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Comer, Abnormal Psychology, 8th edition

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Title: Comer, Abnormal Psychology, 8th edition


1
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2
Substance Use Disorders
3
Substance Use Disorders
  • Some substances can also lead to long-term
    problems
  • People who regularly ingest them may develop
    substance use disorders
  • Also called addiction

4
Substance Use Disorders
5
Substance Use Disorders
6
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

7
Depressants Alcohol
  • 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 blocks messages between
    neurons
  • Alcohol helps GABA (an inhibitory messenger) shut
    down neurons and relax the drinker

8
Depressants Alcohol
  • 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

9
Depressants Alcohol
  • 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 gt 0.55 Death
  • Most people lose consciousness before they can
    drink this much

10
Depressants Alcohol
  • 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 can't increase the speed of this process!

11
Depressants Alcohol
12
Is All Drug Misuse the Same? DSM-5 has combined
two past disorders, substance abuse (excessive
and chronic reliance on drugs) and substance
dependence (excessive reliance accompanied by
tolerance and withdrawal symptoms) into a single
categorysubstance use disorder. Critics worry
that clinicians may now fail to recognize and
address the different prognoses and treatment
needs of individuals who abuse substances and
those who depend on substances.
13
Depressants Alcohol
  • Alcohol use disorder
  • In general, people who abuse alcohol 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 alcohol abuse vary

14
Depressants Alcohol
  • Alcohol dependence
  • For many people, the pattern of alcohol misuse
    includes dependence
  • They build up a physiological tolerance and need
    to drink greater amounts to feel its effects
  • They may experience withdrawal, including nausea
    and vomiting, when they stop drinking
  • A small percentage of alcohol-dependent people
    experience a dramatic and dangerous withdrawal
    syndrome known as delirium tremens (the DTs)
  • Alcohol withdrawal can be fatal

15
What is the personal and social impact of
alcoholism?
16
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

17
Depressants Barbiturates
  • Widely prescribed in the first half of the 20th
    century to fight anxiety and to help people sleep
  • They can cause many problems such as abuse,
    dependence, and overdose
  • At low doses, they reduce excitement in a manner
    similar to alcohol by attaching to the GABA
    receptors and helping GABA operate
  • At too high a level, they can halt breathing,
    lower blood pressure, and can lead to coma and
    death

18
Depressants Barbiturates
  • Repeated use of barbiturates can quickly result
    in a pattern of abuse and/or dependence
  • A great danger of barbiturate dependence 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

19
Depressants Benzodiazepines
  • Benzodiazepines are often prescribed to relieve
    anxiety
  • Most popular sedative-hypnotics available
  • Class includes Xanax, Ativan, and Valium
  • Benzodiazepines have a depressant effect on the
    CNS by binding to GABA receptors and increasing
    GABA activity
  • Benzodiazepines relieve anxiety without causing
    drowsiness
  • Less likely to slow breathing and lead to death
    by overdose

20
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

21
Depressants Opioids
  • 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)

22
Depressants Opioids
  • 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

23
Depressants Opioids
  • 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

24
Depressants Opioids
  • What are the dangers of heroin abuse?
  • 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
  • About 2 of those dependent on heroin and other
    opioids die under the influence of the drug each
    year
  • Users run the risk of getting impure drugs
  • Opioids are often cut with noxious chemicals
  • Dirty needles and other equipment can spread
    infection

25
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

26
Stimulants Cocaine
  • Most powerful natural stimulant known
  • Cocaine produces a euphoric rush of well-being
  • Produces this effect largely by increasing
    supplies of dopamine at key neurons throughout
    the brain
  • Also appears to increase norepinephrine and
    serotonin

27
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
    psychotic disorder
  • As the stimulant effects of the drug subside, the
    user experiences a depression-like letdown,
    popularly called crashing

28
Stimulants Cocaine
  • Cocaine abuse and dependence
  • Regular use may lead to a pattern of abuse in
    which the person remains under the effect of
    cocaine for much of each day and functions poorly
    in social relationships and at work
  • Dependence on the drug may also develop

29
Stimulants Cocaine
  • Cocaine abuse and dependence
  • Cocaine use in the past was limited by the drug's
    high cost
  • Since 1984, cheaper, more powerful 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
  • Currently, 0.5 of all people over the age of 11
    in the U.S. manifest cocaine abuse or dependence
    in a given year

30
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 brain's 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

