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Substance-Related

Disorders

Chapter 13

Copyright © 2006 Allyn & Bacon

Allyn & Bacon copyright 2000 2

Drugs

• Drug: Chemical substance that alters biological

or cognitive processes

• Psychoactive Drugs

• Alter behavior, thought, or perception

• Therefore, can affect consciousness



What is Substance Abuse?

When use leads to negative consequences

When drugs are overused and relied on to deal with

everyday life

A person is a substance abuser if:

• The person has used a substance for one month

• Use has caused legal, personal, social, or

vocational problems

• The person repeatedly uses the substance even

in situations when doing so is hazardous

2



Alcohol Abuse and

Dependence

• Alcoholic: Person with a serious drinking

problem whose drinking impairs his or her

health, personal relationships, and

occupational functioning

• Alcoholism: Dependence on alcohol that

seriously interferes with life adjustment



Properties of Drugs

Dependence: Occurs when the drug becomes part

of the body’s functioning

Withdrawal: Occurs when dependence has

developed and use of the drug is discontinued

Tolerance: Higher and higher doses of a drug are

needed to produce the same effect

Addiction: A combination of tolerance and

dependence



Alcohol Abuse and

Dependence

• One in seven people meet the criteria for

alcohol abuse

• More than 37% of alcohol abusers suffer

from at least one coexisting mental disorder

• Alcohol abuse cuts across all age,

educational, occupational, and

socioeconomic boundaries

3



With Dependence

Withdrawal symptoms will occur if use is decreased

or stopped

• Withdrawal symptoms are typically the opposite

of a drug’s effects

• Typically unpleasant

• Can be stopped by taking more drugs

• Doing so is often considered addiction



True or False

Are the following statements about alcohol

true or false?

Everybody drinks

Damage to the liver always shows up long before brain damage

One can become an alcoholic just by drinking beer

Alcohol withdrawal is potentially more lethal than opiate withdrawal

People with “strong wills” need not be concerned about becoming alcoholics

False

False

True

True

False



Alcohol & The Brain

• Alcohol has complex and often contradictory

effects on the brain

– At lower levels, alcohol stimulates certain brain

cells and activates the brain’s “pleasure areas”

– At higher levels, alcohol depresses brain

functioning

4



Psychoactive Drugs

Must affect the nervous system

– Most do so by crossing the Blood–Brain

Barrier

– Mechanism that prevents some

molecules from entering the brain

Once in the brain, drugs alter neural activity



The Clinical Picture of Alcohol

Abuse and Dependence

• Excessive drinking can be viewed as

progressing from early- to middle- to late-

stage alcohol abuse disorder

• For individuals who drink to excess, the

clinical picture is highly unfavorable and

may include

– Cirrhosis of the liver

– Malnutrition

– Stomach pains



Psychosocial Effects

• Include:

– Chronic fatigue

– Oversensitivity

– Depression

– Impaired reasoning

– Personality deterioration

• Several acute psychotic reactions fit the diagnostic classification of substance-induced disorders

5



Drug Abuse and Dependence

Psychoactive drugs most commonly

associated with abuse and dependence:

– Narcotics

– Sedatives

– Stimulants

– Anti-anxiety drugs

– Hallucinogens



Biological Factors

• Genetics probably play an important role in

developing sensitivity to the addictive

power of drugs like alcohol

• Learning factors appear to play an

important role in the development of

substance abuse



Psychosocial Causal Factors

• Potential alcohol abusers tend to

– Be emotionally immature

– Expect a great deal of the world

– Require an inordinate amount of praise and

appreciation

– React to failure with marked feelings of hurt

and inferiority

– Have low frustration tolerance

– Feel inadequate and unsure of their abilities to

fulfill expected male or female roles

6



Psychosocial Causal Factors

• Alcohol abusers also tend to be unable or

unwilling to tolerate tension and stress

• Many people expect that alcohol use will

lower tension and anxiety and increase

sexual desire and pleasure in life

• Adults with less intimate and supportive

relationships tend to show greater drinking

following sadness or hostility



Sociocultural Factors

• The incidence of alcoholism is minimal

among Muslims and Mormons, whose

religious views prohibit the use of alcohol

• The incidence of alcoholism is high among

Europeans (15% in France)



Alcohol

Produces tolerance and dependence

Crosses blood–brain barrier

Depresses brain activity

• Dampens arousal

• Decreases inhibitions

• Slows reaction time

7



Treatment of Alcoholism

• Biological approaches include

– Medications to block the desire to drink:

• Antabuse

• Naltrexone

– Medications to lower the side effects of acute

withdrawal:

• Valium



Treatment of Alcoholism

Group Therapy

• Alcoholics Anonymous has reportedly met with

considerable success

• Project MATCH found equal success rates among

the following treatments:

– A 12-step program

– A CBT program

– Motivational enhancement therapy

Environmental Intervention

Behavior Therapy



Opiates

In the brain, opiates occupy Endorphin receptors

– Neurochemicals manufactured in the brain

– A natural mechanism of pain relief

• Opiates produce high tolerance and

dependence in those who use them for pleasure

• Few people given opiates for pain relief in

hospitals become addicted

8



Opium and Its Derivatives

(Narcotics)

• Narcotics include

– Opium

– Morphine

– Heroin

• These drugs were originally praised for

their medical uses, but they are dangerously

addictive



Opium and Its Derivatives

(Narcotics)

