Chapter 12 – Substance-Related Disorders
➢ 2 categories
3 of the 7 criteria must be present
• 1) Tolerance
• 2) Withdrawal
• 3) Person continues to use substance despite adverse health effects
• 4) Person acknowledges excessive use; has tried to quit in the past but has failed
• 5) Person uses substance for a longer time than was originally intended
• 6) Misses many activities due to substance use
• 7) Spends most of his/her time trying to obtain the substance
Less serious & only requires 1 of the 4 criterias
• 1) Exposure to physical dangers (drinking & driving)
• 2) Legal problems (traffic violation)
• 3) Social & Interpersonal problems (conflict with spouse)
• 4) Failure to fulfill major obligations (attending work)
➢ Aperson can receive a diagnosis of substance dependence and withdrawal when he/she exhibits
withdrawal symptoms when refused the substance.
➢ Withdrawal example: Delerium Tremens
AlcoholAbuse and Dependence
➢ AlcoholAbuse is different from alcohol dependence
➢ Alcohol dependence
May include tolerance or withdrawal
Usually happens w/ heavy drinkers whose bodies have become accustomed to the drug
Can cause many adverse symptoms: anxious, restless, depressed, muscle tremors, Dts,
Occurs in heavy drinkers when levels of alcohol in the blood become unexpectedly low after
what is usually viewed as excessive drinking
Body adapts to the drug; becomes able to process it more efficiently
So more of the drug is needed to produce the same effects
• liver enzymes
• However, tolerance is due to psychological & physiological factors
➢ Polydrug abuse
Using more than 1 drug at a time
Pple smoke & drink at the same time because 1 drug is supposed to enhance the effects of the other
However, this can be dangerous.
Prevalence of Alcohol Abuse & Comorbidity w/ Disorders
➢ More common in men than women however rates for women becoming similar to men's.
➢ Major problems for NativeAmericans/Aboriginal Communities
➢ Prototypical heavy drinker
Ayoung adult male who is not married and who is relatively well of financially ➢ Comorbid with personality disorder, mood disorders, anxiety, & schizophrenia.
Course of the Disorder
➢ Jellinek described a trend in all drinkers where they go from social drinkers to heavy drinkers (4 stages)
➢ Although some of this is true, the pattern of drinking varies amongst drinkers.
➢ There is no single pattern of alcohol abuse.
➢ This also doesn't apply to women; they tend to get hooked on alcohol faster than men?
➢ Alcohol abuse is the 4rth leading cause of worlwide disability; it accounts for more years lost to death or
disability as opposed to tobacco or other illegal drugs.
➢ Results in car accidents; injuring drivers and others, suicide, medical expenses, rape, assault, homocide.
➢ Believed that over ½ of all murders are committed under the influence of alcohol.
➢ Adirect link between alcohol intoxication & violence.
➢ Has a biphasic effect
At 1 it produces pleasurable effects that leads to sociability and feelings of well-being (by reducing
tension via stimulating GABAreceptors & increasing seratonin & dopamine) and as the alcohol in
the blood level peaks, it then declines and leads to negative affect.
Alcohol inhibits glutumate receptors which may cause the cognitive effects
➢ However short-term effects vary depending a variety of factors
The amount of food in stomach; level of concentration of the drug
How much was ingested within a certain amount of time
➢ Your expectations of the effects have an influence
You believing that you'll experience something, will cause you to feel it
➢ Biological damage & psychological deterioration
➢ Almost every tissue and organ in body is affected by prolonged consumption of alcohol.
➢ Contributes to malnutrition by impairing digestion of food and absorption of vitamins.
➢ Could lead to cirrhosis of the liver (fatal disease) due to reduction in the intake of proteins
➢ Damage to Endocrine glands and pancreas, heart failure, stroke, hypertension, & capillary hemmorhages
➢ Destroys brain cells (loss of grey matter from temporal lobes)
➢ May produce some cognitive impairment
➢ Reduces the effectiveness of the immune system and increases chances of getting diseases (breast
➢ Fetal Alcohol Syndrome if taken during pregnancy
➢ Positive effects of alcohol (red wine) may lower cholesterol levels for light drinkers
➢ Inhalant Use Disorders
➢ Growing concern; many young children & adolescents are doing this
➢ Sniffing glue, white-out, gasoline, aerosol spray, paint, etc
Sniffing, Huffing (breathing fumes from a rag stuffed in mouth), & Bagging (Breathing fumes from
a plastic bag held up to mouth
➢ 2 out of 5 8 graders know that solvent use is dangerous; can cause damage to central nervous system
➢ They`re also dangerous because they are cheap and readily available
➢ Peak age of inhalant use is 14 & 15
➢ Inhalant use`s frequent among Natives; providing similar effects of alcohol, mainly euphoria & psychic
numbing. Nicotine and Cigarette Smoking
➢ When not smoked, tobacco can be chewed or ground into small pieces and then inhaled
➢ Nicotine is the addicting agent of tobacco
➢ We have nicotinic recpetors in our brain and these become stimulated by nicotine and thus the dopamine
neurons are also stimulated (the dopamine receptors are responsible for producing reinforcing effects)
➢ Evidence shows that nicotine may be much more addictive than originally thought
➢ Some can get addicted with their 1 puff or 1 cigarette
➢ However, mental addiction may occur earlier than physical addiction
➢ Nicotine may operate differently on the brains of females vs. Males
Females and males have different levels of activity in the brain (biological difference)
Females had much greater brain activity, however these differences disappeared when nictorine was
Could be responsible for different smoking patterns in females vs. males (Females have greater
change in cognitive activity after nicotine exposure)
Prevalence & Health Consequences of Smoking
➢ Smoking results in premature death and it is the only one that is preventable
➢ Health risks are less for cigar & pipe smokers since they don`t inhale but cancers of the mouth is still a
➢ Medical Problems
Cardiovascular disease, lung cancer, emphysema, cancer of the larynx
Harmful components of tobacco
Nicotine, Carbon monoxide and tar (consists of carcinogens)
The risks for such problems could be reduced after quitting however, your lung won`t ever get back
to the way it used to be
➢ Studies indicate:
Annual comparisons show that fewer Canadians are smoking, & smokers are smoking fewer
cigarettes on a daily basis
High prevalance rate amongstAboriginal People in Canada
Increasing in teenagers
Decreasing in grades 5 to 9
➢ Smoking may lead to errectile problems in men.
➢ Consequences of Second-Hand Smoke
➢ 2 hand smoke contains higher concentrations of ammonia, carbon monoxide, nicotine, & tar than does
the smoke actually inhaled by the smoker
➢ Dangerous as asbestos & radon
➢ Chances of getting lung disease (25%) and heart disease (10%) with frequent exposure
➢ Infants & children can suffer from middle year infenction, respiratory illnesses, sudden infant death
➢ Consists of the dried and crushed leaves and flowering tops of the hemp plant Cannabis sativa.
➢ Most often smoked, but it may be chewed, prepared as tea, or eaten in baked goods
➢ It was first used for its fibres in making cloth and rope
➢ It was then used as medication for treating cholera and such, and even though people smoked it for
pleasurable effects, it wasn`t that popular
➢ It became popular when alcohol was banned
➢ It was banned due to its link with crimes ➢ It`s now banned in Canada
Effects of Marijuana
➢ Effects depend on dosage size