{"id":4197,"date":"2018-09-18T17:18:08","date_gmt":"2018-09-18T21:18:08","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4197"},"modified":"2019-05-26T00:16:45","modified_gmt":"2019-05-26T04:16:45","slug":"substance-use-disorders","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/substance-use-disorders\/","title":{"rendered":"Substance Use Disorders"},"content":{"rendered":"

Clinical Descriptions, Prevalence, and Effects of Substance Use Disorders <\/strong><\/p>\n

DSM-5 Criteria:<\/p>\n

\n
1) Problematic pattern of use that impairs functioning \uf0b7 2) 2 or more symptoms within a 1 year period:\n
\n
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<\/li>\n<\/ul>\n<\/li>\n
Severity: Mild<\/strong> = meet 2-3 criteria, Moderate<\/strong> = meet 4-5 criteria, Severe<\/strong> = meet 6+ criteria<\/li>\n
Marijuana is most popularly used illegal drug<\/li>\n
Alcohol is the most used substance<\/li>\n
DSM-IV-TR had 2 categories: substance abuse and substance dependence, DSM-5 only has substance<\/li>\n<\/ul>\n
USE<\/p>\n
\n
DSM-5 now includes gambling disorder in chapter on substance-related and addictive disorders<\/li>\n<\/ul>\n
\n
Addiction<\/strong> = 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\n
\n
Physiological dependence<\/strong> = presence of either tolerance or withdrawal o W\/o physiological dependence<\/strong> = absence of tolerance and withdrawal<\/li>\n<\/ul>\n<\/li>\n
Tolerance and withdrawal often part of severe substance use disorder<\/li>\n
Tolerance<\/strong> = 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<\/li>\n
Withdrawal<\/strong> = 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<\/li>\n
Drug and alcohol use disorder are among most stigmatized disorders<\/li>\n<\/ul>\n
I. Alcohol Use Disorder<\/h2>\n
\n
Generally show more severe symptoms: tolerance, withdrawal<\/li>\n
Delirium tremens<\/strong> (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<\/li>\n
Often associated with other drug use, 80-85% are smokers<\/li>\n
Nicotine and alcohol are cross-tolerant \uf0e0 can induce tolerance for the rewarding effects of the other<\/li>\n<\/ul>\n
Nicotine influences the way alcohol works in the brain\u2019s dopamine pathways associated with reward Prevalence<\/p>\n
\n
5%<\/strong> meet criteria for DSM-IV-TR categories of alcohol dependence\/abuse (rates are declining)<\/li>\n
Binge drinking<\/strong> = having 5+ drinks in a short period of time *common among college-age students (39.5%)<\/li>\n
Heavy-use drinking<\/strong> = having 5 drinks on the same occasion five or more times in 30-day period (12.7%)<\/li>\n
More men than women have problems with alcohol<\/li>\n
European American and Hispanic adolescents\/adults more likely to binge drink than African<\/li>\n<\/ul>\n
American o Least likely among Asian American and African American<\/p>\n
\n
Most prevalent among Native Americans and Hispanics<\/li>\n
Comorbid with personality disorders, mood disorders, schizophrenia, and anxiety disorders (and other drug use)<\/li>\n
8% have another psyc disorder Short-Term Effects of Alcohol<\/li>\n
Alcohol being metabolized by enzymes enter small intestine and is absorbed into blood<\/li>\n
Broken down in liver, can metabolize 1 ounce or 100-proof (50%) liquor per hour<\/li>\n
Women achieve higher blood alcohol concentrations after adjustments for body weight<\/li>\n
Alcohol stimulates GABA receptors (reduces tension)<\/li>\n
Increases levels of serotonin and dopamine *pleasurable effects<\/li>\n
Inhibits glutamate receptors *causes cognitive effects (slowed thinking, memory loss)<\/li>\n<\/ul>\n
Long-Term Effects of Prolonged Alcohol Abuse<\/p>\n
\n
Impairs digestion of food and absorption of vitamins<\/li>\n
Deficiency of B-complex vitamins can cause amnestic syndrome<\/strong> = severe loss of memory for recent and long-past events<\/li>\n
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<\/li>\n
Damage to: endocrine glands, brain, pancreas, heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhages (redness in face)<\/li>\n
Fetal alcohol syndrome<\/strong> = growth of fetus is slowed, production of cranial, facial and limb abnormalities as a result of heavy alcohol consumption while pregnant<\/li>\n
