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Chapter 9

Chapter 9 - Very thorough textbook and class notes

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Psychology 2030A/B
David Vollick

Chapter 9 - Substance Related and Addictive Disorders Substance-Related Disorders • Why can some people stop at just one drink, while others lack the internal brakes that keep them from spiraling into addiction? Biological, psychological, and cultural factors influence the development of substance use disorders • Substance use = low- to moderate-use experiences that do not produce problems with social, educational, or occupational functioning o The definition of use makes no claims as to the legality of th e behavior • Substance intoxication = the effect of substance use varies from mild to extreme o Characterized in DSM as a substance -induced disorder o Intoxication: ▯ Reversible ▯ Substance specific ▯ Results in maladaptive behavioral or psychological changes associ ated with the CNS ▯ Effects of intoxication emerge during or shortly after drug use ▯ Can be an isolated event, or it can be a recurring state in the context of a substance use disorder • (DSM-5) Substance Use Disorder = cluster of physiological, behavioral, an d cognitive symptoms which indicate that the individual continues to use the substance despite significant problems due to use o Substance abuse disorder o Substance dependence disorder ▯ Includes intoxication, withdrawal, and other substance induced mental diso rders ▯ Withdrawal = syndrome of physical symptoms that occurs when concentration of a substance decline in an individual who had maintained prolonged and heavy use of a substance o Requires two of more symptoms present for a diagnosis ▯ Severity characterized by number of symptoms present o Behavioral features ▯ Using more than the intended amount ▯ Desiring or attempting to cut down ▯ Spending time trying to acquire the substance ▯ Giving up social, occupational, or recreational activities becaus e of substance use ▯ Continuing use despite known physical or psychological problems caused by the substance use • Tolerance = requiring an increased dose of a substance to achieve the desired effect, or having a markedly reduced effect when consuming the usu al dose • Whether a person develops a substance use disorder depends on the drug’s addictive potential and on the characteristics of the person using the drug Commonly Used “Licit” Drugs Caffeine • Overview: o CNS stimulant (boosts energy, mood, awareness, con centration, and wakefulness) o Side effects: ▯ Headache ▯ Trouble concentrating ▯ Depressed mood ▯ Irritability ▯ Inactivity ▯ Feeling foggy o Affects multiple organ systems in the body o Long-term effects include tolerance, dependence, and withdrawal o Neurotransmitter affected: Adenosine, serotonin o Has a long half-life, so some people can experience its effects for 6+ hours • Functional impairment: o Over time, caffeine may contribute to: CV disorders, reproductive problems, osteoporosis, cancer, psychiatric disturbances o 5+ cups of coffee per day can lead to: anxiety, respiratory, urinary, gastric and CV distress; restlessness, nervousness, excitement, insomnia, flushed face, diuresis, muscl e twitching, rambling flow of thought or speech, fast/irregular heartbeat ▯ Known as acute caffeine intoxication o Caffeine-associated death can occur after consumption of extremely high doses (50 -100 cups) • Epidemiology o Most widely used drug worldwide o 87% of American adults consume caffeinated beverages (soda, tea, coffee, espresso, energy drinks) Nicotine • HIGHLY addictive drug • Methods of delivery: cigarettes, cigars, pipes • Nicotine can enter the bloodstream via the lungs, mouth/nose, skin • Both a stimulant and a sedative • Produces rapid effects (relief from tension) - which is part of the reason why this drug is highly rewarding and reinforcing • Physical effects o Stimulates the adrenal glands, causes release of epinephrine, leading to the feeling of a rush ▯ Also leads to glucose release, increased blood pressure, respiration, and heart rate o Nicotine also affects the pancreas by suppressing insulin secretion (leading to elevated