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PSYC 3140
Joel Goldberg

Chapter 17: Substance-Related Disorders  A substance is any natural or synthesized product that has psychoactive effects – it changes perceptions, thoughts, emotions, and behaviours.  Tobacco, alcohol, and cannabis are common substances (US and CAN). o Cocaine use = higher in US; LSD use = higher in CAN.  Men are more likely than women to use an illegal drug in their lifetime. o Women, however, are more likely to become dependent on it.  A substance-related disorder occurs when the use of a substance leads to significant problems in everyday functioning; i.e., shirking responsibilities, acting impulsively, endanger their own lives, etc. Definitions of Substance-Related Disorders…  There are four types of disorders recognized by the DSM: substance intoxication, substance withdrawal, substance abuse, and substance dependence.  Drugs are classified into five categories: o CNS Depressants (alcohol, barbiturates, benzodiazepines, and inhalants). o CNS Stimulants (cocaine, amphetamines, nicotine, and caffeine). o Opioids (heroin and morphine). o Hallucinogens and phencyclidine (PCP). o Cannabis.  There is a mixed group of drugs (club drugs), which includes: o Ecstasy, GHB, ketamine, and Rohypnol.  Intoxication o Substance intoxication is a set of behavioural and psychological changes that occur as a direct result of the physiological effects of a drug. o May suffer from hallucinations, attention is reduced, along with good judgment. It’s harder to control their bodies; their reactions are slow or awkward. o Either want to sleep a lot, or not at all. o Their interpersonal relationships change: they may become gregarious, aggressive, etc. o Intoxication declines when the amount of the substance in the body declines; however, it may take hours or days for the substance to be completely out of the body. o Symptoms of intoxication depend on what was taken, how much was taken, and the user’s tolerance.  E.g., initial high may be different from subsequent highs. o Setting in which a substance is taken also affects symptoms experienced.  E.g., drinking at a party makes you loud; drinking at home makes you depressed.  E.g., may also be at a lower risk of harming oneself if drinking at home. o A diagnosis of substance intoxication is usually only given when an individual is experiencing significant disruptions in his or her life.  E.g., relationships, personal harm, etc.  Withdrawal o Substance withdrawal is a set of physiological and behavioural symptoms that result when people who have been heavy substance users stop (or reduce) using. o Symptoms are usually the opposite of substance intoxication of the same substance. o A diagnosis isn’t given unless it severely impacts the individual’s life.  E.g., side effects of caffeine withdrawal may be annoying (e.g., headache, etc.), they do not typically cause significant impairment. o Caffeine withdrawal is not included in the DSM. o Symptoms of withdrawal can begin a few hours after consumption stops.  End usually after a few days or weeks. o Some withdrawal symptoms (e.g., seizures) may begin several weeks after stopping.  Abuse o Substance abuse is when a person’s recurrent use of a substance results in significant harmful consequences. o So, you can use a substance, but it isn’t abuse until you experience harmful consequences. o Four categories of harmful consequences:  Fails to fulfill important obligations (work, school, home).  May fail to show up, unable to concentrate, etc.  Repeatedly uses the substance in situations in which it is hazardous to do so.  Such as while driving.  Repeated legal problems.  Arrests for drunk driving, etc.  Continues to use the substance, despite having had legal or social problems. o Must show problems in at least one area within a 12-month period to qualify.  Dependence o Substance dependence (drug addict). o Shows tolerance (a person experiences less and less effect rom the same dose of a substance and needs greater and greater doses to achieve intoxication) or withdrawal. o E.g., a person who’s smoked for 20 years probably smokes so much that back in the day it would have made them violently ill. o A person who has a tolerance for a substance may have a higher blood- concentration level, but show fewer symptoms (i.e., they’re unaware of it). o Alcohol, opioids, stimulants, and nicotine have a high risk for tolerance.  PCP and marijuana have lower risks for tolerance. o Those that are dependent often show severe withdrawal symptoms when they stop taking it.  These people may take the substance to avoid the withdrawal symptoms. o Most people who are dependent crave the substance and will do anything to get it. o Their lives may revolve around getting the substance.  