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01:830:340 (47)
Chapter 10


12 Pages

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Sara Campbell

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CHAPTER 10: substance related and impulse control disorders ■ substance related disorders: problems associated with the use and abuse of drugs and other substances people use to alter the way they think, feel, and behave ○ extremely costly in human and financial terms ■ impulse control disorders: disorder in which a person acts on an irresistible but potentially harmful impulse ■ controversy surrounds both disorders because people believe these disorders result from a lack of “will” perspectives on substance related disorders ■ more than 8% of the general population is believed to use illegal substances ■ polysubstance use: the use of multiple mind and behavior altering substances such as drugs I. levels of involvement ■ substance: term used to describe chemical compounds that are ingested to alter mood or behavior ■ psychoactive substance: substances such as drugs that alter mood behavior or both ■ substance use: the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, functional, or occupational functioning ○ ex drinking a cup of coffee or smoking a cigarette ■ substance intoxication: physiological reaction causing impaired judgement, mood changes, decreased motor ability resulting from the ingestion of psychoactive substances. ■ substance abuse: a pattern of psychoactive substance use leading to significantly distress or impairment in social and occupational roles and in hazardous situations ○ DSM IV defines abuse by how significantly it interferes with the users life ○ study showed that HS drug use predicted later job outcomes and that repeated hard drug use predicted poor job outcome at age 29 ■ substance dependence: maladaptive pattern of substance use, characterized by two dimensions ○ physiological dependence a) tolerance: the need for increasing amounts of the substance to achieve desired effect, experiences a diminished effect with use of the same amount b) withdrawal: severely negative physiological reaction to removal of a psychoactive substance, which can be eliminated by ingestion of the same or similar substance (1) example: withdrawal from alcohol can cause alcohol withdrawal delirium and a person will experience frightening hallucinations c) not all substances are psychologically addicting or addicting in the same way ○ psychological dependence (drug seeking behaviors) a) person repeatedly uses drug and shows a desperate need to use the drug at any cost b) person is highly likely to resume using drug after a period of abstinence ○ DSM IV defines dependence in terms of psychological and physiological aspects but is still a “work in progress” bc need to separate a seriously harmful phenomenon from other less debilitating addictions (ex shopping addiction) ○ people can use drugs without becoming addicted to them and it is not known how to predict who or what type of person is likely to become addicted ○ substance dependence can be present without abuse in some cases one time users may become dependent on drugs a) ex cancer patients that become addicted to morphine and go through withdrawal but never abused use of morphine ○ society bands drugs based on factors known about how addictive they are II. diagnostic issues ■ alcohol and drug abuse was originally grouped together in DSM as antisocial personality disorders but now have a separate substance related disorders category ■ almost three quarters of people with addictions have additional psychiatric disorders ○ 40% mood and anxiety disorders ○ 25% PTSD cases ■ drug intoxication and withdrawal can cause psychosis symptoms ■ substance categories a. depressants: result in behavioral sedation and can induce relaxation; includes alcohol and sedative, hypnotic, and anxiolytic drugs in the family of barbiturates and benzodiazepines b. stimulants: causes users to be active, alert and can elevate mood; includes amphetamines, cocaine, nicotine, and caffeine c. opiates: use produces analgesia temporarily (reduce pain) and euphoria; includes heroine, opium, codeine, and morphine d. hallucinogens: use alters sensory perception and can produce hallucinations, delusions, and paranoia; includes marijuana and LSD e. other: includes inhalants, steroids, and other over the counter prescription medication DEPRESSANTS ■ primarily decrease central nervous system activity and levels of physiological arousal ■ among the substances most likely to produce dependence, tolerance, and withdrawal symptoms I. alcohol use disorders A. clinical description ■ its initial effect is stimulant ■ alcohol depresses areas of the brain affecting motor coordination, reaction time, judgement, hearing, vision, etc B. effects ■ it is absorbed into the bloodstream by the stomach and small intestine then is distributed throughout the body ■ some of it goes to the lungs and is vaporized (why a breathalyzer works) ■ alcohol is broken down in the liver ■ unlike other drugs alcohol effects a number of neuroreceptor systems a) GABA system- inhibitory NT, alcohol makes it difficult for neurons to communicate with one another, GABA system contributes to anxiety to alcohol decreases anxiety by inhibiting this system (why we become more sociable) b) glutamine system- excitatory NT, involved in learning and memory and may be the root for the effect of alcohol on our cognitive abilities and loss of memory during blackouts c) serotonin system- NT affects mood, sleep, and eating behavior, may