Abnormal hand out_ch10

11Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 10, 5e – Chapter 10Slides & Handouts by Karen Clay Rhines, Ph.D.Slides & Handouts by Karen Clay Rhines, Ph.D.

Chapter 10 Chapter 10 HandoutsHandouts

Substance-Related DisordersSubstance-Related Disorders

2Comer, Comer, Fundamentals of Abnormal PsychologyFundamentals of Abnormal Psychology, 5e – Chapter 10, 5e – Chapter 10

Substance-Related Substance-Related DisordersDisorders

What is a drug?What is a drug? ____________________________________________________________________________

Need not be a medicine or be illegalNeed not be a medicine or be illegal

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



Substances may cause ______________ Substances may cause ______________ changes in behavior, emotion, or changes in behavior, emotion, or thoughtthought May result in substance intoxication May result in substance intoxication

(literally, “poisoning”)(literally, “poisoning”)



Substances can also produce long-term Substances can also produce long-term problems:problems: Substance abuse: a pattern of behavior in which a Substance abuse: a pattern of behavior in which a

person relies on a drug excessively and person relies on a drug excessively and repeatedly, damaging their relationships, repeatedly, damaging their relationships, affecting work functioning, and/or putting affecting work functioning, and/or putting themselves or others in dangerthemselves or others in danger

Substance dependence: a more advanced pattern Substance dependence: a more advanced pattern of use in which a person abuses a drug and of use in which a person abuses a drug and centers his or her life around itcenters his or her life around it

Also called “___________________”Also called “___________________” May include ______________ (need increasing doses to get May include ______________ (need increasing doses to get

an effect) and ________________ (unpleasant and an effect) and ________________ (unpleasant and dangerous symptoms when substance use is stopped)dangerous symptoms when substance use is stopped)




About 10% of all adults in the U.S. display About 10% of all adults in the U.S. display substance abuse or dependencesubstance abuse or dependence Only 26% receive treatmentOnly 26% receive treatment

Many drugs are available in our societyMany drugs are available in our society Some are naturally occurring; others are Some are naturally occurring; others are

produced in a laboratoryproduced in a laboratory Some require a physician’s prescription for Some require a physician’s prescription for

legal use; others, like alcohol and nicotine, are legal use; others, like alcohol and nicotine, are legally available to adultslegally available to adults

Still others, like heroin, are illegal under all Still others, like heroin, are illegal under all circumstancescircumstances



Recent statistics suggest that drug use Recent statistics suggest that drug use is a significant social problemis a significant social problem Over 28 million people in the U.S. have Over 28 million people in the U.S. have

used an illegal substance within the past used an illegal substance within the past yearyear

Over 19 million are using one of them Over 19 million are using one of them currentlycurrently

Almost 25% of all high school seniors have Almost 25% of all high school seniors have used an illegal drug within the past monthused an illegal drug within the past month



There are several categories of There are several categories of substances used and studied:substances used and studied: DepressantsDepressants

StimulantsStimulants

HallucinogensHallucinogens

CannabisCannabis

Polydrug usePolydrug use


DepressantsDepressants

Depressants slow the activity of the Depressants slow the activity of the central nervous system (CNS)central nervous system (CNS) Reduce tension and inhibitionsReduce tension and inhibitions

May affect judgment, motor activity, and May affect judgment, motor activity, and concentrationconcentration

Three most widely used depressants:Three most widely used depressants: AlcoholAlcohol

Sedative-hypnotic drugsSedative-hypnotic drugs

OpioidsOpioids


Depressants: AlcoholDepressants: Alcohol

About 2/3 of the U.S. population drinks About 2/3 of the U.S. population drinks alcoholalcohol Nearly 7% of people over age 11 are heavy Nearly 7% of people over age 11 are heavy

drinkers, having 5 drinks on at least 5 drinkers, having 5 drinks on at least 5 occasions per monthoccasions per month

Among heavy drinkers, the ratio of men to women is Among heavy drinkers, the ratio of men to women is 3:1 (around 9% to 3%)3:1 (around 9% to 3%)

When people consume five or more drinks on a When people consume five or more drinks on a single occasion, it is called a binge-drinking single occasion, it is called a binge-drinking episodeepisode

Over the past decade, the number of such episodes Over the past decade, the number of such episodes per person has increased significantlyper person has increased significantly



Ethyl alcohol, or ethanol, is the alcohol in Ethyl alcohol, or ethanol, is the alcohol in beer, wine, and hard liquorbeer, wine, and hard liquor

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

Short-term: alcohol ____________________ Short-term: alcohol ____________________ ________________________________ Alcohol helps _______ (an inhibitory messenger) Alcohol helps _______ (an inhibitory messenger)

shut down neurons and “relax” the drinkershut down neurons and “relax” the drinker



First brain area affected is that which First brain area affected is that which controls judgment and inhibitioncontrols judgment and inhibition