31
Stimulants Amphetamines
  • Amphetamines stimulant drugs 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
  • 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

32
Stimulants Amphetamines
  • 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

33
Stimulant Use Disorder
  • Regular use of either cocaine or amphetamines may
    lead to stimulant use disorder
  • The stimulant dominates the individuals life
  • Leads to poor function in social relationships
    and at work

34
Stimulants Caffeine
  • Worlds most widely used stimulant
  • 80 of the world's population consumes it daily
  • Most is in the form of coffee the rest is in the
    form of tea, cola, energy drinks, chocolate, and
    over-the-counter medications
  • 99 of ingested caffeine is absorbed by the body
    and reaches its peak concentration within an hour
  • 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)

35
Stimulants Caffeine
  • 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

36
Hallucinogens, Cannabis, and Combinations of
Substances
  • Hallucinogens
  • Produce delusions, hallucinations, and other
    sensory changes
  • Cannabis substances
  • Produce sensory changes, but have both depressant
    and stimulant effects
  • Combinations of substances

37
Hallucinogens
  • Hallucinogens produce powerful changes in sensory
    perceptions (sometimes called trips)
  • Natural hallucinogens
  • Mescaline
  • Psilocybin
  • Laboratory-produced hallucinogens
  • Lysergic acid diethylamide (LSD)
  • MDMA (Ecstasy)

38
Hallucinogens
  • LSD is one of the most powerful hallucinogens
  • Brings on a state of hallucinogen intoxication
    (hallucinosis)
  • Increased and altered sensory perception
  • Hallucinations and/or synesthisia
  • Effects wear off in about six hours
  • 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

39
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

40
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

41
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

42
Cannabis abuse and Dependence
  • Marijuana was once thought not to cause abuse or
    dependence
  • One theory about the increase in abuse and
    dependence is the change in the drug itself
  • The marijuana available today is significantly
    more potent than the drug used in the early 1970s

43
Cannabis
44
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
  • The U.S. Federal Government has continued to
    fight and punish the production and distribution
    of marijuana for medical purposes
  • However, in 2009, the US Attorney General
    directed federal prosecutors to not pursue cases
    against medical marijuana users complying with
    state laws
  • Both the Netherlands and Canada permit its use

45
Teenagers and Substance Use
46
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

47
Combinations of Substances
48
Combinations of Substances
49
Combinations of Substances
50
Combinations of Substances
  • 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

51
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

52
Causes of Substance Use Disorders Sociocultural
Views
53
Causes of Substance Use Disorders Psychodynamic
Views
  • Psychodynamic theorists believe that people who
    abuse substances 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 use disorders

54
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

55
Causes of Substance Use Disorders
Cognitive-Behavioral Views
  • Other behaviorists have proposed that classical
    conditioning may play a role in substance abuse
    and dependence
  • 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

56
Causes of Substance Use Disorders Biological
Views
57
Causes of Substance Use Disorders Biological
Views
58
Causes of Substance Use Disorders Biological
Views
59
Pleasure Centers in the Brain
60
Causes of Substance Use Disorders Biological
Views
61
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

62
How Are Substance Use Disorders Treated?
  • The value of treatment for substance abuse or
    dependence can be difficult to determine
  • Different substance use disorders pose different
    problems
  • Many people with substance abuse patterns drop
    out of treatment early
  • Some people recover without any intervention at
    all
  • Different criteria are used by different clinical
    researchers

63
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

64
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

65
Behavioral Therapies
  • Aversion therapy is most commonly applied to
    alcohol abuse/dependence
  • 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
  • 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

66
Cognitive-Behavioral Therapies
  • These treatments help clients identify and change
    the patterns and cognitions contributing to their
    patterns of use
  • 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

67
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

68
Biological Treatments
  • 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
  • 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

69
Biological Treatments
  • 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 narcotics, naltrexone for
    alcohol

70
Biological Treatments
  • Drug maintenance therapy
  • A drug-related lifestyle may be a greater problem
    than the drug's 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

71
Sociocultural Therapies
72
Sociocultural Therapies
  • 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
  • Many self-help programs have expanded into
    residential treatment centers or therapeutic
    communities
  • People formerly dependent on drugs live, work,
    and socialize in a drug-free environment while
    undergoing individual, group, and family therapies

73
Sociocultural Therapies
  • 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

74
Sociocultural Therapies
  • 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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