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Chapter 12

Chapter 12 - Substance Related Disorders

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Konstantine Zakzanis

Chapter 12 Substance-Related Disorders - the pathological use of substances falls into 2 categories: substance abuse and substance dependence substance dependence the abuse of a drug sometimes accompanied by a physiological dependence on it, made evident by tolerance and withdrawal symptoms; also called addiction - substance dependence is characterized by DSM-IV-TR as the presence of at least 3 of the following: the person develops tolerance, indicated by either (a) larger doses of the substance being needed to produce the desired affect or (b) the effects of the drug becoming markedly less if the usual amount is taken withdrawal symptoms negative physical and physiological effects develop when the person stops taking the substance or reduces the amount; the person may also use the substance to relive or avoid withdrawal symptoms 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 have 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 physical problems caused or exacerbated (worsened) by the drug (eg: smoking despite knowing that it increases the risk for cancer and cardiovascular disease) the person gives up or cuts back participation in many activities (work, recreation, socializing) because of the use the substance - substance dependence is diagnosed as being accompanied by physiological dependence (also called dependence) if either tolerance or withdrawal is present substance abuse the use of a drug to such an extent that the person is often intoxicated throughout the day and fails in important obligations and in attempts to abstain, but there is no physiological dependence - for the less serious diagnosis of substance abuse, the person must experience one of the following as a result of the recurrent use of the drug: failure to fulfill major obligations (eg: absencesfrom work or neglect of children) exposure to physical dangers (eg: operating machinery or driving while intoxicated) legal problems (eg: arrests for disorderly conduct or traffic violations) persistent social or interpersonal problems (eg: arguments with a spouse) - if a person addicted to a drug is denied it and then experiences withdrawal, that person receives a diagnosis of both substance dependence and substance withdrawal delirium tremens (DTs) one of the withdrawal symptoms that sometimes occurs when a period of heavy alcohol consumption is terminated; marked by fever, sweating, trembling, cognitive impairment, and hallucinations Alcohol Abuse and Dependence - DSM-IV-TR distinguishes between alcohol dependence and alcohol abuse - the term abuse is often used to refer to both aspects of the excessive and harmful use of alcohol st - those who begin drinking early in life develop their 1 withdrawal symptoms in their 30s or 40s; the effects of the abrupt withdrawal of alcohol in a chronic, heavy user may dramatic because the body has become accustomed to the drug - subjectively, the patient is often anxious, depressed, weak, restless, and unable to sleep - tremors of the muscle, especially of the small musculatures of the fingers, face, eyelids, lips, and tongue may be marked, and pulse, blood pressure, and temperature are elevate - in relatively rare cases, a person who has been drinking heavily for a number of years may also experience delirium tremens when the level of alcohol in the blood drops suddenly; the person becomes delirious as well as tremulous and has hallucinations that are primarily visual, but may be tactile - levels of alcohol in the blood of excessive drinkers are unexpectedly low after what is viewed as excessive drinking - some research suggests that tolerance results from changes in the number or sensitivity of GABA or glutamate receptors; withdrawal may be the result of increased activation in some neural pathways to compensate for alcohols inhibitory effects in the brain; when drinking stops, the inhibitory effects of alcohol are lost, resulting in a state of over excitation - the person who abuses alcohol does not show tolerance, withdrawal, or the compulsive drinking patterns seen in the person who is alcohol dependent www.notesolution.com polydrug abuse the misuse of more than one drug at a time, such as drinking heavily and taking cocaine - its estimated, for example, that 80-85% of alcohol abusers are smokers cross tolerant. - nicotine can induce tolerance for the rewarding effects of alcohol and vice versa - thus, consumption of both drugs may be increased to maintain their rewarding effects - polydrug abuse can create serious health problems because the effects of some drugs when taken together are synergistic; the effects of each combine to produce an especially strong reaction - alcohol is also believed to contribute to deaths from heroin, for it can reduce the amount of the narcotic needed to make a dose lethal Prevalence of Alcohol Abuse and Comorbidity with Other Disorders - lifetime prevalence rates for alcohol dependence defined by DSM criteria were greater than 20% for men and just over 8% for women in a large US epidemiological study - the prevalence of alcohol dependence declines with advancing age, both because of early death among long-term abusers and because of achievement of stable abstinence from alcohol among others - the prototypical heavy drinker in Canada is a young adult male who is not married and who is relatively well off financially Course of the Disorder - Jellinek 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 - although Jellineks description has been widely cited, the available evidence doesnt always corroborate it; the histories of alcohol dependent people do indeed show a progression from alcohol abuse to alcohol dependence, however, data reveal considerable fluctuations in drinking patterns, from heavy drinking for some periods of time to abstinence or lighter drinking at others - evidence also indicates that Jellineks account doesnt apply to women - difficulties with alcohol usually begin at a later age in women than in men and often after an inordinately (extremely) stressful experience, such as a serious family crisis - for women, the time interval between the onset of heavy drinking and alcohol abuse is briefer than it is for men - women with drinking problems tends to be steady drinkers who drink alone and are more unlikely than men to binge Costs of Alcohol Abuse and Dependence - data indicates that alcohol abuse is the 4 leading cause of worldwide disability - the suicide rate for alcohol abusers is much higher than that for the general population - the prototypical drinking driver in Canada is a male between 25-34 who drinks large amounts of alcohol on a regular basis or is a social drinker who occasionally drinks heavily - the likelihood of experiencing alcohol related harm may be especially high in smaller communities Short-Term Effects of Alcohol - alcohol is metabolized by enzymes after being swallowed and reaching the stomach - most of it goes into the small intestines where its absorbed into the blood - its then broken down, mostly in the liver - absorption of alcohol can be rapid, but removal is always slow - the effects of alcohol 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 - alcohol has a biphasic effect; this means that 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 - large amounts of alcohol interfere with complex thought processes; motor coordination, balance, speech, and vision are also impaired; at this stage of intoxication, some people become depressed and withdrawn - alcohol produces it effects through its interactions with several neural systems in the brain; it stimulates GABA receptors, which may be responsible for reducing tension - alcohol also increases levels of serotonin and dopamine, and this may be the source of its ability to produce pleasurable effects - finally, alcohol inhibits glutamate receptors, which may cause the cognitive effects of alcohol intoxication, such as slurred speech and memory loss Long-Term Effects of Prolonged Alcohol Abuse - chronic drinking creates severe biological damage in addition to psychological deterioration; almost every tissue www.notesolution.com and organ of the body is affected adversely by prolonged consumption of alcohol - malnutrition may be severe; because alcohol provides calories, heavy drinkers often reduce their intake of food - alcohol also contributes directly to malnutrition by impairing the digestion of food and absorption of vitamins - 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; memory gaps are often filled in with reports of imaginary, improbable events - prolonged alcohol use with reduction in the intake of proteins contributes to the development of cirrho
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