Benefits: physiological (increases coronary blood flow), psychological (less-driven lifestyle and diminished hostility)<\/li>\n
Low-moderate consumption of red wine may lower bad cholesterol and raise god cholesterol<\/li>\n<\/ul>\n
II. Tobacco Use Disorder<\/h2>\n
\n
Nicotine<\/strong> = addicting agent of tobacco *activates neural pathways that stimulate dopamine neurons in mesolimbic area<\/li>\n<\/ul>\n
Prevalence and Health Consequences<\/p>\n
\n
18%<\/strong> prevalence rate<\/li>\n
Smoking is the single most preventable cause of premature death in the US<\/li>\n
People in US who are most likely to smoke are those with a psyc disorder<\/li>\n
Consequences: emphysema, cancer of larynx\/esophagus\/pancreas\/bladder\/cervix\/stomach, pregnancy complications, SIDS, periodontitis, cardiovascular disorders<\/li>\n
Harmful ocmponents: nicotine, carbon monoxide, tar<\/li>\n
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)<\/li>\n
More men than women smoke *except in 12-17 year-olds<\/li>\n
More prevalent in those of low SES<\/li>\n
Those who smoke menthol cigarettes inhale more deeply and hold smoke in for a longer time<\/li>\n<\/ul>\n
Secondhand Smoke<\/p>\n
\n
Secondhand smoke<\/strong> = 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<\/li>\n
1) Lung damage \u2013 those living with smokers are at greater risk<\/li>\n
2) Babies of women exposed to secondhand smoke during pregnancy more likely to be born prematurely, LBW and defects<\/li>\n
3) Children of smokers more likely to have upper respiratory infections, asthma, bronchitis, inner-ear infections, SIDS<\/li>\n
No safe level of exposure to secondhand smoke<\/li>\n<\/ul>\n
E-Cigarettes<\/p>\n
\n
Heat up nicotine liquid, inhale\/exhale vapor<\/li>\n
Do not contain tar and carbon monoxide<\/li>\n
Often called vape pipes\/hookah pens<\/li>\n
Can still be used with nicotine, which is still an addictive drug<\/li>\n
Marijuana <\/strong>& Cannabis Use Disorder\n
\n
Marijuana<\/strong> = consists of dried and crushed leaves and flowering tops of hemp plant Cannabis sativa<\/li>\n
Hashish<\/strong> = stronger than marijuana, produced by removing and drying resin exudate of the tops of cannabis plants<\/li>\n
Synthetic marijuana sold under names: Spice or K2, illegal as of 2011<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Prevalence<\/p>\n
\n
Most frequently used illicit drug (19,000,000 reported use in 2012)<\/li>\n
Most commonly used drug across all age groups<\/li>\n
Higher prevalence among men than women (2x as man men 18+ than women) *11.8% vs. 6.6%<\/li>\n
Fairly equivalent use across racial and ethnic groups<\/li>\n
Legal use in adults over 21 in Colorado and Washington<\/li>\n<\/ul>\n
Effects<\/p>\n
\n
Major active chemical: delta-9-tetrahydrocannabinol (THC)<\/li>\n
Marijuana is now more potent than it used to be (30 years ago) and users smoke more now than in the past<\/li>\n
Psychological Effects:\n
\n
Depend on potency and dose size o Feel relaxed and sociable<\/li>\n
Rapid shifts in emotion, dull attention, fragment thoughts, impaired memory, sense that time moves slowly<\/li>\n
Extreme doses can induce hallucinations, extreme panic o May take up to 30 minutes for effects to appear<\/li>\n
Can interfere with cognitive functioning: planning, decision making, working memory, problem solving<\/li>\n
Being high impairs psychomotor skills necessary for driving \uf0b7 Physical Consequences:<\/li>\n
Bloodshot and itchy eyes, dry mouth\/throat, increased appetite, reduced pressure within the eye, raised blood pressure<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Long-term use can impair lung structure and function<\/p>\n
Smoke less cigarettes than tobacco smokers, but inhale more deeply and retain in lungs longer<\/p>\n
\n
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<\/li>\n<\/ul>\n
\n
CB1 and CB2 (cannabinoid brain receptors)\n
\n
CB1 throughout body and brain, high number in hippocampus *effects memory & learning<\/li>\n<\/ul>\n<\/li>\n
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 \uf0b7 Therapeutic Effects and Legalization:<\/li>\n
