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Chapter 12

PSYB32_Chapter 12

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Konstantine Zakzanis

Chapter 12-Substance Related Disorders Substance dependence is characterized by at least THREE of the following: o Toleranceindicated by a larger does needed to produce an effect or the effects become less if the usual amount is taken o Withdrawalnegative physical and psychological effects if the person stops taking the substance o The person uses more of the substance or for longer periods o Tries to reduce usage but is unable to do so o Much of the time is spent trying to obtain or recover from the substance o Substance use continues despite physical or psychological problems o Cut back in many activities Substance dependence is diagnosed with physiological dependence if tolerance OR withdrawal is presentmore severe The less severe substance abuse the person must experience ONE of the following: o Failure to fulfil obligations o Exposure to physical dangers o Legal problems o Social or interpersonal problems Substance intoxication is when a substance effects the CNS and creates maladaptive behavioural or cognitive effects Alcohol Abuse and Dependence The term abuse refers to excessive and harmful aspects of alcohol A person with alcohol dependence may experience tolerance or withdrawal The person become anxious, restless, and tremors of muscles with higher blood pressure In rare cases a person may experience delirium tremensperson has hallucinations that are primarily visual Alcohol in the blood of people who have built a tolerance is very low because the body adapts the drug and processes it better Tolerance may be due to the number or sensitivity changes of GABA or glutamate receptors. Withdrawal may be the result of the ending of inhibitory effects of alcohol resulting in a state of overexitation Alcoholics may eventually suffer memory loss and blackouts during events A person who abuses alcohol shows impairment in social or occupation aspects but does not show tolerance or withdrawal Polydrug abuse is using more than one drug at a time o 85% of people who drink smoke as well o Nicotine can induce a tolerance for the effects of alchohol and vice versa Prevalence of Alcohol Abuse and Comorbidity with Other Disorders Alcohol abuse common among Native Americans Problem drinking comorbid with mood and personality disorders Binge Drinking at Universitites, Colleges, and Schools 1 out of 6 met criteria for heavy drinking Students living at home were less likely to be heavy drinkers Greater proportion of Canadian students drink but heavy alcohol use is higher with American students Single parents, parents from blended families and higher achieving parents were more clued in about their childrens illicit drug use Being male, living or residence, and having a high recreational orientation and low education orientation increased the likelihood of being a heavy drinker Course of the Disorder There is no single pattern of alcohol abuse Difficulties with alcohol begin later in women than men and usually after a stressful experience o Alcohol abuse is briefer, and they then to be steady drinkers that drink alone and less likely to binge Costs of Alcohol Abuse and Dependence Fourth cause of worldwide disability The typical drinking and driver is between 25 and 34 A large portion of drinking drivers engage in anti social acts Short Term Effects of Alcohol Is metabolized by enzymes and is absorbed into blood in the small intestines It is then broken down in the liver which can metabolize 30 ml of 50% alcohol an hour Absorption is rapid, removal is slow The effects of alcohol vary with concentration in bloodstream, which depends on amount ingested, the presence of food in the stomach (to reduce it absorption rate) and the size of a persons body and liver The effects of alcohol is biphasicthe initial effect is stimulating (sociability, feels good) when the blood alcohol level rises but as blood alcohol levels begins to drop it acts as a depressant and leads to negative emotions Alcohol stimulates GABA receptors used to alleviate tension and increases levels of serotonin and dopamine Alcohol also inhibits glutamate receptors causing cognitive effects such as memory loss and slurred speech Some short term effects of alcohol are strongly linked to the drinkers expectations (placebo) o Example: it increases sexual arousal (in reality it actually impedes it) Long Term Effects of Prolonged Alcohol Abuse Heavy drinkers reduce food intake because alcohol provides many empty calories Alcohol contributes to malnutrition by impairing the digestion of food and absorption of vitamins Memory gaps are common with people filling in imaginary things Prolonged alcohol use destroys the liver There is also risk of stroke, damage of endocrine glands and pancreas and capillary hemorrages responsible for swelling in the face (especially nose) There is also lose of grey matter in temporal lobes Alcohol consumption during pregnancy can cause fetal alcohol syndromethe growth of the fetus is slowed resulting in abnormalities Most pregnant women drink not knowing they are pregnant due to half of pregnancies are unplanned Light drinking of wine can result in decreased risk of coronary heart disease The French paradox: despite diets rich in fats, they have low cholesterol, some hypothesize wine is the result of this Inhalant Use Disorders Especially prevalent in Native children Most act as depressants such as alcohol Nicotine and Cigarette Smoking Nicotine is the addicting agent of tobacco and stimulates nicotinic receptors in the brain that stimulate dopamine neurons in the mesolimbic area Addiction starts shortly after the first puff Female smokers have greater changes in cognitive activity after nicotine exposure
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