PSY353 Chapter Notes - Chapter 11: Drug Abuse Resistance Education, Delirium Tremens, Psychoactive Drug
CHAPTER 11: Substance-Related, Addictive, and
Impulse-Control Disorders
INTRODUCTION
Substance-related and addictive disorders – associated with the
abuse of drugs and other substances people take to alter the way
they think, feel, and behave
• costs U.S. citizens hundreds of billions of dollars each year
• kills 500,000 Americans annually
• implicated in street crime, homelessness, and gang
violence
• smoking cigarettes, drinking alcohol, and using illegal
drugs → all related to these disorders
• responsible for astronomical financial costs and the tragic
waste of hundreds of thousands of human lives each year
• most of us have behaved in ways characteristic of these
disorders at some point in our lives
Gambling disorder – newly added disorder to this category in DSM-5
Impulse-control disorders – represent a number of related
problems that involve the inability to resist acting on a drive or
temptation → those who cannot resist aggressive impulses or the
impulse to steal or to set fires
Controversy surrounds substance-related, addictive, and impulse-
control disorders → society sometimes believes that these problems
result simply from a lack of ill
PERSPECTIVES ON SUBSTANCE-RELATED AND
ADDICTIVE DISORDERS
The cost in lives, money, and emotional turmoil → made the issue of
drug abuse a major concern worldwide
• 9.7% of the general population (12 years +) → believed to
use illegal drugs
• Many U.S. presidential administrations have declared
various as on drugs → but the problem remains
• Roman Catholic Church issued a universal catechism in
1992 → officially declared drug abuse and drunk driving to
be sins
LEVELS OF INVOLVEMENT
Each drug has a unique effect → there are similarities in the ways
they are used and how people who abuse them are treated
Can you use drugs without meeting criteria for a disorder? Can you
use drugs and not become addicted to them?
• need to outline definitions of substance use, substance
intoxication, substance use disorder, and substance
dependence/addiction
Substance – chemical compounds that are ingested to alter mood or
behavior
Psychoactive substances – alter mood, behavior, or both
• drugs such as cocaine and heroin
• also includes more commonplace legal drugs (safe
dugs → alcohol, nicotine, caffeine
• also affect mood and behavior, can be addictive, and
account for more health problems and a greater mortality
rate than all illegal drugs combined
• You could make a good argument for directing the war on
drugs to cigarette smoking (nicotine use) because of its
addictive properties and negative health consequences
Substance Use
Substance use – the ingestion of psychoactive substances in
moderate amounts that does not significantly interfere with social,
educational, or occupational functioning
• e.g. drinking a cup of coffee in the morning to wake up,
smoking a cigarette, having a drink with a friend to relax,
occasional ingestion of illegal drugs (cannabis, cocaine,
amphetamines, or barbiturates)
Intoxication
Substance intoxication – physiological reaction to ingested
substances (drunkenness or getting high)
For a person to become intoxicated, many variables interact:
- type of drug taken
- amount ingested
- person’s individual biological reaction
For many of the substances, intoxication is experienced as:
- impaired judgment
- mood changes
- lowered motor ability (e.g. problems walking or talking)
Substance Use Disorders
Defining substance use disorders by how much of a substance is
ingested is problematic
Substance use disorders – defined by DSM-5 in terms of how
significantly the use interferes with the user’s life
• if substances disrupt your education, job, or relationships
with others, and put you in physically dangerous situations
→ you would be considered to have a disorder
Drug use can predict later job outcomes
researchers controlled for factors such as educational
interests and other problem behavior
• still found that repeated hard drug use (using one or more
of the following: amphetamines, barbiturates, crack,
cocaine, PCP, LSD, other psychedelics, crystal meth,
inhalants, heroin, or other narcotics) predicted poor job
