Abnormal Psychology Chapter 12

Substance Use and Addictive Disorders

Chapter 12

Comer, Abnormal Psychology, 8e DSM-5 Update

Slides & Handouts by Karen Clay Rhines, Ph.D.

American Public University System

Substance Use Disorders

Many drugs are available in our society

Some are harvested from nature, others derived from natural substances, and still others are produced in a laboratory

Some require a physicians prescription for legal use; others, like alcohol and nicotine, are legally available to adults

Still others, like heroin, are illegal under all circumstances


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Recent statistics suggest that drug use is a significant social problem

22 million people in the U.S. have used an illegal substance within the past month

Almost 24% of all high school seniors have used an illegal drug within the past month


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What is a drug?

Any substance other than food that affects our bodies or minds

Need not be a medicine or illegal

Current language uses the term substance rather than drug to overtly include alcohol, tobacco, and caffeine


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Substances may cause temporary changes in behavior, emotion, or thought May result in substance intoxication (literally,

poisoning), a temporary state of poor judgment, mood changes irritability, slurred speech, and poor coordination

Some substances such as LSD may produce a particular form of intoxication, sometimes called hallucinosis, which consists of perceptual distortions and hallucinations


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Substances can also lead to long-term problems:

Substance use disorder: a pattern of maladaptive behaviors and reactions brought about by repeated use of substances

In many cases, people become physically dependent on the substances, developing a tolerance for it (needing increasing doses to get an effect) and experiencing withdrawal reactions (unpleasant and dangerous symptoms when substance use is stopped or cut down)


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About 9% of all teens and adults in the U.S. display substance use disorders The highest rate in the U.S. is found among

American Indians (15.5%), while the lowest is among Asian Americans (3.5%)

White Americans, Hispanic Americans, and African Americans display rates between 9 and 10%

Only 11% receive treatment from a mental health professional


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The substances people misuse fall into several categories:

Depressants

Stimulants

Hallucinogens

Cannabis


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Depressants

Depressants slow the activity of the central nervous system (CNS) Reduce tension and inhibitions May interfere with judgment, motor activity, and

concentration

Three most widely used depressants: Alcohol Sedative-hypnotic drugs Opioids


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Depressants: Alcohol

The World Health Organization estimates that 2 billion people worldwide consume alcohol

In the U.S., more than half of all residents drink alcoholic beverages from time to time


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When people consume 5 or more drinks in a single occasion, it is called a binge-drinking episode 24% of all people in the U.S. over the age of 11,

most of them male, binge-drink each month

Nearly 7% of people over age the age of 11 binge-drink at least 5 times each month Considered heavy drinkers, males outnumber

females by more than 2:1 (around 8% to 4%)


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All alcoholic beverages contain ethyl alcohol

It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS

Short-term: alcohol binds to certain neurons

Alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker


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The first brain area affected is that which controls judgment and inhibition

Next affected are additional areas in the CNS, leaving the drinker even less able to make sound judgments, speak clearly, and remember well

Motor difficulties increase as drinking continues, and reaction times slow


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The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood A given amount of alcohol has a lesser effect on a large

person than on a small one

Gender also affects blood alcohol concentration Women have less alcohol dehydrogenase, an enzyme in

the stomach that metabolizes alcohol before it enters the blood

Women become more intoxicated than men on equal doses of alcohol


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Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood:

BAC = 0.06: Relaxation and comfort

BAC = 0.09: Intoxication

BAC > 0.55: Death

Most people lose consciousness before they can drink this much


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The effects of alcohol subside only after alcohol is metabolized by the liver

The average rate of this metabolism is 25% of an ounce per hour

You cant increase the speed of this process!


