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PSYCH257 Chapter Notes -Health Canada, Motivational Interviewing, Silver Nitrate

Course Code
David Moscovitch

of 12
Substance-related disorders = abuse of drugs ppl take to alter the way they think, feel, and behave
Polysubstance use = using multiple substances
Substance = chemical cmpds ingested in order to alter mood/beh’
Levels of Involvement
Substance use = ingestion of psychoactive substances in moderate amnts tht dN significantly interfere w/
soc/edu/occupational f’n’g
i.e. drinking cup of coffee, smoking cigarette, marijuana, cocaine
Substance intoxication = physiological reac’n to ingested substances (i.e. drunkenness/getting high)
- exp’d as impaired judgment, mood changes, lowered motor ability
- criteria: person dvlps reversible substance-specific syndrome due to recent ingestion of (or exposure
to) a substance
Substance abuse = maladaptive pattern of substance use leads to clinically significant impairment/distress
as manifested by 1/more of these during same 12mth period: 1.) job/edu/rel’nshps
disrupted; 2.) put in physically dangerous situations; 3.) have related legal problems;
and/or 4.) cont’d substance use despite having persistent/recurrent soc/interpersonal
problems caused/exacerbated by effects of substance (i.e. physical fights, arguments
with spouse about consequences of intoxication)
Substance dependence = person is physiologically (d) on drug(s), req’s i↑’ly more of drug to exp’ same
effect (tolerance), and will respond physically in ve way when substance no
longer ingested (withdrawal)
- alcohol withdrawal delirium = aka delirium tremens (DTs); person can exp’ frightening hallucinations
and body tremors
- w/drawal from many substances can bring on chills, fever, diarrhea, nausea & vomiting
- not all substances physiologically addicting
i.e. dN go t/ severe physical w/drawal when you stop taking LSD/marijuana
Substance dependence = person is psychologically (d) on drug(s); measured by drug-seeking beh’s
- repeated use of drug
- desperate need to ingest more of substance (i.e. steal money to buy drugs)
- likelihood tht use will resume after period of abstinence
According to standard psychiatric definition, any drug user who passes 3 of 9 tests is hooked:
1.) takes substance or does activity more than originally intended
2.) wants to cut back or has tried to cut back but failed
3.) spends lots of time trying to get/take substance, set up/do activity, or recovering
4.) often intoxicated or suffers w/drawal symptoms when expected to fulfill obligations at
5.) curtails or give sup important soc/occupational/recreational activities b/c of substance/activity
6.) uses substance/does activity despite persistent soc/psych/phys problems caused by substance/activity
7.) needs more and more of substance/activity to achieve same effect (tolerance)
8.) suffers characteristic w/drawal symptoms when activity/substance is discont’d (cravings, anxiety,
depression, jitters)
9.) takes substance/does activity to relieve/avoid w/drawal symptoms
Today’s commonly used drugs ranked by addictiveness:
1.) nicotine
2.) ice, glass (methamphetamine smoked)
3.) crack
4.) crystal meth (methamphetamine injected)
(d)ce can be present w/o abuse
i.e. cancer patients who take morphine for pain
Diagnostic Issues
Symptoms of other Ds can complicate substance abuse picture significantly
i.e. do some ppl drink to excess b/c they are depressed, or do drinking and its consequences (loss of
friends/job) create depression?
