Copyright © Houghton Mifflin Company. All rights reserved.9 - 1 Substance-Related Disorders...

Copyright © Houghton Mifflin Company. All rights reserved. 9 - 1

Substance-Related Disorders

• Psychoactive substances– Affecting the central nervous system– Causing significant social, occupational,

psychological, or physical problems– Can result in abuse or dependence

• User may – Become a danger to others– Engage in criminal activities

• Gateway Theory


Percentage of Persons Who Reported Using Specific Substances at Any Time During Their Lives (Age 12 and Over)



• DSM-IV-TR– Substance-use disorders

• Dependence and abuse

– Substance-induced disorders• Withdrawal• Substance-induced delirium



• Substance abuse– Maladaptive pattern of recurrent use that

• Extends over a period of 12 months• Leads to notable impairment or distress• Continues despite social, occupational, psychological,

physical or safety problems

• Substance dependence– Maladaptive pattern of use over 12-month period

• Unsuccessful efforts to control use• Takes more of substance than intended• Devotes considerable time to activities necessary to

obtain the substance



– Tolerance • Increasing doses are necessary to achieve desired

effect

– Withdrawal• Distress/impairment in social, occupational, other

areas of functioning or physical/emotional symptoms persist after reducing/ceasing intake

– shaking, irritability, inability to not think about the drug

– Tolerance or withdrawal indicates physiological dependence


Depressants or Sedatives

• Caused generalized depression of the central nervous system and a slowing down of responses

• Alcoholic– Person who abuses/ is dependent on alcohol

• Alcoholism– Characterized by abuse of, or dependency on,

alcohol, which is a depressant

• Binge drinking– Person abstains for a while, but is unable to

control/moderate intake when drinking resumes


Alcohol-Use Disorders

• Pattern of problem drinking– Finds taste unpleasant– Swears never to drink again – Heavy drinking serves a purpose – Use continues despite negative

consequences– Preoccupation with alcohol consumption– Deterioration of social and occupational

functioning


The Effects of Alcohol

• Physiological and psychological effects– Depends on such factors as a person’s weight,

amount of food in stomach, stress, etc.– Depresses CNS functioning– Affects mood and behavior– Long-term

• Blackouts, tolerance, destruction of brain cells, cirrhosis of liver and other lethal diseases

– Fetal Alcohol Syndrome (FAS)• Can result in mentally retarded, physically deformed

children


Other Depressants or Sedatives• Narcotics

– Opiates – opium, morphine, heroin, methadone – Relieves pain, anxiety, tension– Tolerance builds rapidly – Withdrawal Syndrome

• Barbiturates – “downers” – Depresses the CNS – Commonly used to induce relaxation/sleep– Accidental overdose when combined with alcohol

• Benzodiazepines (e.g., Valium)– Rohypnol

• “Roofies”• “date-rape” drug


“Club Drugs”

• Used by 70% of attendees at dance clubs/raves– Stimulants

• Ecstasy/MDMA• LSD• GHB• Ketamine• methamphetamine

– Cardiovascular failure• High heart rate and blood pressure• Heart wall stress

– Cognitive deficits


Stimulants

• Stimulant– Central nervous system energizer

• elation, grandiosity, hyperactivity, agitation, and appetite suppression

– Amphetamines• Increased CNS activity • Increased alertness, energy• Feelings of euphoria and confidence • “uppers”

– Caffeine


Stimulants

• Nicotine– Cannot stop or reduce use– Cold turkey can cause withdrawal symptoms– Continued use despite serious physical disorder

• Cocaine– From the coca plant – Feelings of euphoria and self-confidence – Followed by depression– Chronic abuse

• Changes in CNS• Premature ventricular heartbeats and death

– Crack• Purified, potent form of cocaine produced by heating cocaine with

ether


Hallucinogens

• Hallucinogen– Produces hallucinations– Vivid sensory awareness– Heightened alertness– Perceptions of increased insight– Marijuana

• The mildest and most commonly used

– Lysergic Acid Diethylamide (LSD)– Phencyclidine (PCP)


Causes of Substance-Use Disorders

• Biological – Heredity and Congenital factors– Two types of alcoholism

• Familial– Family history of alcoholism– Genetic predisposition

» Identified for certain traits in alcoholism.» Neurotransmitters sensitivity/responsiveness to alcohol» Changes in CNS functioning

• Non-familial– Suggesting environmental factors


Causes of Substance-Use Disorders• Psychodynamic

– Childhood trauma• Especially in oral stage• Leads to repression of painful conflicts involving dependency

needs– Alcohol allows repressed conflicts to be expressed and

offers oral gratification to satisfy dependency needs.• Personality characteristics

– High activity level– Emotionality– Goal impersistence– Sociability– Life transitions/maturational events– No evidence for “alcoholic personality,”

• Antisocial behavior• Depression



• Sociocultural factors– More males than females– More young adults than older adults– More Catholics than Protestants or Jews– Parents– Peers

• Two-way street regarding peers: – Users seek out other users– Users influence their friends to use

– Cultural values



• Behavioral– Anxiety reduction

• Approach-avoidance conflict

– Learned expectations– Cognitive influences

• Tension-reducing model– Alcohol reduces tension and anxiety– Relief of tension reinforces drinking behavior

• Coping responses plus expectancy



– Relapse• Resume drinking after voluntary abstinence

– Negative emotional states– Negative physical states– Gender differences (women: interpersonal conflict)– Social pressure– Coping responses

• Abstinence violation effect– Loss of personal control after drinking begins

• Biological– Physical dependence– Avoid withdrawal symptoms


Figure 9.5: The Relapse Process


Theories of the Addiction Process

• Solomon’s opponent process theory– Conditions that cause drug experimentation

have not been identified.– Best predictor

• Availability

– Addiction• An acquired motivation • Opponent process theory of acquired motivation• Motivation changes with repeated consumption


Theories of the Addiction Process (cont’d)

• Wise’s two-factor model– Positive and negative reinforcement

• Tiffany’s theory of automatic processes– Drug-use behaviors are controlled by

“automatic” processes– Once activated, drug-use behaviors are

resistant to change.

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