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Alcohol Use Disorder

Though legal, alcohol is one of the most dangerous recreational drugs

Its effects can extend across the life span

Alcohol use is a major problem on college campuses


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Surveys indicate that 7.4% of all adults in the U.S. display alcohol use disorder over a one-year period while over 13% display it at some point in their lives

Men outnumber women 2:1

Many teenagers also experience the disorder


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The prevalence of alcoholism in a given year is about the same (7% to 9%) for White Americans, African Americans and Hispanic Americans The men in these groups show strikingly different age

patterns

American Indians, particularly men, tend to display a higher rate of alcohol use disorders than any of these groups Overall 15% of them have the disorder


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Generally, Asians have lower rates of alcohol disorders than do people from other cultures

As many as one-half of these individuals have a deficiency of alcohol dehydrogenase; thus, they have a negative reaction to even modest alcohol intake


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Clinical Picture

In general, people with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious

Eventually the drinking interferes with social behavior and the ability to think and work

Individual patterns of alcoholism abuse vary


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Tolerance and Withdrawal For many individuals, alcohol use disorder includes

the symptoms of tolerance and withdrawal reactions As their bodies build up a tolerance for alcohol, they need

to drink greater amounts to feel its effects They may experience withdrawal symptoms, including

nausea and vomiting, when they stop drinking A small percentage of these people experience a dramatic

and dangerous withdrawal syndrome known as delirium tremens (the DTs) Alcohol withdrawal can be fatal


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What is the personal and social impact of alcoholism? Alcoholism destroys families, social relationships,

and careers Losses to society total many billions of dollars annually

Plays a role in suicides, homicides, assaults, rapes, and accidents

Has serious effects on the children (some 30 million) of persons with this disorder


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What is the personal and social impact of alcoholism? Long-term excessive drinking can seriously damage

physical health Especially damaged is the liver (cirrhosis)

Long-term excessive drinking can cause major nutritional problems Example: Korsakoffs syndrome

Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) and increased risk of miscarriage


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Depressants: Sedative-Hypnotic Drugs

Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness At low doses, they have a calming or sedative

effect

At high doses, they function as sleep inducers or hypnotics

Sedative-hypnotic drugs include barbiturates and benzodiazepines


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Depressants: Barbiturates

First discovered more than 100 years ago, barbiturates were widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep

Although still prescribed, they have been largely replaced by benzodiazepines

They can cause many problems, not the least of which is misuse


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Barbiturates are usually taken in pill or capsule form

At low doses, they reduce excitement in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate

Also similar to alcohol, barbiturates are metabolized by the liver


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At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death


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Repeated use of barbiturates can quickly result in sedative-hypnotic use disorder

A great danger of barbiturate tolerance is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects

Barbiturate withdrawal is particularly dangerous because it can cause convulsions


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Depressants: Benzodiazepines

Benzodiazepines are often prescribed to relieve anxiety

Most popular sedative-hypnotics available

Class includes Xanax, Ativan, and Valium


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Benzodiazepines have a depressant effect on the CNS by binding to GABA receptors and increasing GABA activity

Unlike barbiturates and alcohol, however, benzodiazepines relieve anxiety without causing drowsiness

They are also less likely to slow breathing and lead to death by overdose


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Once thought to be a safe alternative to other sedative-hypnotic drugs, benzodiazepines can cause intoxication and lead to an addictive pattern of use

As many as 1% of U.S. adults display a sedative-hypnotic use disorder that centers on benzodiazepines at some point in their lives


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Depressants: Opioids

This class of drug includes both natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds and is known collectively as narcotics

Each drug has a different strength, speed of action, and tolerance level


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Narcotics are smoked, inhaled, injected by needle just under the skin (skin popped), or injected directly into the bloodstream (mainlined) Injection seems to be the most common method of use,

although other techniques have been increasing in recent years

An injection quickly brings on a rush a spasm of warmth and ecstasy that is sometimes compared with orgasm

This spasm is followed by several hours of pleasurable feelings (called a high or nod)


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Opioids create these effects by depressing the CNS Opioids bind to the receptors in the brain that

ordinarily receive endorphins (NTs that naturally help relieve pain and decrease emotional tension)

When these sites receive opioids, they produce pleasurable and calming feelings, just as endorphins do

