Chapter 12

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University of Toronto Scarborough
Konstantine Zakzanis

PSYB32: Abnormal Psychology Meera Mehta Summer 2012 Chapter 12: Substance-Related Disorders - Substance dependence – DSM Criteria for Diagnosis: o person develops tolerance (ie – larger doses needed to produce desired effect and effects of the drug becoming less if usually amount is taken) o withdrawal symptoms – negative physical and psychological effects that develop when the person stops taking the substance or reduces the amount o person uses more of substance, or for longer time than intended o person recognizes excessive use of substance and tries to reduce usage, but unable to do so o much of person’s time is spent in efforts to obtain the substance or recover from its effects o substance use continues despite psychological or physical problems caused/exacerbated by drug (ie – smoking despite knowing that it increases risk for cancer) o person gives up or cuts back participation many activities (work, socializing) because of substance use - Substance abuse (less serious form of substance dependence)— person must experience one of following due to drug: o failure to fulfill major obligations (ie – absent from work) o exposure to physical dangers (ie- driving while intoxicated) o legal problems (arrests for disorderly conduct) o persistent social or interpersonal problems - DTs (delirium tremens): a severe form of alcohol withdrawal due to sudden and severe mental and physiological changes o DSM-5 changes:  since the difference between substance abuse and substance dependence is quantitative, both diagnoses will be included on a single continuum Alcohol Abuse and Dependence - Alcohol dependence includes people who are physically dependent on alcohol and have more severe symptoms (ie – tolerance or withdrawal reactions) o people who begin drinking early in life develop first withdrawal symptoms in 30s or 40s o patient is often anxious, depressed, weak, restless and unable to sleep, tremors of muscles (face, eyelids, lips and tongue) o rarely – chronic alcohol dependence causes Delirium tremens - person becomes delirious and has visual hallucinations or physiological paroxysms (sudden worsening of symptoms) o increased tolerance evident in heavy prolonged drinking  body adapts to drug and becomes able to process it more efficiently  research suggests tolerance results from changes in number or sensitivity of GABA or glutamate receptors o Polydrug abuse can create serious health problems because effects of some drugs when taken together are synergistic (effects combine to form especially strong reaction)  Ex. – mixing alcohol and barbiturates is common suicide method, lethal dose PREVALENCE OF ALCOHOL ABUSE AND COMORBIDITY WITH OTHER DISORDERS - Lifetime alcohol abuse 17.8%, 12-month alcohol abuse is 4.7% - Lifetime alcohol dependence 12.5%, 12-month 3.8% - Alcohol misuse affects 3 in 10 Americans - rates are higher among men, younger cohorts and Whites - Canadian prototypical heavy drinker is young adult male, who is not married, and is financially stable - Canadian Addiction Survey, 22.6% of alcohol drinkers exceeded low-risk drinking guidelines (which advises no more than 2 drinks per day) - popularity of drinking is rising, 9% increase in Canada’s overall alcohol consumption in past decade - comorbid with mood and anxiety disorders, a factor in 25% of suicides - Canadian Perspectives 12.1: Binge Drinking at Universities, Colleges and Schools o US study – 50% of men and 40% of women engaged in binge drinking (4-5 drinks in row) within previous month among students o 1 in 4 American students were frequent binge drinkers who usually binged at least once a week o students who binge on campus are more likely to damage property, get into legal trouble, miss classes and experience injuries  non-drinking students in close proximity to binge drinkers are more likely to be target of physical assaults, unwanted sexual advances o 1 in 6 Canadian students met criteria for ‘heavy-frequent drinking’ 1 | P a g e PSYB32: Abnormal Psychology Meera Mehta Summer 2012 o problems associated with heavy drinking include hangovers, memory loss, regrets for actions and missing classes due to hangover o students living at home less likely to be heavy drinkers, students who reported having first experience of drunkenness before age 16 are more likely to be heavy drinkers in college o shocking trend– lack of parental awareness of child’s substance abuse is low  34% were aware of child’s alcohol use and 11% aware of child’s use of illicit drugs  single parents, parents from blended families and parents of higher-achieving students more likely to know about illicit drug use o situational