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Chapter 12&13

Chapter 12 & 13 - Substance Use Disorders & Eating Disorders and Related Conditions

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Western University
Psychology 2320A/B
Elizabeth Hayden

Chapter 12: Substance Use Disorders Adolescent Substance Use Disorders  Substance use disorder (SUDs) during adolescence include substance dependence and substance abuse o Result from self-administration of any substance that alters mood, perception or brain functioning o Almost all abused substance lead to psychological dependence, some also extend to physical dependence o Psychological dependence – refers to the subjective feeling of needing the substance to adequately function o Physical dependence – occurs when the body adapts to the substance’s constant presence  Withdrawal – adverse physiological symptom that occurs when consumption of an abused substance is ended abruptly and is thus removed from the body  Tolerance – refers to requiring more of the substance to experience an effect once obtained at a lower dose  To receive diagnosis of substance dependence, adolescent must show a maladaptive pattern of substance use for at least 12 months, accompanied by three or more significant clinical signs of distress: o Tolerance o Withdrawal o Compulsive use  Criteria for substance abuse involves one or more harmful and repeated negative consequences of substance use over last 12 months Prevalence and Course  Alcohol is the most prevalent substance used and abused by adolescents  Binge drinking – episodic heaving drinking of five or more drinks in a row  As daily cigarette smoking has decreased, daily marijuana use among adolescents appears to be increasing  Age of onset o Certain amount of substance use during adolescence is normative behaviour o In general, alcohol use before age 14 is strong predictor of subsequent alcohol abuse or dependence, especially when early drinking is followed by rapid escalation in the quantity of alcohol consumption  Sex and ethnicity o Sex differences in lifetime prevalence rates of substance use are converging, due mostly to increased substance use among girls o African American youth have substantially lower usage rates for most illicit drugs compared to whites  Course o Typically rates of substance use peak around late adolescence and then begin to decline during young adulthood o Substance use lowers inhibitions, reduces judgment, and increases the risk of physical harm and sexual assault o Also a risk factor for unhealthy weight control, suicidality, and mood and anxiety disorders o Those diagnosed with SUDs tend to use more than one drug simultaneously, with alcohol and marijuana the most common combination, followed by alcohol and hallucinogens Causes  Personality characteristics o Stem from basic temperament characteristics such as increased sensation seeking  Preference for novel, complex and ambiguous stimuli, linked to a range of high-risk behaviours  Family functioning o Lack of parental involvement and parent-child affection, inconsistent parenting and poor monitoring, and negative parent-child and inter-parent interactions are all factors that increase the risk of substance use  Peers and culture influence Treatment and Prevention  Approx. those who receive treatment for SUDs relapse within first 3 months following treatment, only 20-30% remain abstinent at 1 year  Family-based approaches seek to modify negative interactions between family members, and develop effective problem-solving skills to address areas of conflict  Multisystemic Therapy (MST) – involves intensive intervention that targets family, peer, school, and community systems, and has been especially effective in the treatment of SUDs among delinquent adolescents  Motivational interviewing (MI) – uses patient-centered and directive approach that addresses the ambivalence and discrepencies between a person’s current values and behaviours and their future goals Chapter 13: Eating Disorders and Related Conditions How Eating Patterns Develop  Normal development o Troublesome eating habits and limited food preferences – distinguishing characteristics of early childhood o Picky eaters more common among girls than boys but relationship to emergence of eating disorders in adolescence is unclear o Beginning around age 9, girls are more anxious about losing weight than boys o Typical development patterns are function of societal norms and expectations – especially for girls o Desire to achieve an ideal image can turn into an obsession during adolescence  Developmental risk factors o Drive for thinness – key motivational variable that underlies dieting and body image, among young females in particular, whereby individual believes that losing more weight is the answer to overcoming her troubles and to achieving success o Disturbed eating attitudes describe a person’s belief that cultural standards for attractiveness, body image, and social acceptance are closely tied to one’s ability to control diet and weight gain o Anorexia and bulimia typically occur during adolescence and onset thereafter is rare  Timing of maturation also affects dieting behaviour – girls who mature earlier are likely to be heavier o Pubertal weight gain, beginning of social dating, and threats to achievement status often promote body dissatisfaction, distress, and perceived loss of control in young adolescents ,especially because they occur cumulatively over a relatively short period  Biological regulators o Metabolic rate, or balance of energy expenditure, is established based on individual genetic and physiological makeup, as well as eating/exercise habits  Serves to self-monitor and self-regulate behaviour o Body weight  90-95% of those who lose weight regain it within several years  A person’s natural weight is regulated around his or her own set point – comfortable range of body weight that the body tries to “defend” and maintain Obesity  Approx. 1 in 6 children and adolescents in North America are obese  Childhood obesity is considered to be a chronic medical condition similar to hypertension and diabetes, and is characterized by excessive body fat  Usually defined in terms of a body mass index (BMI), which is above the 95 percentile, based on norms for the child’s age/sex th th o Childhood BMI between 85 and 95 percentiles is considered overweight  Prevalence and development o Obesity rates for all age groups of children and adolescents have increased from 5% to over 17% o Childhood-onset obesity is most likely to persist into adolescence and adulthood o Preadolescent obesity is a risk factor in the later emergence of eating disorders, especially for females  Causes o Function of pedigree – child of obese parents has 3 times the chance of being obsess, and if one sibling is obese, there is a 40% chance that a second sibling will also be obese o Although heritability accounts for substantial proportion of variance in obesity other individual and family-related factor, such as dietary and lifestyle preferences, also play a role o Leptin – hormone that carries instructions to brain to regulate energy and appetite  Leptin deficiencies have been found among children with severe obesity  Treatment o Family functioning influences eating patterns and obesity, as well as prevention and treatment of obesity o Treatment should instill active, less sedentary routines o Behavioural interventions focus on goal of making child’s eating behaviours and physical activity patterns more adaptive and self-managed  Self-control procedures encourage children to set their own goals for diet, weight, and exercise, and teach them the necessary skills to achieve these goals with minimal outside directives from parents or therapists o Contribution of schools in promoting healthy eating habits and body image Feeding and Eating Disorders  Feeding disorder of infancy or early childhood – characterized by sudden/marked deceleration of weight gain in an infant or a young child and a slowing or disruption of emotional and social devel
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