PSYB32H3 Study Guide - Final Guide: Naltrexone, Psychopathy, Alcohol Tolerance

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4 Feb 2016
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Chapter 10: Substance-Related Disorders
LEARNING GOALS
1. Be able to differentiate between substance dependence and abuse.
2. Be able to describe the epidemiology and symptoms of drug and alcohol abuse and
dependence.
3. Be able to understand the major etiological factors for substance-related disorders,
including sociocultural factors, mood and expectancy effects, genetic factors, and
neurobiological factors.
4. Be able to describe the approaches to treating substance- related disorders, including
psychological treatments, medications, and drug substitution treatments.
5. Be able to delineate the major approaches to prevention of substance-related disorders.
Summary
Clinical Descriptions
Using substances to alter mood and consciousness is a human characteristic, and
so too is the tendency to abuse them. DSM-IV-TR distinguishes between substance
dependence and substance abuse. Dependence refers to a compulsive pattern of substance
use and consequent serious psychological and physical impairments, often including
tolerance and withdrawal. With the less serious disorder, substance abuse, drug use leads
to failure to meet obligations and to interpersonal and legal problems.
Alcohol has a variety of short-term and long-term effects on human beings,
ranging from poor judgment and impaired motor coordination to chronic health problems.
People can become dependent upon nicotine, most often via smoking cigarettes.
Despite somberly phrased warnings from public-health officials, it continues to be used.
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Medical problems associated with long-term cigarette smoking include many cancers,
emphysema, and cardiovascular disease. Moreover, the health hazards of smoking are not
restricted to those who smoke, as secondhand (environmental) smoke can also cause lung
damage and other problems.
Recent trends indicate that marijuana use declined in the 1980s, increased in the
1990s, and has leveled off since then. When used regularly, marijuana can damage the
lungs and cardiovascular system and can lead to cognitive impairments. Constituents of
marijuana may also adversely affect heart function in people who already have coronary
problems, and pulmonary function. In addition, tolerance to marijuana can develop.
Ironically, just as the possible dangers of marijuana began to be uncovered, it was found
to have therapeutic effects, easing the nausea of cancer patients undergoing
chemotherapy and the discomfort associated with AIDS.
Opiates slow the activities of the body and, in moderate doses, are used to relieve
pain and induce sleep. Heroin has been a focus of concern because usage has increased
and stronger varieties have become available. Another group is the synthetic sedatives
and tranquilizers. Barbiturates have been implicated in both intentional and accidental
suicides; they are particularly lethal when taken with alcohol.
Stimulants, which include amphetamines and cocaine, act on the brain and the
sympathetic nervous system to increase alertness and motor activity. Tolerance and
withdrawal are associated with all of these drugs. Methamphetamine abuse, a derivative
of amphetamine, has risen dramatically since the 1990s.
The hallucinogens—LSD, mescaline, and psilocybin—alter or expand
consciousness. Their use reflects humankind’s desire not only to escape from unpleasant
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realities but also to explore inner space. Use of the hallucinogen-like drug Ecstasy has
dramatically risen, and it is also considered a threat to health. PCP use often leads to
violence.
Etiology
Several factors are related to the etiology of substance abuse and dependence.
Sociocultural variables, such as attitudes toward the substance, peer pressure, and how
the substance is portrayed by the media, are all related to how frequently a substance is
used. Many substances are used to alter mood (for example, to reduce tension or increase
positive affect), and people with certain personality traits, such as those high in negative
affect or psychopathy, are especially likely to use drugs. Cognitive variables, such as the
expectation that the drug will yield positive effects, are also important. Finally,
neurobiological factors, most notably a genetic predisposition or diathesis and the brain’s
reward pathways, appear to play a role in the use of some substances.
Treatment
Treatments of all kinds have been used to help people refrain from the use of both
legal drugs (e.g., alcohol and nicotine) and illegal drugs (e.g., heroin and cocaine).
Biological treatments have attempted to release users from their dependency often by
substituting another drug. Some benefits have been observed for treatments using such
drugs as clonidine, naltrexone, and methadone. Nicotine replacement via gum, patches, or
inhalers has met with some success in reducing cigarette smoking. None of these
approaches appears to lead to enduring change however, unless accompanied by
psychological treatments. These treatments aim to help patients resist pressures to
indulge, cope with normal life stress, control emotions without relying on chemicals, and
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