In addition to reducing pain and tension, opioids can cause nausea, narrowing of the pupils, and constipation


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Heroin use exemplifies the problems posed by opioids: After just a few weeks, users may become caught in a

pattern of abuse (and often dependence)

Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it

Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration


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Such individuals soon need the drug just to avoid experiencing withdrawal, and they must continually increase their doses in order to achieve even that relief

Many users must turn to criminal activity to support their habit and avoid withdrawal symptoms


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Surveys suggest that close to 1% of adults in the U.S. display opioid use disorder at some time in their lives


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What are the dangers of opioid use ? Once again, heroin provides a good example:

The most immediate danger is overdose The drug closes down the respiratory center in the brain,

paralyzing breathing and causing death

Death is particularly likely during sleep

Ignorance of tolerance is also a problem People who resume use after having avoided it for some time

often make the fatal mistake of taking the same dose they had built up to before


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What are the dangers of opioid use? Each year approximately 2% of persons addicted

to heroin and other opioids die under the drugs influence

In addition, users run the risk of getting impure drugs Opioids are often cut with noxious chemicals

Dirty needles and other equipment can spread infection


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Stimulants

Stimulants are substances that increase the activity of the central nervous system (CNS) Cause increases in blood pressure, heart rate, and

alertness Cause rapid behavior and thinking

The four most common stimulants are: Cocaine Amphetamines Caffeine Nicotine


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Stimulants: Cocaine

Derived from the leaves of the coca plant, cocaine is the most powerful natural stimulant known

28 million people in the U.S. have tried cocaine

1.6 million people are currently using it


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Stimulants: Cocaine

Cocaine produces a euphoric rush of well-being

It seems to work by increasing dopamine at key receptors in the brain and overstimulating them

Also appears to increase norepinephrine and serotonin


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Stimulants: Cocaine

High doses of cocaine can produce cocaine intoxication, whose symptoms include mania, paranoia, and impaired judgment Some people also experience hallucinations

and/or delusions, a condition known as cocaine-induced psychosis

As the stimulant effects of the drug subside, the user experiences a depression-like letdown, popularly called crashing


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Stimulants: Cocaine

Cocaine use in the past was limited by the drugs high cost

Since 1984, newer, more powerful, and sometimes cheaper versions of the drug have become available, including: A freebase form where the drug is heated and

inhaled with a pipe

Crack, a powerful form of freebase that has been boiled down for smoking in a pipe


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Stimulants: Cocaine

What are the dangers of cocaine? Aside from its behavioral effects, cocaine poses

significant physical danger

The greatest danger of use is the risk of overdose Excessive doses depress the brains respiratory function, and

stop breathing

Cocaine use can also cause heart failure

Pregnant women who use cocaine have an increased likelihood of miscarriage and of having children with abnormalities


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Stimulants: Amphetamines

Amphetamines are stimulant drugs that are manufactured in the laboratory

Most often taken in pill or capsule form

Some people inject the drugs intravenously or smoke them for a quicker, more powerful effect


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Like cocaine, amphetamines: Increase energy and alertness and reduce appetite

when taken in small doses

Produce a rush, intoxication, and psychosis in high doses

Cause an emotional letdown as they leave the body

stimulate the CNS by increasing dopamine, norepinephrine, and serotonin


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One kind of amphetamine, methamphetamine, has had a major surge in popularity in recent years Almost 6% of all persons over the age of 11 in the US

have used this stimulant at least once

Most of the nonmedical meth is made in stovetop laboratories

Meth is about as likely to be used by women as men and has gained popularity as a club drug


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Stimulant Use Disorder

Regular use of either cocaine or amphetamine may lead to stimulant use disorder The stimulant comes to dominate the individuals life Tolerance and withdrawal reactions may also develop

In a given year, 0.5% of all people over the age of 11 display stimulant use disorder centered on cocaine and 0.25 display it centered on amphetamines


