Clinical Descriptions, Prevalence, and Effects of Substance Use Disorders

DSM-5 Criteria:

  • 1) Problematic pattern of use that impairs functioning  2) 2 or more symptoms within a 1 year period:
    • Failure to meet obligations, repeated use in situations where it is physically dangerous o Repeated relationship problems, continued use despite problems caused by substance o Tolerance, withdrawal, substance taken for longer time or in greater amounts than intended o Efforts to reduce or control use do not work, much time spent trying to obtain the substance o Social/hobbies/work activities given up or reduced, craving to use the substance is strong
  • Severity: Mild = meet 2-3 criteria, Moderate = meet 4-5 criteria, Severe = meet 6+ criteria
  • Marijuana is most popularly used illegal drug
  • Alcohol is the most used substance
  • DSM-IV-TR had 2 categories: substance abuse and substance dependence, DSM-5 only has substance

USE

  • DSM-5 now includes gambling disorder in chapter on substance-related and addictive disorders
  • Addiction = a severe substance use disorder with 6+ symptoms o Using more than intended amounts, trying unsuccessfully to stop, physical/psyc problems made worse by drug, problematic relationships
    • Physiological dependence = presence of either tolerance or withdrawal o W/o physiological dependence = absence of tolerance and withdrawal
  • Tolerance and withdrawal often part of severe substance use disorder
  • Tolerance = indicated by: 1) larger doses of the substance being needed to produce the desired effect, or 2) the effects of the drug becoming markedly less if the usual amount is taken
  • Withdrawal = negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount o Muscle pain, twitching, sweats, vomiting, diarrhea, insomnia
  • Drug and alcohol use disorder are among most stigmatized disorders

I. Alcohol Use Disorder

  • Generally show more severe symptoms: tolerance, withdrawal
  • Delirium tremens (DTs) = person becomes delirious when alcohol level in blood suddenly drops, as well as tremulous and has hallucinations that are primarily visual and may be tactile as well
  • Often associated with other drug use, 80-85% are smokers
  • Nicotine and alcohol are cross-tolerant  can induce tolerance for the rewarding effects of the other

Nicotine influences the way alcohol works in the brain’s dopamine pathways associated with reward Prevalence

  • 5% meet criteria for DSM-IV-TR categories of alcohol dependence/abuse (rates are declining)
  • Binge drinking = having 5+ drinks in a short period of time *common among college-age students (39.5%)
  • Heavy-use drinking = having 5 drinks on the same occasion five or more times in 30-day period (12.7%)
  • More men than women have problems with alcohol
  • European American and Hispanic adolescents/adults more likely to binge drink than African

American o Least likely among Asian American and African American

  • Most prevalent among Native Americans and Hispanics
  • Comorbid with personality disorders, mood disorders, schizophrenia, and anxiety disorders (and other drug use)
  • 8% have another psyc disorder Short-Term Effects of Alcohol
  • Alcohol being metabolized by enzymes enter small intestine and is absorbed into blood
  • Broken down in liver, can metabolize 1 ounce or 100-proof (50%) liquor per hour
  • Women achieve higher blood alcohol concentrations after adjustments for body weight
  • Alcohol stimulates GABA receptors (reduces tension)
  • Increases levels of serotonin and dopamine *pleasurable effects
  • Inhibits glutamate receptors *causes cognitive effects (slowed thinking, memory loss)

Long-Term Effects of Prolonged Alcohol Abuse

  • Impairs digestion of food and absorption of vitamins
  • Deficiency of B-complex vitamins can cause amnestic syndrome = severe loss of memory for recent and long-past events
  • Alcohol use plus reduction in protein intake leads to developed or cirrhosis of the liver o Liver cells become engorged with fat and protein, impeding their function
  • Damage to: endocrine glands, brain, pancreas, heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhages (redness in face)
  • Fetal alcohol syndrome = growth of fetus is slowed, production of cranial, facial and limb abnormalities as a result of heavy alcohol consumption while pregnant
  • Benefits: physiological (increases coronary blood flow), psychological (less-driven lifestyle and diminished hostility)
  • Low-moderate consumption of red wine may lower bad cholesterol and raise god cholesterol

II. Tobacco Use Disorder

  • Nicotine = addicting agent of tobacco *activates neural pathways that stimulate dopamine neurons in mesolimbic area

