Substance-Related, Addictive, and Impulse-Control Disorders - PowerPoint Presentation

Slide1

Substance-Related, Addictive, and Impulse-Control Disorders

Chapter 10Slide2

Substance Use

Ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning

Drinking coffee, smoking a cigarette, having a drink

Occasional ingestion of illegal drugsSlide3

Intoxication

Physiological reaction to ingested substances- being drunk, getting high

Impaired judgement, mood changes, lowered motor abilitySlide4

Substance Abuse

Not necessarily how much

Significant interference- disrupts education, jobs, relationships, puts you in a physically dangerous situation

A pattern of use

Drug use can predict later job outcomesSlide5

Addiction

AKA Substance dependence

Physiological dependent on drug

Requires increasingly greater amounts of the drug to experience the same effect (Tolerance)

Will respond in a negative way when the substance is no longer ingested (Withdrawal)

Tolerance and Withdrawal are physiological reactions to the chemicals being

injestedSlide6

Withdrawal

Headaches can be caffeine withdrawal if you are used to drinking coffee regularly (if you drink coffee will it go away?)

Alcohol can cause delirium (hallucinations and body tremors)

Many substances- chills, fever, diarrhea, nausea and vomiting, aches and painsSlide7

Withdrawal

Not all substances are physiologically addicting

You would not go through withdrawal when you stop taking LSD

Cocaine- anxiety, lack of motivation, and boredom

Cannabis- nervousness, appetite change, sleep disturbanceSlide8

Psychological Dependence

Behaviors “drug-seeking”

Repeated use, desperate need to ingest more (stealing money, standing outside in the cold), likelihood that use will resume after a period of abstinence

Different than physiological reactions

Old DSM- substance abuse and substance dependence

Combined in DSM5- now substance-related disorders with levels of severity (mild- 2 or 3/11 criteria, moderate- 4 or 5/11 criteria, or severe- 6 or more/11 criteria)Slide9

Does drug use lead to addiction

We cannot predict who may be more likely to lose control and abuse drugs/ likely to become dependent with passing use

Some people use occasionally and are fine (even “harder” drugs)

Some use only once/a few times and have a problemSlide10

Dependence versus Abuse

Dependence can be present without abuse

Cancer patients may become dependent on morphine for pain- build up tolerance and go through withdrawal if it is stoppedSlide11

Comorbidity

¾ of people in addiction treatment have an additional psychiatric disorder

More than 40% have mood disorders

Anxiety/PTSD in more than 25%

Do they symptoms exist outside the realm of substance use- are symptoms seen during drug use or within withdrawal period or did they exist before use and continue after withdrawal period would have passedSlide12

Types of substances- 6 categories

Depressants- behavioral sedation:

etoh

, barbiturates, and benzos

Stimulants- cause us to be more active/alert and elevate mood: amphetamines, cocaine, nicotine, caffeine

Opiates- produce analgesia (pain reduction) and euphoria: heroin, opium, codeine, and morphine

Hallucinogens- alter sensory and perception and can produce delusions, paranoia, and hallucinations: cannabis and LSD

Other Drugs of Abuse- psychoactive effects: inhalants, anabolic steroids, other over-the-counter and prescription meds such as nitrous oxide

Gambling disorder- unable to resist urge causing negative consequencesSlide13

Depressants

Decrease CNS activation

Reduce physiological arousal, help us relax

Etoh

, sedative, hypnotic, and anxiolytic drugs, those prescribed for insomnia

Wernicke-

Korsakoff

syndrome: confusion, loss of muscle coordination, and unintelligible speech- thiamine deficiency which is a vitamin metabolized poorly by heavy drinkers

Fetal alcohol syndrome- fetal growth retardation, cognitive deficits, behavior problems, and learning difficulties; characteristic facial featuresSlide14

Binge Drinking

5 or more drinks on the same occasion (23% of the population in the past month).