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

Motor difficulties increase as drinking Motor difficulties increase as drinking continues, and reaction times slowcontinues, and reaction times slow



The extent of the effect of ethyl alcohol is The extent of the effect of ethyl alcohol is determined by its concentration (proportion) determined by its concentration (proportion) in the blood in the blood A given amount of alcohol will have less effect on a A given amount of alcohol will have less effect on a

large person than on a small onelarge person than on a small one

Gender also affects blood alcohol Gender also affects blood alcohol concentrationconcentration

Women have less alcohol dehydrogenase, an enzyme in the Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the bloodstomach that metabolizes alcohol before it enters the blood

Women become more intoxicated than men on equal doses Women become more intoxicated than men on equal doses of alcoholof alcohol



Levels of impairment are closely Levels of impairment are closely related to the concentration of ethyl related to the concentration of ethyl alcohol in the blood:alcohol in the blood: BAC = 0.06: Relaxation and comfortBAC = 0.06: Relaxation and comfort

BAC = 0.09: IntoxicationBAC = 0.09: Intoxication

BAC BAC >> 0.55: Death 0.55: Death Most people lose consciousness before they Most people lose consciousness before they

can drink this muchcan drink this much



The effects of alcohol subside only The effects of alcohol subside only after alcohol is metabolized by after alcohol is metabolized by the_____________the_____________ The average rate of this metabolism is The average rate of this metabolism is

13% of an ounce per hour13% of an ounce per hour

________________________________________________________________________________



Alcohol abuse and dependenceAlcohol abuse and dependence Though legal, alcohol is one of the most Though legal, alcohol is one of the most

dangerous recreational drugsdangerous recreational drugs

Its reach extends across the lifespanIts reach extends across the lifespan Alcohol use is a major problem in high school, Alcohol use is a major problem in high school,

college, and adulthoodcollege, and adulthood

In a given year, about 8% of U.S. adults display an In a given year, about 8% of U.S. adults display an alcohol use disorderalcohol use disorder

In their lifetime, between 9% and 18% of adults In their lifetime, between 9% and 18% of adults will display one of these patterns, with men will display one of these patterns, with men outnumbering women 2:1outnumbering women 2:1



The prevalence of alcoholism in a given The prevalence of alcoholism in a given year is _______________ for white year is _______________ for white Americans, African Americans, and Americans, African Americans, and Hispanic AmericansHispanic Americans The men in these groups show strikingly The men in these groups show strikingly

different age patterns, howeverdifferent age patterns, however

____________________, particularly men, tend ____________________, particularly men, tend to display a higher rate of alcohol abuse to display a higher rate of alcohol abuse and dependence than any of these groupsand dependence than any of these groups



Alcohol abuseAlcohol abuse In general, people who abuse alcohol In general, people who abuse alcohol

drink large amounts regularly and rely drink large amounts regularly and rely on it to enable them to do things that on it to enable them to do things that would otherwise make them anxiouswould otherwise make them anxious Eventually the drinking interferes with work Eventually the drinking interferes with work

and social functioningand social functioning

Individual patterns of alcohol abuse Individual patterns of alcohol abuse varyvary



Alcohol dependenceAlcohol dependence For many people, the pattern of alcohol For many people, the pattern of alcohol

misuse includes dependencemisuse includes dependence They build up a physiological tolerance and need to They build up a physiological tolerance and need to

drink greater amounts to feel its effectdrink greater amounts to feel its effect

They may experience withdrawal, including nausea They may experience withdrawal, including nausea and vomiting, when they stop drinkingand vomiting, when they stop drinking

A small percentage of alcohol dependent people A small percentage of alcohol dependent people experience a dramatic and dangerous withdrawal experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”)syndrome known as delirium tremens (“the DTs”)

Can be fatal!Can be fatal!



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

social relationships, and careerssocial relationships, and careers Losses to society total almost $200 billion Losses to society total almost $200 billion

annuallyannually

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

Seriously affects the children (some 30 million) Seriously affects the children (some 30 million) of alcoholic parentsof alcoholic parents



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

damage physical healthdamage physical health ____________________________________________________________________________________________

Long-term excessive drinking can cause major Long-term excessive drinking can cause major nutritional problemsnutritional problems

Example: Korsakoff’s syndromeExample: Korsakoff’s syndrome

Women who drink alcohol during pregnancy place Women who drink alcohol during pregnancy place their fetuses at risk of _______________________ their fetuses at risk of _______________________ (FAS)(FAS)


Sedative-Hypnotic DrugsSedative-Hypnotic Drugs

Sedative-hypnotic drugs produce Sedative-hypnotic drugs produce feelings of relaxation and drowsinessfeelings of relaxation and drowsiness At low dosages, they have a calming or At low dosages, they have a calming or

sedative effectsedative effect

At higher dosages, they function as At higher dosages, they function as sleep inducers or hypnoticssleep inducers or hypnotics