Reduction in nausea and loss of appetite that accompany chemotherapy for some people with cancer, glaucoma, chronic pain, muscle spasms, seizures, discomfort from AIDS<\/li>\n<\/ul>\n
\n
Opiates <\/strong>& Opioid Use Disorder\n
\n
Opiates<\/strong> = include opium and its derivatives: morphine, heroin and codeine *group of addictive sedatives o In moderate doses can relieve pain and induce sleep<\/li>\n
Synthetic sedatives<\/strong> \u2013 separate category from DSM-5 sedative\/hypnotic\/anxiolytic use disorder<\/li>\n
Hydrocodone and oxycodone are prescribed as pain medications, but are also abused<\/li>\n
Vicodin (hydrocodone and acetaminophen) is one of the mot commonly abused drugs containing hydrocodone<\/li>\n
OxyContin is one of the most commonly abused drugs containing oxycodone<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
Prevalence of Abuse and Dependence<\/p>\n
\n
More common to begin taking heroin after first taking prescription pain medication<\/li>\n
Most commonly abused opiates are prescription pain medication taken for nonmedical purposes<\/li>\n<\/ul>\n
(more men than women) o Highest abuse among European Americans and Native Americans<\/p>\n
\n
Prescriptions are forged, stolen or diverted to dealers on black market<\/li>\n
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)<\/li>\n
Rates of abuse of pain medications have remained stable since 2002<\/li>\n<\/ul>\n
Psychological and Physical Effects<\/p>\n
\n
Produce euphoria, drowsiness, lack of coordination<\/li>\n
Produce a \u201crush\u201d \u2013 feeling of warm, suffusing ecstasy immediately after injection<\/li>\n
Shed worries and fears, great self confidence 4-6 hours, followed by a severe letdown<\/li>\n
Stimulate neural receptors of the body\u2019s opioid system (endorphins and enkephalins) o Heroin<\/strong> converted to morphine in the brain, binds to opioid receptors\n
\n
\u00bd million addicted to heroin in USA *difficult to get accurate prevalence rates<\/li>\n
Accounted for 62-82% of drug-related hospital admissions 2003<\/li>\n<\/ul>\n<\/li>\n
Affect the nucleus accumbens (or possibly dopamine system)<\/li>\n
Show tolerance and withdrawal (even after 8 hours of last injection) *muscle pain, sneezing, sweating, tearful, yawns<\/li>\n<\/ul>\n
Withdrawal symptoms more severe after 36 hours *muscle twitching, cramps, chills\/sweating, rise in heart rate<\/p>\n
\n
Unable to sleep, vomiting, diarrhea ***symptoms persist for 72 hours<\/li>\n<\/ul>\n
\n
Drug and process of obtaining it become centre of the person\u2019s existence<\/li>\n
Costs upwards of $200\/day<\/li>\n
Needle sharing leads to exposure to infectious agents (e.g. HIV)<\/li>\n<\/ul>\n
V. Stimulants<\/h2>\n
\n
Stimulants<\/strong> = act on the brain and sympathetic nervous system to increase alertness and motor activity<\/li>\n
Synthetic: amphetamines, Natural: cocaine (coca leaf)<\/li>\n<\/ul>\n
Amphetamines (synthetic stimulant)<\/p>\n
\n
g. Benzedrine, Dexedrine, methedrine \u2013 produce effects by causing release of norepinephrine and dopamine, block reuptake<\/li>\n
Orally or intravenously taken, addicting<\/li>\n
Heightens wakefulness, intestinal functions inhibited, appetite reduced (used in dieting), increased heart rate, blood\/mucous membranes\/vessels constrict<\/li>\n
Person becomes alert, euphoric, outgoing, boundless energy and self-confidence<\/li>\n
Large dose \u2013 nervous, agitated, confused, palpitations, headaches, dizziness, sleeplessness \uf0b7 Tolerance develops rapidly (after 6 days of repeated use)<\/li>\n
Methamphetamine<\/strong>:\n
\n
Most commonly abused stimulant o More often used by men<\/li>\n
Used in small towns more than big cities o Taken orally, intravenously, nasally o Crystal meth \u2013 when in clear crystal form o Craving lasts for several years after discontinuing use<\/li>\n
Immediate rush that lasts for hours followed by a crash (tweaking) o Both tolerance and withdrawal symptoms<\/li>\n
Long term use affects dopamine and serotonin systems of the brain o Smaller volume of hippocampus<\/li>\n
Lower brain activation in several areas (predicts relapse) **especially with decision making tasks<\/li>\n<\/ul>\n<\/li>\n
Cocaine<\/strong>:\n
\n
Comes from leaves of coca shrub, crack<\/strong> comes in rock-crystal form (heated, melted then smoked)<\/li>\n