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Stimulants: Caffeine

Caffeine is the worlds most widely used stimulant Around 80% of the worlds population consumes it

daily Most consumption is in the form of coffee; the rest is in

the form of tea, cola, energy drinks, chocolate, and over-the-counter medications

Around 99% of ingested caffeine is absorbed by the body and reaches its peak concentration within an hour


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Caffeine acts as a stimulant in the CNS, producing a release of dopamine, serotonin, and norepinephrine in the brain

More than 2 to 3 cups of brewed coffee can lead to caffeine intoxication

Seizures and respiratory failure can occur at doses greater than 10 grams of caffeine (about 100 cups of coffee)


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Many people who suddenly stop or cut back their usual intake experience withdrawal symptoms, including headaches, depression, anxiety, and fatigue

Studies suggest correlations between high doses of caffeine and heart rhythm irregularities, high cholesterol levels, and risk of heart attacks

High doses during pregnancy also increase the risk of miscarriage


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Hallucinogens, Cannabis, and Combinations of Substances

Other kinds of substances may also cause problems for users and for society

Hallucinogens

Produce delusions, hallucinations, and other sensory changes

Cannabis

Produces sensory changes, but have both depressant and stimulant effects

Many individuals take combinations of substances


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Hallucinogens

Hallucinogens, also known as psychedelic drugs, cause powerful changes in sensory perceptions (sometimes called trips) Include natural hallucinogens

Mescaline

Psilocybin

And laboratory-produced hallucinogens Lysergic acid diethylamide (LSD)

MDMA (Ecstasy)


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Hallucinogens

LSD is one of the most famous and powerful hallucinogens Within two hours of being swallowed, it brings on a

state of hallucinogen intoxication (hallucinosis) Increased and altered sensory perception Hallucinations may occur

The drug may cause different senses to cross, an effect called synesthesia

May induce extremely strong emotions May have some physical effects

Effects wear off in about six hours


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Hallucinogens

LSD produces these symptoms by binding to serotonin receptors

These neurons help control visual information and emotions, thereby causing the various effects of the drug on the user


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Hallucinogens

More than 14% of Americans have used hallucinogens at some point in their lives

Tolerance and withdrawal are rare But the drugs do pose dangers

Users may experience a bad trip the experience of enormous unpleasant perceptual, emotional, and behavioral reactions

Another danger is the risk of flashbacks Can occur days or months after last drug use


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Cannabis

The drugs produced from varieties of the hemp plant are, as a group, called cannabis They include:

Hashish, the solidified resin of the cannabis plant Marijuana, a mixture of buds, crushed leaves, and flowering

tops

The major active ingredient in cannabis is tetrahydrocannabinol (THC) The greater the THC content, the more powerful the

drug


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Cannabis

When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects At low doses, the user feels joy and relaxation

May become anxious, suspicious, or irritated

This overall high is technically called cannabis intoxication

At high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations

Most of the effects of cannabis last 2 to 6 hours Mood changes may continue longer


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Cannabis

Cannabis Use Disorder In the 1970s, use of marijuana rarely led to cannabis

use disorder

Today many users are developing this disorder Some users develop tolerance and withdrawal, experiencing

flulike symptoms, restlessness, and irritability when drug use is stopped

About 1.7% of people in the U.S. displayed marijuana abuse or dependence in the past year Between 4 and 5% will fall into these patterns at some point in

their lives


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Cannabis

Cannabis Use Disorder

One theory about the increase in cannabis use disorder is the change in the drug itself

The marijuana available today is significantly more potent than the drug used in the early 1970s


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Cannabis

Is marijuana dangerous?

As the strength and use of the drug has increased, so have the risks of using it

May cause panic reactions similar to those caused by hallucinogens

Because of its sensorimotor effects, marijuana has been implicated in accidents

Marijuana use has been linked to poor concentration and impaired memory


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Cannabis

Is marijuana dangerous?

