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Lecture 18

Psychology 46-322 Lecture 18: Notes on Substance Disorders

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Lecture 18 on Substance Disorders Normal Adolescence (substance abuse disorder)  Adolescence used to be described as "storm and stress" 100 years ago  huge levels of conflicts, family problems, arguments, fights, etc.  but adolescence is not necessarily like this; most adolescents rebel, but most get through teenage years without significant problems  Adolescence is about identity search, greater sense of self, also a time for significant changes o Biochemical changes  puberty, adult level of sexuality, hormone changes (significant effects on cognition, brain development, social interaction) o Take on social roles  script  Society expects the adolescents to achieve more complicated tasks (ex. driving)  Might expect them to identify significant partners; whether or not they want to become parents o Set boundaries with the parents in goals, values, choice in music, etc. o Parents maintain their importance in adolescence compared to peer relationships (the point is the importance of parents in adolescence is how relative to the importance of them in childhood) o Common psychopathologies  Depression (rates increase in adolescence)  Psychosis  end of adolescence to in transition to adulthood  Substance related disorders (abuse and dependence)  Eating disorders Substance Use/Abuse  Substances have been around for a long time  Experimentation in adolescence is normative  Use of drugs and alcohol in adolescents is declining  Substance use or abuse is more problematic for US and Canada than anywhere else in the world  Marijuana has become the drug of choice and has relatively high in experimentation (40% of adolescence is experienced with the drug)  Poly-drug  becoming more common; fewer adolescents experimenting but not experimenting with just one substance but multiple  Age of onset is also going down (experiment on prior the age of 12 is nearly zero)  At 14, the number starts to go up (rather dramatically)  At 23-25, experiments go down dramatically (very few people in their 20s will experiment but if they do, often develop substance disorder)  Until 10 years ago, males were more likely to experiment with substances (but now girls are just as likely)  Choice of substance usually determined by what is easily available  Poor kids are more likely to experiment drugs and alcohol earlier, but more affluent catch up in later adolescence Substance Abuse  Excessive use  the "too much" usually depends on which substance and age of the individual  The use of the substance must interfere with work/school and social relationships (ex. fighting with your mom because of substance abuse) Substance Dependence  Assumes the user is excessive and the use is interfering  The DSM does not use the term addiction  Tolerance  need more and more of the same drug in order to achieve desired effect  Withdrawal  Symptoms that associated with not getting the substance (ex. being cranky, irritable, having headaches because you didn’t get the substance)  Addiction  inability to not use or inability to desist  Preoccupation  person thinks about using when not using  Addicts report preoccupation with thoughts of substance for weeks, months, or even years Problems with the DSM  Diagnostic orphans  these individuals do not reach diagnostic levels (person fits in neither abuse nor dependence) o Those who drop out of school and not work, that doesn’t interfere with your work/school o Substance independence  we cannot diagnose, we end up with NOS  Young people are less likely to experience physiological dependence (less likely to experience tolerance and withdrawal as these symptoms are seen over a long period of time with substance use)  Adolescents with substance use, particularly girls, are less likely to experience legal difficulties (more likely to be sent to work, monitoring programs)  Symptoms  more commonly seen symptoms are not in the DSM (ex. blackouts, mood problems/deregulation, cravings, reduced activity levels, risky sexual behaviours) Other Risk Factors  Comorbidity  mood problems (ex. depression), conduct disorder  Adolescents might use the substance for self-treatment (mood problems)  Depression and substance problems  also suicidal behaviours  CD  more likely to associate with deviant peers, thus increase substance use (using substances gets you halfway to CD diagnosis)  Biological risk factor o Inheritability (10-25%) o Smoking inheritability (40-60%) o Prenatal exposure  fetuses exposed to substances are more prone to later difficulties with dependence, as brain is primed at pleasure centers (dopamine) o Temperamental factors (difficult temperament; more likely to diagnosed for ADHD and half of those are likely to be diagnosed with CD, also substance use and abuse)  Family Context o Parental psychopathology  modeling (from parents inappropriate use of a substance; probably the availability of the substance)  adolescent's own home or home of a friends o Parents who are depressed or with social personality disorders o Child maltreatment increases the risk for substance problems o Parenting style  positive relationships between child and the parent predicts reduction in substance use  Authoritative parenting  greater monitoring usually predicts more structure, thus less opportunity for exposure o Early exposure predicts higher risks for substance use in later years of the child  Social Context o Exposu
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