Sedative-hypnotic drugs include Sedative-hypnotic drugs include barbiturates and benzodiazepinesbarbiturates and benzodiazepines


Sedative-Hypnotic Drugs: Sedative-Hypnotic Drugs: BarbituratesBarbiturates

First discovered in the late 19First discovered in the late 19thth century, century, barbiturates were widely prescribed in barbiturates were widely prescribed in the first half of the 20the first half of the 20thth century to fight century to fight anxiety and to help people sleepanxiety and to help people sleep Although still prescribed, they have been Although still prescribed, they have been

largely replaced by benzodiazepineslargely replaced by benzodiazepines

Barbiturates can cause many problems, not Barbiturates can cause many problems, not the least of which are abuse, dependence, the least of which are abuse, dependence, and overdoseand overdose



Barbiturates are usually taken in pill Barbiturates are usually taken in pill formform

In low doses, they reduce anxiety in a In low doses, they reduce anxiety in a manner similar to alcohol by attaching manner similar to alcohol by attaching to the ______________ and helping GABA to the ______________ and helping GABA operateoperate

At too high a dose, barbiturates stop At too high a dose, barbiturates stop respiration, lower blood pressure, and respiration, lower blood pressure, and can cause deathcan cause death



Repeated use of barbiturates can Repeated use of barbiturates can quickly result in a pattern of abuse quickly result in a pattern of abuse and/or dependenceand/or dependence A great danger of barbiturate dependence A great danger of barbiturate dependence

is that the _____________ of the drug remains is that the _____________ of the drug remains the same even while the body is building a the same even while the body is building a __________________________________________________________________

Barbiturate withdrawal is particularly Barbiturate withdrawal is particularly dangerous because it can cause convulsionsdangerous because it can cause convulsions


Sedative-Hypnotic Drugs: Sedative-Hypnotic Drugs: BenzodiazepinesBenzodiazepines

Benzodiazepines are often Benzodiazepines are often prescribed to relieve anxiety prescribed to relieve anxiety Most popular sedative-hypnotics Most popular sedative-hypnotics

availableavailable Class includes Xanax and ValiumClass includes Xanax and Valium



Benzodiazepines calm people by Benzodiazepines calm people by binding to ______________ and binding to ______________ and increasing ____________increasing ____________ Unlike barbiturates and alcohol, Unlike barbiturates and alcohol,

however, benzodiazepines relieve however, benzodiazepines relieve anxiety without causing related anxiety without causing related drowsinessdrowsiness As a result, they are ___________ to slow As a result, they are ___________ to slow

breathing and lead to death by overdosebreathing and lead to death by overdose



Once thought to be a safe alternative Once thought to be a safe alternative to other sedative-hypnotic drugs, to other sedative-hypnotic drugs, benzodiazepines can cause benzodiazepines can cause intoxication and lead to abuse and intoxication and lead to abuse and dependencedependence As many as 1% of U.S. adults abuse or As many as 1% of U.S. adults abuse or

become physically dependent on become physically dependent on benzodiazepines at some point in their benzodiazepines at some point in their liveslives


OpioidsOpioids

This class of drug includes both This class of drug includes both natural (opium, heroin, morphine, natural (opium, heroin, morphine, codeine) and synthetic (methadone) codeine) and synthetic (methadone) compounds and is known collectively compounds and is known collectively as “narcotics”as “narcotics” Each drug has a different strength, Each drug has a different strength,

speed of action, and tolerance levelspeed of action, and tolerance level


OpioidsOpioids

Narcotics are smoked, inhaled, Narcotics are smoked, inhaled, injected by needle just under the skin injected by needle just under the skin (“skin popped”), or injected directly (“skin popped”), or injected directly into the bloodstream (“mainlined”)into the bloodstream (“mainlined”) An injection quickly brings on a “rush”: a An injection quickly brings on a “rush”: a

spasm of warmth and ecstasy that is spasm of warmth and ecstasy that is sometimes compared with orgasmsometimes compared with orgasm

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


OpioidsOpioids

These drugs provide pain relief and relaxation These drugs provide pain relief and relaxation by depressing the central nervous system by depressing the central nervous system Opioids bind to the receptors in the brain that Opioids bind to the receptors in the brain that

ordinarily receive ordinarily receive ____________________________________________________________________________________________________________________________________________________________________________

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

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


OpioidsOpioids

Heroin abuse and dependenceHeroin abuse and dependence Heroin use exemplifies the problems posed Heroin use exemplifies the problems posed

by opioids:by opioids: After just a few weeks, users may become caught After just a few weeks, users may become caught

in a pattern of abuse (and often dependence)in a pattern of abuse (and often dependence) Users quickly build a tolerance for the drug and Users quickly build a tolerance for the drug and

experience withdrawal when they stop taking itexperience withdrawal when they stop taking it Early withdrawal symptoms include anxiety and Early withdrawal symptoms include anxiety and

restlessness; later symptoms include twitching, restlessness; later symptoms include twitching, aches, fever, vomiting, and weight loss from aches, fever, vomiting, and weight loss from dehydrationdehydration


