abnormal psychology

Fourth Canadian Edition

Chapter 12Chapter 12Substance-Related Disorders

Prepared by: Tracy Vaillancourt, Ph.D.

Modified by: Réjeanne Dupuis, M.A.

Chapter Outline

• Alcohol Abuse and Dependence • Inhalant Use Disorder• Sedatives and Stimulants • LSD and Other Hallucinogens • Etiology of Substance Abuse and Dependence • Therapy for Alcohol Abuse and Dependence • Therapy for the Use of Illicit Drugs • Treatment for Cigarette Smoking • Prevention of Substance Use

Substance Abuse and Dependence

• Pathological use of substances falls into two categories: – Substance abuse – Substance dependence

Substance Dependence• Substance dependence—presence of at least

three of the following + duration of 12 months:– Development of tolerance– Withdrawal symptoms– Uses > of substance or uses it for longer time– Recognizes excessive use of the substance– Much of time is spent in efforts to obtain the

substance or recover from its effects– Use continues despite psychological or physical

problems – Person gives up or cuts back participation in many

activities

Substance Abuse• Substance abuse—must experience one of

the following as a result of recurrent use of the drug + duration of 12 months:– Failure to fulfill major obligations – Exposure to physical dangers – Legal problems – Persistent social or interpersonal problems

Alcohol Abuse and Dependence

• Alcohol dependence may include tolerance or withdrawal reactions – People who are physically dependent on alcohol tend

to have more severe symptoms of the disorder

• Alcohol abuse does not include physically dependence or tolerance

• Alcohol abuse or dependence is often part of polydrug (or polysubstance) abuse– Using or abusing more than one drug at a time– Example: 80 to 85% of alcohol abusers are smokers

Prevalence and Comorbidity

• In the U.S. prevalence rates– Lifetime prevalence rate for alcohol abuse: 17.8% and

4.7%– 12-month prevalence rate for alcohol dependence:

12.5% and 3.8%– Dependence with advancing age

• Comorbid with mood and anxiety disorders, other drug use and schizophrenia– Factor in 25% of suicides – Comorbid psychiatric disorders predicts high relapse

rates and less initial treatment improvement

Binge Drinking at University

• 1 in 6 Canadian university students is a heavy-frequent drinker

• 1 in 4 American university students are frequent binge drinkers

• 32% of undergraduate report hazardous or harmful patterns of drinking (17% in the general population)

• More Canadian students drink; more American students are heavy drinkers

• First experience of drunkenness prior to age 16 is more likely to lead to heavy drinking later

• 1 in 4 Ontarians in grades 7 to 12 admit binge drinking within last month – no gender differences was found

Short-Term Effects of Alcohol

• Metabolized by enzymes after swallowed and reaching stomach

• Most goes into small intestines where absorbed into blood

• Broken down in liver– can metabolize about 30 millilitres of 100-proof (50%

alcohol) whisky/hour– quantities in excess of this amount stay in the

bloodstream

• Biphasic effect– Initial effect of alcohol is stimulating then acts as a

depressant

Mechanism

• Produces effects through interactions with several neural systems in the brain – Stimulates GABA receptors

• Reducing tension

– Increases levels of serotonin and dopamine• Pleasurable effects

– Inhibits glutamate receptors• Cognitive effects of alcohol intoxication, such as

slurred speech and memory loss

Long-Term Effects• Chronic drinking causes severe biological

damage and psychological deterioration– Almost every tissue and organ is adversely

affected • Malnutrition • Deficiency of B-complex vitamins → amnestic

syndrome• Cirrhosis of the liver• Damage to the endocrine glands and pancreas• Heart failure, hypertension, stroke, and capillary

hemorrhages, which are responsible for• Brain damage

Fetal Alcohol Syndrome• Leading cause of mental

retardation— heavy alcohol consumption during pregnancy– growth of the fetus is

slowed– cranial, facial, and limb

anomalies are produced– known as fetal alcohol

syndrome– see also partial fetal

alcohol syndrome and alcohol-related neurodevelopmental disorder (ARND)

Inhalant Use Disorder

• Although use not confined to children and adolescents, alarming # of young people begin their substance abuse by inhaling substances– Glue, correction fluid, spray paint, cosmetics,

gasoline, household aerosol sprays, nitrous oxide found in spray cans of whipped cream

– Abuse among young people = 17.3%

Nicotine and Cigarette Smoking

• Nicotine— addictive agent of tobacco

• Stimulates nicotinic receptors in brain – Then active neural pathways stimulate

dopamine neurons in mesolimbic area• Seem to be involved in producing reinforcing

effects of most drugs

Prevalence and Health Consequences

• Estimated that smoking causes > 47,000 deaths per year Canada

• Medical problems associated with cigarette smoking include:– Lung cancer– Emphysema– Cancer of larynx and esophagus– Cardiovascular diseases

• Harmful components – Nicotine, carbon monoxide, and tar (which includes

carcinogens)

Smoking Statistics• In 2009, ~17% of Canadians aged 15 > are

current smokers – But fewer Canadians are smoking and smokers are

smoking fewer cigarettes on a daily basis

• Men smoke > cigarettes on a daily basis than women

• Rates of smoking have been among teenagers

• 13% of Canadian university students smoke daily

Second-Hand Smoke• Second-hand smoke (or environmental tobacco smoke)

– Contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than does the smoke inhaled by smoker

– 2/3rd of smoke not inhaled by the smoker but enters air around smoker

– Has at least 2X the nicotine and tar as smoke inhaled by smoker– Regular exposure lung disease by 25% and heart disease by

10%– Aggravates symptoms in people with allergies and asthma– Infants and children exposed to second-hand smoke are more

likely to suffer:• Chronic respiratory illness, impaired lung function, middle ear

infections, and food allergies, and can even succumb to sudden infant death syndrome

• In Canada, 2.4 million homes with children under 12 years of age report regular exposure

Marijuana• Marijuana—dried and crushed leaves and flowering tops

of Cannabis sativa– Major active chemical is delta-9-tetrahydrocannabinol (THC)

• Psychological Effects of Marijuana– Feel more relaxed and sociable– Can dull attention, fragment thoughts, and impair memory – Extremely heavy doses can induce hallucinations and extreme

panic

• Somatic Effects– Specific cannabinoid receptors in brain (CB) have been located in

various brain regions• Believed receptors in hippocampus account for short-term

memory loss

• Therapeutic Effects

Sedatives

• Sedatives (downers) slow activities of body and reduce responsiveness. – Includes opiates—opium and its derivatives,

morphine, heroin, and codeine– and synthetic barbiturates and tranquilizers,

such as secobarbital (Seconal) and diazepam (Valium)

• Opidates— sedatives that relieve pain and induce sleep

Psychological and Physical Effects

• Opium and derivatives (morphine and heroin) produce:– Euphoria, drowsiness, daydream, and lack of coordination– Heroin has an additional initial effect— the rush

• Effects produced by stimulating neural receptors of the body’s own opioid system– Heroin (example) converted into morphine in brain and then

binds to opioid receptors– Body produces opioids (endorphins and enkephalins)– Opium and derivatives fit into receptors and stimulate them

• In 24-year follow-up of 500 heroin addicts– 28% had died by age 40

Stimulants• Stimulants (uppers) such as cocaine, act on brain and

sympathetic nervous system to increase alertness and motor activity

• Amphetamines– Originally used to control control mild depression and

appetite– Today used to treat hyperactive children– Examples: Benzedrine, Dexedrine, and Methedrine

• Produce effects by causing the release of norepinephrine and dopamine and blocking the reuptake of these neurotransmitters

• Cocaine– Pleasure induced by cocaine related to has blocked

dopamine reuptake

LSD and Other Hallucinogens

• LSD= d-lysergic acid diethylamide

• LSD is a hallucinogen– Main effect of drug is hallucinations– Other effects include flashbacks

• Other important hallucinogens are:– Mescaline– Psilocybin– Synthetic compounds MDA and MDMA

Etiology

Biological Variables• Evidence for genetic predisposition for alcohol abuse • Adoption studies add further support

See also Shep Sigel’s Work from McMaster University• Conditioning theory of tolerance— underscores need to

jointly consider biological processes and environmental stimuli – Based on notion that tolerance is a learned response– Environmental cues present when addictive behaviours are

developed influence behaviours via Pavlovian conditioning

• Feedforward mechanisms— regulatory responses made in anticipation of a drug – Anticipating drug effects before they actually occur

Therapy• Admitting the Problem

– Do you sometimes feel uncomfortable when alcohol is not available?– Do you drink more heavily than usual when you are under pressure?– Are you in more of a hurry to get to the first drink than you used to be?– Do you sometimes feel guilty about your drinking?– Are you annoyed when people talk about your drinking?– When drinking socially, do you try to sneak in some extra drinks?– Are you constantly making rules for yourself about what and when to

drink?

• Traditional Hospital Treatment– Detoxification

• Biological Treatments– Example: disulfiram (Antabuse)

• Alcoholics Anonymous

12 Steps of AA

Therapy (cont.) • Couples and Family Therapy• Adolescent Treatment Centre• Cognitive and Behavioural Treatment

– Aversion Therapy• Covert sensitization

– Contingent-Management Therapy• emphasizes patient control and includes:

– Stimulus control– Modification of the topography of drinking – Reinforcing abstinence

– Moderation in Drinking• Controlled drinking• Harm reduction therapy

Therapy for Use of Illicit Drugs

• Detoxification—central to treatment of people who use addicting drugs

• Biological Treatments– Heroin substitutes

• Drugs chemically similar to heroin that replace body’s craving

• Example: methadone, levomethadyl acetate, bupreorphine

– Heroin antagonists• Drugs that prevent user from experiencing heroin high

• Psychological Treatments– CBT and Motivational Interviewing

Treatment for Smoking

• Biological Treatment– Nicotine replacement therapy

• Nicotine gum, patches, inhalers etc.

• Psychological Treatment

Prevention• Peer-pressure resistance

training • Correction of normative

expectations• Inoculation against mass-

media messages • Information about

parental and other adult influences

• Peer leadership • Affective education, self-

image enhancement. • Other components

– Providing information about harmful effect

– Encouraging students to make public commitment not to smoke

Copyright

Copyright © 2011 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.