ch 12 substance related disorder.docx

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Konstantine Zakzanis

CHAPTER 12 SUBSTANCE-RELATED DISORDERS - The pathological use of substances falls into 2 categories: substance abuse and substance dependence. - Substance dependence: presence of atleast 3 things- the person develops tolerance; indicated by either larger doses of the substance being needed to produce the desired effect or 2) the effects of the drug becoming markedly less if the usual amount is taken. It has been proposed in the initial draft of DSM-5 tht the distinction btwn substance abuse and dependence be dropped and replaced with an inclusive category named Addiction and Related Disorders and further recommended tht dependencebe limited in use and only refer to physiological dependence - Withdrawal: symptoms tht cause neg physical and psycho effects which develops when the person stops tkng the substance or reduces the amnt. The person may also use the substance to relieve or avoid withdrawal symptoms - Person uses more of the substance or uses it for a longer time than intended - Person recognizes excessive use of substance; he or she may have tried to reduce usage but has been unable to do so - Much of the person`s time is spend in efforts to obtain the substance or recover frm its effects - Substance abuse continues despite psych or phys prblms caused or exacerbated by the drug ex. Smoking - Person gives up or cuts back participation in many activities b.c of the use of the drug (wrk, socialization) - DSM internet addiction was not included - Substance abuse: person must experience one of the following as a result of recurrent use of the drug: failure to fulfill major obligations (absences frm work or neglect of children); exposure to physical dangers (operating machinery or driving while intoxicated); legal prblms (arrests for disorderly conduct or traffic violations); persistent social or interpersonal prblms (arguments with a spouse) - substance intoxication is diagnosed when the ingestion of a substance effects the nervous system and produces maladaptive cognitive and behavioural effects. If a person addicted to a drug is denied it and then experiences withdrawal, person recves a diagnosis of both substance dependence and substance withdrawal. Ex: alcohol withdrawal delirium, commonly known as the DTs (delirium tremens) - prblm- clear distinction btwn substance abuse vs. substance dependence. There`s a quantitative distinction rather than qualitative so voth disorders should be incl on a single continuum ALCOHOL ABUSE AND DEPENDENCE - abuse- often used to refer to both aspects of the excessive and harmful use of alcohol - dependence may include tolerance or withdrawal reactions. Ppl who are physically dependent on alcohol generally have more severe symptoms of the disorder. Those tht begin drinking early in life dvlp their withdrawal symptoms in their 30s or 40s. abrupt withdrawal frm alcohol is hard, patient feels anxious, depressed, weak, restless, and unable to sleep. Tremors of muscles, esp for the small musculatures of the fingers, face, eyelids, lips, and tongue, and blood presume, pulse and temperature are elevated. - Rarely, a person who has been drinking heavily for years may also experience delirium tremens when the level of alcohol in the blood drops suddenly, becomes tremulous and has hallucinations tht are primarily visual but may be tactile (like animals or insects crawling all over them so claw on their skin frantically or hide in a corner) - The delirium and physiological praxysms caused by withdrawal of alcohol indicate tht the drug is addictive - Central nervous system is impacted, although changes in the liver enzymes tht metabolize alcohol can account to a small extent for tolerance - Some rsrch suggest tht tolerance results frm changes in the number or sensitivity of GABA or glutamate receptors. Withdrawal may be the result of increased activation in some neural pathways to compensate for alcohol`s inhibitory effects in the brain; when drinking stops the inhibitory effects of alcohol are lost resulting in a state of over-excitation - Rsrch has proven tht expectations nd consequences of behaviour can have a direct influence on tolerance and the effects of alcohol - Craving may be overpowering they will ingest alcohol in a non-beverage form such as hair tonic - When u abuse alcohol, the person experiences negative social and occupational effects frm the drug but does not show tolerance, withdrawal, or the compulsive drinking patterns seen in the person who is alcohol dependent - Alcohol abuse or dependence is often part of poly drug (poly substance) abuse: using or abusing more than one drug at a time, about 80-85% of alcohol abusers are smokers. Nicotine