How a person administers a substance can effect how quickly a person becomes intoxicated, and likely it will produce withdrawal symptoms.  Routes of administration that get it right to the blood stream create dependency quicker. o Injecting, smoking, and snorting. o Also more likely to OD.  The quicker they act on the CNS, the more likely they are to become dependent.  Substances with short-lasting effects are more likely to become dependent. Depressants…  Slow the activity of the CNS.  In moderate doses, they relax people, reduce concentration, and impair thinking and motor activity.  In heavy doses, they induce a stupor.  Alcohol o Effects on the brain occur in two stages. o Low doses = promotes confidence, relaxation, perhaps euphoria. o Increasing doses = may induce symptoms of depression: fatigue and lethargy; decreased motivation, sleep disturbances, etc. o Alcohol intoxication = slurred speech, unsteady gaits, trouble with attention and memory, slow and awkward in reactions. May act inappropriately; aggressive or rude. o A blackout is amnesia (once you’re sober) about when you were drunk. o More food in your stomach  longer it takes to get drunk (because it takes longer to pass from the stomach to the small intestine). o Countries where alcohol is consumed more regularly (e.g., France) show a lower rate of alcohol-related disorders. o The legal definition of alcohol intoxication = blood-alcohol content above 0.08. o Drinking in large quantities can result in death;  1/3 is the result of respiratory paralysis. o Alcohol can react fatally (e.g., with antidepressant drugs). o Most alcohol-related deaths are due to accidents (car, private plane/boat), and drownings.  Almost ½ of fatal car accidents are due to alcohol.  Almost 1/3 of all drownings are alcohol-related. o Believed that most murderers are under the influence of alcohol. o Abuse and Dependence  Diagnosis (abuse): 1. Use it in dangerous situations (e.g., when driving). 2. Fail to meet obligations (e.g., school, work). 3. Have recurrent legal or social problems as a result of alcohol.  Alcohol dependency = problems of abuser + may show tolerance to alcohol, spend a great deal of time intoxicated or withdrawing, organize their lives around drinking, and continue drinking despite social, medical, or legal problems.  Three distinct patterns of alcohol use:  Some drink a large amount every day and plan their days around drinking.  Abstain from drinking for long periods than go on binges, which last days or weeks.  Sober during the week; binge drink on the weekend.  Binge drinking = consuming five or more drinks within a couple of hours.  Argued that for women it should be four or more.  23% of Americans reported binge drinking in the previous month.  19% of Ontario = binge drink in the previous month.  Study found that more Canadians drink, but Americans drink more.  Heavy alcohol consumption is associated with on-campus living, and more Americans than Canadians live on-campus.  Binge drinking is increasing in school-age adolescents.  Nearly 50% of grade-12 students in Ontario reported binge drinking.  Easy to spot alcohol abuse/dependence. However, one confrontation or a series of confrontations often do not motivate abusers to change their behaviour or seek help.  Alcohol dependence is a heterogeneous disorder.  Antisocial (vs. non-antisocial) alcoholics:  Have more severe symptoms of alcoholism.  Remain alcoholics for longer.  Have poorer social functioning; have more marriage failures.  Heavier drug involvement.  More likely to come from a family of alcoholics.  Begin drinking at an earlier age.  Children are more likely to have behavioural problems.  Negative affect alcoholism = had depressive or anxious tendencies in childhood, and only began heavy alcohol abuse in adulthood.  Seen more in women than men. o Withdrawal  Divided into three stages:  Stage one usually begins within a couple of hours after cessation. o Tremulousness (the shakes), weakness and perspiration. o Anxiety, headaches, nausea, abdominal cramps, vomiting, retching. o Flushed, restless an easily startled. o Those with a moderate dependence may only experience the first stage.  Stage two o Seizures may begin as early as 12 hours after cessation, but more often occur 2-3 days later.  Stage three o Delirium tremens (DT). Hallucinations occur. o Sleep very little and become agitated. o Active and very disoriented. o Fever, sweating, irregular heartbeat may develop. o Fatal in 10% of cases. o Death may occur from hyperthermia (raised body temp), or collapse of the peripheral vascular system. o DTs are more likely to occur in those who drank a large amount who have additional medical illnesses.  Long-Term Effects of Alcohol Abuse  Toxic effects on the stomach, esophagus, pancreas, and liver.  