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Chapter 11

Abnormal Psychology CHAPTER 11 NOTES - I got a 4.0 in the course

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University of Miami
PSY 240

Chapter 11: Substance-Related and Impulse-Control Disorders Perspectives on Substance-Related Disorders: big bold blue • More than 8% of the general population is believed to use illegal drugs • Polysubstance use: using multiple substances Levels of Involvement: • Although each drug has unique effects, there are similarities in the ways they are used and how people who abuse them are treated • Substance: chemical compounds that are ingested to alter mood or behavior • To understand substance related disorders, we must first know what it means to ingest psychoactive substances (which alter mood, behavior, or both) to become intoxicated or high, to abuse these substances and to become dependent on or addicted to them Substance Use: o Substance use is the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning o Drinking a cup of coffee or smoking a cigarette or having a beer is substance use. The occasional ingestion of illegal drugs is as well Intoxication: o Our physiological reaction to ingested substances is referred to as substance intoxication o For many substances intoxication is experiences as impaired judgment, mood changes, and lowered motor ability SubstanceAbuse: o Defining substance abuse by how much of a substance is ingested is problematic. So we define it in terms of how significantly it interferes with the user’s life. Substance Dependence: o The person is physiological dependent on the drug or drugs, requires increasingly greater amounts of the drug to experience the same effect (tolerance), and will respond physically in a negative way when the substance is no longer ingested (withdrawal) o Withdrawal from many substances can bring on chills, fever, diarrhea, nausea, and vomiting, and aches and pains. o Another view of substance dependence uses the drug seeking behaviors themselves as a measure of dependence. The repeated use of a drug, a desperate need to ingest more of the substance, and the likelihood that use will resume after a period of abstinence are behaviors that define the extent of drug dependence Depressants: • Primarily decrease central nervous system activity. Reduce our levels of physiological arousal and help us relax • Behavioral sedation and can induce relaxation • Include alcohol and the sedative, hypnotic, and anxiolytics drugs in the families of barbiturates (Seconal) and benzodiazepines (Valium, Xanax) Alcohol Use Disorders: • Alcohol is produced when certain yeasts react with sugar and water and fermentation takes place. • We metabolize alcohol with the help of an enzyme called alcohol dehydrogenase (ADH) Clinical Description: o Although alcohol is a depressant, its initial effect is an apparent stimulation. We generally experience a feeling of well-being, our inhibitions are reduces, and we become more outgoing o This is because what are initially depressed are the inhibitory centers in the brain. o With continued drinking, however, alcohol depresses more areas of the brain, which impedes the ability to function properly Effects: o After it is ingested, it passes through the esophagus and into the stomach where small amounts are absorbed. From there most of it travels to the small intestine where it is easily absorbed into the bloodstream. The circulatory system distribute the alcohol throughout the body, where it contacts every major organ, including the heart o As alcohol passes through the liver, it is broken down or metabolized into carbon dioxide and water by enzymes o Alcohol influences a number of neuroreceptor systems. o GABA- major role is to interfere with the firing of the neuron it attaches to. When GABAattaches to its receptor, chloride ions enter the cell and make it less sensitive to the effect of other neurotransmitters.Alcohol seems to reinforce the movement of these chloride ions and as a result, the neurons have difficulty firing o Because the GABAsystem seems to act on our feelings of anxiety, alcohol’s anti-anxiety properties may result from its interaction with the GABAsystem o Glutamate system-in contrast to the GABAsystem, the glutamate system is excitatory, helping neurons fire. It is suspected to involve learning and memory and it may be the avenue through which alcohol affects our cognitive abilities o Serotonin system-affects mood, sleep, and eating behavior and is thought to be responsible for alcohol cravings o The long term effects of heavy drinking are often severe. o Withdrawal from chronic alcohol use typically includes hand tremors, nausea, anxiety, hallucinations, agitation, insomnia, and withdrawal delirium or delirium tremens (a condition that an produce frightening hallucinations and body tremors o Two types of organic brain syndromes may result from long term heavy alcohol use: dementia and Wenicke-Korsakoff syndrome (confusion, loss of muscle coordination, and unintelligible speech) Statistics on Use and Abuse: o Half of allAmericans over the age of 12 report being current drinkers of alcohol o Whites report the highest frequency of drinking and drinking is lowest among Native Hawaiians o About 58 millionAmericans report binge drinking in the past month o Asians report the lowest level of binge drinking and Hispanics report the highest o Men are more likely to report several binges in the 2 week period