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Substance Use Disorders III April 6, 2011 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

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Title: Substance Use Disorders III April 6, 2011 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.


1
Substance Use Disorders III April 6, 2011 PSYC
2340 Abnormal Psychology Brett Deacon, Ph.D.
2
From Last Class
  • Disease model
  • Alcoholics Anonymous/Twelve Steps
  • Note Exam 3 is Friday 4/8

3
In the News
  • Actress Ashley Judd on the Today Show
    http//today.msnbc.msn.com/id/26184891/vp/42431047
    42431047
  • Sought treatment at Shades of Hope in Texas for
    depression
  • Twelve Step Model used for all disorders
  • Covert sexual abuse in childhood
  • Repressed memories of childhood sexual abuse

4
Motivational Interviewing
  • Chapter 7 (Mood Disorders)
  • Major depressive and manic episodes
  • Nature, causes, and treatment of
  • Major depressive disorder
  • Bipolar disorder
  • Suicide

5
Exam Review
  • Chapter 8 (Eating Disorders)
  • pp. 256-282 only (not Sleep Disorders section)
  • Anorexia
  • Bulimia
  • Causes
  • Treatment

6
Exam Review
  • Chapter 11 (Substance-Related Disorders)
  • Not pp. 413-414 (Impulse Control Disorders)
  • Substance abuse and dependence
  • Alcohol effects, cultural patterns, disease
    model
  • Addictive properties of different substances
  • Properties and effects of different substances
  • Treatments

7
Addictive Properties of Common Drugs
8
Drug Addictiveness
  • Which of the following drugs is most addictive?
  • 1. Nicotine
  • 2. Heroin
  • 3. Cocaine
  • 4. Alcohol
  • 5. Caffeine
  • 6. Marijuana

9
Addictive Properties of Common Drugs
10
Brief Review of Different Substances
  • Sedative, Hypnotics, Anxiolytics
  • Stimulants
  • Opioids
  • Hallucinogens
  • Other Drugs of Abuse

11
Fetal Alcohol Syndrome
  • CDC estimates rate of 2.7/1000 live births
  • Fetal growth retardation, cognitive deficits,
    behavior problems, learning difficulties
  • Occurs in 2-10 of children of alcohol abusers
  • More common in African Americans and Native
    Americans than Caucasians

12
Fetal Alcohol Syndrome
  • Effects of low-moderate maternal alcohol
    consumption (lt 1 drink per day average) on the
    fetus
  • Henderson et al. (2007) http//www3.interscience.w
    iley.com/cgi-bin/fulltext/118523339/PDFSTART
  • Combined results from 46 studies
  • Examined effects on miscarriage, stillbirth,
    intrauterine growth restriction, prematurity,
    birthweight, small for gestational age at birth
    and birth defects including fetal alcohol
    syndrome
  • Findings This systematic review found no
    convincing evidence of adverse effects of
    prenatal alcohol exposure at lowmoderate levels
    of exposure. At lowmoderate levels of
    consumption, there were no consistently
    significant effects of alcohol on any of the
    outcomes considered.

13
Fetal Alcohol Syndrome
  • Plenty of evidence that repeated abusive heavy
    drinking is associated with FAS and related
    problems
  • FAS usually occurs with chronically alcoholic
    mother who binged during pregnancy
  • Third variable problem smoking, malnutrition,
    poor health care

14
Sedative, Hypnotic, or Anxiolytic Substance use
Disorders
  • Drugs in this class
  • Sedatives calming (e.g., barbiturates)
  • Hypnotic sleep inducing
  • Anxiolytic anxiety reducing (e.g.,
    benzodiazepines)

15
Sedative, Hypnotic, or Anxiolytic Substance use
Disorders
  • Effects similar to large doses of alcohol
  • Synergistic effect when combined with alcohol
  • Adverse effects
  • Dependence, tolerance, withdrawal, overdose

16
Stimulants
  • Nature of stimulants
  • Most widely consumed class of drug in the US
  • Drugs increase alertness and increase energy
  • Examples include amphetamines, cocaine, nicotine,
    and caffeine

17
Stimulants Amphetamines
  • Used for all-nighters, weight control, and high
  • Effects
  • Elation, vigor, reduce fatigue
  • Followed by extreme fatigue and depression
  • Ecstasy and Ice
  • Produces effects similar to speed, but no
    comedown
  • Used by 2 of college students
  • Very high risk of dependence

18
Stimulants Nicotine
  • Approximately 25 of Americans smoke
  • Effects
  • Stress relief, relaxation, wellness, pleasure
  • Withdrawal depression, insomnia, irritability,
    anxiety, increased appetite
  • Highly addictive and extremely difficult to quit
  • Cues that elicit urges to smoke are ubiquitous
  • Users dose themselves frequently

19
Stimulants Caffeine
  • Used regularly by 90 of Americans
  • Effects of the gentle stimulant
  • Found in tea, coffee, cola drinks, and cocoa
    products
  • Small doses elevate mood and reduce fatigue
  • Regular use can result in tolerance and dependence

20
Opioids An Overview
  • Opiate narcotic-like chemical in opium poppy
  • Examples heroin, opium, codeine, and morphine
  • Effects
  • Pain relief, euphoria, drowsiness, slowed
    breathing
  • High doses can be fatal
  • Withdrawal symptoms can be lasting and severe
  • Elevates risk for HIV
  • High mortality rates for addicts

21
Hallucinogens An Overview
  • Substances that alter perceptions of the world
  • Examples Marijuana, LSD
  • Effects
  • Delusions, paranoia, hallucinations, and/or
    altered sensory perception