Researchers estimate more than ½ the ppl w/ alcohol Ds have additional psychiatric D, such as major
depression, ASPD, bipolar D
Substance use might occur concurrently w/ other Ds b/c:
i.) substance-related Ds and anxiety & mood Ds highly prevalent in society and may occur
together so frequently just by chance
ii.) drug intoxication and w/drawal can cause symptoms of anxiety, depression, and psychosis, and can i
risk taking
iii.) mental health Ds cause substance use D
To define when symptom is result of substance abuse or not, basically, if symptoms seen before other
psychological D, would diagnose w/ substance-related D, and if symptoms seen after other psychological
D, would not diagnose w/ substance-related D
Indvdl substances:
- depressants = result in beh’al sedation and can induce relaxation
i.e. alcohol, sedatives, barbiturates, benzodiazepines
- stimulants = cause us to be more active & alert and can elevate mood
i.e. amphetamines, cocaine, nicotine, caffeine
- opiates = major effect is to produce analgesia temporarily (reduce pain) and euphoria
i.e. heroin, opium, codeine, morphine
- hallucinogens = alter sensory perception and can produce delusions, paranoia, hallucinations
i.e. marijuana, LSD
- other drugs of abuse = other substances tht are abused but dN fit neatly into other categories
i.e. inhalants (airplane glue), anabolic steroids, over-the-counter & prescription meds
Pathological Gambling
Person displays persistent and recurrent maladaptive gambling beh’ as indicted by 5/more of following:
1.) preoccupied w/ gambling (i.e. reliving past gambling exp’s, handicapping/planning next venture,
thinking of ways to get money w/ which to gamble)
2.) needs to gamble w/ i↑’g amnts of $ to achieve desired excitement
3.) has repeated unsuccessful efforts to ctrl/cut back/stop gambling
4.) restless/irritable when attempting to cut down/stop gambling
5.) gambles as way of escaping from problems/of relieving dysphoric mood (i.e. feelings of helplessness,
guilt, anxiety, depression)
6.) after losing $ gambling, often returns another day to get even (chase loss)
7.) lies to family members/therapist/others to conceal extent of involvement w/ gambling
8.) has committed illegal acts such as forgery/fraud/theft/embezzlement to finance gambling
9.) has jeopardized/lost significant rel’nshp/job/edu or career opportunity b/c of gambling
10.) relies on others to provide $ to relieve desperate financial situation caused by gambling
Gambling beh’ not better acc’d for by manic episode
1ly d CNS activityreduce levels of physiological arousal and help us relax
Most likely to produce symptoms of phys (d), tolerance, and w/drawal
Alcohol Use Disorders
Criteria: a) recent ingestion of alcohol
b) clinically significant maladaptive beh’/psych changes (i.e. inappropriate sexual/aggressive
beh’, impaired judgment, impaired soc/occupational f’n’g) tht dvlp’d during/shortly after use
c) 1/more of following sings, dvlp’g during/shortly after use: slurred speech, incoordination,
unsteady gait, nystagmus (involuntary rapid and repetitive mvmt of eyes), impairment in
attention/memory, stupor/coma
Initial effect: stimulant
- inhibitions reduced, more outgoing
w/ cont’d drinking, alcohol depresses more areas of brain impedes ability to f’n properly
- motor coordination impaired, reac’n time slowed, become confused, judgment ability reduced
although alcohol makes us more outgoing, it makes it difficult for neurons to communicate w/ each other
alcohol influences a # of diff neuroreceptor sys’s:
- blackoutsloss of memory for what happens during intoxicationmay results from interaction w/
glutamate sys
- serotonin sys—affects mood, sleep, and eating beh’—sensitive and thought to be responsible for
alcoholic cravings
- effects on dopamine rewards sys: may be responsible for pleasurable feelings ppl exp’ when drinking
- alcohol results in release of endogenous opioids—our bodies’ naturally occurring analgesicswhich
may explain why alcohol has pain-numbing effects
LT effects of heavy drinking often severe:
- w/drawal from chronic alcohol use typically includes hand tremors, nausea/vomiting, anxiety, transient
hallucinations, agitation, insomnia, DTs
- liver disease
- pancreatitis
- cardiovascular Ds
- brain damage (i.e. memory and ability to perform certain tasks may be impaired)
- at worst: Wernicke’s diseaseconfusion, loss of musc coordination, and unintelligible speechor
dementiageneral loss of intellectual abilities
Whether alcohol will cause organic damage depends on genetic vulnerability, frequency of use, length of
drinking binges, blood-alcohol levels attained during drinking periods, and whether body given time to
recover btwn binges
Fetal alcohol syndrome (FAS) = combo of problems tht can occur in child whose mother drank while
pregnant, including fetal growth retardation, cognitive deficits, beh’
problems, learning difficulties, often have characteristics facial f/s
Statistics on Use
M more likely than F to drink and also more likely to drink heavily
- 16% of M classified as heavy drinkers
- 4% of F classified as heavy drinkers
Drinking practices vary across societies
i.e. higher proportion of CDN than USA students drink alcohol, but higher proportion of USA students
are binge drinkers
Statistics on Abuse and Dependence
Abt 9% of CDN drinkers exp’ some level of problem w/ alcohol, w/ abt 3% CDN adults thought to be
alcohol (d) in any given year
Among general pop’n, young (18-29), single M most likely heavy drinkers and have alcohol use problems
Outside CAN, rates vary widely
- lowest reported 1.2% in rural villages in Taiwan
- highest reported 14.1% in USA
Low prevalence rates among Asian studies
- cultural diff’s can be acc’d for by diff attitudes toward drinking, availability of alcohol, physiological
reac’ns, family norms & patterns
Many who abuse/are (d) on alcohol fluctuate btwn heavy & abstinent
20% w/ severe alcohol (d) have spontaneous remission and dN re-exp’ problems w/ drinking