Long-term use poses additional dangers

May cause respiratory problems and lung cancer

May affect reproduction In males, it may lower sperm count

In women, abnormal ovulation has been found


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Cannabis

Cannabis and Society: A Rocky Relationship

For centuries, cannabis played a respected role in medicine, but its use fell out of favor and was criminalized

In the late 1980s, several interest groups campaigned for the medical legalization of marijuana


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Cannabis

Cannabis and Society: A Rocky Relationship In 2009, the US Attorney General directed federal

prosecutors to not pursue cases against medical marijuana users complying with state laws

In 2011 and 2012, several state and city-level officials petitioned the government to reclassify marijuana as a drug with acceptable medical usage


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Cannabis

Cannabis and Society: A Rocky Relationship

In 2012, residents of Colorado and Washington voted to legalize marijuana for use of any kind, although such state measures can be blocked by the federal government

In the meantime, both the Netherlands and Canada permit its use for medical purposes


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Combinations of Substances

People often take more than one drug at a time, a pattern called polysubstance use

Researchers have studied the ways in which drugs interact with one another, focusing on cross-tolerance and synergistic effects


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Cross-tolerance Sometimes two or more drugs are so similar in their

actions on the brain and body that as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other (even if they have never taken it)

Users who display this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other Example: alcohol and benzodiazepines


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Synergistic effects

When different drugs are in the body at the same time, they may multiply, or potentiate, each others effects

This combined impact is called a synergistic effect, and is often greater than the sum of the effects of each drug taken alone


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Synergistic effects

One kind of synergistic effect occurs when two or more drugs have similar actions

Example: alcohol, barbiturates, benzodiazepines, and opioids

All depressants, these drugs may severely depress the CNS when mixed, leading to death


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Synergistic effects

A different kind of synergistic effect results when drugs have opposite (antagonistic) effects

Example: stimulants or cocaine with barbiturates or alcohol May build up lethal levels of the drugs because of metabolic

issues (stimulants impede the livers processing of barbiturates and alcohol)


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Each year tens of thousands of people are admitted to hospitals because of polysubstance use

May be accidental or intentional

As many as 90% of people who use one illegal drug are also using another to some extent


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What Causes Substance Use Disorders?

Clinical theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence

No single explanation has gained broad support

Best explanation: a COMBINATION of factors


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Causes of Substance Use Disorders: Sociocultural Views

A number of theorists propose that people are more likely to develop substance use disorders when living in stressful socioeconomic conditions

Example: higher levels of unemployment correlate with higher rates of alcohol use

Example: people of lower SES have higher rates of substance use in general


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Causes of Substance Use Disorders: Sociocultural Views

Other theorists propose that substance use disorders are more likely to appear in families and social environments where substance use is valued or accepted

Example: rates of alcohol use vary among cultures


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Causes of Substance Use Disorders: Psychodynamic Views

Psychodynamic theorists believe that people with substance use disorders have powerful dependency needs that can be traced to their early years Caused by a lack of parental nurturing

Some people may develop a substance abuse personality as a result

Limited research does link early impulsivity to later substance use, but the findings are correlational and researchers cannot presently conclude that any one personality trait or group of traits stands out in substance-related disorders


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Causes of Substance Use Disorders: Cognitive-Behavioral Views

According to behaviorists, operant conditioning may play a key role in substance abuse They argue that the temporary reduction of tension

produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again

Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion


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Causes of Substance Use Disorders: Cognitive-Behavioral Views

Cognitive theorists further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation is sufficient to motivate individuals to increase drug use at times of tension


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Causes of Substance-Related Disorders: Cognitive-Behavioral Views

In support of these views, studies have found that many subjects do in fact drink more alcohol or seek heroin when they feel tense

In a manner of speaking, this model is arguing a self-medication hypothesis


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If true, one would expect higher rates of substance use among people with psychological problems

More than 22% of all adults who suffer from psychological disorders have displayed substance use disorders within the past year


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Other behaviorists have proposed that classical conditioning may play a role in these disorders Objects present at the time drugs are taken may act as

classically conditioned stimuli and come to produce some of the pleasure brought on by the drugs themselves