be responsible for cravings while drinking ■ withdrawal delerium (delerium tremens)- the frightening hallucinations and body tremors that result when a heavy drinker withdraws from alcohol ■ long term alcohol abuse ○ may not be true that it kills brain cells ○ dementia- general loss of intellectual ability can result from excessive amounts of alcohol/ alcohol “poisoning” ○ wernicke-korsakoff syndrome- results in confusion, loss of msucle coordination, and unintelligible speech, results from a thiamine deficiency which cannot be metabolized properly in heavy drinkers ○ fetal alcohol syndrome- a pattern of problems including learning difficulties, behavioral deficits, and characteristic physical flaws, resulting from heavy drinking by the victim's mother while pregnant B. statistics ■ most adults in the US categorize themselves as light drinkers or abstainers however about half of the americans over the age of 12 report being current drinkers of alcohol ■ many racial differences- whites are the highest (56.5%) and lowest in native hawaiians (37.3%) ■ 23% of americans report binge drinking in the past month ■ asians report the lowest rates of binge drinking, american indians and hispanics report the highest ■ college students- 42% said they had gone binge drinking in the past two weeks ■ study found that students with an A average had no more than three drinks per week but those with D or F had over 11 C. dependence statistics ■ more than 3 million adults are alcohol dependent ■ dependence varies widely across cultures and can be accounted for by different attitudes towards drinking D. progression ■ people with alcohol dependence may fluctuate between bingeing, drinking socially, and not drinking ■ 20% of people with alcohol dependence can stop on their own ■ the course of alcohol dependence is more progressive while the course of alcohol abuse is more variable ■ study showed that starting to drink at a young age (11-14) was predictive of later alcohol use disorders ■ study on males in alcohol rehabilitation centers- reported moderate consequences of their drinking in their 20’s and more serious consequences in their 30’s and 40’s ○ alcohol abuse and dependence results in increasingly severe consequences ■ statistics often link alcohol with violent behavior study showed that many violent acts such as rape or murder were linked to the culprit being intoxicated *does not mean that alcohol will make you violent alcohol can contribute to but does not cause aggression II. sedative, hypnotic, or anxiolytic substance use disorders A. clinical description ■ sedative= calming ■ hypnotic = sleep-inducing ■ anxiolytic = anxiety reducing ■ barbiturates: a sedative (and addictive) drug such as amytal, seconal, or nembutal that is used as a sleep aid ○ less risk of abuse and dependence than benzodiazepines ■ benzodiazepines- an anxiety drug including xanax, valium, dalmane, or halcion, also used to treat insomnia, anxiety, and panic disorder at high potency ○ show some side effects such as cognitive and motor impairment ○ may result in substance dependence ○ relapse rates are extremely high when discontinued ○ large doses have similar effects as alcohol and withdrawal effects are similar ○ can have synergistic effects when combined with alcohol B. statistics ■ barbiturate use has declined and benzodiazepine use has increased ■ of patients who are seeking help for substance abuse less than one percent of those people are those addicted to benzodiazepine ■ those who do seek help are typically white women over the age of 35 STIMULANTS ■ off all drugs used in the US stimulants are the most common ■ includes caffeine, amphetamines, nicotine, and cocaine I. amphetamine use disorders ■ can cause feelings of elation and vigor and can reduce fatigue when taken at low dosages but then person crashed feeling depressed ■ manufactured in a lab; first used to treat asthma and as a nasal decongestant ■ some people take them to lose weight because they cause lack of appetite ■ used by pilots truck drivers and students to stay awake and get an energy “boost” ■ ex Ritalin used to treat ADHD ■ one in ten college students reported using stimulants illegally ■ DSM IV criteria ○ behavioral symptoms of euphoria, blurting out uncontrollably, changes in sociability, tension, anger, impaired judgement, impaired social or occupational fx ○ physiological symptoms include elevated heart rate and bp, nausea, perspiration, vomiting, weight loss, coma, severe intoxication can cause hallucinations, panic, delusion ■ tolerance builds quickly making it very dangerous ■ withdrawal results in apathy, prolonged periods of sleep, irritability, and depression ■ “designer drugs” ○ ex methylene-dioxymethamphetamine- used to suppress appetite; now used recreationally (ecstasy) ○ causes person to be aggressive and remains in system for a long period of time ○ feelings of making everything feel “better” ■ stimulate CNS by affecting norepinephrine and dopamine; help release of NT and block reuptake II. cocaine use disorders A. clinical description ■ in small amounts increases alertness and produces euphoria, inc bp and heart rate, reduce appetite similar to amphetamines ■ effects are short lived unlike amphetamines ■ cocaine induced paranoia- fear resulting from bingeing B. statistics ■ 1.9 million report using cocaine in last year in the US; more than any other drug besides weed ■ cultural- of cases brought to the emergency room most are white males (29%); followed by black males (23%), white women (18%), and black women (12%) ■ majority of those seeking help