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Chapter Eleven

Chapter Eleven. SUBSTANCE USE DISORDERS. Substance Use Disorders. Definition of psychoactive substance Substance abuse and substance dependence definitions Course Epidemiology Etiology Treatment. Drugs of Abuse (Psychoactive Substance) .

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Chapter Eleven

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  1. Chapter Eleven SUBSTANCE USE DISORDERS

  2. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment

  3. Drugs of Abuse (Psychoactive Substance) • A chemical substance that alters mood, changes perception, or changes brain functioning • These substances can range from legal (Nicotine) to prescription (Valium) to illegal (LSD) drugs • It is not unusual for people with substance abuse to use more than one drug (polysubstance abuse)

  4. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment • Special topic: Is college drinking a phase?

  5. Substance Use Disorders • DSM-IV differentiates between two substance use disorders: • Substance dependence • Substance abuse

  6. Substance Abuse • A person’s ability to function becomes impaired • Harmful results appear, without signs of tolerance, withdrawal, or compulsive drug use (i.e., not meet criteria for dependence)

  7. DSM-IV Definition of Substance Abuse During a 12 month period, 1 or more of the following 4 criteria caused clinically significant impairment or distress: • Recurrent substance use: • Resulting in failure to fulfill role obligations • In situations in which it is hazardous • That result in substance-related legal problems • Despite continued social or occupational problems caused by the drug

  8. Substance Dependence • Repeated use of a drug that often results in tolerance, withdrawal, or compulsive drug taking behavior • Commonly called addiction

  9. Psychological Dependence • The urge to take a psychoactive substance for reasons such as alleviating negative moods, avoiding withdrawal symptoms, and preparing for public speaking or writing

  10. Physiological Dependence • Tolerance and withdrawal are seen as indicators of a physiological dependence on a psychoactive substance

  11. Tolerance • Through the ongoing use of any drug of abuse the nervous system becomes less sensitive to the physiological effects of that chemical over time For example: You now need to drink 4 beers to get the same ‘high’ you used to get from drinking 2 beers

  12. Withdrawal • Physiological symptoms a person experiences when drug use is stopped (specific symptoms depend on substance) • Withdrawal symptoms for nicotine include: drowsiness, muscle tremors and nausea • Withdrawal symptoms for alcohol in the most severe cases include: convulsions, hallucinations, and possibly alcohol withdrawal delirium

  13. DSM-IV Substance Dependence Criteria During a 12 month period, 3 or more of the following caused clinically significant impairment or distress: • Tolerance • Withdrawal • Substance taken in larger amounts or for longer periods of time than intended • Persistent desire or failed efforts to reduce drug use • Great deal of time spent trying to obtain, use, or recover from effects of the drug • Important social or occupational activities are given up or reduced because of drug use • Continuous substance use despite knowledge of consequences of drug use

  14. Substance Dependence vs. Substance Abuse • The level of impairment or distress caused by the use of psychoactive substances differentiates dependence from abuse • Substance dependence is the more severe disorder

  15. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment • Special topic: Is college drinking a phase?

  16. Course • For both dependence and abuse: the course as well as the age of onset vary from one person to the next • Alcoholism research indicates that individuals alternate between periods of heavy use and periods of relative abstinence • Lifetime prevalence rate of alcohol abuse or dependence is 14% • Young adults have highest prevalence rate for alcohol dependence

  17. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment • Special topic: Is college drinking a phase?

  18. Lifetime Prevalence: Drug Use and Dependence (NCS data) • Tobacco 75.6 24.1 31.9 • Alcohol 91.5 14.1 15.4 • Cannabis 46.3 04.2 09.1 • Cocaine 16.2 02.7 16.7 • Amphetamines 15.3 01.7 11.2 • Sedatives 12.7 01.2 09.2 • Hallucinogens 10.6 00.5 04.9 • Heroin 01.5 00.4 23.1 Proportion with Proportion with Dependence History of Use History of Among Users Dependence

  19. Substance Use Among College Students (Shinew, 2002) • 83% drink alcohol • 67% started in high school • 24% use drugs • Marijuana (98%) and ecstasy (28%) • 80% indicated drinking as a leisure activity

  20. Prevalence of Alcohol Dependence and Abuse • Gender differences • Men five times more likely to chronically abuse alcohol than women • Age differences • Rates higher among young adults (18-29) and lowest among elderly (65 and over)

  21. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment • Special topic: Is college drinking a phase?