outcomes after college
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Substance use disorder is usually described as addiction
• although we use the term addiction routinely when we
describe people who seem to be under the control of
drugs → disagreement about how to define addiction
In order to meet criteria for a disorder → a person must meet
criteria for at least two symptoms in the past year that interfered
with his/her life or bothered him/her a great deal
• moderate range → four or five symptoms
• severe substance use disorder → six or more symptoms
Symptoms for substance use disorders can include:
- tolerance: a physiological dependence on the drug or
drugs → the use of increasingly greater amounts of the
drug to experience the same effect
- withdrawal: a negative physical response when the
substance is no longer ingested
Tolerance and withdrawal are physiological reactions to the
chemicals being ingested
• alcohol withdrawal delirium – caused by withdrawal from
alcohol → a person can experience frightening
hallucinations and body tremors
• withdrawal from many substances can bring on chills,
fever, diarrhea, nausea and vomiting, and aches and pains
Not all substances are physiologically addicting → you do not go
through severe physical withdrawal when you stop taking LSD
Cocaine withdrawal has a pattern that includes:
- anxiety
- sleep changes
- lack of motivation
- boredom
Cannabis withdrawal includes such symptoms as:
- irritability
- nervousness
- appetite change
- sleep disturbance
Drug-seeking behaviors – behaviors/symptoms that define the
extent of substance use disorders
- repeated use of a drug
- desperate need to ingest more of the substance (stealing
money to buy drugs, standing outside in the cold to
smoke)
- likelihood that use will resume after a period of abstinence
are
• Such behavioral reactions are different from the
physiological responses to drugs
• sometimes referred to in terms of psychological
dependence
Previous version of the DSM → considered substance abuse and
substance dependence as separate diagnoses
• DSM-5 combines the two into the general definition of
substance-related disorders → based on research that
suggests the two co-occur
You can you use drugs and not abuse them
• some people drink wine or beer regularly without drinking
to excess
• some people use drugs such as heroin, cocaine, or crack
occasionally (several times a year) without abusing them
• BUT we do not know ahead of time who might be likely to
lose control and abuse these drugs and who is likely to
become dependent with even a passing use of a
substances
Dependence can be present without abuse
• cancer patients who take morphine for pain → may
become dependent on the drug without abusing it
• build up a tolerance and go through withdrawal if it is
stopped
DIAGNOSTIC ISSUES
In early editions of the DSM → alcoholism and drug abuse weren’t
treated as separate disorders → categorized as sociopathic
personality disturbances
• a forerunner of the current antisocial personality disorder
• substance use was seen as a symptom of other problems
• was considered a sign of moral weakness
• influence of genetics and biology was hardly
acknowledged
DSM-III → created a separate category for substance abuse
disorders
• acknowledged the complex biological and psychological
nature of the problem
DSM-5 → substance-related disorders include 11 symptoms
• range from relatively mild (e.g., substance use results in a
failure to fulfill major role obligations) to more severe
(e.g., occupational or recreational activities are given up or
reduced because of substance use)
• removed the previous symptom that related to substance-
related legal problems
• added a symptom that indicates the presence of craving or
a strong desire to use the substance
• distinctions help clarify the problem and focus treatment
on the appropriate aspect of the disorder
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Symptoms of other disorders can complicate the substance use
disorder picture significantly
• do some people take drugs to excess because they are
depressed, or does drug use and its consequences (loss of
friends, job) create depression?