OpioidsOpioids

Heroin abuse and dependenceHeroin abuse and dependence People who are dependent on heroin People who are dependent on heroin

soon _____ soon _____ _______________________________________ _______________________________________ and must continually increase their and must continually increase their doses to achieve even that reliefdoses to achieve even that relief

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


OpioidsOpioids

Heroin abuse and dependenceHeroin abuse and dependence Surveys suggest that close to 1% of Surveys suggest that close to 1% of

adults in the U.S. become addicted to adults in the U.S. become addicted to heroin or other opioids at some point in heroin or other opioids at some point in their livestheir lives


OpioidsOpioids

What are the dangers of heroin abuse?What are the dangers of heroin abuse? The most immediate danger is __________________ The most immediate danger is __________________

The drug closes down the respiratory center in the The drug closes down the respiratory center in the brain, paralyzing breathing and causing deathbrain, paralyzing breathing and causing death

Death is particularly likely during sleepDeath is particularly likely during sleep ___________________________ is also a problem___________________________ is also a problem

About 2% of those dependent on heroin and other About 2% of those dependent on heroin and other opioids die under the influence of the drug each yearopioids die under the influence of the drug each year

Users run the risk of getting ____________________ Users run the risk of getting ____________________ Opioids often are “cut” with noxious chemicalsOpioids often are “cut” with noxious chemicals

Dirty needles and other equipment can spread Dirty needles and other equipment can spread infectioninfection


StimulantsStimulants

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

alertnessalertness Cause speeded-up behavior & thinkingCause speeded-up behavior & thinking

The four most common stimulants are:The four most common stimulants are: CocaineCocaine AmphetaminesAmphetamines CaffeineCaffeine NicotineNicotine


Stimulants: CocaineStimulants: Cocaine

Derived from the leaves of the coca Derived from the leaves of the coca plant, cocaine is the most powerful plant, cocaine is the most powerful natural stimulant knownnatural stimulant known 28 million people in the U.S. have tried 28 million people in the U.S. have tried

cocainecocaine 2 million people are currently using it2 million people are currently using it



Cocaine produces a euphoric rush of Cocaine produces a euphoric rush of well-being and confidencewell-being and confidence It stimulates the higher centers of the It stimulates the higher centers of the

central nervous systemcentral nervous system

It seems to work by increasing It seems to work by increasing ___________ at key receptors in the ___________ at key receptors in the brain brain Also appears to increase Also appears to increase

norepinephrine and serotoninnorepinephrine and serotonin



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

and/or delusions, a condition known as and/or delusions, a condition known as cocaine-induced psychotic disordercocaine-induced psychotic disorder

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



Cocaine abuse and dependenceCocaine abuse and dependence Regular use may lead to a pattern of Regular use may lead to a pattern of

abuse in which the person remains under abuse in which the person remains under the effect of cocaine for much of each day the effect of cocaine for much of each day and functions poorly in major areas of lifeand functions poorly in major areas of life

Dependence on the drug may also developDependence on the drug may also develop Currently, close to 1% of all people in the Currently, close to 1% of all people in the

US manifest cocaine abuse or US manifest cocaine abuse or dependence, with 3% falling into such dependence, with 3% falling into such patterns at some point in their livespatterns at some point in their lives



Cocaine abuse and dependence Cocaine abuse and dependence Most people now ingest cocaine by Most people now ingest cocaine by

“freebasing,” a technique in which the “freebasing,” a technique in which the drug is heated and inhaled with a pipedrug is heated and inhaled with a pipe Millions more use “crack,” a powerful form Millions more use “crack,” a powerful form

of freebase that has been boiled down for of freebase that has been boiled down for smoking in a pipesmoking in a pipe



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

significant physical danger, especially from significant physical danger, especially from accidents and suicideaccidents and suicide

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

The greatest danger of use is the The greatest danger of use is the ______________________________________

Excessive doses depress the respiratory system of the Excessive doses depress the respiratory system of the brain and stop breathingbrain and stop breathing

Cocaine use can also can cause heart failureCocaine use can also can cause heart failure


Stimulants: Stimulants: AmphetaminesAmphetamines

Amphetamines are stimulant drugs Amphetamines are stimulant drugs that are manufactured in the that are manufactured in the laboratorylaboratory Methamphetamine, in particular, has Methamphetamine, in particular, has

had a surge in popularity in recent yearshad a surge in popularity in recent years

Most often taken in pill or capsule formMost often taken in pill or capsule form Can be injected or taken in “ice” and “crank” Can be injected or taken in “ice” and “crank”

form, counterparts of free-base cocaine and form, counterparts of free-base cocaine and crackcrack



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

lower appetite when taken in small lower appetite when taken in small dosesdoses

Produce a rush, intoxication, and Produce a rush, intoxication, and psychosis in high dosespsychosis in high doses