factors associated with increased drinking include drinking at party, bar/club, off-campus, during weekends and peer-oriented drinking environments COURSE OF DISORDER - Jellinek’s theory: male alcohol abuser progresses from social drinking to alcohol dependence in 4 stages o many different patterns of alcohol abuse- i.e: may be restricted to weekends, or may binge with long period of abstinence - Jellinek’s theory does not apply to women who experience alcohol difficulties later in life o usually due to life stressors such as a family crisis o women with drinking problems tend to be steady drinkers who drink alone COST OF ALCOHOL ABUSE AND DEPENDENCE th - alcohol is 4 leading cause of worldwide disability o leads to more disability and deaths than tobacco or illegal drugs - drinkers have higher medical expenses and use health services more often - in Canada, drunk drivers kill average about 3 to 4 people per day and injure 187 people in Canada every day o impaired drivers have general tendency to engage in anti-social acts (aggression, violence, narcotics) o prototypical drinking driver in Canada is male between ages 25 and 34 who drink large amounts of alcohol regularly, or is a heavy social drinker SHORT-TERM EFFECTS OF ALCOHOL - absorption of alcohol is rapid (in intestines to blood stream) but removal is slow (liver, average metabolism rate is 30mL of whisky per hour) - factors affecting alcohol metabolism: presence of food in stomach to retain alcohol and reduce its absorption rate, size of person’s body and efficiency of liver - Biphasic effect: initially is stimulating; drinker feels sociability and well-being as blood-alcohol level rises o after peak alcohol acts as depressant and may lead to negative emotions - large amounts of alcohol interfere with complex thought processes, motor coordination, balance, speech and vision - alcohol stimulates GABA receptors, which are responsible for reducing tension o increases levels of serotonin and dopamine – may cause pleasurable effects o inhibits glutamate receptors – may cause cognitive effects (slurred speech and memory loss) LONG-TERM EFFECTS OF PROLONGED ALCOHOL ABUSE - severe malnutrition because alcohol provides calories but no essential nutrients - in older chronic abusers, deficiency of vitamin B causes amnesic syndrome – severe loss of memory, memory gaps filled with imaginary, improbable events - prolonged alcohol use with reduction in protein intake causes cirrhosis of liver o fatal disease in which liver cells become filled with fat and protein, interrupt function, creates scar tissue and obstructs blood tissue - damage to endocrine glands and pancreas, heart failure, hypertension, stroke and capillary hemorrhages, responsible for swelling and redness of face, destroys brain cells o reduces effectiveness of immune system - Fetal Alcohol Syndrome (FAS): heavy alcohol consumption during pregnancy is causes mental retardation of fetus during critical growth (growth rate is slowed and cranial/facial/limb anomalies are produced o occurs in 1 out of 100 pregnancies o estimated $5.3 Billion of lost productivity due to health care, social service and education costs o estimating that 50% of Canadian/American women drink socially and 50% of pregnancies are unplanned, 100 000 Canadian infants are exposed to alcohol during gestation - Light drinking (fewer than 3 drinks a day) of wine related to decreased risk for coronary heart disease and stroke o not well researched, better to avoid alcohol 2 | P a g e PSYB32: Abnormal Psychology Meera Mehta Summer 2012 Inhalant Use Disorders - considered a ‘stepping-stone’ for developing other disorders - young people start abuse by inhaling vapours from glue, correction fluid, spray pain, cosmetics, gasoline, household aerosol sprays, nitrous oxides from spray cans - Inhalant use disorders involve o Sniffing: nasal inhalation o Huffing: breathing fumes from a small rag snuffed in the mouth o Bagging: breathing fumes from a plastic bag held up to the mouth - most inhalants act as depressants, result in feelings of euphoria and psychic numbing - may cause damage to central nervous system, experience nausea and headaches NICOTINE AND CIGARETTE SMOKING - Nicotine: addicting agent of tobacco, stimulates nicotinic receptors in the brain o nicotinic acetylcholine receptor subtype causes nicotine dependence o released neurotransmitter produces stimulation, pleasure and mood regulation o nicotine had high reinforcing efficacy, monkeys willing to perform over 600 lever presses to self-administer nicotine o even one puff/one cigarette is enough for some people to begin addiction to nicotine  mental addiction occurs before physical addiction o females have significant greater changes in cognitive