Prevalence and Health Consequences

  • 18% prevalence rate
  • Smoking is the single most preventable cause of premature death in the US
  • People in US who are most likely to smoke are those with a psyc disorder
  • Consequences: emphysema, cancer of larynx/esophagus/pancreas/bladder/cervix/stomach, pregnancy complications, SIDS, periodontitis, cardiovascular disorders
  • Harmful ocmponents: nicotine, carbon monoxide, tar
  • Similar rates among adolescent males/females, higher among Hispanic and white adolescents than African/Asia American **African Americans retain nicotine in their blood longer (metabolize it more slowly) *less likely to quit, more likely to get lung cancer **smoke more menthol (inhaled more deeply and longer)
  • More men than women smoke *except in 12-17 year-olds
  • More prevalent in those of low SES
  • Those who smoke menthol cigarettes inhale more deeply and hold smoke in for a longer time

Secondhand Smoke

  • Secondhand smoke = smoke coming from the burning end of the cigarette, AKA environmental tobacco smoke (ETS) o Contains higher concentration of ammonia, carbon monoxide, nicotine, and tar than the inhaled smoke
  • 1) Lung damage – those living with smokers are at greater risk
  • 2) Babies of women exposed to secondhand smoke during pregnancy more likely to be born prematurely, LBW and defects
  • 3) Children of smokers more likely to have upper respiratory infections, asthma, bronchitis, inner-ear infections, SIDS
  • No safe level of exposure to secondhand smoke

E-Cigarettes

  • Heat up nicotine liquid, inhale/exhale vapor
  • Do not contain tar and carbon monoxide
  • Often called vape pipes/hookah pens
  • Can still be used with nicotine, which is still an addictive drug
  • Marijuana & Cannabis Use Disorder
    • Marijuana = consists of dried and crushed leaves and flowering tops of hemp plant Cannabis sativa
    • Hashish = stronger than marijuana, produced by removing and drying resin exudate of the tops of cannabis plants
    • Synthetic marijuana sold under names: Spice or K2, illegal as of 2011

Prevalence

  • Most frequently used illicit drug (19,000,000 reported use in 2012)
  • Most commonly used drug across all age groups
  • Higher prevalence among men than women (2x as man men 18+ than women) *11.8% vs. 6.6%
  • Fairly equivalent use across racial and ethnic groups
  • Legal use in adults over 21 in Colorado and Washington

Effects

  • Major active chemical: delta-9-tetrahydrocannabinol (THC)
  • Marijuana is now more potent than it used to be (30 years ago) and users smoke more now than in the past
  • Psychological Effects:
    • Depend on potency and dose size o Feel relaxed and sociable
    • Rapid shifts in emotion, dull attention, fragment thoughts, impaired memory, sense that time moves slowly
    • Extreme doses can induce hallucinations, extreme panic o May take up to 30 minutes for effects to appear
    • Can interfere with cognitive functioning: planning, decision making, working memory, problem solving
    • Being high impairs psychomotor skills necessary for driving  Physical Consequences:
    • Bloodshot and itchy eyes, dry mouth/throat, increased appetite, reduced pressure within the eye, raised blood pressure

Long-term use can impair lung structure and function

Smoke less cigarettes than tobacco smokers, but inhale more deeply and retain in lungs longer

  • 1 marijuana cigarette equivalent to 5 tobacco cigarettes in CO content, 4 in tar intake and 10 in terms of damage to cells lining the airways
  • CB1 and CB2 (cannabinoid brain receptors)
    • CB1 throughout body and brain, high number in hippocampus *effects memory & learning
  • Increased blood flow to brain regions associated with emotion (amygdala, anterior cingulate) o Decreased blood flow to temporal lobe (auditory attention) o Habitual use does produce tolerance (addictive evidence) o Withdrawal symptoms can occur  Therapeutic Effects and Legalization:
  • Reduction in nausea and loss of appetite that accompany chemotherapy for some people with cancer, glaucoma, chronic pain, muscle spasms, seizures, discomfort from AIDS
  1. Opiates & Opioid Use Disorder
    • Opiates = include opium and its derivatives: morphine, heroin and codeine *group of addictive sedatives o In moderate doses can relieve pain and induce sleep
    • Synthetic sedatives – separate category from DSM-5 sedative/hypnotic/anxiolytic use disorder
    • Hydrocodone and oxycodone are prescribed as pain medications, but are also abused
    • Vicodin (hydrocodone and acetaminophen) is one of the mot commonly abused drugs containing hydrocodone
    • OxyContin is one of the most commonly abused drugs containing oxycodone

