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PSYC 235
Christopher Bowie

Chapter 11: Substance-Related Disorders Substance-Related Disorders : associated with the abuse of drugs and a variety of other substances that people take to alter the way the feel, think and behave Equifinality: particular disorders may arise from multiple & different paths Levels of involvement: ingesting psychoactive substances (alter mood/behaviour) to become high, abuse these substances and to become dependent a) Use: ingestion of psychoactive substances in moderate amounts that do not significantly interfere with social, educational, or occupational functioning b) Intoxication: physiological reaction to ingested substance -> depends on which drug, how much was taken, person’s individual reaction A. Develops reversible substance=specific syndrome due to recent ingestion or exposure to substance B. Clinically maladaptive behavioral/psychological changes due to the effect of the substance on the central nervous system EX: belligerence, impaired social/cognitive functioning C. Not due to a GMC and MD c) Abuse: how significantly it interferes with the user’s life A. Maladaptive pattern of substance abuse leads to impairment/distress by 1 or more of: (12 month span) 1) Recurrent substance use resulting in a failure to fulfill major role obligations at home, work, school 2) Recurrent substance use in situations when physically dangerous 3) Recurrent related legal problems 4) Continued substance use despite reoccurring social/family deterioration B. Symptoms have never met the criteria for substance depended for this class of substance Substance Dependence : physiological dependence on drugs which requires a higher dosage due to the tolerance that is built up -> Leads to withdrawal (negative physical response) when no longer ingested Recurrent Pattern with 3 or more at anytime during 12-month period 1. Tolerance a) Need for a higher dosage to achieve desired intoxication/effect b) Diminished effect with same dosage 2. Withdrawal: same/close substance is used to avoid withdrawal symptoms 3. Higher amounts or longer period than intended 4. Unsuccessful attempts to cut down or control substance abuse 5. Great deal of time seeking to obtain, use or recover from effects 6. Lower social/recreational life 7. Continue despite knowledge of physical or psychological problem Drug-seeking behaviour as a measure of dependence -> repeated use leads to desperate need for substance (steal money to buy drugs, smoke in the cold) -> use will resume after a period of abstinent Diagnostic Issues More than half of people with alcohol disorders have an additional psychiatric disorder (MD, Anti-Social, Bipolar) -> Highly comorbid with mood & anxiety disorders & pathological gambling 1. Substance related disorders are highly prevalent in out society and may occur together frequently by chance 2. Drug intoxication & withdrawal can cause symptoms of anxiety, depression and psychosis 3. Alcohol’s effects in increasing risk-taking may contribute to the high co- occurrence of alcohol & gambling disorders 4. Mental health disorders cause the substance use disorder Five main Categories of Substances 1) Depressants: result in behavioral sedation EX: alcohol, sedative, anxiolytic drugs 2) Stimulants: increase alertness and elevate mood EX: cocaine, nicotine, caffeine 3) Opiates: primarily produce analgesia & euphoria EX: heroin, morphine, codeine 4) Hallucinogens: alter sensory perception EX: marijuana, LSD 5) Other drugs of abuse: inhalants, anabolic steroids, medications Depressants : primarily decrease central nervous system activity. Main effect is to reduce levels of physiological arousal and help us relax Most likely to produce symptoms of physical dependence, tolerance and withdrawal a) Alcohol Use Disorders :initial effect is a stimulant and gradually inhibitions are reduced (in the brain) 1. After ingestion it passes through the esophagus 2. Into the stomach where small amounts are absorbed 3. Goes to the small intestine where it is easily absorbed through the bloodstream 4. Circulatory system distributes the alcohol throughout the body where it contacts every major organ, including the heart 5. Alcohol passes through the liver and is broken down or metabolized into carbon dioxide and water by enzymes Psychological & Physiological Effects: Central Nervous system depressant -Influences several neurotransmitter systems  -Mainly GABA Neuronal inhibition -> Behavioral Disinhibition interfere with