Although classical conditioning may be at work, it has not received widespread research support as the key factor in such patterns


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Causes of Substance Use Disorders: Biological Views

In recent years, researchers have come to suspect that drug misuse may have biological causes

Studies on genetic predisposition and specific biochemical processes have provided some support for this model


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Genetic predisposition Research with alcohol-preferring animals has

demonstrated that their offspring have similar alcohol preferences

Similarly, research with human twins has suggested that people may inherit a predisposition to misuse substances Concordance rates in identical (MZ) twins: 54%

Concordance rates in fraternal (DZ) twins: 28%


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Genetic predisposition

Clearer support for a genetic model may come from adoption studies

Studies compared adoptees whose biological parents abuse alcohol with adoptees whose biological parents do not By adulthood, those whose biological parents were

dependent showed higher rates of alcoholism themselves


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Genetic predisposition

Genetic linkage strategies and molecular biology techniques provide more direct evidence in support of this hypothesis

An abnormal form of the dopamine-2 (D2) receptor gene was found in the majority of research participants with substance use disorders, but in less than 20% of participants who do not display such disorders


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Biochemical factors

Over the past few decades, investigators have pieced together several biological explanations of drug tolerance and withdrawal

Based on NT functioning in the brain

The specific NTs affected depend on which drug is used

Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a reward center or pleasure pathway in the brain


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Biochemical factors The reward center apparently extends from the ventral

tegmental area of the brain to the nucleus accumbens and on to the frontal cortex

The key NT appears to be dopamine When dopamine is activated at this reward center, a person

experiences pleasure

Certain drugs stimulate the reward center directly Examples: cocaine, amphetamines, caffeine

Other drugs stimulate the reward center in roundabout ways Examples: alcohol, opioids, marijuana


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Biochemical factors

A number of theorists believe that when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances

This theory, called the incentive-sensitization theory, has received considerable support in animal studies


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Biochemical factors Other theorists believe that people who abuse

substances suffer from a reward-deficiency syndrome Their reward center is not readily activated by normal

life events so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress Defects in D2 receptors have been cited as a possible cause


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How Are Substance Use Disorders Treated?

Many approaches have been used to treat substance use disorders, including psychodynamic, behavioral, cognitive-behavioral, and biological, along with sociocultural therapies

Although these treatments sometimes meet with great success, more often they are only moderately helpful

Today treatments are typically used in combination on both an outpatient and inpatient basis


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How Are Substance Use Disorders Treated?

The value of treatment for substance use disorders can be difficult to determine Different substance use disorders pose different

problems Many people with such disorders drop out of

treatment early Some people recover without any intervention at all Different criteria are used by different clinical

researchers


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Psychodynamic Therapies

Psychodynamic therapists first guide clients to uncover and work through the underlying needs and conflicts that they believe led to the disorder then try to help them change their styles of living

Research has not found this model to be very effective Tends to be of greater help when combined with

other approaches in a multidimensional treatment program


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Behavioral Therapies

A widely used behavioral treatment is aversion therapy, an approach based on classical conditioning principles Individuals are repeatedly presented with an

unpleasant stimulus at the very moment they are taking a drug

After repeated pairings, they are expected to react negatively to the substance itself and to lose their craving for it


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Aversion therapy is most commonly applied to alcoholism In one version, drinking behavior is paired with drug-

induced nausea and vomiting

Another version of this approach requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking The pairing is expected to produce negative responses to

liquor itself


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A behavioral approach that has been successful in the short-term is contingency management

This procedure makes incentives contingent on the submission of drug-free urine specimens


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Behavioral interventions have usually had onlhy limited success when used alone

They work best when used in combination with either biological or cognitive approaches


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Cognitive-Behavioral Therapies

Cognitive-behavioral treatments for substance use disorders help clients identify and change the patterns and cognitions contributing to their patterns of substance misuse


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Cognitive-Behavioral Therapies

The most prominent of these approaches is relapse-prevention training

The overall goal is for clients to gain control over their substance-related behaviors