Cause an emotional letdown as they Cause an emotional letdown as they leave the bodyleave the body



Also like cocaine, amphetamines stimulate Also like cocaine, amphetamines stimulate the CNS by increasing dopamine, the CNS by increasing dopamine, norepinephrine, and serotoninnorepinephrine, and serotonin

__________ builds quickly, so users are at __________ builds quickly, so users are at ______________ of becoming dependent______________ of becoming dependent When people dependent on the drug stop taking When people dependent on the drug stop taking

it, serious depression and extended sleep followsit, serious depression and extended sleep follows

Around 2% of Americans become dependent Around 2% of Americans become dependent on amphetamines at some point in their liveson amphetamines at some point in their lives


Hallucinogens, Cannabis, Hallucinogens, Cannabis, and Combinations of and Combinations of

SubstancesSubstances Other kinds of substances can cause Other kinds of substances can cause

problems for users and for societyproblems for users and for society Hallucinogens Hallucinogens

Produce delusions, hallucinations, and other Produce delusions, hallucinations, and other sensory changessensory changes

Cannabis substancesCannabis substances Produce sensory changes, but have both Produce sensory changes, but have both

depressant and stimulant effectsdepressant and stimulant effects

Combinations of substances = Combinations of substances = polysubstance usepolysubstance use



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

MescalineMescaline

PsilocybinPsilocybin

And synthetic hallucinogensAnd synthetic hallucinogens Lysergic acid diethylamide (LSD)Lysergic acid diethylamide (LSD)

MDMA (Ecstasy)MDMA (Ecstasy)



LSD is one of the most famous and powerful LSD is one of the most famous and powerful hallucinogenshallucinogens Within two hours of being ingested, it brings on Within two hours of being ingested, it brings on

a state of hallucinogen intoxication (hallucinosis)a state of hallucinogen intoxication (hallucinosis) Increased and altered sensory perceptionIncreased and altered sensory perception

Hallucinations may occurHallucinations may occur

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

May produce extremely strong emotionsMay produce extremely strong emotions May have some physical effectsMay have some physical effects

Effects wear off in about six hoursEffects wear off in about six hours



Hallucinogens appear to produce Hallucinogens appear to produce these symptoms by binding to these symptoms by binding to __________________ __________________ These receptors control visual These receptors control visual

information and emotions, thereby information and emotions, thereby causing the various effects of the drug causing the various effects of the drug on the useron the user



More than 14% of Americans have used More than 14% of Americans have used hallucinogens at some point in their liveshallucinogens at some point in their lives About 2% have used hallucinogens in the past yearAbout 2% have used hallucinogens in the past year

______________________________________________________________________________ But the drugs do pose physical dangersBut the drugs do pose physical dangers

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

Another danger is the risk of hallucinogen Another danger is the risk of hallucinogen persisting perception disorder (“_________________”)persisting perception disorder (“_________________”)

Can occur a year or more after last drug useCan occur a year or more after last drug use


CannabisCannabis

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

Hashish, the solidified resin of the cannabis plantHashish, the solidified resin of the cannabis plant

Marijuana, a mixture of buds, crushed leaves, and Marijuana, a mixture of buds, crushed leaves, and flowering topsflowering tops

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

the drugthe drug


CannabisCannabis

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

May become anxious, suspicious, or irritatedMay become anxious, suspicious, or irritated

This overall “high” is technically called cannabis intoxicationThis overall “high” is technically called cannabis intoxication

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

Most of the effects of cannabis last three to six Most of the effects of cannabis last three to six hourshours Mood changes may continue longerMood changes may continue longer


CannabisCannabis

Marijuana abuse and dependenceMarijuana abuse and dependence Marijuana was once thought not to cause abuse or Marijuana was once thought not to cause abuse or

dependencedependence

Today many users are caught in a pattern of abuseToday many users are caught in a pattern of abuse Some users develop tolerance and withdrawal, Some users develop tolerance and withdrawal,

experiencing flu-like symptoms and irritability when drug experiencing flu-like symptoms and irritability when drug use is stoppeduse is stopped

About 2% of people in the U.S. displayed marijuana abuse About 2% of people in the U.S. displayed marijuana abuse or dependence in the past yearor dependence in the past year

About 5% will fall into these patterns at some point in About 5% will fall into these patterns at some point in their lives their lives


CannabisCannabis

Marijuana abuse and dependenceMarijuana abuse and dependence One theory about the increase in abuse One theory about the increase in abuse

and dependence is the change in the and dependence is the change in the drug itselfdrug itself

________________________________________________________________________________________________________________________________________________________


CannabisCannabis

Is marijuana dangerous?Is marijuana dangerous? As the potency of the drug has As the potency of the drug has

increased, so have the risks of using itincreased, so have the risks of using it May cause panic reactions similar to those May cause panic reactions similar to those

caused by hallucinogenscaused by hallucinogens

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

Marijuana use has been linked to poor Marijuana use has been linked to poor concentration and impaired memoryconcentration and impaired memory


