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Textbook notes Ch 12, 13, 8 (midterm 3)

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Chapter 12: Substance Use Disorders
-Addictive Behav: Need for a substance activity
-Psychoactive drugs affect mental functioning
-Addiction/substance related disorders divided into 2 groups
1. Those that involve organic impairment, resulting from the prolonged & excessive ingestion of
psychoactive substances (ie. Korsakoffs syndrome)
2. Substance induced organic mental disorders & syndromes; physiological changes in brain due to
vitamin deficiency; most fall into this category
-Substance Abuse: (1) Hazardous behav, such as driving while drunk
(2) Continued use aside from social/psych/health problems
-Substance Dependent: more sever forms of substance use disorder, involves marked physiological need for
increasing amounts of substance to achieve desire effects. Dependence: indiv will show a tolerance for a drug
& experience withdrawal when unavailable
-Alch is a nervous system stimulant & depressant
-Alcohol dependence syndrome: A state psychic & also usually physical, resulting from taking alcohol,
characterized by behavioural & other responses that always include a compulsion to take alcohol on a
continuous or periodic basis in order to experience its psychic effects, & sometimes to avoid the discomfort of
its absence; tolerance may or may not be present
Lifetime: 12%
Life span of abusers/dependence is 12 years shorter than normal
Heavy drinking associated w. partner violence
Lowers cognitive/problem solving performance
Brain shrinkage in ppl w. alcohol dependence
37% suffer from a mental disorder
Occurs often w. personality disorder
Binge drinker: Boy = 5 drinks, Girl = 4 drinks on 1 occasion 2 weeks
5:1 ratio
Marriage, education, being older associated w. lower alcoholism
-Clinical Picture of Alcohol Abuse & Dependence
Causes decreased sexual inhibition, lower sexual performance, blackouts, lapses of memory
Hangovers: Headaches, nausea, fatigue
Effects on brain: At lower levels of alcohol it activates brain pleasurable areas releasing opioids. At
higher levels, it depresses brain functioning, inhibiting brains glutamate slowing down activity in parts
of brain, impairs judgment, self-control; experiences sense of warmth, expansiveness, well-being, self-
esteem rise, worries temp. left behind
Development of alch dependence: early to middle to late stage; consumption by mother during
Physical Effects: 5-10% eliminated from breath/urine/sweat the rest by work of liver, but in large
amounts liver is overworked causing damages (15-30% cirrhosis); high calorie drug; can suffer from
malnutrition; stomach problems

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Psychosocial Effects: Chronic fatigue, oversensivity, depression; impaired reasoning, poor judgment,
personality deterioration, inappropriate behav, loses pride in appearance, neglects family, touchy,
irritable, unwillingly to discuss problem, cant hold job, marital breakup
Psychosis Associated w. sever alch abuse: Ppl who have been drinking over a long period of time, brain
lesion causes confusion/excitement/delirium which lasts 3-6 days followed by deep sleep; temp loss of
Full Blown Symptoms of Alcoholic Psychosis
(1)Disorientation for time & place
(2)Vivid hallucinations
(3)Acute fear
(4)Extreme suggestibility
(6)Perspiration, weak heartbeat, coated tongue, foul breath
Drugs help withdrawal delirium
Alcohol amnesic disorder “Korsakoffs syndrome”: memory defect, falsification of
events/confabulation, delirious, delusional, disorientated for time & place, impairments in planning,
judgment, intellect, emotions deficits; vitamin B deficiency; memory restored w. abstinence
Biological Factors in Abuse of & Dependence on Alch & Other Substances
-Feelings of award & pleasure
-Role of genetic inheritance& environmental factors
1/3 have parents w. problem, runs in families
Adopted children at young ages didnt develop it like their parents
Asians have alch flush
Exposure to it plays a role
Neurobiology of Addiction
Mesocorticolimbi Dopamine Pathway: centre of psychoactive drug activation in brain; involved in control of
emotions, memory, gratification; alch produces euphoria by stimulating this area
-Psychosocial Causal Factors in Alcohol Abuse & Dependence
Socially dependent to enjoy social situations
-Failures in Parental Guidance
Unstable families
Parent substance use associated w. early adolescent substance use
Negative parental models, lack of monitoring, stress & (-) affect, stressful childhood experiences
-Psychological Vulnerability
Alcoholic Personality” emotionally immature, expect great deal of world, require praise &
appreciation, low frustration tolerance, unsure of abilities to fulfill expected roles
Link w. antisocial personality, depression, schizophrenia, conduct disorder, aggression
Relationship btw depressive disorders & alcohol abuse stronger in women
-Stress, Tension Reduction & Reinforcement
Drink to relax (Tension-Reduction Hypothesis)
-Expectations of Social Success
Young adolescents expect that it will lower tension & anxiety & increase sexual pleasure in life
Reciprocal influence model: Adolescents begin drinking due to expectations that it’ll increase
popularity & acceptance by their peers
Time & experience are moderating variables, older students showed less expectations than froshes

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-Marital & Other Intimate Relationships
Adults in less intimate relationships tend to show increased drinking & sadness, self devaluation
Divorce, financial, sexual problems
6 Family Relationships Problems central to development of alcoholism
Alcoholic father, acute marital conflict, lax maternal supervision & inconstant discipline, many moves in
familys early years, lack of attachment to father, lack of family cohesiveness
Sociocultural Factors
-Muslims & Mormons, orthodox Jews limited alcohol due to religion, but high among Europeans
Treatment of Alcohol Abuse Disorders
-Treatment objectives usually include detoxification, physical rehab, control over alch-abuse behav, & indiv
realizing that they can cope w. the problem of living & lead a more rewarding life w.out alch
Used to reduce cravings
Antabuse meds that block desire to drink a drug that causes violent vomiting when followed by
ingestion of alchy
Naltrexon blocks pleasure-producing effects of alch
Used to Reduce Side Effects of Acute Withdrawal
Primary goals in treatment of withdrawal symptoms is to reduce physical symptoms such as insomnia,
headache. Drugs overcome motor excitement, nausea, vomiting, prevent withdrawal delirium &
convulsions reduces tension & anxiety
-Psychological Treatment Approaches
Detox followed by psychological treatment
Group Therapy: Forced to face problems
Environmental Intervention: alleviate patients aversive life situation, environmental support
Behavioural & Cognitive-Beh Therapy: Aversive conditioning, noxious stimulant w. alch consumption
to suppress drinking behav, involves injection of emetine hydrochloride so when alch comes into play
the patients conditioned response occurs
Social Learning Theory & Modeling of Behav: Skills training procedure, aimed at younger drinkers at risk of
developing alch abuse, develop skills to cope in situations, modifying cognitions and expectancies, stress
management skills, training in life
Controlled Drinking Vs Abstinence: learn to drink moderately more common in less severe patients
Alcoholics Anonymous: Self help counseling program, only 1st names used, discussion of persons
problems, greater ego strength, has high drop out rates compared to other therapies
-Outcome Studies & Issues in Treatment
Ppl w. personality/mood disorder have poorer outcomes in alch treatment
Treatment most likely to be effective when person accepts they need help and attends treatment
regularly, having a good relationship w. therapist
Patients w. certain personality characteristics or different degrees of severity might do better in one
therapeutic approach rather than in another
Project MATCH; matching patient to treatments didnt appear to be important to having an effective
outcome(1)12 step program along lines of AA
(2)Cog-beh therapy
(3)Motivational enhancement therapy, assume responsibility for helping self
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