Prevalence of Abuse and Dependence

  • More common to begin taking heroin after first taking prescription pain medication
  • Most commonly abused opiates are prescription pain medication taken for nonmedical purposes

(more men than women) o Highest abuse among European Americans and Native Americans

  • Prescriptions are forged, stolen or diverted to dealers on black market
  • 8 million pain medication users for nonmedical purposes o OxyContin prescriptions jumped 1800% between 1996 and 2000 o Hydrocodone use increased from 4.5-5.7 million users o Oxycodone abuse increased 43% in just 1 year (1997-98)
  • Rates of abuse of pain medications have remained stable since 2002

Psychological and Physical Effects

  • Produce euphoria, drowsiness, lack of coordination
  • Produce a “rush” – feeling of warm, suffusing ecstasy immediately after injection
  • Shed worries and fears, great self confidence 4-6 hours, followed by a severe letdown
  • Stimulate neural receptors of the body’s opioid system (endorphins and enkephalins) o Heroin converted to morphine in the brain, binds to opioid receptors
    • ½ million addicted to heroin in USA *difficult to get accurate prevalence rates
    • Accounted for 62-82% of drug-related hospital admissions 2003
  • Affect the nucleus accumbens (or possibly dopamine system)
  • Show tolerance and withdrawal (even after 8 hours of last injection) *muscle pain, sneezing, sweating, tearful, yawns

Withdrawal symptoms more severe after 36 hours *muscle twitching, cramps, chills/sweating, rise in heart rate

  • Unable to sleep, vomiting, diarrhea ***symptoms persist for 72 hours
  • Drug and process of obtaining it become centre of the person’s existence
  • Costs upwards of $200/day
  • Needle sharing leads to exposure to infectious agents (e.g. HIV)

V. Stimulants

  • Stimulants = act on the brain and sympathetic nervous system to increase alertness and motor activity
  • Synthetic: amphetamines, Natural: cocaine (coca leaf)

Amphetamines (synthetic stimulant)

  • g. Benzedrine, Dexedrine, methedrine – produce effects by causing release of norepinephrine and dopamine, block reuptake
  • Orally or intravenously taken, addicting
  • Heightens wakefulness, intestinal functions inhibited, appetite reduced (used in dieting), increased heart rate, blood/mucous membranes/vessels constrict
  • Person becomes alert, euphoric, outgoing, boundless energy and self-confidence
  • Large dose – nervous, agitated, confused, palpitations, headaches, dizziness, sleeplessness  Tolerance develops rapidly (after 6 days of repeated use)
  • Methamphetamine:
    • Most commonly abused stimulant o More often used by men
    • Used in small towns more than big cities o Taken orally, intravenously, nasally o Crystal meth – when in clear crystal form o Craving lasts for several years after discontinuing use
    • Immediate rush that lasts for hours followed by a crash (tweaking) o Both tolerance and withdrawal symptoms
    • Long term use affects dopamine and serotonin systems of the brain o Smaller volume of hippocampus
    • Lower brain activation in several areas (predicts relapse) **especially with decision making tasks
  • Cocaine:
    • Comes from leaves of coca shrub, crack comes in rock-crystal form (heated, melted then smoked)
    • Crack is cheaper than cocaine, used in urban areas
    • Used by men more often than women o Cocaine use declined between 2002-09, dropping from 1.4% from 2% o Acts rapidly on brain, blocking reuptake of dopamine in mesolimbic areas o Increased sexual desire and feelings of self-confidence, well-being, indefatigability o Overdoes: chills, nausea, insomnia, paranoia, hallucinations
    • Long-term use: heightened irritability, impaired social relationships, paranoid thinking, eating/sleeping disturbances
    • Some develop tolerance, others become more sensitive to effects (can lead to death) o Severe withdrawal symptoms
    • Vasoconstrictor – causes blood vessels to narrow *often die of overdose leading to heart attack

Increased risk for stroke, causes cognitive impairments

Lower volumes of grey matter in prefrontal cortex if exposed prenatally o Freebase cocaine produces powerful effects, absorbed so rapidly (heated by ether)

 Induces an intense 2-minute high followed by restlessness and discomfort VI. Hallucinogens, Ecstasy and PCP

LSD and Other Hallucinogens – Hallucination Persisting Perception Disorder

  • Hallucinogen = refers to the main effects of such drugs, hallucinations
  • Used more by men than women
  • LSD = lysergic acid diethylamide – no evidence of withdrawal, tolerance appears to develop rapidly o Can alter sense of time (seems to pass slowly), sharp mood swings, expanded consciousness o Intense anxiety – perceptual experiences/hallucinations can provoke fears that they are going crazy
  • Flashbacks = visual recurrences of perceptual experiences after physiological effects of the drug have worn off

