Substance-Related and Impulse-Control Disorders

Chapter 11Abnormal Psychology

Impulse-Control Disorders

Irresistible impulse to perform a behavior Anticipation of pleasure/release

Harmful/maladaptive consequences

Intermittent Explosive Disorder Acting on violent/aggressive impulses

Rule out- personality disorders, psychotic disorders

Controversy- used as a legal defense?

Use of CBT- identifying “triggers”

Kleptomania

Strong urge to steal *not out of necessity*

Sense of tension before stealing, relief/pleasure after stealing

Often co-morbid with mood disorders

Pyromania Fire-setting

Tension and arousal before, release and gratification afterwards

Family history

Treatment- coping strategies, identifying triggers

Pathological Gambling

Pattern of urge and release

Common characteristics- denial, impulsivity, *continued optimism*

Use of cognitive behavioral interventions

Trichotillomania Pulling one’s hair

Hair loss, distress, social impairments, attempts to hide the behavior

Stress, trauma, anxiety are risk factors

SSRIs, Cognitive-Behavioral Therapy

Substance-Related Disorders Substance Use vs. Abuse- how does the

drug affect one’s functioning/life?

Substance Dependence- addiction; physiological dependence

Tolerance

Withdrawal

Can you use drugs and not become addicted/dependent?

Individual differences

Constellation of risk factors

May be difficult to predict

Substance Abuse:Some Considerations

Dual Diagnosis

Mental health problems co-occurring with addiction

Alcohol Use Disorders

Brain effects of Alcohol Abuse

Complex effects

GABA- anti-anxiety effects of alcohol Glutamate- excitatory effects Serotonin- mood properties- associated

with cravings

Progression

May follow different trajectories for different individuals

Drinking at an early age is correlated with later addictions

Causes of Substance-Related Disorders

Family studies indicate genetic vulnerabilities

Research: initial use of drugs may have more to do with environment/experience, later dependence is more closely linked with genetics

Causes of Substance-Related Disorders

Brain areas- a “pleasure pathway”

Role of dopamine

Role of Positive Reinforcement and Negative Reinforcement

Social Factors Influencing Addiction

Exposure to the drug Peer groups The role of context Cultural considerations

Multiple Influences Shaping Addiction

Stress and trauma

Different pathways and individual differences in the development and progression of addictions

Treatment of Addiction Biological approaches: medication

Psychosocial approaches: inpatient and outpatient treatment; AA and 12-step programs; community-based programs

Controversy surrounding the teaching of “controlled drinking”

Treatment of Addiction

CBT

Identification of antecedents and consequences- identifying high risk situations

Prevention efforts