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
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%)
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