blood glucose) • Neurotransmitter: dopamine (directly affects the brain’s pleasure and motivation centers) • Functional Impairment: o Frequent use ▯ addiction and tolerance o Giving up smoking leads to withdrawal symptoms that can last 1+ months ▯ Depressed mood ▯ Difficulty concentrating ▯ Insomnia ▯ Restlessness ▯ Irritability ▯ Decreased heart rate ▯ Frustration/anger ▯ Increased appetite ▯ Anxiety ▯ Weight gain o Large preventable cause of death in the world o Impacts of cigarette smoking ▯ Increased risk of cancer ▯ CV disease ▯ Respiratory illness ▯ Pregnancy complications (premature birth, low-birth weight infants, stillbirth, SIDS) o 70% of smokers want to quit; only 2.3% achieve sustained abstinence • Epidemiology: o Number of people who smoke has been declining o 45.3 million Americans smoke o Present among all ethnic and racial groups, and across all socioeconomic strata Alcohol • Alcohol is a depressant • Ethyl alcohol is absorbed via the stomach and intestines into the bloodstream; then it is distributed throughout the body and quickly acts to depress the central nervous system • Neurotransmitter: GABA o Brain’s primary inhibitory neurotransmitter • Continued drinking ▯ depression of the central nervous system, impairing motor coordination, decreasing reaction times, leading to sad mood, impaired memory, poor judgment, visual and auditory disturbances • Functional impairment: o Others who drink regularly may experience tolerance o Withdrawal symptoms from chronic heavy drinking can range from mild to severe ▯ Tremors ▯ Vomiting ▯ Anxiety ▯ Headache ▯ Irritability ▯ Sweating ▯ Agitation ▯ Hallucinations ▯ Craving ▯ Formication - bugs crawling ▯ Insomnia under skin ▯ Vivid dreams ▯ Seizures ▯ Hyper-vigilance ▯ Delirium tremens o Withdrawal can be treated by benzodiazepines o Excessive consumption can lead to: ▯ Alcohol cirrhosis (liver disease; deterioration and malfunction of the liver) ▯ Wernicke-Korsakoff syndrome (confusion, amnesia, confabulation = adaptation to memory loss in which the individual fills in blanks with made -up information] ▯ Fetal alcohol syndrome • When a pregnant woman drinks, the alcohol can cross the placenta and harm the fetus • Epidemiology: o Alcohol is the second most commonly use psychoactive substance o Prevalence of alcohol abuse: 4.65% [remains stable over time] o Males > females ▯ Men are at higher risk for alcohol use disorders; women are more vulnerable to the negative consequences of heavy drinking o Whites > African Americans, Asians, Hispanics Illicit Drugs Marijuana • Comes from the Cannibis sativa plant • Can be used in food, drink, or smoked (most frequent) • Most commonly used illicit drug in the US • Active ingredient: THC o THC enters the brain and lasts for 1 -3 hours • User experiences a pleasant state of relaxation, intensified color and sound, slowed perception of time • Side effects: dry mouth, muchies, thirst, fatigue, trembling • High doses ▯ visual and auditory activity, increased heart rate and blood pressure, bloodshot eyes, anxiety, panic, and paranoia • THC binds to cannabinoid receptors in the brain which influence pleasure, learning, memory, higher cognitive functions, sensory perceptions, and motor coordination o Also activates the brain’s reward system by stimulating the release of dopamine • Functional impairment: o Heavy use: persistent memory loss, impairm ent of attention, learning skills, and motor movement; addiction, chronic respiratory problems, increased risk of head, neck, and lung cancer o Also has medicinal uses… ▯ Treatment of nausea in cancer chemotherapy, glaucoma, and appetite stimulation in people with AIDS, MS, chronic pain ▯ Many states have legalized medicinal marijuana ▯ Still need controlled clinical trials o Tolerance: none noted o Withdrawal symptoms: restlessness, loss of appetite, trouble sleeping, weight loss, shaky hands, irritability, anxiety • Epidemiology: o Most common elicit substance (18.1 million people in the US) o Males > females o Prevalence has remained relatively stable CNS Stimulants • Legal stimulants: Caffeine, Nicotine • Illegal stimulants: Cocaine, amphetamines (amphetamine, dextroamphetamine, methamphetamine) • Effects: o Euphoria o Rapid speech o Increased energy o Sense of power/courage o Mental alertness o Increased feelings of intimacy • Adverse effects: Dangerous elevations of blood p ressure and heart rate, CV abnormalities, respiratory arrest, seizures • Increase dopamine ▯ elevated mood and increased alertness • Amphetamines o FDA approved treatment of asthma, nasal congestion, ADHD, sleep disorder o Popular because they prolong wakefulnes s and suppress appetite o Can either be swallowed (pill) or injected o Increase dopamine, epinephrine, serotonin o MDMA - club drug o Crystal meth - form of methamphetamine, but is longer lasting and has more intense effects • Functional impairment: o Effects; increased heart rate and blood pressure; damage to blood vessels in the brain (stroke); paranoid anxiety; confusion; insomnia ; emaciation due to appetite suppression ▯ These effects can last for many years after last use o Tolerance: develops very rapidly o Withdrawal: depression, irritability, prolonged periods of sleep • Epidemiology: o 1.2 Americans o Males = Females o Whites > other groups Cocaine • Comes from the leaves of the coca plant o Provides relief from fatigue and hunger; also a pain killer • Legal in the US during the 1800s - it was an additive to cigars, cigarettes, Coca-Cola • Powdered form - snorted or dissolved in water and injected; Rock form - smoked • Functional impairment: o Highly addictive o Inhibits the nerve cells’ reabsorption of dopamine -- therefore a very powerful stimulant o Tolerance is common (overdose common) • Epidemiology: o 1.4 million Americans o >90% of cocaine users report using marijuana before every using cocaine (gateway drug) o Males > females o Indians > African Americans > Hispanics > Asians Sedative Drugs • 2 classes: barbiturates and benzodiazepines • CNS depressants • Barbiturates were originally prescribed to treat anxiety and insomnia, but due to their high risk of abuse, dependence and overdose, benzodiazepines are more commonly prescribed n ow • Barbiturates (Amobarbital, Pentobarbiital, Secobarbital) : o “Downers” o Act on the GABA-ergic system o Swallowed or injected o Low doses ▯ disinhibition, euphoria in an attempt to relieve feelings of anxiety o Higher doses ▯ slurred speech, decreased respiration, fatigue, disorientation, lack of coordination, dilated pupils; impaired memory and coordination, irritability, paranoid and suicidal thoughts • Benzodiazepines (Valium, Xanax): o Widely prescribed for anxiety o High doses ▯ light headedness, vertigo, muscle control problems o Safer than barbiturates (lower potential for abuse and dependence when used as prescribed) o Rohipnol ▯ Powerful benzodiazepine ▯ Causes partial amnesia ▯ “date rape drug” • Functional impairment: o Overuse ▯ over sedation and problems thinking and interacting with others o Barbiturates: ▯ Tolerance develops rapidly ▯ high risk for overdose ▯ Withdrawal produces tremors, increased BP and HR, sweating and seizures o Benzodiazepines: ▯ Tolerance develops slowly ▯ Withdrawal produces anxiety, insomnia, tremors, delirium • Epidemiology: o 59% of benzodiazepine-related hospital admissions are female o Whites and those with high levels of individuals are most common users o These drugs are most commonly prescribed to women Opioids • Heroin, morphine, codeine, methadone (synthetic) • Derived from the opium poppy (hence opioids) • Primarily used to alleviate pain • Main effects: o Pain relief o Reduced anxiety o Euphoria o Tranquility o Sedation • Side effects: narrowing of pupils, slowed heart rate, low body temperature • Mimic the body’s natural opioids (endorphins) • Smoked, snorted, injected • Functional impairment: o Tolerance develops very rapidly (2-3 days) ▯ Users may administer lethal doses o Dangers associated with heroin: tainted preparations, medical risks associated with sharing needles (hepatitis, liver damage, HIV/AIDS), violence o Withdrawal symptoms (within 4 -6 hours after) ▯ rapid breathing, yawning, crying, sweating, runny nose ▯ Worsen with chronic use ▯ hyperactivity, intensified awareness, agitation, increased HR, fever, dilated p
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