Progression: o It used to be thought that once problems arose with drinking they would become steadily worse, following a predictable downward pattern as long as the person kept drinking. This was based on a famous but faulty study  Sent 1600 surveys out toAAmembers asking them to describe symptoms realted to drinking and to note when these reactions first occurred  Only 98 out of 1,600 surveys were returned  Retrospective responses (recalling past events) so reports may have been inaccurate  Jellinek developed a 4 stage model for the progression of alcoholism based on this limited information  Prealcoholic stage (drinking occasionally with few serious consequences)  Prodromal stage (drinking heavily but with few outward signs of a problem)  Crucial stage (loss of control, with occasional binges)  Chronic stage (the primary daily activities involve getting and drinking alcohol) o It appears instead that the course of alcohol dependence may be progressive for most people, whereas the course of alcohol abuse may be more variable. For example, early use of alcohol may predict later abuse o Drinking at an early age was predictive of later alcohol use disorders o Statistics often link alcohol with violent behavior (rape, assault, murder) Sedative, Hypnotic, orAnxiolytic Substance Use Disorders: • The general group of depressants also includes sedative (calming), hypnotic (sleep inducing), and anxiolytic (anxiety reducing) drugs. • These drugs include barbiturates and benzodiazepines: • Barbiturates are a family of sedative drugs first synthesized in Germany in 1882. They were prescribed to help people sleep and replaced such dugs as alcohol and opium. By the 1950s, they were among the drugs most abused by adults in the US • Benzodiazepines have been used primarily to reduce anxiety. These drugs were originally touted as a miracle cure for the anxieties of living in our highly pressure technological society • In general, benzodiazepines are considered much safer than barbiturates, with less risk of abuse and dependence. • Reports on the misuses of Rohypnol, however, show how dangerous even these benzodiazepine drugs can be (Roofies) Clinical Description: o At low doses, barbiturates relax the muscles and can produce a mild feeling of well-being. Larger doses can have results similar to those of heavy drinking: slurred speech and problems walking, concentrating, and working. Overdosing on barbiturates is a common means of suicide o Like barbs, benzos are used to calm an individual and induce sleep.Also described as muscle relaxants and anticonvulsants. People who use them for nonmedical reasons report first feeling a pleasant high and a reduction of inhibition. With continued use, tolerance and dependence can develop o Like alcohol, sedative, hypnotic, and anxiolytic drugs affect the brain by influencing the GABAneurotransmitter system, although by slightly different mechanisms: as a result, when people mix these drugs with alcohol, there can be synergistic effects. Statistics: o Barb use has declines and benzo use has increased since 1960. o Of those seeking treatment for substance related problems, less than 1% present problems with benzos compared to other drugs of abuse o Those who do seek help tend to be female, Caucasian, and over the age of 35 Stimulants: • Of all the psychoactive drugs used in the US, the most commonly consumed are stimulants • Caffeine, nicotine, amphetamines, cocaine • Make you more alert and energetic Amphetamine Use Disorders: • At low doses, can induce feelings of elation and vigor and can reduce fatigue.After a period of elevation, you come back down and crash, feeling depressed or tired • Are manufactured in the laboratory; first synthesized in 1887 and later used as a treatment for asthma and as a nasal decongestant. • Are prescribed with people with narcolepsy, a sleep disorder characterized by excessive sleepiness. Or to children with ADD orADHD • Euphoria or affective blunting (a lack of emotional expression), changes in sociability, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviors, impaired judgment, and impaired social or occupational functioning. • Severe intoxication or overdose can cause hallucinations, panic, agitation, and paranoid delusions. • MDMA, crystal meth • Stimulate the central nervous system by enhancing the activity of norepinephrine and dopamine. Help the release of these neurotransmitters and block their reuptake, thereby making more of them available throughout the stem. Too much can lead to hallucinations and delusions. • This effect has stimulated theories on the causes of schizophrenia Cocaine Use Disorders: • Cocaine replaced amphetamines as the stimulant of choice in the 1970s • Derived from the leaves of the coca plant, a flowering bush indigenous to SouthAmerica. • LatinAmericans have chewed coca leaves for centuries to get relief from hunger and fatigue. Clinical Description: o In small amounts cocaine increases alertness, produces euphoria, increases blood pressure and pulse, and causes insomnia and loss of appetite. o Cocaine induced paranoia is common among cocaine abusers, occurring in two thirds or more o Crack babies appear at birth to be more irritable than normal babies and have long bouts of high pitched crying. Decreased birth weight and decreased head circumference, and are at increased risk for later behavior problems Statistics: o In the US, more than 1.9 million people report using cocaine each year, more than any