PSYB32H3 Chapter Notes - Chapter 12: Fetal Alcohol Spectrum Disorder, Substance Abuse, Substance Intoxication

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Published on 2 Jul 2012
School
UTSC
Department
Psychology
Course
PSYB32H3
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 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
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 doesn’t 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
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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
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 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 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
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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 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 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
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