  22. Etiology of Substance Abuse/Dependence Three generations of the Barrymore family

  23. Etiological Considerations • Not everyone who uses drugs will move to the level of abuse or dependence • The role of biological factors in substance addictions • Social and psychological factors play a role in substance use The etiological factors that will be presented for the rest of the lecture will be those that influence alcoholism

  24. Etiology: Genes • Males: MZ = 56% DZ = 33% • Females: MZ = 30% DZ = 17% • MZ concordances are higher than DZ concordances • Higher concordance rates in male twins reflect higher rates of alcoholism among men • Gender difference in alcoholism for MZ and DZ twins could be attributed to: • Women have lower physical tolerance • Negative social attitudes towards public intoxication (for women)

  25. Cloninger Adoption Study • Examined alcohol abuse in adoptees in Sweden (males born out of wedlock and adopted at an early age) • Collected data from official records of hospitals, insurance companies and national criminal register

  26. Cloninger’s System of Alcoholism • TYPE 1: • Biological parents had later onset (after age 25) of drinking problems with absence of criminal behavior • TYPE 2: • Biological parents had early onset (before age 25) of drinking problems, and had undergone treatment or presence of criminal behavior

  27. Comparison Groups • Type 1 and Type 2 children of alcoholic parents were adopted into two kinds of homes: • Heavy drinking • Absence of heavy drinking • Control group

  28. Rate of Alcoholism in Adult Children Adoptive Father

  29. Rate of Alcoholism in Adult Children (cont.) Adoptive Father

  30. Etiology: Social Factors • Culture or religion could influence how early someone is exposed to alcohol, as well as their attitudes toward drinking • Initial experimentation more likely among those who are rebellious, extraverted, and if parents or peers model/encourage use • Unpleasant emotional environment and low parental monitoring increase risk that children will affiliate with peers who use drugs

  31. Substance Use Disorders • Definition of psychoactive substance • Substance abuse and substance dependence definitions • Course • Epidemiology • Etiology • Treatment • Special topic: Is college drinking a phase?

  32. Treatment Considerations • Most people do not seek treatment in part because they refuse to acknowledge they have a problem • When treatment is initiated compliance is low and dropout rates are high • High comorbidity rate of alcoholism with other mental disorders makes treatment more challenging

  33. Treatment Goals • Abstinence versus moderation • Some treatment programs’ goal may be abstinence (e.g., AA), whereas the goal of others may be drinking in moderation • Scope of treatment • Should treatment address areas such as occupational, social, or medical problems

  34. Treatment Outcomes • Consistent findings across studies • Although improvement usually persists after treatment, relapse is not uncommon • Research evidence suggests that no one treatment is clearly superior to others. However, 12 step programs, such as AA, are usually more successful at achieving abstinence

  35. Treatment Outcomes • Improvements in general health, social, and occupational functioning usually accompany reduction in drug use • Positive long-term outcomes are most favorable for individuals who have a high degree of coping resources, available social support, and low stress situations

  36. Optional Slides

  37. Substance Dependence • Tolerance and withdrawal are not required for diagnosis • Not requiring tolerance or withdrawal for diagnosis broadens the number of people who may meet the criteria for substance dependence • Not all psychoactive substances result in withdrawal symptoms after drug has been stopped (e.g., cannabis, LSD typically do not lead to withdrawal symptoms)

  38. Diagnosing Substance Use Disorders • Although different drugs produce different physiological and psychological effects, the same criteria list is used to diagnose both substance dependence and substance abuse • What are the implications for diagnosing cannabis dependence (no withdrawal symptoms) and alcohol dependence, which does lead to withdrawal symptoms?

  39. City Men/College Men Study • Longitudinal study examined 456 inner-city adolescents from Boston and 268 former undergrads from Harvard • Begun in 1940 and followed both groups past the age of 60 • 35% of city men and 21% of college men met diagnosis for alcohol abuse at some point in their life • Men who abused alcohol died earlier than those who did not • Most alcoholic men went through repeated cycles of abstinence followed by relapse

  40. Current, Binge, and Heavy Alcohol Use Among Persons Aged 12 or Older, by Race/Ethnicity: 2003

  41. Etiology: Psychological Factors (Expectations) • Alcohol Expectancies • Alcohol enhances social and physical pleasure • Alcohol enhances sexual performance • Alcohol improves mood • Alcohol reduces tension • Alcohol increases social assertiveness

  42. Etiology: Psychological Factors (Expectations) • Positive expectations have stronger influence on increased drinking than negative expectations have on decreased drinking • Parents, peers, and media may influence adolescents’ expectations of alcohol • Adolescents who experiment with alcohol and have more positive expectations consume greater amounts of alcohol

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