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PS280 - Ch 12 Textbook.docx

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Wilfrid Laurier University
Todd Ferretti

Chapter 11  Substance-Related Disorders  Mead – an alcoholic beverage naturally formed by the fermentation of honey; probably the first alcohol that humans consumed.  Opiate derivatives were once widely used in Asian cultures, Greece and Rome Diagnosis and Assessment  DSM-IV-TR: substance intoxication is used to describe a reversible & temporary due to the recent ingestion or exposure to a substance – a person must demonstrate clinically significant maladaptive behaviour or cognitive changes: belligerence, disturbed mood & perception, altered mood = results  Substance Abuse: Refers to recurrent substance use that results in significant adverse consequences in social or occupational functioning – interpersonal relationships may deteriorate or end, and use of the substance hazardously o Addiction - Used to describe the lack of control over substance use to the point that a person may feel enslaved; substance dependence 1. Physiological Dependence: Defined in terms of tolerance (a person needs to achieve the same effect) and withdrawal (experience unpleasant & sometimes dangerous symptoms: nausea, headache, tremors – with no drug) 2. Psychological Dependence: More recent concept, habituation refers to being psychologically accustomed to a substance or activity as a consequence of regular use – when substance is unavailable: restless, irritable, uneasy a. Impairment of Control: By exceeding the amounts of a substance or time using a substance than intended by the individual  Polysubstance Abuse: Simultaneous misuse or dependence upon 2 or more substances – ½ of cocaine users are alcohol dependent, amphetamine users tend to also use Benzos and opioids are paired with alcohol, coke, and benzos Alcohol  Distillation – The fermented solution containing alcohol is heated & the vapors are collected, and condensed into liquor to form “spirits” originally  Canadians  4 of every 5 Canadians reported drinking alcohol in a year, with 14% former drinkers and 7% never had drinking before. Rates are higher for men than women (82% to 77%) Young adults are more likely to drink and more heavily, peak consumption in mid 20s, especially for singles.  Low Risk Drinking: Centre for Addiction & Mental Health (CAMH) in Toronto to provide an indication of the upper limits on drinking so it does not impair.  High Risk Drinking: Direct relationship between overall level of consumption within a population & the number of alcohol-dependent people; and the risks  Ethyl Alcohol: Effective chemical compound in alcoholic beverages – reduces anxiety, produces euphoria & creates a sense of well being. Reduces inhibitions – perception that alcohol enhances social and physical pleasure.  Ethanol is water-soluble, it passes directly into the blood from the stomach & is carried quickly to the CNS –blood alcohol level (BAL) expressed as % of blood  Short Term Effects: Biphasic Effect: Initial effect of alcohol is stimulating, resulting in pleasant feelings as BAL rises, when it peaks & begins to decline, alcohol acts as a depressant – many increase as negative emotions. Chapter 11  Substance-Related Disorders o Blackouts: Drinking large amounts of alcohol, particularly on empty stomach causing memory blackouts – interval of time for which a person cannot recall key details or an entire event.  Long Term Effects: Prolonged use is damaging to the endocrine glands, pancreas & especially to the liver – associated with cancers of the mouth, tongue, larynx, stomach etc. Also increasing mouth cancer, damage to the heart muscle, high blood pressure & strokes. o Korsakoff’s Psychosis – Chronic disease characterized by impaired memory and loss of contact with reality.  Abuse Effects: More than 9% of all current drinkers admitted at least one problem with health (5%), friendships & social (3%), and finances (3%) Etiology  The average age at which Canadians start drinking is 13 years – not changing  Genetics: Alcohol abuse & dependence runs in families; twim studies have confirmed the male MZ twins are more similar than DZ in development. Alcohol is broken down by aldehyde dehydrogenase (less in woman, Asians)  Neurobiological: Biological processes of alcoholics, non-problem drinkers and children of both are compared to determine markers of vulnerability to alcohol – one marker is brain wave activity measured by EEG o Monoamine Oxidase (MAO): Involved in metabolism of the neurotransmitters dopamine and norepinephrine.  Psychological: Behavioural Disinhibition – People with alcohol problems tend to have relative inability to inhibit behavioural impulse – more rebellious, more impulsive, more aggressive, and more willing to take risks o Negative Emotionality – (neuroticism) Tendency to experience psychological distress, anxiety and depression. o Tension-Reduction – Anxiety-Relief, hypothesis suggests that drinking is reinforced by its ability to reduce tension, anxiety, anger, depression and other unpleasant emotions. o Alcohol Expectancy Theory: Drinking behaviour is largely determined by the reinforcement that an individual expects to receive from it – alcohol transforms experiences positively, enhancing.  Behavioural Tolerance: Effects accounts for the observation that heroin addicts can use a larger amount of heroin in their typical environment (where tolerance is greatest) but can fatally overdose when used novelty.  Socio-Cultural: Alcohol use is influenced by such social & cultural factors as family values, attitudes & expectations that are passed from generations.  Treatment: Became more liberal after WWII – in Canada 1009 treatment programs moved toward the use of outpatients from standardized programs.  Residential Treatment – Minnesota Model: For people who show signs of withdrawal, treatment begins in a hospital or detoxification clinic under medical supervision and often includes prescription drugs. (AA uses 12 step) Pharmacotherapy & Support Groups Chapter 11  Substance-Related Disorders  Medication has been used in treating alcoholics to assist in detoxification, to reduce pleasurable effects associated with drinking – produce nausea; benzos are also often administered to alcoholics as a first step in treatment.  Antagonist Drug: Medication prescribed as a method of reducing the immediate gratification accompanying drinking; Naltrexone: targets NT that mediate alcohol’s effects on the brain & blocks its pleasurable effects.  Agonist Drug: Acamprosate: Used to reduce craving for alcohol & to reduce distress during early abstinence; facilitate inhibiting action of GABA receptor  Antabus: Disulfiram and CCC – block the action of the metabolizing enzyme acetaldehyde dehydrogenase, resulting in buildup of acetaldehyde in the body.  Alcoholics Anonymous (AA)  Works with the most alcoholics worldwide – it is a self help group ‘fellowship of men & women who share their experience, strength & hope with each other that they may solve their common problem and help others to recover from alcoholism’ – based on a disease model & is complete abstinence – no cure for alcoholism (recovery)  Behavioural Treatment: Treats alcoholism is learned behaviour – an unconditioned stimulus, elicits unconditioned responses in the form o pleasant physical reactions – alcohol associated with pleasant – create an aversive response to alcohol by pairing alcohol with an unpleasant stimulus.  Relapse: Seen as failure of persons cognitive & behavio
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