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Chapter 11

PSYC 235 Chapter 11: PSYC235 Chapter 11 Textbook Notes

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Queen's University
PSYC 235
Christopher Bowie

Chapter 11: Substance-Related, Addictive and Impulse-Control Disorders Perspectives on Substance-Related Disorders - Polysubstance use: using multiple substances - Substance: chemical compounds that are ingested in order to alter mood or behaviour - Psychoactive substances: alter mood, behaviour or both - All substances have similarities in how they are used and how people who abuse them are treated Levels of Involvement Use - Ingestion in moderate amounts that do not significantly interfere with social, educational or occupational functioning - Examples of this would be having a drink once in a while, or smoking a cigarette Intoxication - Physiological reaction to ingested substances (Ex. Drunkenness or getting high) - Depends on what drug they use - Also dependent on person’s individual biological reaction - Experienced as impairment in judgement, mood changes and lowered motor ability Abuse - Difficult to define abuse - When substances disrupt your education, job, relationships with others, or put you in physically dangerous situations  would be considered drug abuser - May predict later job outcomes o When controlling for educational interests and other problem behaviour, found that hard drug use (Ex. Crystal meth) predicted poor job outcomes Substance Dependence - Usually described as addiction - Physiologically dependent on the drug and required increased dose to experience similar effects (tolerance) - Tend to respond negatively when the substance is no longer ingested (withdrawal) - Alcohol Withdrawal Delirium (DT’s) o A person can experience hallucinations o Body tremors, fever, diarrhea, vomiting, pain etc - Not all substances are physiologically addicting o No severe pain withdrawal when you stop taking LSD - Dependence also measured by drug-seeking behaviours o Repeated use of drug, desperate need to ingest more of the drug and likelihood that use will resume after a period of abstinence o Defined as the psychological dependence - DSM-5 combined substance abuse and substance dependence into a general definition o Now described in terms of severity (ex. Mild, moderate, severe) depending on how many criteria are met - Dependence can be present without abuse o Ex. Cancer patients may become dependent on morphine, but use it without abusing it Diagnostic Issue - In early DSM’s, these disorders were classified as sociopathic personality disorders - The DSM-5 includes 11 symptoms that range in severity o Ex. Failure to fulfill major obligations - Also removed symptom that indicated substance-related legal trouble - Symptoms of other disorders can complicate substance use o Ex. Depression ▪ Do people drink more because they are depressed or does excess drinking cause depression? - ~50% of people with alcohol disorders have an additional psychiatric disorder o Found to be highly comorbid with mood and anxiety disorders o Have to consider that may just happen together by chance due to prevalence in society o Drug intoxication withdrawal can also increase depression, anxiety, risk taking - Also found to be associated with pathological gambling o Ingestion of alcohol led to increased risk-taking among regular gamblers when they were using a visual lottery terminal ▪ Increasing risk taking may affect this comorbidity - High comorbidity could also be due to the fact that mental illness may cause substance use disorders o May self-medicate and lead to that response - Need to identify when the symptoms were present o Ex. If you were highly depressed before stopping use, and continue to be after use, then you may have 2 separate disorders 6 general categories: 1. Depressants: result in behavioural sedation and can cause relaxation 2. Stimulants: cause us to be more active, alert and elevate mood 3. Opiates: produce analgesia (reduce pain temporarily) and euphoria 4. Hallucinogens: alter sensory perception and produce delusions, paranoia and hallucinations 5. Other drugs of abuse: inhalants, anabolic steroids, and over-the-counter meds 6. Gambling Disorder: unable to resist urge to gamble resulting in negative personal consequences Depressants - Decrease central nervous system activity - Reduce physiological arousal and help us relax - Included: alcohol and sedative, hypnotic and anxiolytic drugs Alcohol-Related Disorders - Alcohol has been consumed recreationally for hundreds of years Clinical Description - Stimulation is the initial effect