The immediate effects of narcotics include

– Alleviation of physical pain

– Relaxation and pleasant feelings

– Alleviation of anxiety and tension

Long-term effects include

– Physiological craving for the drug

– Withdrawal symptoms

– Gradual deterioration of well-being



Treatments and Outcomes

• Methadone

• Buprenorphine

• Rehabilitation program

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Stimulants

Drugs that increase alertness, confidence, reduce

fatigue, and elevate mood states

Increase blood pressure, heart rate, metabolic rate,

and decrease appetite

Act on the peripheral and central nervous systems

All stimulants have tolerance and dependence

properties



Stimulants

Caffeine

Nicotine

– Addictive drug in tobacco

– Does not have strong tolerance properties

– Does lead to strong dependence and

unpleasant withdrawal symptoms



Amphetamines

Also produce strong dependence and tolerance

Produce arousal and alertness

Some people use amphetamines for their appetite-

suppressing effects

Continued use can cause altered thoughts

• Unfounded suspicion

• May result in brain damage &

psychopathology

• Symptoms similar to Schizophrenia

10



Cocaine

Increases alertness

Rapidly creates positive feelings

These effects are short-lived, creating an urge to

use more

Strong potential for abuse



Barbiturates (Sedatives)• Barbiturates were once widely used to

induce sleep

• They are dangerous drugs commonly associated with

– Physiological and psychological dependence

– Lethal overdoses

• Those who become dependent on barbiturates tend to be middle-aged people who rely on them as sleeping aids

• Withdrawal is a key issue in treatment



Hallucinogens

Sometimes called Psychedelic drugs

Affect mood, thought, memory, judgment, and

perception

Alter perception and produce vivid imagery

Their impact varies widely depending on the user

and the particular drug

11



LSD and Related Drugs

(Hallucinogens)

• Hallucinogens cause an individual to see or

hear things in different and unusual ways

• Includes:

– LSD

– Mescaline

– Psilocybin

– PCP

– Ecstasy



LSD

Lysergic Acid Diethylamide

– Produces altered visual and auditory

perception

– Sometimes causes changes in time and

distance perception



Mescaline

• 3,4,5-trimethoxyphenethylamine: is a

hallucinogenic alkaloid

• Naturally in the peyote cactus

http://en.wikipedia.org/wiki/Psychedelics%2C_dissociatives_and_deliriants

http://en.wikipedia.org/wiki/Alkaloid

http://en.wikipedia.org/wiki/Peyote

12



Psilocybin

• Also known as psilocybine: Is a

psychedelic alkaloid

• It is a fungi

• Psilocybin-containing mushrooms are

commonly called magic mushrooms or

more simply "shrooms"



PCP

• Phencyclidine: is a dissociative drug

formerly used as an anesthetic agent,

exhibiting hallucinogenic and neurotoxic

effects. It is commonly known as Angel

Dust .



Ecstasy

Methylenedioxymethamphetamine (MDMA)

– Causes massive release of serotonin in the

brain

• Produces feelings of well-being and

kinship

• This action may be dangerous

– May lead to prolonged problems regulating

serotonin levels

– May contribute to depression and memory

problems

http://en.wikipedia.org/wiki/Psychedelic_drug

http://en.wikipedia.org/wiki/Alkaloid

http://en.wikipedia.org/wiki/Fungi

http://en.wikipedia.org/wiki/Mushrooms

http://en.wikipedia.org/wiki/Psychedelic_mushroom

http://en.wikipedia.org/wiki/Dissociative_drug

http://en.wikipedia.org/wiki/Anesthesia

http://en.wikipedia.org/wiki/Hallucinogen

13



Marijuana

• Elation and well-being

• Sleepiness

• Paranoia and nausea

• Marijuana affects

judgment and

coordination

• Euphoria

• Hilarity

• Hyper-talkativeness

• Anxiety

• Depression

• Hallucination

The dried leaves and flowering tops of the cannabis

sativa plant

Most widely used illicit drug

Reactions vary widely but may include:



Marijuana

• Marijuana may be classified as a mild hallucinogen

• Marijuana is not strongly physiologically addictive, but it may be psychologically addictive for some people

• Psychological treatment methods have been shown to be effective in reducing use in dependent adults



Marijuana

Produces neither tolerance nor dependence

– But, some people use marijuana to the point

that it interferes with their lives

– Seems to create a “psychological”

dependence in some

14



Sedatives/Hypnotics

A class of drugs that relax and calm a user

Can induce sleep at higher doses

Depress neural activity

• Sometimes called Depressants



Sedative–Hypnotics

Tranquilizers

Barbiturates

Opiates

– Derived from the opium poppy

– Opium, morphine, and heroin

– Synthetic opiates

• Oxycodone (Oxycontin) and Hydrocodone

(Vicodin)

• Chemically similar and have similar effects

– Medical uses include pain relief



Drug Use and Abuse

Legal or over-the-counter medications are often

not thought of as drugs

– Leads to underestimating hazards of

drugs such as alcohol and tobacco

– Alcohol and tobacco present the biggest

drug problem in the United States

• 51% of adolescents are current

drinkers and 27% are current smokers

15



Pathological Gambling

• Although pathological gambling does not

involve a chemically addictive substance it

is similar in the following ways:

– The personality factors that tend to characterize

addictive gamblers

– The difficulties attributable to compulsive

gambling

– The treatment problems involved

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Substance-Related Disorders - potentiality.orgpotentiality.org/drjwilcoxson/wp-content/uploads/2010/02/Chapter... · •Project MATCH found equal success rates among ... Nicotine