CannabisCannabis

Is marijuana dangerous?Is marijuana dangerous? Long-term use poses additional dangersLong-term use poses additional dangers

May cause _______________________________May cause _______________________________

May affect _____________________:May affect _____________________: In men, it may inhibit sperm productionIn men, it may inhibit sperm production

In women, it may block ovulation In women, it may block ovulation


Combinations of Combinations of SubstancesSubstances

People often take more than one People often take more than one drug at a time, a pattern called drug at a time, a pattern called polysubstance use polysubstance use Researchers have examined the ways in Researchers have examined the ways in

which drugs interact with one another, which drugs interact with one another, focusing on synergistic effectsfocusing on synergistic effects



Synergistic effectsSynergistic effects When different drugs are in the body at When different drugs are in the body at

the same time, they may multiply, or the same time, they may multiply, or potentiate, each other’s effectspotentiate, each other’s effects

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



Synergistic effects Synergistic effects One kind of synergistic effect occurs when two One kind of synergistic effect occurs when two

or more drugs have _________________________or more drugs have _________________________ Example: ______________________________________Example: ______________________________________ All depressants, they may severely depress the CNS All depressants, they may severely depress the CNS

when mixed, leading to deathwhen mixed, leading to death A different kind of synergistic effect results A different kind of synergistic effect results

when drugs have __________________________when drugs have __________________________ Example: __________________________________________Example: __________________________________________

May build up lethal levels of the drugs because of May build up lethal levels of the drugs because of ______________________ (stimulants impede the ______________________ (stimulants impede the liver’s processing of barbiturates and alcohol)liver’s processing of barbiturates and alcohol)



Each year tens of thousands of Each year tens of thousands of people are admitted to hospitals people are admitted to hospitals because of polysubstance usebecause of polysubstance use May be accidental or intentionalMay be accidental or intentional


What Causes Substance-What Causes Substance-Related Disorders?Related Disorders?

Clinical theorists have developed Clinical theorists have developed sociocultural, psychological, and sociocultural, psychological, and biological explanations for substance biological explanations for substance abuse and dependenceabuse and dependence No single explanation has gained broad No single explanation has gained broad

supportsupport

Best explanation: Best explanation: ______________________________________________


Causes of Substance-Causes of Substance-Related Disorders: The Related Disorders: The

Sociocultural ViewSociocultural View A number of theorists propose that A number of theorists propose that

people are more likely to develop people are more likely to develop patterns of substance abuse or patterns of substance abuse or dependence when living in stressful dependence when living in stressful socioeconomic conditionssocioeconomic conditions Example: higher rates of unemployment Example: higher rates of unemployment

correlate with higher rates of alcohol usecorrelate with higher rates of alcohol use

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



Sociocultural ViewSociocultural View Other theorists propose that Other theorists propose that

substance abuse and dependence substance abuse and dependence are more likely to appear in societies are more likely to appear in societies where substance use is valued or where substance use is valued or acceptedaccepted Example: rates of alcohol use varies Example: rates of alcohol use varies

between cultures between cultures


Causes of Substance-Causes of Substance-Related Disorders: The Related Disorders: The Psychodynamic ViewPsychodynamic View

Psychodynamic theorists believe that people Psychodynamic theorists believe that people who abuse substances have powerful who abuse substances have powerful dependency needs that can be traced to their dependency needs that can be traced to their early yearsearly years Caused by a lack of parental nurturingCaused by a lack of parental nurturing

Some people may develop a “substance abuse personality” Some people may develop a “substance abuse personality” as a resultas a result

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


Causes of Substance-Related Causes of Substance-Related Disorders: The Behavioral and Disorders: The Behavioral and

Cognitive ViewsCognitive Views According to behaviorists, operant According to behaviorists, operant

conditioning may play a key role in the conditioning may play a key role in the development and maintenance of substance development and maintenance of substance abuseabuse They argue that the ____________________________ They argue that the ____________________________

produced by a drug has a _____________ effect, thus produced by a drug has a _____________ effect, thus ___________________________ that the user will seek ___________________________ that the user will seek this reaction againthis reaction again

Similarly, the rewarding effects may also lead Similarly, the rewarding effects may also lead users to try higher doses or more users to try higher doses or more ________________________________________________________



Cognitive ViewsCognitive Views Cognitive theorists further argue Cognitive theorists further argue

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



Cognitive ViewsCognitive Views In support of these views, studies have found In support of these views, studies have found

that many subjects do in fact drink more that many subjects do in fact drink more alcohol or seek heroin when they feel tensealcohol or seek heroin when they feel tense

