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Chapter

PSYB32H3 Chapter Notes -Methamphetamine, Xerostomia, Binge Drinking


Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis

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Chapter 12: Substance-Related Disorders
The pathological use of substances falls into 2 categories:
Substance dependence: characterized by DSM-IV-TR as presence of at least three of the
following:
Person develops tolerance, indicated by either larger doses of the substance being
needed to produce the desired effect OR the effects of the drug becoming markedly less
if the usual amount is taken
Withdrawal symptoms (negative physical and psychological effects- develop when the
person stops taking the substance or reduces the amount). An example of substance
withdrawal is alcohol withdrawal commonly known as the delirium tremens
Person uses more of the substance or uses it for a longer time than intended
Person recognizes use of the substance; he/she may have tried to reduce usage but has
been unable to do so
Much of the person’s time is spent in efforts to obtain the substance or recover from its
effects
Substance or use continues despite psychological or physical problems caused by the
drug (smoking- knowing that it increases the risk for cancer
Person gives up or cuts back participation in many activities
- DSM-5 has suggested that pathological gambling fall into substance dependence description, as well as
other behavioural addictions
- DSM-5 may drop distinction between substance abuse and dependence and instead replace with an
inclusive category named addiction and related disorders
both disorders should be included on a single continuum
Substance abuse (less serious): person must experience one of the following as a result of re-
current use of the drug
Failure to fulfill major obligations (absence from work or neglecting children)
Exposure to physical dangers (operating machinery or driving while intoxicated)
Legal problems (arrests for disorderly conduct or traffic violations)
Persistent social or interpersonal problems (arguments with a spouse)
- DSM-IV-TR section on substance-related disorders involves other diagnoses:
substance intoxication: diagnosed when the ingestion of a substance affects the CNS and produces
maladaptive cognitive and behavioural effects
ALCOHOL ABUSE AND DEPENDENCE
- Those who begin drinking in early life develop their first withdrawal symptoms in their 30’s or 40’s
- alcohol dependence may include tolerance and withdrawl reactions
- patient is often anxious, depressed, weak, restless and unable to sleep tremors of muscles, pulse
increases, blood pressure and temperature elevations are also common
- In rare cases, a person who has been drinking heavily may experience delirium tremens when the level
of alcohol in the blood drops suddenly
person will have hallucinations (snakes, cockroaches, spiders may appear to be crawling up the wall or
over the person’s body, person may claw at his/her own skin to get rid of it
- increase tolerance is evident following heavy, prolonged drinking levels of alcohol in blood may also
be low compared to what they drank, suggesting that the body adapts to the drug and becomes able to
process it more efficiently

