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PSYB32H3 (1,174)
Chapter 12

chapter 12

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 12: Substance-Related Disorders Pathological use of substance falls into two categories: substance abuse and substance dependence o Substance dependence is characterized by the DM4 as the presence of at least 3 of the following: Person develops tolerance, indicated by either (a) larger doses of the substance being needed to produce the desired effects (b) effects of drug becoming markedly less if the usual amount is taken Withdrawal symptoms: negative physical and psychological effects- develop when the person stops taking the substance or reduces the amount. Person may also used substance to relieve or avoid these symptoms Person uses more of the substances or uses it for a longer time than intended Person recognizes excessive use of the substance; they may have tried to reduce usage but unable to do so Much of persons time is spent in efforts to obtain the substance or recover from its effects Substance use continues despite the psychological or physical problems caused or exacerbated by the drug Person gives up or cuts back participation in many activities because of the use of the substance o SD is diagnosed as being accompanied by physiological dependence (addiction) if either tolerance or withdrawal is present-- physical dependence on a drug is associated with more severe problems o Less serious diagnoses of substance abuse, person must experience one of the following as a result of recurrent use of the drug Failure to fulfil major obligations (absences from work; neglect of children) Exposure to physical dangers (operating machinery or driving while intoxicated) Legal problems (arrests for disorderly conduct; traffic violations) Persistent social or interpersonal problems (arguments with spouse) Substance intoxication: ingestion of substance affects the CNS and produces maladaptive cognitive and behavioural effects If a person is addicted to a drug and is denied it and then experiences withdrawal, that person receives diagnosis of both substance dependence and substance withdrawal Substance withdrawal: alcohol withdrawal delirium: DTs (delirium tremens) Drugs can cause dementia and symptoms of other axis I disorders ALCOHOL ABUSE & DEPENDENCE Abuse refer to both aspects of excessive and harmful use of alcohol Alcohol dependence: may include tolerance or withdrawal reactions o Those who begin drinking early in life develop their first withdrawal symptoms in their 30s or 40s www.notesolution.com o Effects of abrupt withdrawal of alcohol in a chronic, heavy user may be dramatic because the body has become accustomed to the drug o Patient is anxious, depressed, weak, restless and unable to sleep; tremors of the musclessmall musculatures of the fingers, face, eyelids, lips and tongue, pulse, BP and temperature are elevated o In rare cases they may also experience delirium tremors when the level of alcohol in the blood drops suddenly o The person may become delirious as well as tremulous and has hallucinations that are primarily visual, but may be tactile as well o Unpleasant and very active creatures- snakes, roaches, spiders- may appear to be crawling on the wall or over the persons body or they may fill the room--Feverish, disoriented and terrified, the person may claw frantically at his skin to get rid of the vermin or may cower in the corner to escape army of animals o Delirium and physiological paroxysms caused by withdrawal of alcohol indicates its addictive Increased tolerance is evident following heavy, prolonged drinking; blood alcohol levels are unexpectedly low in these people suggesting that the body adapts to the drug and becomes able to process it more efficiently Tolerance may result from liver enzymes that metabolize alcohol; CNS involved; changes in number or sensitivity of GABA or glutamate receptors Withdrawal may result of increased activation in some neural pathways to compensate for alcohols inhibitory effects in the brainwhen drinking stops, inhibitory effects of alcohol are lost, resulting in state of over-excitation Tolerance is mostly due to physiological factors; Vogel-Sproutt say there are psychological factors involved too since response expectations and consequences of behaviour can have a direct influence on tolerance and effects of alcohol Development of addictions often reflects the interplay of biological and psychological factors The person who abuses alcohol experiences negative social and occupational effects from drug but does not show tolerance, withdrawal or 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) o 80-85% of alcohol abusers are smokers o High level of comorbidity may occur because alcohol and nicotine are cross-tolerantnicotine may induce tolerance for the rewarding effects of alcohol and vice versa, thus consumption of both drugs may be increased to maintain their rewarding effects o Polydrug use may create serious heath problems because the effects of some drugs when taken together are synergistic; effects of each combined to produce an especially strong reactioni.e. mixing of alcohol and barbiturates if a common means of suicide, intentional and accidental Alcohol is believed to contribute to deaths from heroin, for it can reduce the amount of the narcotic needed to make a dose lethal www.notesolution.com Prevalence of Alcohol abuse and comorbidity with other disorders Life time prevalence rates for alcohol dependence defined by DSM were greater than 20% in men and 8%in women in USA 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 Rates of problem drinking among young women are approaching those of men Alcohol abuse is common among Native American people and is associated with 40% deaths and with all crimes committed by these people Alcohol abuse and abuse of other substances is an extremely serious problem in many aboriginals communities in Canada Problem drinking is comorbid with several personality disorders; Canadian researchers have sought to identify genetic factors that are common to personality disorders and alcohol misuse Problem drinking is also comorbid with mood and anxiety disorders, with other drug use and schizophrenia It is a factor in 25% suicides Course of the Disorder Male alcohol abuser pass through 4 stages, beginning with social drinking and progressing to a stage at which he lives only to drink There is considerable fluctuations in drinking patterns, from heavy drinking for some periods of time to abstinence or lighter drinking at others Patterns of maladaptive use of alcohol are more variable o Heavy use of alcohol may be restricted to weekends, or long periods of abstinence maybe interspersed with binges of continual drinking for several weeks o No single pattern of alcohol abuse Difficulties with alcohol usually begin at a later age in women than in men and often after an inordinately stressful experience such as a serious family crisis For women time 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 Cost of Alcohol Abuse and Dependence Alcohol abuse is the fourth leading cause of world wide disability Alcohol abuse accounts for more years lost to death or disability than the use of either tobacco or illegal drugs www.notesolution.com People who abuse alcohol constitute a large proportion of new admissions to mental and general hospitals Problem drinkers use health services 4 times more than non-abusers and their medical expenses are twice as high as those of non-drinkers Suicide rate of alcohol abusers is much higher than that for general population Alcohol increase likelihood and severity of traffic accidents Prototypical drinking driver in Canada is a male b/w ages 25-34 who drinks large amounts of alcohol on a regular basis or is a social drinker who occasionally drinks heavily Substantial proportion of impaired drivers have a general tendency to engage in anti-social acts Likelihood of experiencing alcohol-related harm may be especially higher in smaller communities Alcohol may contribute to other injuries like rape, assault and family violence and homicide Over half of all murders are committed under the influence of alcohol Alcohol is the drug with the most evidence of there being a direct link b/w intoxication and violence Short Term Effects of Alcohol It is metabolized by enzymes after being swallowed and reaching the stomach Most of it goes to small intestine where it is absorbed into the blood It is broken down mostly in the liver (it metabolizes 30 mL of 100-proof whisky per hour); quantities in excess of this amount stay in the blood stream Absorption of alcohol can be rapid, but removal is always slow Effects of it vary with level of concentration of the drug in the bloodstream, which in turn depends on the amount ingested in particular period of time, the presence or absence of food in the stomach to retain the alcohol and reduce its absorption rate, size of the persons body and the ef
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