Low-grade hypertension is the most common medical condition associated with alcohol abuse. o Combined with low triglycerides and bad cholesterol = increased risk for heart disease.  Chronic alcohol consumption prevents the absorption of nutrients (why they’re often malnourished; they also drink more than they eat).  Some show a thiamine deficiency (problems with the CNS): o Numbness and pain in extremities. o Deterioration of the muscles. o Loss of visual acuity (near and far).  Alcohol-induced persisting amnesic disorder = permanent cognitive disorder caused by damage to the CNS. o Wernicke’s encephalopathy = mental confusion and disorientation. Severe states = coma. o Korsakoff’s psychosis = loss of memory for recent events and issues with recall.  Person may tell implausible stories to cover up for the fact they can’t remember.  Alcohol-induced dementia = loss of intellectual abilities (memory, abstract thinking, judgment, problem solving), and changes in personality (e.g., paranoia). o 9% of all people who abuse alcohol. o Common cause of adult dementia.  Children may be born with fetal alcohol syndrome (FAS). o Retarded growth, facial abnormalities, CNS damage, mental retardation, motor abnormalities, tremors, hyperactivity, heart defects, and skeletal abnormalities. o Est. 9 in every 1000 babies has FAS.  Even small amounts of alcohol are dangerous while pregnant. o Growth, memory, and learning problems. o Cultural Differences  Low alcohol consumption in places governed by Islamic law (e.g., middle east).  Low alcohol consumption in Southeast Asians may be due to a lack of an enzyme, acetaldehyde, which first breaks down alcohol.  If they do consume alcohol, it may be uncomfortable for them.  Finnish and Canadians drink about the same amount; Finnish men drink more than Canadian men.  Alcohol use and dependence are some of the most common in Canada.  Ratio of treatment-nontreatment = 13:1.  Ages 10-19 (Canadian) = Europeans more likely to drink than Asians.  Aboriginal people appear to be at a higher risk for alcohol abuse and dependence. o Gender Differences  62% of men said they’d consumed an alcoholic beverage in the last month; 46% of women.  Men are more likely than women to binge drink, and have alcohol- related disorders.  Difference is greater between those who adhere to gender roles.  Women are less likely than men to seek out treatment. o Trends Across the Lifespan  Overtime, about half of those who’d abused alcohol stopped.  Alcohol dependency tends to be chronic.  Use of illegal substances tends to decline with age.  Liver metabolizes alcohol slower with age; older people become drunker, faster.  Maturity?  Grew up in a time when there was a prohibition on consumption; therefore, curtail their behaviours better.  Those who abuse alcohol may have died before they reach old age.  Benzodiazepines, Barbiturates, and Inhalants o Initially, users may feel euphoric and become disinhibited. Later, may experience depressed moods, lethargy, and perceptual distortions, etc. o Benzodiazepines (Valium, etc.) and barbiturates (e.g., methaqualone) are legally manufactured to treat anxiety and insomnia.  Most common pattern of abuse and dependency: begins being used at parties, then chronic use, then addiction.  Especially likely among people who already abuse alcohol, opioids, cocaine, amphetamines, etc.  Another pattern: often in women and older people who get it from their physicians; they photocopy prescriptions, obtain prescriptions from different doctors, etc.  Cause drops in BP, heart and respiratory rates. May OD due to respiratory failure or heart collapse.  OD more likely to occur when taken with alcohol (particularly benzodiazepines). o Inhalants are volatile substances that produce chemical vapours.  Recent users may appear disoriented, drunk, etc.  May be nauseated, irritable, inattentive, etc.  Solvents = gas, paint thinners, glue, spray paint.  Medical anaesthetic gases = nitrous oxide (laughing gas).  Nitrates = dilate blood vessels and relax muscles; used as sexual enhancers (AKA poppers or snappers).  According to OSDUS, use of inhalants = declines with age.  Use often accompanied by alcohol use.  Gasoline is the most common.  Chronic users have respiratory problems, and may develop rashes.  May lead to severe dementia. Can also cause hepatitis, liver, and kidney damage.  Death may occur because of depression of the respiratory or cardiovascular system.  Sudden sniffing death = acute irregularities in the heartbeat, or loss of oxygen.  Users can also die because of delusions (e.g., I can fly!).  May suffocate themselves with bags over their mouths. Stimulants…  Activate the CNS; feelings of energy, happiness, power, lack of sleep, lack of appetite.  