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Chapter 17

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Stephanie Cassin

Chapter 17: Substance-related disorders Substance: any natural or synthesized product that has psychoactive effects (changes perceptions, thoughts, emotions, and behaviors) - A person need not be physically dependent on drug to have problems from taking substance - Some stats: o cocaine use higher in US, LSD higher in Canada o illicit drug use highest in young adults o men more likely than women to have used substance in lives o but once women use substance are at least as likely to become dependent on it and may suffer greater physiological damage than men o peaked in 1970s Society and substance use - strict any drug laws in China - in Great Britain, substance addiction considered medical disease, treated by physicians o traffickers are prosecuted, but users given treatment - Dutch system o Soft drugs (cannabis) versus hard drag o Both illegal, but cannabis rarely prosecuted o Based on belief that if enforce strict prohibition of soft drugs, would go underground and more likely to get hard drugs too - "needle park" in Zurich, Switzerland allowed by authorities. Now closed. - Medicinal purposes o 1500 B.C. natives chewed coca leaves to increase endurance (cocaine) o In twentieth century, cocaine in Coca Cola and other drinks used to relieve fatigue o Opium (from poppy plant) used to relieve pain o Khat plant used in Middle East, South America, Africa to relieve fatigue o Modern derivatives of khat used to make amphetamines Class of drugs used to treat ADD, narcolepsy, obesity, over-the- counter cold remedies, appetite suppressants - Religious ceremonies o Peyote cactus causes visual hallucinations. Used by Aztecs Substance related disorder: use of substances leads to significant problems in ability to function in daily lives Alcohol is associated with over half of traffic accident deaths, 30% of all suicides - Costs Canada $14 billion per year Substances grouped into FIVE categories 1) Central nervous system depressants a. Alcohol, barbiturates, benzodiazepines, inhalants 2) Central nervous system stimulants a. Cocaine, amphetamines, nicotine, caffeine 3) Opiods a. Heroin, morphine 4) Hallucinogens and phencyclidine (PCP) 5) Cannabis Also have mixed group called club drugs -> ecstasy, GHB, ketamine, rohypnol And also other substances used for intoxicating effects that rarely lead to substance related disorders. - Most people don't experience any or only mild psychoactive and transient effects, but some do - Given diagnosis of other substance-related disorder SEE PAGE 603 tables!!! FOUR substance-related disorders 1) Substance intoxication 2) Substance withdrawal 3) Substance abuse 4) Substance dependence 1) Substance intoxication -> set of behavioral and psychological changes that occur as a direct result of the physiological effects of a substance on the CNS - Perceptions change, attention diminished, good judgment gone, can't think straight - Can't control bodies as well as they normally can - Either want to sleep a lot or not at all - Interpersonal interactions change -> more aggressive or more withdrawn Intoxication begins to decline as amount of a substance in blood or tissue declines, but symptoms may last for hours or days after substance no longer in body. - Specific symptoms depend on what substance is taken, how long, user's tolerance - For example, short term cocaine -> outgoing, friendly, upbeat o Chronic use -> withdrawn, less gregarious - Also expectations about substance can alter symptoms o Those who are frightened about disinhibition of marijuana may experience anxiety - Also setting in which substance is taken can influence symptom types and how maladaptive Diagnosis only given if significantly maladaptive and disrupt person's life 2) Substance withdrawal -> set of physiological and behavioural symptoms that result when people who have been using substances heavily for prolonged periods of time stop using them or greatly reduce their use - Symptoms are typically the opposite of intoxication symptoms of same substance Only get diagnosis if cause significant distress or impairment in functioning - For example, caffeine withdrawal (nervousness, headaches) is annoying but NOT including in DSM! Symptoms can begin a few hours after stop taking drug that breaks down quickly - More intense symptoms usually end within a few days to few weeks - However, seizures for example can develop several weeks after take high doses of substance that takes a while to leave body (such as some antianxiety substances) - Subtle signs (problems in attention, perception, motor skills) may be present for many weeks or months after 3) Substance abuse -> When a person's recurrent use of a substance results in significant harmful consequences Four categories of harmful consequences i) Fails to fulfill important obligations at work, school, or home ii) Repeatedly uses substance in situations where it is physically hazardous to do so (like driving) iii) Repeatedly has legal problems as a result of substance use iv) Continues to use the substance, even though he or she has repeatedly had social or legal problems as a result of the use - Person has to show repeated problems in at least one of these for 12 month period for diagnosis - Can evolve into dependence which is considered a more advanced condition that abuse! 4) Substance dependence -> closest to what is referred to as drug addiction Physiologically dependent when he or she shows either tolerance or withdrawal from the substance - Tolerance: experience less and less effect from the same dose and needs greater doses to get intoxicated o e.g. smoking cigs - a highly tolerant person has very high blood level of substance without being aware of any effects (e.g. alcohol tolerance) - risk for tolerance varies between substances o alcohol, opiods, stimulants, nicotine are high risk o cannabis and PCP are low risk - also often show sever withdrawal symptoms when stop taking drug physiological dependence is NOT required for diagnosis though - diagnosis can be given when person compulsively uses a substance, despite experiencing social, occupational, psychological, or medical problems because of it - "craving" Way substance is administered important factor in determining how rapidly become intoxicated and will produce withdrawal symptoms or lead to abuse or dependences - Those that produce rapid and efficient absorption lead to more intoxication and greater likelihood of dependence o Injecting, smoking, snorting (rather than eating or drinking) o Also more likely to overdose this way - Those that act more rapidly on CNS more likely to lead to faster intoxication and dependence/abuse - Those whose effects wear off quickly more likely to lead to dependence or abuse than those with long-lasting effects Depressants Slow activity of CNS In moderate doses, make relaxed and sleepy, reduce concentration, impair thinking and motor skills In heavy doses, induce stupor Alcohol Effects on brain occur in two phases - Low doses: feel self-confident, more relaxed, slightly euphoric, less inhibited - High doses: symptoms of depression such as fatigue, lethargy, decreased motivation, sleep disturbances, depressed mood, confusion - Even low doses can severely impair sexual functioning - Once sober, may have amnesia (known as blackout) for events that occurred during intoxication
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