Crack is cheaper than cocaine, used in urban areas<\/li>\n
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<\/li>\n
Long-term use: heightened irritability, impaired social relationships, paranoid thinking, eating\/sleeping disturbances<\/li>\n
Some develop tolerance, others become more sensitive to effects (can lead to death) o Severe withdrawal symptoms<\/li>\n
Vasoconstrictor \u2013 causes blood vessels to narrow *often die of overdose leading to heart attack<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Increased risk for stroke, causes cognitive impairments<\/p>\n
Lower volumes of grey matter in prefrontal cortex if exposed prenatally o Freebase cocaine produces powerful effects, absorbed so rapidly (heated by ether)<\/p>\n
\uf0a7 Induces an intense 2-minute high followed by restlessness and discomfort VI. <\/strong>Hallucinogens, Ecstasy and PCP<\/strong><\/p>\n
LSD and Other Hallucinogens \u2013 Hallucination Persisting Perception Disorder<\/p>\n
\n
Hallucinogen<\/strong> = refers to the main effects of such drugs, hallucinations<\/li>\n
Used more by men than women<\/li>\n
LSD<\/strong> = lysergic acid diethylamide \u2013 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 \u2013 perceptual experiences\/hallucinations can provoke fears that they are going crazy<\/li>\n
Flashbacks<\/strong> = visual recurrences of perceptual experiences after physiological effects of the drug have worn off<\/li>\n<\/ul>\n
Ecstasy and PCP \u2013 Other Hallucinogen Use Disorder<\/p>\n
\n
Ecstasy<\/strong> = made from MDMA (methylenedioxymethamphetamine) *became illegal in 1985<\/li>\n
Contains compounds from hallucinogen and amphetamine families<\/li>\n
Popular on college campuses and in clubs<\/li>\n
Taken in pill form, often mixed with other substances making the effects vary dramatically \uf0b7 Molly<\/strong> = purer powder version of ecstasy<\/li>\n
Average age of first use is 20<\/li>\n
Affects release and reuptake of serotonin<\/li>\n
May have neurotoxic effects on serotonin system<\/li>\n
Enhances intimacy and insight, improves interpersonal relationships, elevates mood and selfconfidence, promotes aesthetic awareness<\/li>\n
Can cause muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills, sweating, anxiety, depression, depersonalization, confusion<\/li>\n
PCP<\/strong> (phencyclidine) = \u201cangel dust\u201d, phencyclidine use disorder o Causes serious negative reactions, severe paranoia, violence, coma and death o Affects multiple NTMs in the brain\n
\n
Likely to have used other drugs before or concurrently<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Etiology of Substance Use Disorders<\/h2>\n
\uf0b7 Positive attitude \uf0e0 Experimentation \uf0e0 Regular Use \uf0e0 Heavy Use \uf0e0 Dependence or Abuse<\/p>\n
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<\/p>\n
\n
2) Second group drank less in early adolescence, increased drinking in middle school & again in high school<\/li>\n
Developmental studies d not account for all cases o Not an inevitable progression through stages Genetic Factors<\/li>\n
High genetic component of alcohol use disorder (also true for smoking, marijuana and other drugs in general)<\/li>\n
Peers are particularly important environmental variables among adolescents<\/li>\n
Alcohol dehydrogenase<\/strong> = enzymes involved in alcohol metabolism *difficult to build tolerance if have inherited deficiency<\/li>\n<\/ul>\n
Mutations ADH2 and ADH3 genes linked with alcohol use disorders<\/p>\n
\n
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<\/li>\n<\/ul>\n
\uf0a7 One form of the gene related to lower likelihood of smoking, greater likelihood of quitting and greater sensitivity to smoking cues<\/p>\n
o CYP2A6 gene contributes to body\u2019s ability to metabolize nicotine *less likely to become dependent<\/p>\n
\uf0a7 Slower metabolism = stays in brain longer<\/p>\n
\n
Ability to tolerate large quantities of alcohol may be an inherited diathesis o Asians have lower rates of alcohol abuse<\/li>\n<\/ul>\n
o Deficient enzymes (ADH or alcohol dehydrogenase)<\/p>\n
Neurobiological Factors<\/p>\n
\n
