependent on substances are treated by physicians o Holland makes distinction between soft (cannabis) and hard (cocaine/heroin) drugs Based on belief that enforcing strict prohibition of soft drugs would drive users to underground, putting them in closer contact to hard drug dealers o Many South Americans, Middle Easterners, and East Africans regularly chew khat and see nothing deviant in doing so (khat used to produced amphetamines) o First Nations groups in Canada and in the US use psychoactive ages as part of religious ceremonies Text: Individuals who have great difficulty in using substances in moderation and begin to build their lives around substance use, leading to significant problems in their abilities to function in daily lives have a substance-related disorder Many other substances are used for intoxicating effects that more rarely lead to substance related disorders; people who experience significant problems in cognition, mood, anxiety, hallucinations, delusions and seizures when exposed may be given diagnosis of other substance- related disorder (this drugs include: antihistamines, anesthetics, antimicrobial medications, BP medications, lead, pesticides, etc.) In Canada, alcohol and illicit drugs cost society about $14 billion/year due to lost productivity, legal costs, and health costs There are 86,000 admissions to Canadian hospitals each year for alcohol-related health reasons Alcohol is associated with more than half of traffic deaths and homicides and 30% of all suicides In 2002, 19.3% of all deaths in Canada could be attributed to alcohol, tobacco, or illicit drugs Total cost of substance abuse in Canada 2002 = $40 billion Categories of substances 1. Central nervous system depressants (alcohol, barbiturates, benzodiazepines, inhalants) 2. Central nervous system stimulants (cocaine, amphetamines, nicotine, caffeine) 3. Opiods (E.g., heroin, morphine) 4. Hallucinogens and phencyclidine (PCP) 5. Cannabis 59 Substance-related conditions recognized by the DSM-IV-TR Substance intoxication: experience of significant maladaptive behavioural and psychological symptoms due to the effect of a substance on the central nervous system. o Perceptions change, they may see of hear strange things; attention is diminished, easily distracted; good judgment is gone, unable to think straight; cannot control their bodies, may stumble or be too slow/awkward in reactions; often want to sleep or not at all; interpersonal interactions change (more gregarious, or withdrawn or aggressive/impulsive) o People begin to be intoxicated soon aster they begin ingesting substance; more ingesting = more intoxication o Intoxication declines as amount of substance in persons blood/tissue declines but symptoms of intoxication may last for hours, days after substance no longer detectable in body o Specific symptoms depend on type of substance, how much is taken, how long it has been ingested, users tolerance o Short-term/acute intoxication can produce different symptoms from long-term o Peoples expectations about substances effects can also influence types of symptoms shown o Diagnosis of substance intoxication only given when behavioural/psychological changes person experiences are significantly maladaptive in that they substantially disrupt persons social/family relationships, cause occupational/financial problems, place individual at significant risk for adverse events Substance withdrawal: experience of clinical distress in in social, occupational, or other areas of functioning due to the cessation or reduction of substance use. o Involves set of physiological and behavioural symptoms that result when people who have been using substances heavily for prolonged periods of time stop using the substance or greatly reduce their use o Symptoms are typically opposite of intoxication with the same substance o Diagnosis of substance withdrawal not made unless there is significant distress/impairment in persons everyday functioning. o Symptoms of withdrawal can begin few hours after person stops ingesting substances the more intense symptoms usually end within few days to few weeks; however withdrawal symptoms (like seizures) may develop several weeks after person stops taking high doses of substances that take longer time to leave the body completely See substance abuse below See more on substance dependence below. DSM-IV-TR criteria for substance abuse Substance abuse: diagnosis given when recurrent substance use leads to significant harmful chronic consequences. One or more of the following occurs during a 12-month period, leading to significant impairment or distress: 1. Failure to fulfill important obligations at work, home, or school as a result of substance abuse (e.g. unable to concentrate, performs poorly, takes substance at work/school). 2. Repeated use of the substance in situations in which it physically hazardous to do so (e.g. driving car or boat). 3. Repeated legal problems as a result of substance use (e.g. arrests for possession of illegal substances or for drunk driving). 4. Confirmed use of the substance despite repeated social or legal problems as a result of use. 60DSM-IV-TR criteria for substance dependence Substance dependence: diagnosis given when substance use leads to physiological dependence or significant impairment or distress (with alcohol you test for abuse first; for substances, you test for dependence first, then see if they meet criteria for abuse better). Maladaptive pattern of substance use, leading to three or more of the following: 1. Tolerance, as defined by either: the need for markedly increased amounts of the substance to achieve intoxication or desired effect; markedly diminished effect with continued use of the same amount. Individual experiences less and less effect from same dose of substance, needs greater and greater doses to achieve intoxication. Risk of tolerance varies; alcohol, opioids, stimulants, nicotine = higher risks for tolerance, cannabis & PCP = lower risk. 2. Withdrawal, as manifested by either: the characteristic syndrome for the substance; the same or closely related substance is taken to relieve or avoid withdrawal symptoms. Symptoms may be so severe that the substance must be withdrawn gradually to prevent symptoms from becoming overwhelming/dangerous. 3. The substance is often taken in larger amounts or over a longer period than was intended. 4. There is president desire or unsuccessful efforts to cut back/control use. 5. A great deal of time is spent in activities necessary 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. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem cause or exacerbated by the substance. NOTE: physiological dependence (i.e., evidence of tolerance/withdrawal) is not required for diagnosis of substance dependence. Diagnosis can be given when person compulsively
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