Tailgating

…

42% of college students had gone on binge of heavy drinking once in the preceding 2 weeks

GPA of A- no more than 3 drinks per week

GPA of D and F- average of 11 drinks per weekSlide15

Drinking

Drinking at early age (11-14 yoa) predictive of later alcohol-related disorders

Individuals who tend not to develop slurred speech, staggering, and other sedative effects are more likely to abuse it in the future

Mixing energy drinks may be problematic- reducing sedative effect may lincrease liklihood of later abuse

Violent behavior?

Chicken or the egg, reduced impulse control, impaired ability to consider consequencesSlide16

Sedative, hypnotic, anxiolytic

Barbiturates (Amytal,

Seconal

, Nembutal) and Benzodiazepines (Valium, Xanax, Ativan)

Influence GABA

Barbs- help people sleep and replace

etoh

and opium

Benzos touted as miracle cure for anxiety

Benzos considered safer than Barbs- less risk of abuse and dependence

However-

rohypnol

(

roofies

) same effect as alcohol without odorSlide17

Barbiturates

Relax muscles

Feelings of well-being

Slurred speech

Problems walking, concentrating, and working

Diaphragm muscles can relax so much that they cause death by suffocation

Common means of suicideSlide18

Benzodiazepines

Calm

Induce sleep

Muscle relaxants

Anticonvulsants

Pleasant high, reduction of inhibition

Tolerance and dependence can develop

Withdrawal like

etoh

- anxiety, insomnia, tremors, deliriumSlide19

Stimulant-Related Disorders

Amphetamines

Elation and vigor

Reduce fatigue

Feel “up”

Followed by “crash”, feeling depressed or tired

Created in lab- asthma and nasal decongestant

Weight loss due to reduced

apetite

Use for pulling all-nighters, energy boost to stay awake (truck drivers, pilots, students)

Ritalin, Adderall used for ADHD

2/3 of college students in their 4

th

year had been offered illegal prescription of stimulants, 31% used them (studying)Slide20

Intoxication

Euphoria or affective blunting

Changes in sociability

Interpersonal sensitivity

Anxiety

Tension

Anger

Stereotyped behaviors (repetitive body movements)

Impaired judgment

Impaired social/occupational functioningSlide21

Physiological changes

Heart rate and blood pressure changes

Perspiration or chills

Nausea or

vomitting

Chest pain

Seizures

comaSlide22

Severe intoxication/overdose

Hallucinations

Panic

Agitation

Paranoid delusions

Tolerance builds quickly making it especially dangerous

Withdrawal- apathy, prolonged periods of sleep, irritability, and depressionSlide23

Designer drugs

MDMA (appetite suppressant) now used recreationally (Ecstasy)

After methamphetamine MDMA club drug most often bringing people to emergency room, passed LSD in frequency of use

Methamphetamine (Crystal Meth or Ice)- purified crystallized form of amphetamine; ingested through smoking

Aggressive tendencies

Stays in system longer than cocaine making it particularly dangerous

Potential for dependence is extremely high

MDMA can cause lasting memory problemsSlide24

Cocaine

Derived from leaves of the coca plant

Increase alertness

Produces euphoria

Increases blood pressure and pulse

Causes insomnia and loss of

apetite

Short lived

Cocaine induced paranoia- 2/3 or more of users

Causes heart beat to become rapid and irregular- can have fatal consequences

Crack cocaine is a crystallized form of cocaine that is smoked

Dependence sneaks up on you- thought of as wonder drug at first; tolerance and withdrawal do happen

May result in premature aging of the brain

Withdrawal- apathy and boredom, particularly dangerous; atypical; brings you back to lifeSlide25

Tobacco

20% of all people in the US smoke down from 42% in 1965

Withdrawal- depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, increased appetite and weight gain

Nicotine stimulates CNS: can relieve stress and improve mood

Can also cause high blood pressure, increase the risk of heart disease and cancer

High doses: blur vision, cause confusion, lead to convulsions, sometimes cause death