other drug besides marijuana o Aprox 17% of cocaine users have also used crack cocaine, a crystallized form of cocaine that is smoked • The “up” seems to come primarily from the effect of cocaine on the dopamine system. • Cocaine enters the bloodstream and is carried to the brain. There the molecules block the reuptake of dopamine making it remain in the synapse, causing repeated stimulation of the next neuron. This stimulation of the dopamine neurons in the “ pleasure pathway” causes the high associated with coke • Dependence does not resemble that of many other drugs early on, people find only that they have a growing inability to resist taking more. • Few negative effects are noticed at first, however, with continued use, sleep is disrupted, increased tolerance causes a need for higher doses, paranoia sets in, and user becomes isolated • Cycle develops: cocaine is abused, withdrawal causes apathy, cocaine abuse resumes. The atypical withdrawal pattern misled people into believing that cocaine was not addictive Nicotine Use Disorders: • The nicotine in tobacco is a psychoactive substance that produces patterns of dependence, tolerance, and withdrawal. • The tobacco plant is indigenous to North America, and Native Americans cultivated and smoked the leaves centuries ago. • Nicotine in small doses stimulates the CNS; it can relieve stress and improve mood. But it can also cause high blood pressure and increase the risk of heart disease and cancer • High doses can blur your vision, cause confusion, lead to convulsions, and sometimes even cause death • The rate of relapse among people trying to give up nicotine is equivalent among those using alcohol, heroin, and cigarettes • Nicotine is inhaled into the lungs, where it enters the bloodstream. Only 7-19 seconds after a person inhales the smoke, the nicotine reaches the brain. Nicotine stimulates specific receptors (nAChRs) in the midbrain reticular formation and the limbic system • Smoking has been linked with depression, anxiety, and anger Caffeine Use Disorders: • Most common of the psychoactive substances, used regularly by almost 90% of all Americans. • Called the gentle stimulant because it is thought to be the least harmful of all addictive drugs • Caffeine’s effect on the brain seems to involve the neuromodulator adenosine and the neurotransmitter dopamine. Block adenosine reuptake. We do not yet know the role of adenosine in brain function or whether the interruption of the adenosine system is responsible for the elation and increased energy that come with caffeine use Opioids: • The word opiate refers to the natural chemicals in the opium poppy that have a narcotic effect (they relieve pain and induce sleep) • The broader term opioids refers to the family of substances that includes natural opiated, synthetic variations (heroin, methadone, hydrocodone, oxycodone), and the comparable substances that occur naturally in the brain • Withdrawal from opioids can be so unpleasant that people may continue to use these drugs despite a sincere desire to stop. People who cease or reduce their opioid intake begin to experience symptoms within 6-12 hours • People who use opiates face risks beyond addiction and the threat of overdose. Because these drugs are usually injected intravenously, users are at increased risk for HIV • The high experienced by users comes from activation of the body’s natural opioid system. in other words, the brain already has its own opioids: enkephalins and endorphins that provide narcotic effects • Heroin, opium, morphine, and opiates activate this system Hallucinogens: • Essentially change the way the user perceives the world. • Sight, sound, feelings, taste, and even smell are distorted, sometimes in dramatic ways, when a person is under the influence Marijuana: • Most routinely used illegal substance • Marijuana is the name given to the dried parts of the cannabis or hemp plant. Cannabis grows wild throughout the tropical and temperate regions of the world • Normal experiences seem extremely funny, or the person might enter a dreamlike state in which time seems to stand still • Chronic and heavy users report tolerance, however evidence also indicates reverse tolerance, when regular users experience more pleasure form the drug after repeated use • Marijuana contains more than 80 varieties of the chemicals called cannabinoids which are believed to alter mood and behavior • The most common of these chemicals is THC. LSD and Other Hallucinogens: • LSD is the most common hallucinogenic drug. It is produced synthetically in labs, although naturally occurring derivatives of this grain fungus (ergot) have been found historically • There are a number of other hallucinogens, some occurring naturally in a variety of plants: o Psilocybin- shrooms o Lysergic acid amide found in the seeds of the morning glory plant o DMT found in the bark of the virola tree o Mescaline found in the peyote cactus plant • Perceptual changes such as the subjective intensification of perceptions, depersonalization, and hallucinations • Physical symptoms include pupillary dilation, rapid heartbeat, sweating, and blurred vision • Tolerance develops quickly to a number of hallucinogens. If taken repeatedly over a period of days, these drugs lose their effectiveness • For most hallucinogens, no withdrawal symptoms have been reported • We still do not fully understand how LSD and other hallucinogens affect the
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