Ecstasy and PCP – Other Hallucinogen Use Disorder

  • Ecstasy = made from MDMA (methylenedioxymethamphetamine) *became illegal in 1985
  • Contains compounds from hallucinogen and amphetamine families
  • Popular on college campuses and in clubs
  • Taken in pill form, often mixed with other substances making the effects vary dramatically  Molly = purer powder version of ecstasy
  • Average age of first use is 20
  • Affects release and reuptake of serotonin
  • May have neurotoxic effects on serotonin system
  • Enhances intimacy and insight, improves interpersonal relationships, elevates mood and selfconfidence, promotes aesthetic awareness
  • Can cause muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills, sweating, anxiety, depression, depersonalization, confusion
  • PCP (phencyclidine) = “angel dust”, phencyclidine use disorder o Causes serious negative reactions, severe paranoia, violence, coma and death o Affects multiple NTMs in the brain
    • Likely to have used other drugs before or concurrently

Etiology of Substance Use Disorders

 Positive attitude  Experimentation  Regular Use  Heavy Use  Dependence or Abuse

Developmental Approach (to alcohol abuse) o 1) First group began drinking in early adolescence, increased drinking throughout high school and adulthood o More common in boys

  • 2) Second group drank less in early adolescence, increased drinking in middle school & again in high school
  • Developmental studies d not account for all cases o Not an inevitable progression through stages Genetic Factors
  • High genetic component of alcohol use disorder (also true for smoking, marijuana and other drugs in general)
  • Peers are particularly important environmental variables among adolescents
  • Alcohol dehydrogenase = enzymes involved in alcohol metabolism *difficult to build tolerance if have inherited deficiency

Mutations ADH2 and ADH3 genes linked with alcohol use disorders

  • People who are more sensitive to effects of nicotine are more likely to get addicted (dopamine release, inhibit reuptake) o Gene SLC6A3 related to reuptake regulation of dopamine

 One form of the gene related to lower likelihood of smoking, greater likelihood of quitting and greater sensitivity to smoking cues

o CYP2A6 gene contributes to body’s ability to metabolize nicotine *less likely to become dependent

 Slower metabolism = stays in brain longer

  • Ability to tolerate large quantities of alcohol may be an inherited diathesis o Asians have lower rates of alcohol abuse

o Deficient enzymes (ADH or alcohol dehydrogenase)

Neurobiological Factors

  • Dopamine pathways in the brain are linked to pleasure and reward ***particularly mesolimbic pathway is affected o Possible deficiency in DA receptor DRD2
  • Vulnerability model – do problems in the dopamine system increase vulnerability to substance dependence
  • Toxic effect model – dopamine system problems are the consequence of substance dependence  Support for both models for cocaine use
  • People take drugs to avoid bad feelings associated with withdrawal *explains frequency of relapse
  • Insensitive-sensitization theory – considers both the craving for drugs and the pleasure that comes with taking the drugs o Dopamine system linked to pleasure/liking, becomes supersensitive to the drug and to cues associated with it (needles, spoons, rolling paper)
    • Sensitivity to cues induces craving
    • Overtime, liking decreases and wanting remains intense
  • More craving is associated with more usage, even when trying to quit
  • Brain imaging studies show that cues for a drug activate the reward & pleasure areas of the brain involved in drug use
  • Greater activation in basal ganglia, inferofrontal gyrus, and pre-motor areas = better at inhibiting a response when needed
  • Self-reports of liking and wanting are important for predicting drinking behaviour  Short Term Over Long Term:
    • People with substance use disorders often value the immediate, impulsive pleasure and reward that comes from taking a drug more than the delayed reward (e.g. monthly paycheck)
    • Delay discounting – can compute extent to which people discount the value of larger, delayed rewards
    • People on opiates, nicotine, cocaine and alcohol discount delayed rewards more steeply than others
    • Valuing delayed rewards is associated with prefrontal cortex activation
    • Valuing immediate rewards is associated with amygdala and nucleus accumbens activation Psychological Factors
  • Mood Alteration:

o Drug use is reinforced because it enhances positive moods or diminishes negative ones o Alcohol use reduces anxiety and stress *also lessens positive emotions in response to anxiety-provoking situations

 

 Tension reduction  “alcohol myopia”

