PS280 Chapter Notes - Chapter 11: Peyote, Alcohol By Volume, Standard Drink
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Chapter 11 – Substance-Related Disorders
-Mead, an alcoholic beverage naturally formed by the fermentation of honey, was
probably the first alcohol that humans consumed
-The ancient Egyptians were known for their drinking, and wine was extensively used by
-Opium derivatives were once widely used in Asian cultures, as well as in ancient Greece
-Therapeutically, they were taken to relieve pain or induce sleep; however, the
euphoria that these drugs produced resulted in their widespread use to enhance
-In the Andes, for thousands of years, native populations occasionally chewed the leaf of
the coca plant to relieve fatigue and increase endurance.
-The flower of the peyote cactus has been long used by tribes in South and Central
America as part of religious ceremonies. The chemical contained in this flower was
valued for it’s ability to alter consciousness and results in hallucinations similar to those
caused by LSD
-Effects of substance abuse were particularly grim as the Europeans colonized North and
-Beer was widely consumed, in part because of the poor quality of water
-The tavern became the place to be because of social activities and drinking was a
part of it
-Consumption levels were extremely high by current standards, even among
-When Aboriginals were introduced to alcohol, they discovered a means of being
transported into a strange new world of experience. In an inebriated state, people
committed crimes and acts of self-destruction previously unheard of. A hunter
might trade his entire winter’s catch of furs for a jug or two of whisky, leading to
misery and starvation. As a final insult, liquor reduced resistance to many
-South American cultures suffered in similar ways. Prior to the arrival of the Spanish,
alcohol was used only in religious ceremonies. A few years after the conquest, Aboriginal
people commonly used alcohol to escape from the confusion of their disrupter world.
There was also a striking increase in the use of coca leaf in Andes. Formerly used only
with the permission of the Inca king or his governor, coca became indispensable for
Quechua mine workers because it enables them to work almost without eating.
Diagnosis and Assessment
Diagnosing Substance Use Disorders
-10 different classes: alcohol, cannabis, caffeine, hallucinogens, inhalants, opioids,
sedatives, stimulants, hypnotics and anxiolytics, tobacco and other or known substances.
-An individual can receive a diagnosis for one or more of these classes (e.g., alcohol use
disorder, opioid use disorder). In general, substance use disorder refers to recurrent use of
one of these specific substances that leads to adverse consequences. The disorder ranges
from in severity from mild to moderate to severe, depending on the number of problem
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indicators. The 11 indicators apply to most classes of substances, with a few minor
exceptions (e.g., withdrawal symptoms are not part of inhalant use disorder, there is no
caffeine use disorder.
-Four general groupings of indicators:
(1) Impairment of control – taking the substance in larger amounts or longer
than is intended. Behavioural psychologists have demonstrated that contingencies,
rewards, and punishments can influence the use of a substance even in the most
affected individuals, which suggests that control is impaired but not entirely lost.
Other indicators of i
mpairment of control (2, 3, 4 on page 262) are multiple unsuccessful attempts to
cut down or stop, spending a great deal of time obtaining the substance or
recovering from its effects, and experiencing a strong craving for the substance.
(2) Social Impairment (5, 6, 7,) – refer to a failure to fulfill major role
obligations at work, home, school; continued use despite clear negative
consequences on relationships; and the reduction of other involvements to give
priority to using the substance.
(3) Risky Use Indicators (8, 9) – used in situations in which it might be
hazardous, such as driving or operating machinery, and in which there is
continued use despite the clear indication that use is causing or exacerbating
physical or psychological problems (headaches, depression).
(4) Pharmacological Dependence (10, 11) – tolerance and withdrawal.
Tolerance means that person needs increased amounts of the substance to achieve
the same effect. Individuals suffering withdrawal experience unpleasant and
sometimes dangerous symptoms such as nausea, headache or tremors, when the
substance is removed from the body. Specific drugs have predictable groups of
symptoms typically characterized by over activity of the physiological functions
that were suppressed by the substance and/or depression of the functions that were
stimulated by the substance. Additional ingestion of the specific drug, or one that
is closely related, will alleviate symptoms. Of course, this is part of vicious circle
that maintains dependence.
-A number of substance induced disorders are associated with each of the 10 drug
classes, including intoxication, withdrawal, and other substance or medication induced
mental disorders (psychotic, bipolar, depressive, anxiety, and sleep).
Back to the Future: Addiction in the DSM-5
-change in terminology
-substance dependence (since third edition) instead of alcoholic or addict
-In DSm-5 we revert to the use of the term addiction and drop the use of dependence…
“Substance-related and Addictive Disorders”… Substance use disorder”
-Broadening to include behavioural addictions – gambling disorders
-Future categories may include: sex addiction, work addiction, internet gaming
Polysubstance Use Disorder – simultaneous misuse or dependence upon two or more
substances. Concurrent dependence appears to be the rule rather than the exception. For
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example, 80% of problem drinkers also smoke cigarettes, and are most likely addicted to
-Research has shown that half of cocaine users are dependent on alcohol, and more than
half of all amphetamine users also abuse benzodiazepines.
-Opioid addicts often abuse alcohol, cocaine, and benzos, and increasingly illicit use of
opioids such as heroin is being augmented with legal prescription opioids such as
oxycodone, codeine, morphine, and hydrocodone.
-Sometime pattern of concurrent alternating use
-To prevent excessive excitement, irritability, and insomnia associated with chronic
amphetamine use, addicts will often consume barbiturates when the way to “come down”
or sleep. Later, amphetamines will be used to reduce sedative effects or morning
drowsiness causes by barbiturates.
-Polysubstance abuse is on the rise and most common in young people
-Alcohol is the most common element of involvement in other substance abuse
-There are a number of health and treatment concerns related to polysubstance abuse.
Combining drugs is physically dangerous because they are synergistic. This is, the
combined effects of the drugs exceed or are significantly different from the sum of their
- Example: mixing alcohol and barbiturates or opioids may depress the CNS
functioning to a much greater degree than any of these substances alone.
Amphetamines and other stimulants combined with alcohol, cause physical
damage greater than the damage that would be caused by the drugs if they were
-More likely to have more mental issues (compared to those who only have one
substance use problem)
-Not clear whether substance use disorder or other mental disorder should be
treated first, or at the same time
History of Use
-world’s number one psychoactive substance
-6400BC – alcohol in the form of beer and berry wine
-Discovered in Arabia
-Egyptians, Hebrews, Greeks, Romans
-Distillation of whisky was commonplace in Ireland by AD 1500, and occurred in
America by a large scale in eighteenth century
-Alcohol was not used by Aboriginal Canadians until the French brought brandy and the
British brought rum from Europe
-All attempts to suppress alcohol in Europe and America from the 14th-20th century have
-1920, Prohibition, did effectively reduce overall alcohol intake. Partial or complete
prohibition was also introduced in Canadian provinces around the same time. However,
there was widespread disrespect for the laws, leading to the growth of organized crime
and bootlegging. Much of the bootlegging originated in Canada and was directed to the
States. Concerns about this lawlessness, as well as an appreciation of the revenues to be
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