In a manner of speaking, this model is arguing In a manner of speaking, this model is arguing a “self-medication” hypothesisa “self-medication” hypothesis If true, one would expect higher rates of substance If true, one would expect higher rates of substance

use among people with psychological symptomsuse among people with psychological symptoms Studies have found higher rates of substance use among Studies have found higher rates of substance use among

people with mood disorders, PTSD, eating disorders, and people with mood disorders, PTSD, eating disorders, and schizophreniaschizophrenia



Cognitive ViewsCognitive Views Other behavioral theorists have proposed Other behavioral theorists have proposed

that classical conditioning may play a role that classical conditioning may play a role in drug abuse and dependencein drug abuse and dependence Objects present at the time drugs are taken Objects present at the time drugs are taken

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

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



Biological ViewBiological View In recent years, researchers have In recent years, researchers have

come to suspect that drug misuse come to suspect that drug misuse may have biological causesmay have biological causes

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



Biological ViewBiological View Genetic predispositionGenetic predisposition

Research with “alcohol-preferring” rats Research with “alcohol-preferring” rats has demonstrated that their offspring have has demonstrated that their offspring have similar alcohol preferencessimilar alcohol preferences

Similarly, research with human twins has Similarly, research with human twins has suggested that people may inherit a suggested that people may inherit a predisposition to abuse substancespredisposition to abuse substances

Concordance rates in identical (MZ) twins: Concordance rates in identical (MZ) twins: 54%54%

Concordance rates in fraternal (DZ) twins: 28%Concordance rates in fraternal (DZ) twins: 28%



Biological ViewBiological View Genetic predisposition Genetic predisposition

Stronger support for a genetic model may Stronger support for a genetic model may come from come from __________________________________________________________________ Studies compared adoptees whose biological Studies compared adoptees whose biological

parents were dependent on alcohol with parents were dependent on alcohol with adoptees whose biological parents were not adoptees whose biological parents were not dependent dependent

By adulthood, those whose biological parents were By adulthood, those whose biological parents were dependent showed higher rates of alcohol use dependent showed higher rates of alcohol use themselvesthemselves



Biological ViewBiological View Genetic predisposition Genetic predisposition

Genetic linkage strategies and Genetic linkage strategies and molecular biology techniques have also molecular biology techniques have also provided direct evidence in support of provided direct evidence in support of this hypothesisthis hypothesis An abnormal form of the dopamine-2 (D2) An abnormal form of the dopamine-2 (D2)

receptor gene was found in the majority of receptor gene was found in the majority of subjects with alcohol dependence but in subjects with alcohol dependence but in less than 20% of nondependent subjectsless than 20% of nondependent subjects



Biological ViewBiological View Biochemical factorsBiochemical factors

Over the past few decades, investigators have Over the past few decades, investigators have pieced together a general biological pieced together a general biological understanding of drug tolerance and withdrawal understanding of drug tolerance and withdrawal symptomssymptoms

______________________________________________________________________________________________________

______________________________________________________________________________________________

Recent brain imaging studies have suggested Recent brain imaging studies have suggested that many (perhaps all) drugs eventually that many (perhaps all) drugs eventually activate a single “________________” or activate a single “________________” or “_______________________” in the brain“_______________________” in the brain




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

experiences pleasureexperiences pleasure

Certain drugs stimulate the reward center Certain drugs stimulate the reward center ______________________

Examples: ___________ and __________Examples: ___________ and __________

Other drugs stimulate the reward center Other drugs stimulate the reward center ________________________

Examples: _________, ___________, and __________Examples: _________, ___________, and __________




Theorists suspect that people who Theorists suspect that people who abuse substances suffer from a reward-abuse substances suffer from a reward-deficiency syndromedeficiency syndrome Their reward center is not readily activated Their reward center is not readily activated

by “normal” life events so they turn to by “normal” life events so they turn to drugs to stimulate this pleasure pathway, drugs to stimulate this pleasure pathway, especially in times of stressespecially in times of stress

Defects in D2 receptors have been cited as a Defects in D2 receptors have been cited as a possible causepossible cause


How Are Substance-How Are Substance-Related Disorders Related Disorders

Treated?Treated? Many approaches have been used to treat Many approaches have been used to treat

substance-related disorders, including substance-related disorders, including psychodynamic, behavioral, cognitive-psychodynamic, behavioral, cognitive-behavioral, biological, and sociocultural behavioral, biological, and sociocultural therapiestherapies

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

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


Psychodynamic Psychodynamic TherapiesTherapies

Psychodynamic therapists guide Psychodynamic therapists guide clients to uncover and resolve the clients to uncover and resolve the underlying needs and conflicts that underlying needs and conflicts that they believe lead to the disorderthey believe lead to the disorder

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

combined with other approaches in a combined with other approaches in a multidimensional treatment programmultidimensional treatment program


Behavioral TherapiesBehavioral Therapies

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

an unpleasant stimulus at the very an unpleasant stimulus at the very moment they are taking a drugmoment they are taking a drug

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



Aversion therapy is most commonly Aversion therapy is most commonly applied to alcohol abuse/dependenceapplied to alcohol abuse/dependence

