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Chapter 12

PSYB32H3 Chapter Notes - Chapter 12: Etiology, Aversion Therapy, Inhalant

Course Code
Konstantine Zakzanis

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Chapter 12: Substance-Related Disorders
The pathological use of substances falls into 2 categories
oSubstance abuse
oSubstance 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
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 persons 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
oFailure to fulfill major obligations
oExposure to physical dangers
oLegal problems
oPersistent 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 withdrawal
Alcohol Abuse and Dependence
Alcoholic doesnt have a precise meaning
Alcohol abuse: used to refer to both aspects of excessive and harmful use of alcohol
Alcohol dependence: may include tolerance or withdrawal reactions (people who are
physically dependent on alcohol)
In withdrawal the person is often anxious, depressed, weak, restless and unable to sleep
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
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tolerance, withdrawal, or the compulsive drinking patterns seen in the person who is alcohol
Alcohol abuse or dependence is often part of polydrug abuse using or abusing more than
one drug at a time
oAlcohol serves as a cue for smoking; smoking is 2x as frequent in situations where a
person is also drinking
oComorbid with nicotine because nicotine can induce tolerance for the rewarding
effects of alcohol and vise versa
oThese 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
Problem drinking is comorbid with mood and anxiety disorders and with other drugs use and
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 Jellineks account doesnt 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 than the use of tobacco or
illegal drugs
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
Short-term effects of Alcohol
Alcohol is metabolized by enzymes after being swallowed and reaching the stomach
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 persons 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
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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 though alcohol
actually lowers physiological arousal (which may be caused by cognition)
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
Womens 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 cream
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 sedatives
End up feeling euphoria and psychic numbing, but inhalants can cause damage to the CNS
Hallucinations, memory problems and dizziness can also occur
Nausea and subsequent headaches are experienced eventually in almost all cases
Nicotine and Cigarette Smoking
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