Dopamine<\/strong> pathways in the brain are linked to pleasure and reward ***particularly mesolimbic pathway<\/strong> is affected o Possible deficiency in DA receptor DRD2<\/li>\n
Vulnerability model<\/strong> \u2013 do problems in the dopamine system increase vulnerability to substance dependence<\/li>\n
Toxic effect model <\/strong>\u2013 dopamine system problems are the consequence of substance dependence \uf0b7 Support for both models for cocaine use<\/li>\n
People take drugs to avoid bad feelings associated with withdrawal *explains frequency of relapse<\/li>\n
Insensitive-sensitization theory<\/strong> \u2013 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)\n
\n
Sensitivity to cues induces craving<\/li>\n
Overtime, liking decreases and wanting remains intense<\/li>\n<\/ul>\n<\/li>\n
More craving is associated with more usage, even when trying to quit<\/li>\n
Brain imaging studies show that cues for a drug activate the reward & pleasure areas of the brain involved in drug use<\/li>\n
Greater activation in basal ganglia, inferofrontal gyrus, and pre-motor areas = better at inhibiting a response when needed<\/li>\n
Self-reports of liking and wanting are important for predicting drinking behaviour \uf0b7 Short Term Over Long Term:\n
\n
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)<\/li>\n
Delay discounting \u2013 can compute extent to which people discount the value of larger, delayed rewards<\/li>\n
People on opiates, nicotine, cocaine and alcohol discount delayed rewards more steeply than others<\/li>\n
Valuing delayed rewards is associated with prefrontal cortex activation<\/li>\n
Valuing immediate rewards is associated with amygdala and nucleus accumbens activation Psychological Factors<\/li>\n<\/ul>\n<\/li>\n
Mood Alteration:<\/li>\n<\/ul>\n
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<\/p>\n
<\/p>\n
\uf0a7 Tension reduction \uf0e0 \u201calcohol myopia\u201d<\/p>\n
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<\/p>\n
o Alcohol and nicotine ay increase tension when no distractions are present (crying in one\u2019s beer)<\/p>\n
\n
Expectations About Effects:\n
\n
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<\/li>\n
The greater perceived risk of a drug, the less likely it is to be used \uf0b7 Personality Factors:<\/li>\n
High levels of negative affect \u2013 neuroticism<\/strong>\/negative emotionality<\/strong> \u2013 important in predicting later onset of substance use disorders<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
\uf0a7 Also predicts persistent desire for arousal along with increased positive affect o Constraint<\/strong> = cautious behaviour, harm avoidance, conservative moral standards o Low in constraint, high in negative emotionality = more likely to develop substance use disorder<\/p>\n
\n
Low agreeableness and conscientiousness, high disinhibition (low constraint) and moderate neuroticism<\/li>\n
Kindergarten children high in anxiety & novelty seeking more likely to get drunk, smoke & use drugs in adolescence \uf0b7 Sociocultural Factors:<\/li>\n
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<\/li>\n
High alcohol consumption often found in wine-drinking societies (France, Spain, Italy)<\/li>\n
Men consume more alcohol than women (differs by country) o Easy accessibility affects usage<\/li>\n<\/ul>\n
\uf0a7 2003 \u2013 drug use more common among youths who\u2019d been approached by drug dealer<\/p>\n
(35% compared to 7&)<\/p>\n
\n
Family factors: parental use, marriage conflict, lack of parental monitoring (drug), lack of emotional support from parents (cigarettes, marijuana, alcohol)<\/li>\n
Social Network:\n
\n
Having peers who drink influences drinking behaviours (social influence)<\/li>\n
Individuals also choose friends with drinking patterns similar to their own (social selection)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Treatment<\/strong><\/p>\n
\n
First step to successful treatment is admitting there is a problem<\/li>\n
Many treatment programs require individuals to begin by stopping use, which can exclude many individuals<\/li>\n<\/ul>\n
Treatment of Alcohol Use Disorder<\/p>\n
\n
Only 24% who are physiologically dependent on alcohol ever receive treatment \uf0b7 Impatient Hospital Treatment:<\/li>\n<\/ul>\n
