Chapter 12 – Substance Related Disorders
Symptoms of substance dependence (at least three of the following)- tolerance
either by larger doses of the substance being needed to produce the desired effect or the
effects of the drug becoming markedly less if the usual amount is taken, withdrawal
symptoms – negative physical and psychological effects – develop when the person stops
taking the substance or reduces the amount, person uses more substance or uses it for a
longer time than intended, person recognizes excessive use of substance, much of the
person’s time is spent trying to obtain substance or recover from its effects, substance use
continues despite problems, person gives up or cuts back participating in many activities
because of substance
Substance dependence is diagnosed as being accompanied by physiological dependence if
either tolerance or withdrawal is present.
Substance dependence is more severe and dangerous than substance abuse.
Symptoms of substance abuse – failure to fulfill major obligations, exposure to physical
dangers, legal problems, and persistent social or interpersonal problems.
Delirium tremens (DTs) – withdrawal symptoms. When the alcohol in the blood levels
drop suddenly, the person will enter a delirium state. This can determine the difference
between alcohol dependence and alcohol abuse. Alcohol dependence is DTs exist.
Polydrug (polysubstance) abuse – using or abusing more than one drug at a time. Most
drinkers also smoke.
Prevalence of alcohol abuse – more men drink more alcohol. Declines with age.
It does seem that users tend to go from alcohol abuse to alcohol dependence.
There is however no single pattern of alcohol abuse. Jellinek describe male
alcohol abuse passs through 4 stages, beginning with social drinking and
progressing to a stage at which he lives only to drink.
Comorbidity – comorbid with personality disorders and also depression (people use alcohol
to help them with depression)
Short-term effects of alcohol – effects of alcohol varies depending on the concentration
in the blood and that depends on body mass, amounts of time that the alcohol is ingested,
and the efficiency of the liver, and the presence or absence of food in the system. Most of the
alcohol goes into the small intestines where it is absorbed into the blood, excess of the
amount stay in the bloodstream if it cannot be broken down in the liver. Absorption can be
fast, but removal can be slow. It has a biphasic effect initial effect of alcohol is stimulating –
the drinker experiences an expansive feeling of sociability and well-being as the blood
alcohol level rises – but after the blood alcohol level peaks and beings to decline, alcohol
acts as a depressant that may lead to negative emotions. It stimulates GABA receptors,
which may be respsonsible for reducing tension. Also increases levels of serotonin and
dopamine, and this maybe be the source of pleasurable effects.
Long-term effects of prolonged alcohol abuse – dementia, liver failure. Also
malnutrition (alcohol has alot of calories with no nutrients). Heavy alcohol consumption
during pregnancy is the leading cause of mental retardation (fetal alcohol syndrome). Light
drinking (fewer tahn three drinks a day), especially of wine, has been related to decreased
risk of coronary heart disease and stroke.
Inhalant Use Disorders – substances such as glue, correction fluid, spray paint,
cosmetics, gasoline. They are dangerous because they are inexpensive and readily available.
Nicotine and Cigarette Smoking – nicotine is the addicting agent of tobacco. It
stimulates receptors, called nicotinic receptors, in the brain. Studies who nicotine has high
reinforcing efficacy. Addcitive effects of nicotine start very shortly after one’s first puff.
Prevalence and health consequences of smoking – smoking is the single most preventable
cause of premature death. Health risks of smoking are significantly less for cigar and pipe
smokers because they seldom inhale the smoke into their lungs. Destruction of lung tissue
is not reversible. Cigarette smoking can contributes to erectile problems in men.
Consequences of second hand smoke - second hand smoke (environmental tobacco smoke
(ETS)) contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than
does the smoke actually inhaled by the smoker.
Marijuana – consists of the dried and crushed leaves and flowering tops of the hemp plant,
CANNABIS SATIVA. Hashish – much stronger than marijuana, is produced by removing
and drying the resin exudates of the tops of high quality cannabis plants. Hemp plant was
used for cloth and rope instead of smoking.
Effects or marijuana:
Psychological effects – time moves by really slowly, more relaxed, more sociable,
feeling paranoid. Major active chemical in marijuana is THC and that is what causes the
kind of reaction you will get.
Somatic effects – increases appetite, red eyes, dry mouth and throat, somewhat
raises blood pressure, short term memory loss. One marijuana cigarette is the equivalent of
four tobacco cigarettes in the bad shit. There is a reverse tolerance – experiences smokers
need only a few hits of puffs to become high from marijuana cigarette, whereas less
experiences may need many puffs. THC is stored in the body’s fat tissue and then released
very slowly, perhaps for a month.
Therapeutic effects – reducing pain, treatment for hte discomfort of AIDS.
Sedatives and Stimulants
Sedatives – often called downers, slow the activities of the body and reduce its
Will block pain receptors and therefore slow down pain, and therefore induce sleep also.
Opiates – morphine, heroin, codeine, opium. Morphine was separated from raw opium and
was a bitter-tasting powder proved to be a powerful sedative and pain reliever. Heroin was
initially used to cure for morphine addiction. Opium and its derivatives produce euphoria,
drowsiness, reverie, and a lack of coordination. Heroin has additional initial effects – rush,
a feeling or warm, suffusing ecstasy feeling. Heroin is converted to morphine in the brain
and then binds to opiod receptors. OPIATES ARE ADDICTING.
Synthetic sedatives – barbiturates – another type of sedative, were synthesized as aids
for sleeping and relaxation. Today, benzodiazepines such as valium are more commonly
used and abused. Sedatvies relax the muscles, reduce anxiety, and in small doses produce a
mildly euphoric state. Like alcohol, they are thought to produce their psychological effects
by stimulating the GABA system.
Psychological and physiological effects – produce feelings of euphoria, feeling of complete
lack of worry, they shed any kind of fears, great self confidence, no pain, feeling as if you’re
Stimulants – or uppers, such as cocaine, act on the brain and the sympathetic nervous
system to increase alertness and motor activity.
Amphetamines – for first for treatment for asthma. Benzedrine was used as an inhalant to
relieve stuff noses. Amphetamine such as Benzedrine, Dexedrine, and Methedrine produce
their effects by causing the release or norepinephrine and dopamine and blocking the
reuptake of these neurotransmitters. Methedrine – the strongest of the amphetamines.
Cocaine – increases sexual desire and produces feelings of self-confidence, well-being, and
indefatigability. Permanent executive cognitive impairments even in people that stopped
Substance dependence is diagnosed as being accompanied by physiological dependence if either tolerance or withdrawal is present. Substance dependence is more severe and dangerous than substance abuse. Symptoms of substance abuse failure to fulfill major obligations, exposure to physical dangers, legal problems, and persistent social or interpersonal problems. When the alcohol in the blood levels drop suddenly, the person will enter a delirium state. This can determine the difference between alcohol dependence and alcohol abuse. Polydrug (polysubstance) abuse using or abusing more than one drug at a time. Prevalence of alcohol abuse more men drink more alcohol. I t does seem that users tend to go from alcohol abuse to alcohol dependence. There is however no single pattern of alcohol abuse. Jellinek describe male alcohol abuse passs through 4 stages, beginning with social drinking and progressing to a stage at which he lives only to drink.