activity after nicotine exposure than males - Prevalence and Health Consequences of Smoking o Long-term cigarette smoking increases lung cancer, emphysema, cancer of larynx and esophagus and other cardiovascular diseases o health risks of smoking decline after period of 5-10 years after quitting, but only slightly above non-smokers o destruction of lung tissue is not reversible - Prevalence Rates/Statistics o 17% of Canadians are smokers, Daily smokers in Canada smoke average of 14.9 cigarettes per day o smokers comprise of more than lost work days and days of disability  loss of productivity and health care costs cause a $65 Billion loss in U.S - Second-Hand smoke o smoke coming from burning end of cigarette causes second-hand smoke  contains higher concentrations of ammonia, carbon monoxide, nicotine and tar than smoke inhaled by smoker  regular exposure to second-hand smoke increases chances of lung disease by 25% and heart disease by 10%  aggravates symptoms in people with allergies and asthma, linked with chronic bronchitis and hypertension  infants and children exposed to second-hand smoke more likely to suffer chronic respiratory illness, impaired lung function, food allergies MARIJUANA - dried and crushed leaves/flowering tops of the hemp plant, Cannabis sativa - usually smoked, may be chewed, prepared as tea or eaten in baked goods - Hashish: much stronger than marijuana produced by removing and drying the resin exudates of the tops of high-quality cannabis plant - Psychological Effects of Marijuana: o feel relaxed and sociable o large doses bring large shifts in emotion, dull attention, fragment thoughts and impaired memory, time seems to move slowly o extremely large doses may induce hallucinations and extreme panic o many users get higher than intended because it takes up to half an hour for effects to appear o major active chemical in marijuana is delta-9-tetrahydrocannabinol (THC)  shortly found that body produces its own cannabis-like substance – anandamide (anand= Sanskrit word for bliss) o evidence suggests cognitive deficits; average decrease of 4.1 IQ points by heavy smokers Discovery 12.1: Stepping-stone theory – from marijuana to hard drugs 3 | P a g e PSYB32: Abnormal Psychology Meera Mehta Summer 2012 - theory that marijuana is first step/gateway that leads young people to become addicted to other, more harmful drugs (Ex – heroin) - Canada is classified as ‘high-use’ country according to comparative study of adolescents in 36 countries - 51.5% of students reported using marijuana at some point in their lives o 1 out of 6 had used marijuana within month of survey - marijuana use associated with smoking, heavy drinking and cocaine use - study found rave participants reported experiment with alcohol, then cannabis, LSD, psilocybin, amphetamines, cocaine and ecstasy o 4 out of 5 rave participants engage in polysubstance abuse (average 2.5 psychoactive substances per person) - daily marijuana users also report health, financial and vocational problems o impairs psychomotor skills needed for driving - high school students who reported drug use tended to have higher rates of separation/divorce, more crimes, less-stable employment patterns Somatic Effects  Short term side effects of marijuana: bloodshot itchy eyes, dry mouth and throat, increased appetite, reduced pressure in eye and raided blood pressure o impairs lung functioning; coughing, wheezing, bronchitis, injury to airway tissue, impaired functioning of immune system o one marijuana cigarette equal to 4 tobacco cigarettes tar intake, 5 carbon monoxide intake, 10 in terms of damage to cells lining airways (pg 409) o habitual use of marijuana produces tolerance, thus might be addictive  younger initial marijuana smokers are more likely to develop marijuana disorder o THC after rapidly metabolized is stored in body fatty tissue and then released slowly Therapeutic Effects - THC and related drugs can reduce nausea and loss of appetite from chemotherapy for some cancer patients - treatment for discomfort of AIDS, glaucoma, epilepsy, arthritis and multiple sclerosis - in 1999, Health Canada set up process where people can apply to be exempt from federal marijuana ban Sedatives and Stimulants SEDATIVES - Sedatives: slow the activities of the body and reduce responsiveness (opiates such as morphine, heroin and codeine) Opiates - Opiates: group of addictive sedatives that relieve pain and induce sleep when taken in moderate doses o Opium: principle drug of illegal international trafficking o Morphine (named after Morpheus, Greed god of dreams) was separated from raw opium.  