the firing of the neuron it is attached to -> chloride ions enter the cell and make it less sensitive to the other neurotransmitters) Alcohol seems to reinforce the movement of these ions = difficult firing  Alcohol makes you more sociable because it makes it difficult for neurons to communicate with one another (GABA INTERACTION) Glutamate system: Blackouts/loss of memory may result from the interaction Serotonin System Sensitivity: Alcoholic cravings (affects mood, sleep, eating) Dopamine reward system: pleasure felt during drinking Endogenous opioids (natural analgesics) might contribute to mind numbing effects Withdrawal delirium tremens (DT): extreme alcohol withdrawal that can produce frightening hallucinations and body tremors Long-term effects: liver disease, pancreatitis, cardiovascular disorders and brain damage (blackouts, seizures and hallucinations) 1. Dementia: neurotoxicity or brain poisoning 2. Wernicke-Korsakoff disease: confusion, loss of muscle coordination and unintelligible speech (thiamine deficiency) Fetal Alcohol syndrome: fetal growth retardation, cognitive deficits, behavioral problems and learning difficulties Facts & Stats Canada: 23% exceed low-risk guidelines for alcohol consumption -> 17% classified as high-risk drinkers -> Men more likely to drink heavily than women -> 9% of Canadians experience some level of alcohol problems -> 3% thought to be dependent in any given year -> 20% experience spontaneous recovery Alcohol dependence more progressive although alcohol abuse more variable - Does not cause aggression but it may reduce fear associated with being punished and it may impair the ability to consider the consequences of acting impulsively Anhedonia: lack of pleasure or indifference to pleasurable activities Affective flattening: show little expressed emotion but may still feel emotion b) Sedative, Hypnotic or Anxiolytic Substance use Disorders (Sedative: calming, Hypnotic: sleep sedative (barbiturates) Anxiolytic: anxiety reducing drugs (benzodiazepines)  Effects are similar to large doses of Alcohol  Benzodiazepine considered safer than barbiturates (less abuse & dependence)  Affect the brain by acting on the GABA Neurotransmitter system Clinical Description  Barbiturates at low doses relax muscles and can produce a mild feeling of well-being High dosages can result to alcohol like symptoms (problem walking, concentrating & working) possible death my suffocation -> DECLINED USE  Benzodiazepines use to calm and induce sleep as well as muscle relaxants and anticonvulsants. Pleasant high & reduced inhibition –> HIGHER TOLERANCE -> withdrawal -> INCREASED USE Stimulants : used to be more alert & energetic and most widely consumed EX: amphetamines, cocaine, nicotine & caffeine a)Amphetamine Use Disorders Amphetamines : induce feelings of elation & vigor while reducing fatigue. After elevation period you crash and feel depressed/tired  Used for asthma and nasal decongestant at first  Reduce appetite and used to lose weight  Extra energy boost to stay away  Prescribed for narcolepsy Psychological: euphoria, social changes, interpersonal sensitivity, anxiety, tensions, anger, stereotyped behaviour, impaired judgment/social/occupational functioning Physiological: heart/blood pressure changes, chills, nausea, chest pain, seizures, coma, muscular weakness, weight loss, respiratory depression  SEVERE: hallucinations, panic, agitation, and paranoid delusions  WITHDRAWAL: apathy, prolonged sleep, irritability & depression Ecstasy & Ice : produce similar effects to speed without the crash  Rise in 1980s and currently all time high 7% usage  Aggressive tendencies and stays longer in system than cocaine  Both can result in dependence & associated with mortality risk Enhance release of dopamine and norepinephrine in central nervous system while blocking reuptake -> more available throughout the system b) Cocaine Use Disorders :small doses increase alertness, produces euphoria, increases blood pressure & pulse, insomnia and loss of appetite  Result from blocking the reuptake of dopamine  High addictive and develops slowly DSM CRITERIA for Intoxication & Withdrawal  Psychological & Physiological symptoms  Cycle through patterns of tolerance & withdrawal (apathy & boredom) -> DECREASE in cocaine use c)Nicotine Use Disorders : sensations of relaxation, wellness and pleasure -Stimulates the CNS -> nicotine acetylcholine receptors (7-19 seconds)  Small doses: relieve stress and impr
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