22
Hallucinogens Marijuana
  • Active chemical is tetrahydrocannabinol (THC)
  • Effects
  • Heightened sensory experiences, mood swings,
    paranoia, hallucinations
  • Varies greatly from person to person
  • Amotivational syndrome?
  • Minimal tolerance, withdrawal, dependence
  • Medicinal uses

23
Hallucinogens LSD
  • Derivative of ergot fungus
  • Effects
  • Perceptual changes, depersonalization,
    hallucinations
  • Very rapid tolerance
  • Withdrawal symptoms are rare
  • Can produce psychotic reactions

24
Other Drugs of Abuse Steroids
My lawyers have advised me that I cannot answer
these questions without jeopardizing my friends,
my family and myself. -Mark McGwire
25
Other Drugs of Abuse Steroids
"I did take a banned substance. And for that, I
am very sorry and deeply regretful. -Alex
Rodriguez
26
Other Drugs of Abuse Steroids
  • Synthesized from testosterone
  • Legitimate medical uses asthma, anemia, breast
    cancer, men with inadequate sexual development
  • Used illegally to increase body mass
  • Do not produce a high
  • Long-term mood disturbances and physical problems

27
Causes of Substance-Related Disorders
  • Exposure/access to drug is necessary, but not
    sufficient, for abuse and addiction
  • Use depends on social and cultural expectations
  • Drugs are used because of pleasurable and/or
    reinforcing effects
  • Reasons for drug abuse are complex

28
Biological Influences
  • Drugs affect the pleasure or reward centers in
    the brain
  • Biological changes occur with repeated drug use
  • Unlike substance use, substance abuse and
    dependence has a genetic component

29
Psychological Influences
  • Positive and negative reinforcement
  • Pleasurable effects
  • Self-medication (cope with negative affect)
  • Expectancy effects
  • Expectancies influence drug use and relapse

30
Social and Cultural Influences
  • Exposure to drugs is a prerequisite for use
  • Media, family, peers
  • Parents and the family appear critical
  • Cultural factors
  • Influence the manifestation of substance use and
    abuse

31
Social and Cultural Influences
  • The importance of context
  • 42 of Vietnam war soldiers used heroin
  • Half became dependent in Vietnam
  • Three years after returning home, only 12 were
    still using heroin

32
Social and Cultural Influences
  • Societal views about drug abuse
  • Moral weakness
  • Biological disease model (Twelve Steps)
  • War on drugs

33
American Culture and Drug Use
  • Assumptions of Americas War on Drugs
  • 1. Illicit drug use is bad. How bad?
  • Criminal Offense Average Prison Sentence
  • Murder/manslaughter 153 months
  • Drugs 78 months
  • Rape 67 months
  • Burglary 51 months
  • Aggravated Assault 50 months
  • Source U.S. Bureau of Justice Statistics

34
War on Drugs
  • 2. Illicit drug use is unhealthy, uncontrollable,
    and addictive
  • 3. Prevention and treatment programs work
  • Project DARE
  • Lynam et al. (1999)
  • 10-year follow-up of 1,000 10-year olds
  • Received either DARE or standard drug ed
  • Long-term outcomes

35
American Cultural and Drug Use
  • 4. People are unable to choose whether or not to
    take drugs or to regulate their use
  • Thus, prohibition is necessary
  • 5. There is an end to the drug war
  • When is it over exactly?

36
Biological Treatments
  • Agonist substitution
  • Substitute safer drug with similar chemical
    composition
  • Examples methadone, nicotine gum/ patch
  • Antagonistic treatment
  • Blocks or counteracts pleasurable drug effects
  • Examples - naltrexone for opiate and alcohol
    problems

37
Biological Treatments
  • Aversive treatment
  • Makes drug use extremely unpleasant
  • Examples - Antabuse for alcoholism
  • Efficacy of biological treatment
  • Largely ineffective when used alone

38
Psychosocial Treatment
  • Inpatient vs. outpatient care
  • Comparable efficacy, not cost
  • Controlled use (Sobell study)
  • Project MATCH
  • Compared 12 sessions of twelve step facilitation,
    CBT, or motivational enhancement
  • No differences in outcome
  • No control group

39
Psychosocial Treatment
  • Community support programs
  • Alcoholics Anonymous and related groups
  • Extremely popular but little evidence of benefits
  • From a 2006 literature review No experimental
    studies unequivocally demonstrated the
    effectiveness of Alcoholics Anonymous or 12-Step
    approaches for reducing alcohol dependence or
    problems.

40
Interventions
  • Confrontation by family and friends
  • Element of surprise, often humiliating
  • Intended to break down denial and persuade
    client to enter treatment
  • Confronts individuals with cataclysmic
    consequences if they do not enter treatment
  • Why isnt this approach used with depression,
    anxiety, etc.?

41
Interventions
  • Miller and Sovereign (1989)
  • Two groups 1) confrontational strategies 2)
    client-centered motivational interviewing
  • Clients in confrontational group exhibited MORE
    resistance to treatment than in client-centered
    group and were more likely to be drinking a year
    later
  • G. Alan Marlatt, Ph.D Once you have the person
    on board and involved and you have a good
    continued care program, things will happen in a
    good way. But if you say, Do this or else, you
    take away a persons choice and the consequences
    are negative.

42
Analysis of Intervention Programs
  • Not empirically supported
  • Studies show high rate of entry into treatment
    following an Intervention, but
  • High rate of dropout
  • Higher relapse following treatment (Loneck,
    Garrett, Banks 1996)
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