bitter tasting powder that is powerful sedative and pain reliever  used in medicines before addictive properties were noted  many soldiers were treated, and returned home addicted to drug o Heroin: converted into another powerful pain-relieving drug, even more addictive and potent than morphine Psychological and Physical Effects of Opiates - Opium (derivatives are morphine and heroin) produce euphoria, drowsiness, reverie, lack of coordination o Heroin; initially a rush, feeling of warmth and suffusing ecstasy following an intravenous injection  user sheds worries and fears and has great self-confidence for 4 to 6 hours then experiences letdown/stupor o body produces opioids called endorphins and enkephalins; opium derivatives stimulate receptors for these body opioids o opiates are extremely addictive, users show increased tolerance and withdrawal symptoms when they are unable to get another dose o withdrawal symptoms of heroin after 8 hours of last injection; include muscle pain, sneezes, sweats, extremely tearful and yawn a lot (similar to influenza)  within 36 hours, symptoms are more extreme – may have uncontrollable muscle twitching, cramps, and chills associated with excessive flushing and sweating, rise in heart rate and blood pressure  addicted person is unable to sleep, vomits and has diarrhea  symptoms last for another 72 hours and gradually diminish after 5-10 day period o Dependence on heroin is higher among physicians and nurses than in any other group due to the availability of opiates in medical settings and high job stress 4 | P a g e PSYB32: Abnormal Psychology Meera Mehta Summer 2012 o In study of 500 heroin addicts, 28% died by age 40 Synthetic Sedatives - Synthetic sedatives – Barbiturates: another major sedative synthesized as aids for sleeping and relaxation o relax muscle, reduce anxiety and produces mildly euphoric state o with excessive does, speech is slurred, judgment and concentration impaired, user loses emotional control, becomes irritable and combative before falling into deep sleep o very large dose is lethal because causes diaphragm muscles to relax to such an extent the individual suffocates STIMULANTS - stimulants (uppers) act on brain and sympathetic nervous system to increase alertness and motor activity. Amphetamines - Amphetamines: developed to relieve asthma, inhalant to relieve stuffy noses o used to control mild depression and appetite o supplied to soldiers to ward off fatigue and used to treat hyperactive children o used in dieting because more wakefulness, inhibits intestinal functions, reduces appetite - causes release of norepinephrine and dopamine and blocks reuptake of these neurotransmitters o heart rate quickens and blood vessels in skin constrict o user becomes alert, euphoric, outgoing and seems to possess large self-confidence and energy o large does may cause paranoia, delusions, headaches, dizziness and sleeplessness Discovery 12.2: Caffeine (pg 413) - 2 cups of coffee contains 150 and 300 milligrams of caffeine, affect people within half an hour o metabolism, body temperature and blood pressure increase o urine production increases o hand tremors, diminish appetite, sleeplessness o extremely large doses can cause headaches, diarrhea, nervousness, severe agitation, convulsions - people drink caffeine for sociability and affiliation with others, and get relief from aversive states, need for stimulant Cocaine - Cocaine: extracted from leaves of coca plant, used as a local anaesthetic/reduces pain o blocks reuptake of dopamine in mesolimbic areas that cause pleasurable states/positive feelings o increases sexual desire and produces feelings of self-confidence, well being indefatigability o overdose causes chills, nausea, insomnia, paranoid breakdowns, hallucinations of insects crawling under skin  chronic use changes personality, impairs social skills, paranoid thinking, disturbances in eating and sleeping  many babies born addicted to drug if mother used cocaine during pregnancy o cocaine is a vasoconstrictor, increases person’s risk for stroke, causes cognitive problems with memory and attention, danger for blood supply during pregnancy o ‘Crack’ a new form of cocaine now a street drug; available in small, relatively inexpensive doses LSD and Other Hallucinogens - LSD and Hallucinogens: creates a psychotic state, first synthesized by Albert Hoffman o Mescaline, Psilocybin (magic mushrooms) are types of hallucinogens  thought that they can expand the consciousness, but tolerance develops rapidly  psilocybin decreases OCD symptoms o Ecstasy (similar to MDA and MDMA) is chemically similar to mescaline and amphetamines (a psychoactive ingredient in nutmeg)  4.1% of Canadians reported using ecstasy during their lifetime  user reports that drug enhances intimacy and insight, improves interpersonal relationships, elevates
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