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- changes in liver enzymes that metabolize alcohol may account for tolerance, but research may indicate
that tolerance results from changes in the number or sensitivity of GABA or glutamate receptors
- withdrawl may result from a loss of the inhibitory effects in the brain of alcohol, leading to a state of
excitation
- a person who abuses alcohol rather than is physically dependent on it, experiences negative social and
occupational effects from the drug, but does not show tolerance, withdrawal or the compulsive drinking
patterns usually seen in alcohol dependance
- Polydrug or polysubstance abuse: using/abusing more than 1 drug at a time (estimated that 80-85% of
alcohol abusers are smokers too)
alcohol serves as a cue for smoking smoking is twice as frequent in situations where person is
always drinking
nicotine and alcohol have cross-tolerance: nicotine can induce tolerance for the rewarding effects of
alcohol and vice versa
can create serious health problems (mixing alcohol and barbiturates is a common means of suicide)
alcohol is believed to contribute to the deaths from heroin, for it can reduce the amount of the
narcotic needed to make a dose lethal
- lifetime prevalence of alcohol misuse was more than 3 in 10, and only 1 in 4 with alcohol dependence
ever received treatment
- prevalence rates are higher in males, younger cohorts and whites
- The prototypical drinking driver in Canada is a male between the ages of 25 and 34 who drinks large
amounts of alcohol on a regular basis or is a social drinker who occasionally drinks heavily
- problem drinking is also comorbid with mood and anxiety disorders, and with other drug use and
schizophrenia
- drinking is on the rise in Canada over past decade, there was a 9% increase in alcohol consumption,
with the increase being almost twice as high in BC
alcohol related deaths increased to a similar degree
- big problem with binge drinking in college and university students - study revealed that 50% of men
and 40% of women have engaged in binge drinking (having five drinks in a row for men and four for
women)
- ¼ students frequently binge drank, at least once a week
- seems that greater proportion of Canadian students drink, but heavy alcohol use is higher among
American students
- students who reported having their first experience of drunkness before age 16 are more likely to be
heavy drinkers in college
- great lack of parental awareness on child’s substance abuse (only 34% were aware of the use) – single
parents, parents from blended families and higher-achieving student’s parents were more likely to know
about their childs drug use
- many believe that alcohol abusers have a common downhill progression abuser passes through four
stages, beginning with social drinking and progressing to stage at which he only lives to drink
- however, do not always see a progression from alcohol abuse to alcohol dependence do not have
one single pattern of alcohol abuse
- difficulties with alcohol usually begin later in women than men, and are often after a stressful
experience
also the time between the onset of heavy drinking and alcohol abuse is briefer in women than in men
- problem drinkers use health services four times more often than non-abusers, and their medical
expenses are twice as high as non-drinkers
-suicide rate is higher in drinkers than for general population
- alcohol contributes to many accidents and other injuries, such as rape, assault, and family violence

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Short-term effects of alcohol:
Alcohol is metabolized by enzymes after being swallowed and reaching the stomach
Most of it goes into the small intestines where it is absorbed into the blood
Then it is broken down, mostly in the liver which can metabolize about 30 millilitres of 50%
alcohol per hour (quantities in excess of this amount stay in the blood stream)
Absorption of alcohol can be rapid, but removal is always slow
Effects of alcohol vary with level of concentration in bloodstream, which in turn depends on the
amount ingested, the presence or absence of food in stomach to retain the alcohol and reduce
its absorption rate, the size of the persons body, and the efficiency of the liver
Has a biphasic effect - Initial effect of alcohol is stimulating- drinker experiences an expansive
feeling of sociability and well-being as the blood-alcohol level rises, but after the blood-alcohol
level peaks and begins to decline, alcohol acts as a depressant that may lead to negative
emotions
Large amounts of alcohol interfere with complex thought processes, motor coordination,
balance, speech, and vision
Alcohol produces its effects through its interactions with several neural systems in the brain
stimulates GABA receptors, increases levels of serotonin and dopamine (may be the source of
pleasurable effects) and inhibits glutamate receptors, which may cause the cognitive effects of
alcohol intoxication, like slurred speech and memory loss
Long-term effects of prolonged alcohol abuse:
Chronic drinking creates severe biological damage and psychological deterioration
Almost every tissue and organ of the body is affected adversely by prolonged consumption of
alcohol
A pint of 80-proof spirits supplies about half a day’s caloric requirements (these calories don’t
supply the nutrients essential for health), heavy drinkers often reduce their intake of food
Alcohol also contributes directly to malnutrition by impairing the digestion of good and
absorption of vitamins
Eg. Deficiency of B complex vitamins can cause amnestic syndrome, severe loss of memory for
both recent and long past events
Prolonged alcohol use with reduction in the intake of proteins contributes to the development
of cirrhosis of the liver, a potentially fatal disease in which some liver cells become engorged
with fat and protein, obstructing their function may also get formation of scar tissue in liver,
which obstructs blood flow, causing further cell damage
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 (especially the nose) of chronic alcohol users
Alcohol reduces the effectiveness of the immune system and increases susceptibility to infection
and cancer
Women’s risk of breast cancer increases steadily with the amount they drink
Heavy alcohol consumption during pregnancy is the leading cause of mental retardation (Fetal
alcohol syndrome: growth of fetus is slowed, & cranial, facial, & limb anomalies are produced)
FAS has great human and economic cost, occurring around 1 in every 100 pregnancies, thus
costing health care billions annually
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