are young unemployed adults living in urban areas ■ has similar effects on the brain as amphetamines; blocks the reuptake of dopamine causing repeated stimulation of the next neuron continuous “pleasure pathway” ■ few negative side affects are noticed at first which makes it a dangerous drug; later person experiences sleep disturbance, paranoia, addiction ■ withdrawal is similar to alcohol- feel bored and depressed II. cocaine use disorders ■ nicotine produces patterns of dependence, tolerance, and withdrawal ■ 21% of americans smoke (in 1965 was 42.4%) ■ DSM IV- withdrawal symptoms include depression, insomnia, irritability, anxiety, difficulty concentrating, increased appetite ■ in small doses nicotine relieves stress and improves mood but also causes high bp and cancer ■ high doses blurs vision, can cause convulsions, confusion, and death ■ takes 7-19 seconds to reach brain after inhaled and stimulates nicotinic acetylcholine receptors in the midbrain of the limbic system leading to a pleasure pathway (dopamine pathway responsible for feelings of euphoria) ■ relapse rate is very high and is similar to alcohol and heroin III. caffeine use disorders ■ cost common psychoactive substance used regularly by almost 90% of all americans ■ least addictive so considered least harmful ■ added to energy drinks legal in the us but banned in many european countries ■ in small doses elevates mood and decreases fatigue ■ in larger doses causes you to feel jitter and can cause insomnia ■ takes a long time to leave out systems (6 hours) ■ people react variously to caffeine ■ regular use can result in tolerance and dependence ■ effect on brain involves the neuromodulator adenosine (blocks reuptake) and a lesser effect on dopamine OPIOIDS ■ opiate- natural chemicals in the opium poppy that have a narcotic effect by relieving pain and inducing sleep ■ synthetic variations are heroin, methadone, hydrocodone, oxycodone ■ wizard of oz- witch makes dorothy and toto walk through field of poppies to put them to sleep ■ high doses can lead to death is respiration is completely depressed ■ withdrawal can be so unpleasant that people cannot stop taking the drug even if they have a strong desire to do so ■ start to experience symptoms within 6-12 hours of stopping the drug, include nausea, yawning, vomiting, chills, aches, diarrhea, and insomnia; will persist for 1-3 days and withdrawal process is complete in about a week ■ heroin is the most commonly abused ■ use of opiate containing prescription meds has increased ■ runs a high risk for transfer of hiv and aids ■ england follow up study (33 years) on addicts showed the pessimistic life of the addicts; 22% died and more than half were overdose ■ body already has its own opioids called enkephalins and endorphins that provide the same effect as narcotics HALLUCINOGENS ■ change the way one perceives the world by altering sight, taste, feelings, smell ■ marijuana and LSD I. MARIJUANA ■ most routinely used illegal substance ■ 15.2 million americans report using it in the last month ■ dried parts of a cannabis or hemp plant ■ results in mood swings and heightened sensory experiences ■ reactions people have varies ■ small doses result in feelings of well being, larger doses result in hallucination, dizziness, paranoia ■ studies suggest impairment of memory, concentration, relationships, and negatively affects employment (but some problems may precede usage and type of person is just more likely to use the drug) ■ tolerance is variable some people report that they don't get the same “high” others report that high is better after repeated usage (reverse tolerance) ■ controversy on medicinal uses prescribed to chemo patients and those with HIV associated anorexia, MS pain and cancer pain ■ contains over 80 types of chemicals called cannabinoids including tetrahydrocannabinols which the body naturally makes its own version of in the brain II. LSD and OTHER HALLUCINOGENS ■ LSD or acid is the most common hallucinogenic drug ■ produced in a lab ■ ergot fungus disorder in Europe- caused restricted blood flow to limbs and loss of limbs as a result; also caused hallucinations ■ other hallucinogens: ○ psilocybin- found in mushrooms ○ lysergic acid- found in seeds of morning glory plant ○ dimethyltryptamine- DMT, found in bark of virola tree ○ mescaline- found in peyote cactus plant ■ perceptual changes include intensification, depersonalization, hallucinations ■ physical changes include pupil dilation, rapid heartbeat, sweating, and blurred vision ■ john hopkins study- gave placebo or hallucinogen (psilocybin) reported having hallucinations and mood changes in addition to relating the experience to a spiritual event two months later in follow up ■ tolerance is developed quickly - will lose effectiveness when taken over a period of days ■ for most no withdrawal symptoms are reported but they are still considered dangerous for many reasons including the possibility of a psychotic reaction (ex person jumps out of window bc they believe they can fly) ■ people report having “bad trips” resulting in paranoia ■ most resemble NT including serotonin, norepinephrine, acetylcholine but exact mechanism is unknown OTHER DRUGS OF ABUSE -designer drugs such as steroids and inhalants I. inhalants ■ inhalants ingested directly into respiratory system include spray paint, hair spray, paint thinner, nitric oxide (laughing gas), nail polish remover, etc ■ typical person to use inhalants in male caucasian living in a rural small town ■ rapidly absorbed into bloodstrea
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