Covert sensitization is another version Covert sensitization is another version of this approachof this approach Requires people with alcoholism to Requires people with alcoholism to

imagine extremely upsetting, repulsive, imagine extremely upsetting, repulsive, or frightening scenes while they are or frightening scenes while they are drinkingdrinking

The pairing is expected to produce The pairing is expected to produce negative responses to liquor itselfnegative responses to liquor itself



Behavioral interventions are of Behavioral interventions are of limited success when used alonelimited success when used alone They are best when used in combination They are best when used in combination

with either biological or cognitive with either biological or cognitive approachesapproaches


Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

Two popular combined approaches, both Two popular combined approaches, both applied particularly to alcohol use:applied particularly to alcohol use: Behavioral self-control training (BSCT)Behavioral self-control training (BSCT)

Clients keep track of their own use and triggersClients keep track of their own use and triggers Learn coping strategies for such eventsLearn coping strategies for such events Learn to set limits on drinkingLearn to set limits on drinking Learn skills (relaxation, coping, problem-solving)Learn skills (relaxation, coping, problem-solving)

Relapse-prevention trainingRelapse-prevention training Clients are taught to plan ahead for drinking Clients are taught to plan ahead for drinking

situationssituations Used particularly to treat alcohol abuse; also used to Used particularly to treat alcohol abuse; also used to

treat cocaine and marijuana abusetreat cocaine and marijuana abuse


Biological TreatmentsBiological Treatments

Biological treatments may be used to Biological treatments may be used to help people help people _______________________________ _______________________________ ____________________________________________________________________________________________________________________________________________________ These approaches are of limited long-These approaches are of limited long-

term success when used alone but can term success when used alone but can be helpful when combined with other be helpful when combined with other approachesapproaches



__________________________________________________________ Systematic and medically supervised Systematic and medically supervised

withdrawal from a drugwithdrawal from a drug Can be outpatient or inpatientCan be outpatient or inpatient

Two strategies:Two strategies: Gradual withdrawal by tapering doses of Gradual withdrawal by tapering doses of

the substancethe substance

Induce withdrawal but give additional Induce withdrawal but give additional medication to block symptoms medication to block symptoms



Detoxification Detoxification Detoxification programs seem to help Detoxification programs seem to help

motivated people withdraw from drugsmotivated people withdraw from drugs For people who fail to receive For people who fail to receive

psychotherapy after withdrawal, however, psychotherapy after withdrawal, however, __________________________________________________



Antagonist drugsAntagonist drugs An aid to resist falling back into a An aid to resist falling back into a

pattern of substance abuse or pattern of substance abuse or dependence, antagonist drugs block or dependence, antagonist drugs block or change the effects of the addictive change the effects of the addictive substancesubstance Example: disulfiram (Antabuse) for alcoholExample: disulfiram (Antabuse) for alcohol

Example: naltrexone for narcotics, alcoholExample: naltrexone for narcotics, alcohol



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

problem than the drug’s direct effectsproblem than the drug’s direct effects Example: heroin addictionExample: heroin addiction

Thus, methadone maintenance programs are Thus, methadone maintenance programs are designed to provide a safe substitute for heroindesigned to provide a safe substitute for heroin

Methadone is a laboratory opioid with a long half-life, Methadone is a laboratory opioid with a long half-life, taken orally once a daytaken orally once a day

Programs were roundly criticized as “substituting Programs were roundly criticized as “substituting addictions” but are regaining popularity, partly addictions” but are regaining popularity, partly because of the spread of HIV/AIDSbecause of the spread of HIV/AIDS


Sociocultural TherapiesSociocultural Therapies

Three main sociocultural approaches Three main sociocultural approaches to substance-related disorders:to substance-related disorders: Self-help and residential treatment Self-help and residential treatment

programsprograms

Culture- and gender-sensitive programsCulture- and gender-sensitive programs

Community prevention programsCommunity prevention programs



Self-help and residential treatment Self-help and residential treatment programsprograms Most common: ___________________________Most common: ___________________________

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

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

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



Culture- and gender-sensitive programsCulture- and gender-sensitive programs A growing number of treatment programs A growing number of treatment programs

try to be sensitive to the special try to be sensitive to the special sociocultural pressures and problems sociocultural pressures and problems faced by drug abusers who are poor, faced by drug abusers who are poor, homeless, or members of minority groupshomeless, or members of minority groups

Similarly, therapists have begun to focus Similarly, therapists have begun to focus on the unique issues facing female on the unique issues facing female substance userssubstance users



Community prevention programsCommunity prevention programs Perhaps the most effective approach to Perhaps the most effective approach to

substance-related disorders is to prevent substance-related disorders is to prevent themthem

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The most effective of these prevention efforts The most effective of these prevention efforts focus on multiple areas to provide a consistent focus on multiple areas to provide a consistent message about drug use in all areas of lifemessage about drug use in all areas of life

Education

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