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Chapter 12

PSYB32H3 Chapter Notes - Chapter 12: Delirium Tremens, Substance Intoxication, Substance Abuse

Course Code
Konstantine Zakzanis

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Chapter 12: Substance-Related Disorders
The pathological use of substances falls into 2 categories
Substance abuse
Substance dependence ! presence of at least 3 of the following
The person develops tolerance, indicated by larger doses of the substance being
needed to produce the desired effect or the effects of the drug becoming markedly
less if the usual mount is taken
Withdrawal symptoms (negative physical and psychological effects when they stop
taking it)
The person uses more of the substance or uses it for a longer time than intended
The person recognizes excessive use of the substance, he/she may 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 use continues despite psychological or physiological problems caused or
exacerbated by the drug
The person gives up or cuts back participation in many activities
Substance dependence is diagnosed as being accompanied by physiological
dependence (aka addiction) if either tolerance or withdrawal is present
For less serious diagnoses of substance abuse, the person must experience 1 of the
following as a result of recurrent use of the drug
Failure to fulfill major obligations
Exposure to physical dangers
Legal problems
Persistent social or interpersonal problems
Substance intoxication: ingestion of a substance affects the CNS and produces
maladaptive cognitive and behavioural effects
If a person addicted to a drug is denied it and then experiences withdrawal, the
person receives a diagnoses of both substance dependence and substance
Alcohol Abuse and Dependence
Alcoholic doesn’t have a precise meaning
The term abuse is used to refer to both aspects of the excessive and harmful use of
Alcohol dependence may include tolerance or withdrawal reactions (people who are
physically dependent on alcohol)
People who are physically dependent have more severe symptoms
In withdrawal the person is often anxious, depressed, weak, restless and unable to
Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly the
person has hallucinations (happens when a person has been drinking for a number
of years). They may feel like spiders are crawling on them, feel feverish,
disoriented and terrified
The person who abuses alcohol, in contrast to the person physically dependent on it,
experiences negative social and occupational effects from the drug but does not
show tolerance, withdrawal, or the compulsive drinking patterns seen in the person
who is alcohol dependent
Alcohol abuse or dependence is often part of polydrug abuse using or abusing
more than one drug at a time
Alcohol serves as a cue for smoking; smoking is 2x as frequent in situations where
a person is also drinking

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Comorbid with nicotine because nicotine can induce tolerance for the rewarding
effects of alcohol and vise versa
These cause problem because drugs taken together are synergistic the effects of
each combine to produce an especially strong reaction
Prevalence of Alcohol Abuse and Comorbidity with other disorders
Prevalence 20% for men and over 8% for women ! declines with age (because of
early death from long term abusers or stable abstinence)
Rates if problem drinking among women are approaching those of men
Problem drinking is comorbid with mood and anxiety disorders and with other
drugs use and schizophrenia
It’s a factors in 25% of suicides
Course of the Disorder
The histories of alcohol dependent people do show a progression from alcohol
abuse to alcohol dependence but data shows considerable fluctuations in drinking
patterns from heavy drinking from some periods of time to abstinence or lighter
drinking at others
Heavy use of alcohol may be restricted to weekends or long periods of abstinence
may be interspersed with binges of continual drinking for several weeks
There is no single pattern of alcohol abuse
This Jellinek’s account doesn’t apply to women. For women the interval between the
onset of heavy drinking and alcohol abuse is briefer than it is for men
Women with drinking problems tend to be steady drinkers who drink alone and are
more unlikely than men to binge
Costs of Alcohol Abuse and Dependence
Alcohol abuse is the 4th leading cause of worldwide disability
Alcohol abuse accounts for more years lost to h
Problem drinkers use health services 4x more than do non abusers, and their
medical expenses are twice as high as those of non drinkers
Alcohol is associated with many problems, deaths, assaults and accidents
Over half of all murders are committed under the influence of alcohol
Short-term effects of Alcohol
Alcohol is metabolized by enzymes after being swallowed and reaching the
Most goes to the small intestines and is broken mostly by the liver (which can
metabolize about 50%/hour)
The excess quantities stay in the bloodstream
Absorption of alcohol is rapid but removal is always slow
The effects of the drug vary with the level of concentration of the drug in the
bloodstream, which in turn depends on the amount ingested in a particular period
of time, the presence or absence of food in the stomach to retain the alcohol and
reduce its absorption rate, the size of a person’s body and the efficiency of the liver
It has biphasic effect which means the initial effect of alcohol is stimulating – the
drinker experiences an expansive feeling of sociability and well-being as the blood-
alcohol levels rises- but after the blood-alcohol level peaks and begins to decline,
alcohol acts as a depressant that may lead to negative emotions
Motor coordination, balance, speech, and vision is also impaired
Large doses can cause sedation, sleep and even death
Alcohol stimulates GABA receptors, which may be responsible for reducing tension,
it also increases the level of serotonin and dopamine (pleasurable effects)
Alcohol also inhibits glutamate receptors; which may cause the cognitive effects of
alcohol intoxication (slurred speech and memory loss)
People who actually drink alcohol also report increased sexual arousal, even

