ABNORMAL TEXTBOOK NOTES
Chapter 12- substance related disorders
• The pathological use of substances falls into 2 categories: substance abuse and substance
• In DSM-IV-TR must have at least 3 of the following…
-the person develops tolerance (indicated either by larger doses of the substance being needed to produce
the desired effect or by the effects of the drug becoming markedly less if the usual amount is taken)
-withdrawal symptoms (negative physical and physiological effects)
-the person uses more of the substance or uses it for a longer time than intended
-the person recognizes excessive use of the substance/ may have tried to reduce usage but was unable to
-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 physical problems
-the person gives up/ cuts back on participation in many activities
• Substance dependence is diagnosed as being accompanied by physiological
dependence/addiction if either tolerance or withdrawal is present
• LESS SERIOUS diagnosis of substance abuse
1. Failure to fulfill major obligations
2. Exposure to physical dangers
3. Legal problems
4. Persistent social or interpersonal problems
• DT’S= an example of substance withdrawal is alcohol withdrawal delirium/delirium tremens
• Abuse- used to refer to both aspects of the excessive and harmful use of alcohol
• Dependence- may include tolerance/ withdrawal reactions
• Polydrug= using/ abusing more than 1 drug and is estimated that 80-85% of alcohol abusers are
smokers (smoking is twice as frequent in situations where a person is drinking)
• Lifetime prevalence rates for alcohol defined by the DSM = greater than 20% for men and just
over 8% for woman in a large US epidemiological study
www.notesolution.com • Jellinek 1952- described the male alcohol abuser as passing through 4 stages, beginning with
social drinking and progressing to a stage at which he lives only to drink
• Biphasic effect- the initial effect of alcohol is stimulating, the 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.
• Alcohol increases levels of serotonin and dopamine
• Prolonged alcohol use with reduction in the intake of proteins contributes to the development of
cirrhosis of the liver, a potentially fatal disease.
• Major active chemical in marijuana- THC delta-9-tetrahydrocannabinol
• Sedatives= often called downers slow the activities of the body and reduce its responsiveness.
This group of drugs includes the opiates- opium and its derivatives, morphine, heroin and
codeine, seconal and valium.
• Opiates: are a group of addictive sedatives that relieve pain and induce sleep when taken in
moderation. Opium and its derivatives morphine and heroin produce euphoria, drowsiness, reverie
and lack of coordination.
• Synthetic sedatives: barbiturates (another major type of sedative, were synthesized as aids for
sleeping and relaxing.
• Stimulants/ uppers: such as cocaine, act on the brain and the sympathetic nervous system to
increase alertness and motor activity. Amphetamines are synthetic stimulants- first one was
Benzedrine in 1927. Amphetamine’s such as Benzedrine, Dexedrine, and methedrine; produce
their effects by causing the release of norepinephrine and dopamine and blocking the reuptake of
these neurotransmitters. The heart rate quickens blood vessels in the skin and mucous membranes
constrict. The individual becomes alert, euphoric, and outgoing and is possessed with seemingly
boundless energy and self- confidence. Tolerance to amphetamines develops rapidly. The alkaloid
cocaine was extracted from the leaves of a coco plant. Freud began using cocaine to combat his
depression. Cocaine’s effects include: reducing pain, acts rapidly on the brain, blocking the
reuptake of dopamine in mesolimbic areas that are thought to yield pleasurable states; the result is
that dopamine is left in the synapse and thereby facilitates neural transmission and resultant
positive feelings. An overdose results in chills, nausea, paranoid breakdown, hallucinations and
• LSD= psychotomimetic because it was thought to produce effects similar to the symptoms of
psychosis. Then the term psychedelic, from the greek word for soul and to make manifest- was
applied to emphasize the subjectivity experienced expansions of consciousness reported by users
of LSD/ trip. Current term for LSD= hallucinogen. Mescaline, an alkaloid and the active
ingredient of peyote, was isolated from small, disc-like growths on the top of peyote cactus.
www.notesolution.com Psilocybin is a crystalline powder that Hofmann isolated from the mushroom psilocybe Mexicana
• Ecstasy= refers to 2 closely similar synthetic compounds (MDA and MDMA) used as an appetite
suppressant in ww1. Used from the 50’s-70’s for couples therapy. Second most used after weed.
Cause long term changes in brain structure and cause flood of serotonin + after we can’t produce
baseline leading to depression. Hyperthermia was the leading cause of death. Users report that the
drug enhances intimacy and insight, improves interpersonal relationships, elevates mood, and
promotes aesthetic awareness. It can also cause muscle tension, rapid eye movements, increased
heart rate and blood pressure, nausea, faintness, chills/sweating, anxiety and depression/
• Conditioning theory of tolerance: that underscores the need to jointly consider biological
processes and environmental stimuli that may be involved in the acquisition and maintenance of
• Feedforward mechanisms: are anticipatory regulatory responses made in anticipation of a drug.
They reflect the fact that we learn to anticipate drug effects before they actually occur.
• Detoxification (traditional hospital treatment): usually takes a month, tranquillizers are sometimes
given to ease the anxiety and general discomfort of withdrawal.
• Antabuse/ disulfiram (biological treatment): a drug that discourages drinking by causing violent
vomiting if alcohol is ingested. It blocks the metabolism of alcohol so tha