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Chapter 12

Abnormal Psych Chapter 12.doc

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Konstantine Zakzanis

Chapter 12 SubstanceRelated DisordersThe pathological use of substances falls into 2 categoriesoSubstance abuseoSubstance dependencepresence of at least 3 of the followingThe 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 takenWithdrawal symptoms negative physical and psychological effects when they stop taking itThe person uses more of the substance or uses it for a longer time than intendedThe person recognizes excessive use of the substance heshe may tried to reduce usage but has been unable to do soMuch of the persons time is spent in efforts to obtain the substance or recover from its effectsSubstance use continues despite psychological or physiological problems caused or exacerbated by the drugThe person gives up or cuts back participation in many activitiesSubstance dependence is diagnosed as being accompanied by physiological dependence aka addiction if either tolerance or withdrawal is presentFor less serious diagnoses of substance abuse the person must experience 1 of the following as a result of recurrent use of the drugoFailure to fulfill major obligationsoExposure to physical dangersoLegal problemsoPersistent social or interpersonal problemsSubstance intoxication ingestion of a substance affects the CNS and produces maladaptive cognitive and behavioural effectsIf a person addicted to a drug is denied it and then experiences withdrawal the person receives a diagnoses of both substance dependence and substance withdrawalAlcohol Abuse and DependenceAlcoholic doesnt have a precise meaningAlcohol abuse used to refer to both aspects of excessive and harmful use of alcoholAlcohol dependence may include tolerance or withdrawal reactions people who are physically dependent on alcoholIn withdrawal the person is often anxious depressed weak restless and unable to sleepChapter 12 Substance Related DisordersPage 14Delirium 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 terrifiedThe 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 dependentAlcohol abuse or dependence is often part of polydrug abuse using or abusing more than one drug at a timeoAlcohol serves as a cue for smoking smoking is 2x as frequent in situations where a person is also drinkingoComorbid with nicotine because nicotine can induce tolerance for the rewarding effects of alcohol and vise versaoThese cause problem because drugs taken together are synergistic the effects of each combine to produce an especially strong reactionPrevalence of Alcohol Abuse and Comorbidity with other disordersPrevalence 20 for men and over 8 for womendeclines with ageProblem drinking is comorbid with mood and anxiety disorders and with other drugs use and schizophrenia Its a factors in 25 of suicidesCourse of the DisorderThe 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 abuseThis 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 bingeCosts of Alcohol Abuse and DependencethAlcohol abuse is the 4 leading cause of worldwide disability than the use of tobacco or illegal drugsProblem drinkers use health services 4x more than do non abusers and their medical expenses are twice as high as those of non drinkersAlcohol is associated with many problems deaths assaults and accidentsShortterm effects of AlcoholAlcohol is metabolized by enzymes after being swallowed and reaching the stomachChapter 12 Substance Related DisordersPage 14
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