Cause dangerous changes in BP and heart rate, in the rhythm and electrical current; and constriction of the blood vessels.  Toxic reactions to cocaine and amphetamines account for 40% of substance-related disorders in the ER, and 50% of sudden substance-abuse deaths.  Side effects of caffeine and nicotine are not as severe as cocaine and amphetamines.  Prescriptions such as Ritalin are used to treat obesity, respiratory problems, asthma, and a variety of other diseases.  Cocaine o A white powder extracted from the coca plant. o One of the most addictive substances. o Snorting it = effects felt sooner. o Can dissolve it in water and inject it. o 1970 = freebase cocaine = separating the chemicals and heating it with ether. o Crack = freebase cocaine that is boiled down into tiny chunks. Usually smoked. o Cocaine activates the ventral tegmental area and the nucleus accumbens (regulate reward and pleasure). o Cocaine blocks the reuptake of dopamine into the transmitting neuron, thus sustaining pleasure. o Users often do not feel drugged. o Taken chronically or at high doses, can create feelings of grandiosity, impulsiveness, hypersensitivity, etc., to the point of paranoia and panic. o After stopping use, users may feel tired, depressed, etc.  May also feel a craving for more. o Many cocaine abusers and dependents started out taking marijuana and consuming alcohol. o The strong affect on pleasure centers make it easier to become addicted to. o Has a short half-life (leaves the body quickly); therefore, users must take a lot of the drug to maintain their high.  Spend a lot of money on drugs, and therefore may take up prostitution or do illegal things to make money. o Many cocaine addicts develop HIV/AIDS. o Medical problems:  Heart attacks, chest pain and respiratory failure, neurological effects: strokes, seizures, headaches, gastrointestinal problems, physical symptoms: chest pain, blurred vision, fever, muscle spasms, convulsions, etc. o “Wealthy person’s substance” because it costs a lot.  Amphetamines o Most often in pill form, but can be injected intravenously, and methamphetamine can be snorted to smoked. o Initially introduced as antihistamines; now used to combat depression or chronic fatigue. o A component in many diet drugs. o Street names: speed, meth, and chalk. o Produce their effects by causing the release of dopamine and norepinephrine, and by blocking the reuptake of these neurotransmitters. o Symptoms of intoxication (similar to those of cocaine):  Euphoria, confidence, alertness, agitation, and paranoia. o However, causes neurotoxicity. o Across studies, it is found that amphetamines reduce the availability of dopamine D2 receptors (dopamine, serotonin, and vesicular monoamines. o Produce hallucinations that are frightening. o Paranoid, violent. o Legal problems arise as the result of violent or aggressive acts when trying to get the drugs. o Tolerance develops quickly. o Common medical problems are cardiovascular problems; increased BP, rapid or irregular heartbeat, stroke-like damage to blood vessels. o Elevated body temperature and convulsions occur during an OD. o 12.2% of Canadian youths have tried amphetamines. o Sharing needles may lead to HIV. o Overtime, those who use amphetamines become hostile and irritable. o Meth mouth = poor oral hygiene caused by dry mouth, teeth grinding, and jaw clenching. o Crystal Meth use is especially prominent among gay and bisexual youths.  Nicotine o An alkaloid found in tobacco. o Cigarettes are the most common delivery method. o Tobacco use has declined in industrialized countries, but is on the rise in developing countries.  Greater decline in men than women. o Female adolescents are more likely to initiate smoking; women are less likely than men to quit. o Operates on both the CNS and the PNS. o Releases biochemical that affect the brain; dopamine, norepinephrine, serotonin, and endogenous opioids. o Nicotine resembles the fight-or-flight response; several body systems are aroused in preparation of fight or flight.  Therefore, the “calming effect” of nicotine may be due to the release of tension due to the addiction. o Users need nicotine to feel normal because of the effects on the brain. o Smoking is the number one preventable cause of death. o Female deaths due to smoking are up. o Babies of women who smoke are smaller at birth. o In Canada, the top four causes of death are cancer, heart disease, stroke, and chronic respiratory disease.  Cigarette smoking can contribute to all of them. o Passive smoking = inhaling the smoke of others; the smoke is actually more toxic than what the smoker inhales. o The most potent predictor of youth smoking decisions is whether a household member smokes regularly in the home. o Best evidence for nicotine dependence is tolerance and withdrawal symptoms.  