can induce tolerance for the rewarding effects of alcohol and vice versa. - Mixing alcohol and barbiturates is a common means of suicide both intentional and accidental, alcohol also contributes to death from heroin for it can reduce the amount of the narcotic needed to make a dose lethal Prevalence of Alcohol Abuse and Comorbidity with Other Disorders - In the U.S, lifetime and 12 mnth alcohol abuse was 17.8% and 4.7%; alcohol dependence 12.5% and 3.8%. higher in men particularly younger cohorts and whites. Chronic for 4 yrs for alcohol dependence. - In cda protypical heavy drinker is young adult male who is not married and who is relatively well off financially. - Prblm drinking is also comorbid with mood and anxiety disorders - Comorbidity is imprtnt to assess because comorbid psych disorders predict higher relapse rates and less intial treatment imprvmnt among dually diagnosed individuals with substance abuse - CDN perspective: women have higher binge drinking in 9 out of 35 countries. Course of the Disorder - Survey on 2k members of AA (Jellinek) described male alcohol abuser as passing through 4 stages beginning with social drinking and progressing to a stage at which he lives only to drink but its more variable than wut he implied - Difficulties with alcohol begin late among women, drink alone and less likely to binge than men Cost of Alcohol Abuse and dependence th - WHO- alcohol abuse is the 4 leading cause of worldwide disability - Suicide rate is high for alcohol abusers than the general population - The prototypical drinking driver in cda is a male btwn ages of 25 and 34 who drinks large amnts of alcohol on a regular basis or is a social drinker who occasionally drinks heavily Short term effects of alcohol - Alcohol is metabolized by enzymes after being swallowed and reaching the stomach, most of it goes into small intestines where it is absorbed into the blood then broken down in the liver which can metabolize abt 30mm of 100% (50%) whisky per hr - Absorption is fast but removal is slow - The effects of alcohol vary with level of concentration of the drug in the bloodstream which in turn depends on the amnt ingested in a particular period of time; the presence or absence of food in the stomach to retain the alcohol and reduce its absorption rate; the size of a person`s body; and the efficiency of the liver - Alcohol has biphasic effect; after it peaks then decline it acts as a depressant and has negative emotions - GABA receptors (reduces tension); alcohol stimulates it. GABA is a major inhibitory neurotransmitter; benzo such as valium have an effect on the GABA receptor similar to tht alcohol - Alcohol increases levels of serotin and dopamine which maybe the source of its ability to produce pleasurable effects - Alcohol inhibits glutamate receptors which may cause cognitive effects of alcohol intoxication such as slurred speech and memory loss Long-Term Effects of Prolonged Alcohol Abuse - Chronic drinking creates severe bio damage (every tissue and organ of the body) - Alcohol has calories but doesnt provide nutrients for healthy body - A deficiency of B complex vitamins can cause amnestic syndrome, a severe loss of memory for both recent and long past evnts and memory gaps are oftn filled with reports of imaginary, improbable events - Low protein causes cirrhosis of the liver, a fatal disease where liver cells become engorged with fat and protein, impeding their function; some cells die, triggering an inflammatory process. When scar tissue devlps, blood flow is obstructed - Othr common physiological changes include damage to the endocrine glands and pancreas, heart failure, hypertension, stroke, and capillary hemorrhages which are responsible for the swelling and redness in the face esp nose of chrnic alcohol abusers. - 5 yr longitudinal study found significant loss of grey matter frm the temporal lobe - Increases susceptibilityto illness as immune system becomes weak - Drinking while pregnant causes mental retardation, growth of fetus is slowed and cranial, facial, and limb anomalies are produced- fetal alcohol syndrome (FAS) - Fetal alcohol spectrum disorders are partial fetal alcohol syndrome and alcohol related neurodvlpmental disorder (ARND). Even moderate drinking by mothers can produce less severe butundesirable effects on the fetus so total absentation is recommended. Early detection for FAS has better outcome - It occurs in 1 out of 100 pregnancies and its expensive - FAS leading cause of dvlpmental and cognitive disabilities in children in CDA - In NA even wine and other light dirnks aren`t viewed positively (reduce coronary heart disease and stroke) INHALANT USE DISORDERS - Use of solvents is dangerous, higher among
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