of alcohol, but it is a depressant - Inhibitions are reduced, more outgoing o Inhibitory areas of the brain are depressed - With continued usage, alcohol depresses more areas of the brain - Motor coordination is impaired - Reaction time is slowed - Judgements reduced - Vision and hearing reduced Effects - Affects many parts of the body - Small amounts are absorbed in the stomach - In the small intestine, easily absorbed into the bloodstream - Circulatory system distributes throughout body o Contacts every major organ - As it passes through the liver, it is broken down into CO and H O by enzymes 2 2 - Influences the gamma aminobutyric acid (GABA) system o GABA = inhibitory neurotransmitter to interfere with neuron firing o Sends chloride ions into cell and makes it less sensitive to other neurotransmitters o Alcohol reinforces movement of chloride ions and makes it hard for neurons to communicate with each other - Blackouts, loss of memory may result from interaction with the glutamate system - Serotonin system also sensitive to alcohol - Also affects out dopamine reward system and increases “good feelings” - At certain doses, also releases endogenous opioids – may explain why at times, we have pain-numbing effects - Long-term effects can be severe o Withdrawal usually causes hand tremors, anxiety, vomiting, hallucinations, agitation and withdrawal delirium o Liver disease o Pancreatitis o Cardiovascular disorders o Brain Damage - Organic damage can happen and depends on personal amounts of usage, length of binges etc o Dementia – general loss of intellectual abilities can be direct result of long term heavy alcohol use o Wernicke-Korsakoff’s Syndrome – confusion, loss of muscle coordination, unintelligible speech ▪ May be caused by deficiency of thiamine - Fetal alcohol syndrome (FAS) o Now recognized as combination of problems that happen during pregnancy o Fetal growth retardation, cognitive deficits, behaviour problems, learning difficulties o Often have characteristic facial features Statistics on Use - Most Canadians drink in moderation - 23% found to exceed low-risk guidelines for alcohol consumption - 17% classified as high-risk drinkers - Decrease in use from 1989 – 1994 was paralleled with increased awareness of health effects - Now, levels have exceeded 1989 rates - Men are more likely than women to drink heavily o 16% vs 4% classified as heavy drinkers - Study found that higher amount of Canadian post-secondary students drink than American, but American students were more likely to be binge drinkers Statistics on Abuse and Dependence - 9% of Canadian drinkers experience some level of a problem - 3% of Canadian adults are thought to be alcohol dependent in any given year - 18-29 year olds, single males are most likely to be heavy drinkers and to have alcohol use problems - Cultural differences also exist depending on attitudes toward drinking, availability of alcohol, physiological reactions and family norms and patterns Progression - People who are dependent on alcohol fluctuate between drinking heavily, drinking socially without negative effects, and being abstinent - 20% of people seem to have spontaneous remission and do not re-experience problems with drinking - Initially believed that alcoholism would get progressively worse if left unchecked - Alcohol dependence may be progressive in most people - Alcohol abuse may be more variable o Drinking at an early age was predictive of later alcohol-related disorders - Pattern that seemed to emerge in a study conducted on men: o In their 20s  moderate consequences (Ex. Demotions at work) o During 30s  regular blackouts, signs of alcohol withdrawal o Late 30s and early 40s  long-term consequences (Ex. Hallucinations, convulsions, hepatitis) - Response to sedative effects will affect later use o Those who do not develop staggering, slurred speech etc are more likely to abuse it in the future o Caffeinated alcohol drinks (with energy drinks) can reduce sedative effects - Many people who commit violent crimes such as rape, murder and assault are often intoxicated at the time of the crime o Just because they overlap DOES NOT mean that alcohol will always make you more aggressive o Many other factors (ex. History of violence, amount of consumption) - Decreases fear associated with being punished and impair the ability to consider consequences of acting impulsively Sedative-, Hypnotic-, and Anxiolytic-Related Disorders - Sedative = calming - Hypnotic = sleep inducing - Anxiolytic = anxiety-reducing drugs - Barbiturates are sedative drugs first prescri
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