Detoxification<\/strong> = 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<\/p>\n
\n
Outpatient treatment is more common \uf0b7 Alcoholics Anonymous (AA):<\/li>\n
Largest and most widely known self-help group<\/li>\n
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<\/li>\n
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<\/li>\n
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<\/strong> \u2013 focuses on promoting renewed self-reliance rather than reliance on a higher power<\/li>\n
High dropout rates<\/li>\n<\/ul>\n
\n
Couples Therapy:\n
\n
Reduction in problem drinking even a year after treatment has ended o Improve overall couple distress<\/li>\n
Combines skills from individual CBT with a focus on couple\u2019s relationship and dealing with alcohol-related stressors<\/li>\n<\/ul>\n<\/li>\n
Cognitive and Behavioural Treatments:\n
\n
Contingency management therapy<\/strong> = CBT for alcohol and drug use disorders that involves teaching people to reinforce behaviours inconsistent with drinking\n
\n
Based on belief that environmental contingencies can play a role in encouraging\/discouraging drinking<\/li>\n
Can exchange earned tokens for desirable objects<\/li>\n
Also includes teaching job0hunting and social skills, assertiveness training for refusing drinks<\/li>\n<\/ul>\n<\/li>\n
Relapse prevention \u2013 goal is to help people avoid relapsing once they have stopped substance use<\/li>\n<\/ul>\n<\/li>\n
Motivational Interventions:\n
\n
Tracking drinking behaviour as well as showing statistics on national averages\/education about effects of alcohol can reduce drinking behaviour \uf0b7 Moderation in Drinking:<\/li>\n
Controlled drinking<\/strong> & the guided self-change approach<\/strong> = 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 \uf0b7 Medications:<\/li>\n
Antabuse<\/strong> (disulfiram) = drug that discourages drinking by causing violent vomiting if alcohol is ingested<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
\uf0a7 Must be strongly committed to change o Opiate antagonist naltrexone<\/strong> \u2013 blocks activity of endorphins that are stimulated by alcohol, reducing the craving for it *additionally effective when combined with CBT<\/p>\n
\n
Acamprosate<\/strong> = impacts glutamate and GABA NTM systems, reduces cravings associated with withdrawal<\/li>\n<\/ul>\n
Treatments for Smoking<\/p>\n
\n
More likely to quit smoking of other people around you quit<\/li>\n
Peer pressure to quit seems to be equally as effective as it was to start<\/li>\n
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 \uf0b7 Psychological Treatments:\n
\n
Most common: being told to stop by a physician<\/li>\n
Scheduled smoking<\/strong> \u2013 get users to agree to increase the time in between cigarettes *limits on amount of cigarettes\/day, decrease each week<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
\uf0a7 Only smoke on schedule, not as a result of craving to smoke o Project EX<\/strong> = school based program, includes training in coping skills and Psychoeducational component about harmful effects<\/p>\n
\n
Nicotine Replacement Treatments and Medications:\n
\n
Goal of NRT<\/strong> = reducing a smoker\u2019s craving for nicotine by providing it in a different way (gum, patches, inhalers)<\/li>\n
Nicotine gum is absorbed much more slowly and steadily than that in tobacco \u2013 help smoker cut back and eliminate reliance\n
\n
If dose is too high, causes cardiovascular changes o Patches slowly release the drug into the bloodstream transdermally and then to the brain<\/li>\n
Only need 1 patch\/day, effective after about 8 weeks, use smaller patches as treatment progresses<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
o NRT more effective when combined with antidepressant use or psychological treatment<\/p>\n
Treatment of Drug Use Disorders<\/p>\n
\n
Detoxification<\/strong> = withdrawal from the drug itself, is central for treatment \uf0b7 Psychological Treatments:<\/li>\n<\/ul>\n
o CBT<\/strong> more effective than antidepressants for those with high degree of drug dependence<\/p>\n
\n
Learn how to avoid high-risk situations, recognize lure of the drug, and develop alternatives to drug usage<\/li>\n