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though alcohol actually lowers physiological arousal (which may be caused by
Long-term effects of Prolonged Alcohol Abuse
Almost every tissue and organ of the body is affected adversely by prolonged
consumption of alcohol ! malnutrition may be severe
In older chronic alcohol abusers, a deficiency of B-complex vitamins can cause
amnestic syndrome, a severe loss of memory for both recent and long-past events
Cirrhosis (some liver cells become engorged with fat and protein, impeding their
function; some cells die- triggering the inflammatory process) of the liver is caused
by prolonged alcohol use with reduced protein
Damage to the endocrine glands and pancreases, heart failure, hypertension,
stroke, and capillary haemorrhages, which are responsible for the swelling and
redness in the face (nose)
Prolonged use of alcohol appears to destroy brain cells
Reduces effectiveness of the immune system and increases susceptibility to
infection and cancer
Women’s risk of breast cancer increases steadily with drinking
Heavy alcohol during pregnancy causes mental retardation (the growth of the
fetus is slowed, and cranial ,facial and limb abnormality are produced) -- fetal
alcohol syndrome
Some say that light amounts of alcohol may actually have its physiological gains
but it’s still a controversy
Inhalant use Disorders
An alarming number of young people begin their substance abuse by inhaling
such substances as glue, white-out correction fluid, spray paint, cosmetics, gasoline,
household aerosol sprays and the nitrous oxide found in spray cans of whipped
Peak age of inhalant use is 14-15 years of age (initial onset as young as 6)
Involves behaviours such as sniffing, huffing and bagging
Most inhalants act as a depressant and can be seen as similar to alcohol and
End up feeling euphoria and psychic numbing, but inhalants can cause damage to
the CNS too
Hallucinations, memory problems and dizziness can also occur
Nausea and subsequent headaches are experienced eventually in almost all cases
Nicotine and Cigarette Smoking
Nicotine is the addicting agent of tobacco; it stimulates receptors called nicotinic
receptors in the brain ! stimulates the dopamine neurons in the mesolimbic area
(involved in producing the reinforcing effects of most drugs)
Prevalence and Health Consequences
Smoking has caused more than 45 000 deaths annually in Canada
Health risks for smoking are significantly less for cigar and pip smokers because
they seldom inhale the smoke into their lungs, but cancer of the mouth are
Risks ! lung cancer, emphysema, cancer of the larynx and of the esophagus, and a
number of cardiovascular disease
The most harmful components of smoke from burning tobacco are nicotine, carbon
monoxide and tar; the latter consists primarily of certain hydrocarbons, including
known carcinogens
Smoking decline greatly after 10 years after quitting
Students smoke the most when not living at home but not compared to US
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