Smokers show no aversion to the amount of cigarettes that would’ve made them sick years ago.  Depressed, irritable, angry, anxious, frustrated, restless, hungry, problems concentrating, etc. o Nicotine is available and relatively cheap. o More than 70% of people who smoke say they want to quit. o Antidepressant bupropion can significantly reduce the craving for smoking.  Caffeine o The most used stimulant drug. o 75% is ingested through coffee. o Stimulates the CNS; increasing levels of dopamine, norepinephrine, and serotonin. o Causes metabolism, body temperature, and BP to increase. o Caffeine intoxication = hand tremors, problems sleeping, frequent urination, etc. o Very large doses of caffeine can cause extreme agitation, seizures, respiratory failure, and cardiac problems. o It may be hard to give a diagnosis of caffeine dependence, according to the DSM, because to this day, it doesn’t appear to produce social or occupational problems. o Still, tolerance can develop, as well as withdrawal symptoms. Opioids…  Derived from the sap of the opium poppy to relieve pain.  Morphine, heroin, codeine, and methadone.  Bodies naturally produce opioids, called endorphins and enkaphalins. o E.g., a sports injury causes the body to produce natural painkillers in order to avoid going into shock. Doctors may prescribe hydrocodone (Vicodin), or oxycodone (OxyCotin, Percocet, etc.).  Morphine is highly addictive.  Heroin was developed from morphine.  Explosion of heroin use = Vietnam War.  Mainlining = opioids are injected directly to the veins.  Initial symptom is often euphoria.  Severe intoxication can lead to unconsciousness, coma, and seizures.  Can suppress the part of the brain stem controlling the respiratory and cardiovascular system to the point of death. o i.e. people stop breathing and their hearts stop beating.  Dangerous when combined with depressants.  Withdrawal symptoms = dysphoria, anxiety, and agitation; an achy feeling; increased sensitivity to pain, etc. o May be sick, sweating, get goosebumps, etc. o Usually come on within 8 to 16 hours, and peak at 36 to 72 hours.  Usually develop abuse or dependence began using other drugs first.  First use of heroin is typically in the teen years. o Once dependent, heroin users need to shoot up every 4 – 6 hours to avoid withdrawal. o This can become expensive, so many heroin users become prostitutes, steal, etc. o Heavy users often have a record by the time they’re 20. o Most street heroin is cut with other drugs. As a result, they’re at an increased risk for OD or death.  One of the greatest risks to opioid users is the potential of contracting HIV.  IV users also contract hepatitis, tuberculosis, serious skin abscesses, and deep infections.  Pregnant women are at an increased risk of miscarriage and premature delivery.  Increased risk for SIDS.  Most frequently abused drug is oxycodone. Hallucinogens and PCP…  Clear withdrawal syndrome has not been found for hallucinogens or phenylcyclidine (PCP).  Hallucinogens are a mixture of substances; lysergic acid diethylamide (LSD), and peyote.  LSD is the best-known hallucinogen.  One of the symptoms of intoxication is synesthesia; the overflow of one sensory modality to another. o E.g., “hear” colours.  Moods can shift very quickly. o Some may be detached and show sensitivity to art, while others go from elation to fear.  For some people, the anxiety and hallucinations created by hallucinogens caused psychosis and they were hospitalized.  Phenylcyclidine (PCP)  AKA angel dust.  Manufactured as a powder.  Not classified as a hallucinogen, but has many of the same side effects.  At low doses, it creates a euphoric feeling, a sense of intoxication, lack of concern, talkativeness, and eye twitching.  At intermediate doses, causes disorganized thinking, body image distortions (e.g., feeling like one’s arms don’t belong to one’s body, etc.), depersonalization, etc.  A user may become belligerent, violent, etc.  At even higher doses, it can result in amnesia, coma, seizures, respiratory problems, etc.  Symptoms of severe intoxication can last for days.  Hallucinogen or PCP abuse is diagnosed with the same criteria mentioned above: o Fails to meets obligations o Use in dangerous situations o May have legal problems.  These drugs can cause paranoia or aggressive behaviour.  Use is higher among teenagers. Cannabis…  Also called ganja in Jamaica, kif in North Africa, dagga in South Africa, bhang in India and the Middle East, and macohna in South America.  Most widely used illicit substance in the world.  Teenagers are especially heavy users.  Symptoms of intoxication may develop within minutes… and last for a couple hours.  Symptoms may present as euphoria, being in a dream-like stat
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