Nicotine reduces tension and negative affect during early phases of smoking o Other studies show sensory aspect of smoking (inhaling) reduces tension o Tension reduction more likely when distractions are present o Alcohol and nicotine may increase tension when no distractions are present o Other use drugs due to expectations that they will increase positive affect o User focuses reduced cognitive capacity on immediate distractions o Less attention focused on tension-producing thoughts

o Alcohol and nicotine ay increase tension when no distractions are present (crying in one’s beer)

  • Expectations About Effects:
    • People who expect alcohol to reduce anxiety and stress are more likely to be frequent users o People who believe that drug intake will have positive effects are more likely to become frequent users
    • The greater perceived risk of a drug, the less likely it is to be used  Personality Factors:
    • High levels of negative affect – neuroticism/negative emotionality – important in predicting later onset of substance use disorders

 Also predicts persistent desire for arousal along with increased positive affect o Constraint = cautious behaviour, harm avoidance, conservative moral standards o Low in constraint, high in negative emotionality = more likely to develop substance use disorder

  • Low agreeableness and conscientiousness, high disinhibition (low constraint) and moderate neuroticism
  • Kindergarten children high in anxiety & novelty seeking more likely to get drunk, smoke & use drugs in adolescence  Sociocultural Factors:
  • Interest in and access to drugs influenced by peers, the media, and cultural norms o Alcohol is the most commonly abused substance, followed by marijuana
  • High alcohol consumption often found in wine-drinking societies (France, Spain, Italy)
  • Men consume more alcohol than women (differs by country) o Easy accessibility affects usage

 2003 – drug use more common among youths who’d been approached by drug dealer

(35% compared to 7&)

  • Family factors: parental use, marriage conflict, lack of parental monitoring (drug), lack of emotional support from parents (cigarettes, marijuana, alcohol)
  • Social Network:
    • Having peers who drink influences drinking behaviours (social influence)
    • Individuals also choose friends with drinking patterns similar to their own (social selection)

Treatment

  • First step to successful treatment is admitting there is a problem
  • Many treatment programs require individuals to begin by stopping use, which can exclude many individuals

Treatment of Alcohol Use Disorder

  • Only 24% who are physiologically dependent on alcohol ever receive treatment  Impatient Hospital Treatment:

Detoxification = first step in treatment for many substance use disorders o Inpatient treatments are more expensive, not necessarily more effective, but sometimes needed if individual lacks social support

  • Outpatient treatment is more common  Alcoholics Anonymous (AA):
  • Largest and most widely known self-help group
  • Regular and frequent meetings, newcomers rise to announce that they are alcoholics and give testimonials, share stories of how their lives are better now without alcohol
  • Provides emotional support, understanding and close counseling, plus a social network o Urged to call on one another around the clock when they need encouragement not to relapse
  • Alcohol dependence is a disease that can never be cured, continuing vigilance is necessary o An alcoholic is always an alcoholic, carrying the disease even if it is currently under control o 12 step program, spiritual aspect, belief in the philosophy linked to achieving abstinence o Rational recovery – focuses on promoting renewed self-reliance rather than reliance on a higher power
  • High dropout rates
  • Couples Therapy:
    • Reduction in problem drinking even a year after treatment has ended o Improve overall couple distress
    • Combines skills from individual CBT with a focus on couple’s relationship and dealing with alcohol-related stressors
  • Cognitive and Behavioural Treatments:
    • Contingency management therapy = CBT for alcohol and drug use disorders that involves teaching people to reinforce behaviours inconsistent with drinking
      • Based on belief that environmental contingencies can play a role in encouraging/discouraging drinking
      • Can exchange earned tokens for desirable objects
      • Also includes teaching job0hunting and social skills, assertiveness training for refusing drinks
    • Relapse prevention – goal is to help people avoid relapsing once they have stopped substance use
  • Motivational Interventions:
    • Tracking drinking behaviour as well as showing statistics on national averages/education about effects of alcohol can reduce drinking behaviour  Moderation in Drinking:
    • Controlled drinking & the guided self-change approach = people have more potential control over their immoderate drinking than they typically believe and that heightened awareness of the costs of drinking to excess & benefits of abstaining or cutting down can help  Medications:
    • Antabuse (disulfiram) = drug that discourages drinking by causing violent vomiting if alcohol is ingested

 Must be strongly committed to change o Opiate antagonist naltrexone – blocks activity of endorphins that are stimulated by alcohol, reducing the craving for it *additionally effective when combined with CBT