• ¾ of people in addiction treatment centers have an
additional psychiatric disorder
• mood disorders → observed in more than 40%
• anxiety disorders and PTSD → seen in more than 25%
Substance use might occur concurrently with other disorders for
several reasons
• substance-related disorders and anxiety and mood
disorders → highly prevalent in society → may occur
together so often just by chance
• drug intoxication and withdrawal → can cause symptoms
of anxiety, depression, and psychosis
• schizophrenia and antisocial personality disorder → highly
likely to include a secondary problem of substance use
Substance-related disorders can be so complicated → DSM-5 tries to
define when a symptom is a result of substance use and when it is
not
• if symptoms seen in schizophrenia or in extreme states of
anxiety appear during intoxication or within 6 weeks after
withdrawal from drugs → not considered signs of a
separate psychiatric disorder
• individuals who show signs of severe depression just after
they have stopped taking heavy doses of stimulants →
would not be diagnosed with a major mood disorder
• BUT individuals who were severely depressed before they
used stimulants and those whose symptoms persist more
than 6 weeks after they stop → might have a separate
disorder
6 general categories of substances:
1. Depressants: result in behavioral sedation and can induce
relaxation
• alcohol (ethyl alcohol)
• sedative and hypnotic drugs in the families of barbiturates
(e.g. Seconal)
• benzodiazepines (e.g. Valium, Xanax)
2. Stimulants: cause us to be more active and alert and can
elevate mood
• amphetamines, cocaine, nicotine, caffeine
3. Opiates: produce analgesia temporarily (reduce pain) and
euphoria
• heroin, opium, codeine, and morphine
4. Hallucinogens: alter sensory perception and can produce
delusions, paranoia, and hallucinations
• cannabis and LSD
5. Other drugs of abuse: do not fit neatly into one of the
categories; produce same psychoactive effects
• inhalants (e.g. airplane glue), anabolic steroids, over-the-
counter and prescription medications (e.g. nitrous oxide)
6. Gambling disorder: as with the ingestion of the
substances, individuals are unable to resist the urge to
gamble which → results in negative personal
consequences (e.g., divorce, loss of employment)
DEPRESSANTS
Depressants – decrease central nervous system activity.
• principal effect is to reduce levels of physiological arousal
and help us relax
• alcohol and the sedative, hypnotic, and anxiolytic drugs
(e.g. prescribed for insomnia)
• among those most likely to produce symptoms of physical
dependence, tolerance, and withdrawal
Alcohol – most commonly used of these substances
ALCOHOL-RELATED DISORDERS
Drinking with friends → a rite of passage for many teenagers
Alcohol has been widely used throughout history
• evidence of wine or beer in pottery jars at the site of a
Sumerian trading post in western Iran and the country of
Georgia → date back 7,000 years
• for hundreds of years, Europeans drank large amounts of
beer, wine, and hard liquor
• when they came to North America in the early 1600s →
brought their considerable thirst for alcohol with them
• US early 1800s → consumption of alcohol (mostly
whiskey) was more than 7 gallons per year for every
person older than 15
• this is more than 3 times the current rate of US alcohol use
Alcohol is produced when certain yeasts react with sugar and water
and fermentation takes place
• fermenting alcohol from just about any fruit or vegetable
→ many foods contain sugar
• alcoholic drinks have included:
- mead from honey
- sake from rice
- wine from palm
- mescal and pulque from agave and cactus
- liquor from maple syrup
- liquor from South American jungle fruits
- wine from grapes
- beer from grains
Clinical Description
Apparent stimulation → initial effect of alcohol → although it is a
depressant
• experience a feeling of well-being, inhibitions are reduced,
and become more outgoing
• inhibitory centers in the brain are initially depressed →
slowed
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Document Summary
Gambling disorder newly added disorder to this category in dsm-5. Impulse-control disorders represent a number of related problems that involve the inability to resist acting on a drive or temptation those who cannot resist aggressive impulses or the impulse to steal or to set fires. Controversy surrounds substance-related, addictive, and impulse- control disorders society sometimes believes that these problems result simply from a lack of (cid:862)(cid:449)ill(cid:863) The cost in lives, money, and emotional turmoil made the issue of drug abuse a major concern worldwide. 9. 7% of the general population (12 years +) believed to use illegal drugs: many u. s. presidential administrations have declared various (cid:862)(cid:449)a(cid:396)s on drugs(cid:863) but the problem remains. Roman catholic church issued a universal catechism in. 1992 officially declared drug abuse and drunk driving to be sins. Each drug has a unique effect there are similarities in the ways they are used and how people who abuse them are treated.