Relapse equal among-

etoh

, heroin, and cigsSlide26

Caffeine

Most common of psychoactive substances- 90% of all Americans

Gentle stimulant- least harmful of addictive drugs

Can still be problematic

High levels in pills or energy drinks: some are banned in certain countries

Elevate mood, reduce fatigue

Large doses- jittery, insomnia

Takes about 6 hours to leave body- sleep disturbance

Pregnancy- 1 cup a day is ok

Withdrawal- headaches, drowsiness, unpleasant moodSlide27

Opioids

Natural opiates

Synthetic (heroin, methadone, hydrocodone, oxycodone

Natural (

enkephalins

, beta-endorphins,

dnorphins

Euphoria, drowsiness, slowed breathing

Death if respiration is completely depressed

Analgesics- relieve pain

Withdrawal very bad- makes stopping hard: 6-12 hours- yawning, nausea/vomiting, chills, muscle aches, diarrhea, and insomnia

1-3 days, withdrawal process completed in about a weekSlide28

Heroin

½ a million people, double the number in 2007

Most common abused opiate

Illicit use of opioid containing prescription meds has risen- 12% of high school seniors used opioids for nonmedical reasons

80 addicts- 22% had died (overdose and suicide); of those that survived- 80% were no longer using, 20% were being treated with methadoneSlide29

Cannabis

Most routinely used illegal substance

5-15% of people in western countries reporting regular use

Mood swings, normal experiences seem extremely funny, dreamlike state in which time seems to stand still, heightened sensory experiences, vivid colors, appreciating subtleties of music

More than other drugs- different reactions in people

First use- often no reaction, high can be “turned off” if motivated

Can also change to paranoia, hallucinations, and dizzinessSlide30

Cannabis cont

Impairments in memory, concentration, relationships with others, employment

Though what came first- psychological problems may precede use

Synthetic marijuana (K2, spice)- can be purchased legally- hallucinations, seizures, heart rhythm problems

Contradictory evidence for tolerance: tolerance to high or increased high with use

Irritability, restlessness, appetite loss, nausea, difficulty sleepingSlide31

Medical Marijuana

Successful use of cannabis and by-products for certain diseases

Chemo-induced nausea and vomiting

HIV-associated anorexia

Neuropathic pain in MS

Cancer pain

CarcinogensSlide32

Hallucinogens

LSD (acid): most common hallucinogen, synthetic

Natural- psilocybin (mushrooms), mescaline (peyote)

Phencyclidine (PCP)- snorted, smoked, injected; causes impulsivity and aggressiveness

Perceptual changes such as subjective intensification of perceptions, depersonalization, hallucinations

Pupillary dilation, rapid heartbeat, sweating, blurred visionSlide33

Hallucinogens cont

Tolerance develops quickly; if repeat use over a period of days they lose effectiveness; sensitivity returns a week after abstinence

No withdrawal

Psychotic reactions- e.g., jump out windows because think you can fly

“bad trips” paranoiaSlide34

Positive and Negative Reinforcement

Gives pleasure, takes away pain/stress

Cope with unpleasant feelings

Opponent-process theory- Motivation shifts once tolerance and withdrawal build: Starts with trying to achieve a high, ends with trying to decrease the negative consequence of “crash”: that is why the

neg

part doesn’t lead to decrease

The very drug that is making you feel bad is also the one thing that can take away the pain: enslaved by the cycleSlide35

Cravings

Availability

Contact with paraphernalia

Moods

Small doses of drug

VR can be used

Changes in the brain (neuroplasticity) increase drive to obtain and use

Self-medication

Genetic influencesSlide36

Treatment

Biological treatment-

agonist substitution (methadone ad buprenorphine); nicotine gum, patch,

etc

tappered

off

Antagonist drugs- block the effects of the drug, produces withdrawal (must be free from withdrawal before starting naltrexone), removes high so must be motivated

Aversive treatment- Antabuse: causes nausea, vomiting, and elevated heart rate and respiration if you drinkSlide37

Treatment

Psychosocial treatment-

Inpatient

AA- 12 step program; alcoholism is a disease, more powerful than individual, higher power needed to overcome, destigmatizing, social support, total abstinence

Controlled use

Component treatment- package- covert sensitization, contingency management, community reinforcement,

Motivational Enhancement Therapy- empathetic and optimistic counseling, core values, positive outcome expectancies

CBT