Learn strategies to cope with the craving and resistance of use o Contingency management<\/strong> with vouchers (CBT with vouchers most likely to remain abstinent) o Motivational enhancement therapy <\/strong>\u2013 involves combination of CBT and helping clients generate solutions for alcohol and drug use disorders<\/li>\n<\/ul>\n
o Self-help residential homes<\/strong>:<\/p>\n
\n
Separation of people from previous social contacts (relationships helped maintain drug use disorder)<\/li>\n
Comprehensive environment, drugs are not available, support is offered<\/li>\n
Charismatic role models \u2013 formerly dependent on drugs, meet life\u2019s challenges without drugs<\/li>\n
Direct confrontation in group therapy, accept responsibility for problems, take charge of life<\/li>\n
Respectful setting, no stigmatization as failures\/criminals<\/li>\n
**High dropout rate o Proposition 36<\/strong> \u2013 Substance Abuse and Crime Prevention Act \u2013 allows nonviolent drug offenders to be sent to drug treatment rather than prison *voluntary \uf0b7 Drug Replacement Treatments and Medications:<\/li>\n<\/ul>\n
Heroin substitutes<\/strong> = drugs chemically similar to heroin that can replace the body\u2019s craving for it<\/p>\n
\n
Methadone \u2013 addicting on its own<\/li>\n
Synthetic narcotics are cross-dependent<\/strong> with heroin = by acting on the same CNS receptors, they become a substitute for the original dependency<\/li>\n
Less severe withdrawal reactions<\/li>\n
Side effects: insomnia, constipation, excessive sweating, diminished sexual functioning<\/li>\n
Stigma associated with going to methadone clinics o Opiate antagonists<\/strong> = drugs that prevent the use from experiencing the heroin high<\/li>\n
Naltrexone<\/li>\n
Gradually weaned from heroin, receiving increasing doses of naltrexone<\/li>\n
Molecules occupy receptors to which opiates usually bind, without stimulating them<\/li>\n
Requires frequent visits to a clinic (motivation required) o Buprenorphine \u2013 partial opiate agonist (less addictive than heroin), also contains naloxone (opiate antagonist)<\/li>\n
Less intense high<\/li>\n
Do not need to go to clinic to receive *prescribed<\/li>\n
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<\/li>\n
Body responds by developing antibodies<\/li>\n
Not all users develop enough antibodies to keep cocaine from reaching the brain o Methamphetamine Treatment Project \u2013 Matrix<\/strong> treatment \u2013 16 CBT group sessions, 12 family education sessions, 4 individual therapy sessions, 4 social support sessions<\/li>\n
Positive short-term results, long-term results were equally comparable to treatment as usual (TAU)<\/li>\n<\/ul>\n
Prevention<\/strong><\/p>\n
\n
Half of adult smokers began before age 15, nearly all before age 19<\/li>\n
Top priority to discourage youth<\/li>\n
Family interventions<\/li>\n
Statewide comprehensive tobacco control programs: increasing taxes on cigarettes, restricting advertising, conducting public education campaigns, creating smoke free environments \uf0b7 New health warnings including graphic images on packaging \uf0b7 School programs:<\/li>\n<\/ul>\n
o Peer-pressure resistance training *learn to say no o Correction of beliefs and expectations \u2013 believe it is more prevalent than it actually is o Inoculation against mass media messages \u2013 media makes smoking look positive<\/p>\n
\uf0a7 Truth campaign \u2013 aims to share health and social consequences of smoking o Peer leadership<\/p>\n","protected":false},"excerpt":{"rendered":"
Clinical Descriptions, Prevalence, and Effects of Substance Use Disorders DSM-5 Criteria: 1) Problematic pattern of use that impairs functioning \uf0b7 2) 2 or more symptoms within a 1 year… Continue Reading Substance Use Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4197"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4197"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4197\/revisions"}],"predecessor-version":[{"id":4902,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4197\/revisions\/4902"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4197"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}