  • Acamprosate = impacts glutamate and GABA NTM systems, reduces cravings associated with withdrawal

Treatments for Smoking

  • More likely to quit smoking of other people around you quit
  • Peer pressure to quit seems to be equally as effective as it was to start
  • Only about 50% who go through smoking-cessation programs succeed in abstaining by the time the program is over o Only small amount who have succeeded short term remain nonsmoking a year later  Psychological Treatments:
    • Most common: being told to stop by a physician
    • Scheduled smoking – get users to agree to increase the time in between cigarettes *limits on amount of cigarettes/day, decrease each week

 Only smoke on schedule, not as a result of craving to smoke o Project EX = school based program, includes training in coping skills and Psychoeducational component about harmful effects

  • Nicotine Replacement Treatments and Medications:
    • Goal of NRT = reducing a smoker’s craving for nicotine by providing it in a different way (gum, patches, inhalers)
    • Nicotine gum is absorbed much more slowly and steadily than that in tobacco – help smoker cut back and eliminate reliance
      • If dose is too high, causes cardiovascular changes o Patches slowly release the drug into the bloodstream transdermally and then to the brain
      • Only need 1 patch/day, effective after about 8 weeks, use smaller patches as treatment progresses

o NRT more effective when combined with antidepressant use or psychological treatment

Treatment of Drug Use Disorders

  • Detoxification = withdrawal from the drug itself, is central for treatment  Psychological Treatments:

o CBT more effective than antidepressants for those with high degree of drug dependence

  • Learn how to avoid high-risk situations, recognize lure of the drug, and develop alternatives to drug usage
  • Learn strategies to cope with the craving and resistance of use o Contingency management with vouchers (CBT with vouchers most likely to remain abstinent) o Motivational enhancement therapy – involves combination of CBT and helping clients generate solutions for alcohol and drug use disorders

o Self-help residential homes:

  • Separation of people from previous social contacts (relationships helped maintain drug use disorder)
  • Comprehensive environment, drugs are not available, support is offered
  • Charismatic role models – formerly dependent on drugs, meet life’s challenges without drugs
  • Direct confrontation in group therapy, accept responsibility for problems, take charge of life
  • Respectful setting, no stigmatization as failures/criminals
  • **High dropout rate o Proposition 36 – Substance Abuse and Crime Prevention Act – allows nonviolent drug offenders to be sent to drug treatment rather than prison *voluntary  Drug Replacement Treatments and Medications:

Heroin substitutes = drugs chemically similar to heroin that can replace the body’s craving for it

  • Methadone – addicting on its own
  • Synthetic narcotics are cross-dependent with heroin = by acting on the same CNS receptors, they become a substitute for the original dependency
  • Less severe withdrawal reactions
  • Side effects: insomnia, constipation, excessive sweating, diminished sexual functioning
  • Stigma associated with going to methadone clinics o Opiate antagonists = drugs that prevent the use from experiencing the heroin high
  • Naltrexone
  • Gradually weaned from heroin, receiving increasing doses of naltrexone
  • Molecules occupy receptors to which opiates usually bind, without stimulating them
  • Requires frequent visits to a clinic (motivation required) o Buprenorphine – partial opiate agonist (less addictive than heroin), also contains naloxone (opiate antagonist)
  • Less intense high
  • Do not need to go to clinic to receive *prescribed
  • Effective at relieving withdrawal symptoms o Drug replacement therapy does not seem to be effective for cocaine use disorders o Vaccine to prevent the high associated with cocaine, contains tiny amounts of cocaine attached to harmless pathogens
  • Body responds by developing antibodies
  • Not all users develop enough antibodies to keep cocaine from reaching the brain o Methamphetamine Treatment Project – Matrix treatment – 16 CBT group sessions, 12 family education sessions, 4 individual therapy sessions, 4 social support sessions
  • Positive short-term results, long-term results were equally comparable to treatment as usual (TAU)

Prevention

  • Half of adult smokers began before age 15, nearly all before age 19
  • Top priority to discourage youth
  • Family interventions
  • Statewide comprehensive tobacco control programs: increasing taxes on cigarettes, restricting advertising, conducting public education campaigns, creating smoke free environments  New health warnings including graphic images on packaging  School programs:

o Peer-pressure resistance training *learn to say no o Correction of beliefs and expectations – believe it is more prevalent than it actually is o Inoculation against mass media messages – media makes smoking look positive

 Truth campaign – aims to share health and social consequences of smoking o Peer leadership