Clients are taught to identify and plan ahead for high-risk situations and to learn from mistakes and lapses

This approach is used particularly to treat alcohol use; also used to treat cocaine and marijuana abuse


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Biological Treatments

Biological approaches may be used to help people withdraw from substances, abstain from them, or simply maintain their level of use without further increases

These approaches have limited long-term success when used alone, but can be helpful when combined with other approaches


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Detoxification Systematic and medically supervised withdrawal

from a drug Can be outpatient or inpatient

Two strategies: Gradual withdrawal by tapering doses of the substance

Induce withdrawal but give additional medication to block symptoms


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Detoxification

Detoxification programs seem to help motivated people withdraw from drugs

For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high


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Antagonist drugs

As an aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance

Example: disulfiram (Antabuse) for alcohol

Example: naloxone for opioids, naltrexone for alcohol


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Drug maintenance therapy A drug-related lifestyle may be a greater problem than

the drugs direct effects Example: heroin addiction

Methadone maintenance programs are designed to provide a safe substitute for heroin Methadone is a laboratory opioid with a long half-life, taken

orally once a day Programs were roundly criticized as substituting addictions

but are regaining popularity, partly because of the spread of HIV/AIDS


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Sociocultural Therapies

Three sociocultural approaches have been applied to substance use disorders:

Self-help programs

Culture- and gender-sensitive programs

Community prevention programs


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Self-help and residential treatment programs Most common: Alcoholics Anonymous (AA)

Offers peer support along with moral and spiritual guidelines to help people overcome alcoholism

It is worth noting that the abstinence goal of AA directly opposes the controlled-drinking goal of relapse prevention training and several other interventions for substance misuse this issue has been debated for years


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Self-help and residential treatment programs

Many self-help programs have expanded into residential treatment centers or therapeutic communities

People formerly addicted to drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies


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Culture- and gender-sensitive programs

A growing number of treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of ethnic minority groups

Similarly, therapists have become more aware that women often require treatment methods different from those designed for men


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Community prevention programs Perhaps the most effective approach to substance use

disorders is to prevent them

Some prevention programs argue for total abstinence from drugs, while others teach responsible use

Prevention programs may focus on the individual, the family, the peer group, the school, or the community at large The most effective of these prevention efforts focuses on multiple

areas to provide a consistent message about drug use in all areas of life


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Gambling Disorder

It is estimated that as many as 2.3% of all adults and 3-8% of teens and college students suffer from gambling disorder Clinicians are careful to distinguish between this

disorder and social gambling

Gambling disorder is defined less by the amount of time or money spent than by the addictive nature of the disorder People with the disorder are preoccupied with and

cannot walk away from a bet


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Gambling Disorder

The explanations posed for gambling disorder often parallel those offered for substance use disorders

These include possible genetic predisposition, heightened dopamine activity, impulsive personality styles, and cognitive errors

Research, however, has been limited thus far


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Gambling Disorder

Similarly, the leading treatments for substance use disorder have been adapted for use with gambling disorder

These include cognitive-behavioral approaches and biological approaches

In addition, the self-help group program Gamblers Anonymous is available


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Internet Use Disorder

As people increasingly turn to the Internet for activities that used to take place in the real world, a new psychological problem has emerged: an uncontrollable need to be online

This pattern has been called Internet use disorder, Internet addiction, and problematic Internet use


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For people who display this pattern, the Internet has become a black hole Sufferers at least 1% of all people spend all or

most of their waking hours texting, tweeting, networking, gaming, Internet browsing, emailing, blogging, visiting virtual worlds, shopping online, or viewing online pornography

Specific symptoms of this pattern parallel those found in substance use disorders and gambling disorder


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Although clinicians, the media, and the public have shown enormous interest in this problem, DSM-5 has not listed it as a disorder

Instead, it has recommended that the pattern receive further study for possible inclusion in future editions


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Documents

Abnormal Psychology Chapter 12