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From Last Class

Substance Use Disorders IV (Chapter 11) April 9 , 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. From Last Class. Disease model of alcoholism Twelve step treatment. Twelve Steps of Alcoholics Anonymous. Twelve Step treatment critical analysis:

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From Last Class

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  1. Substance Use Disorders IV(Chapter 11)April 9, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

  2. From Last Class • Disease model of alcoholism • Twelve step treatment

  3. Twelve Steps of Alcoholics Anonymous • Twelve Step treatment critical analysis: • http://www.youtube.com/watch?v=8tPNgHrIkgo • http://www.youtube.com/watch?v=5uwx2P5LJgk&feature=related • http://www.youtube.com/watch?v=7PjpOsE3xoY

  4. Exam Review • Chapter 7 (Mood Disorders) • Major depressive and manic episodes • Nature, causes, and treatment of: • Major depressive disorder • Bipolar disorder • Suicide • 15 questions from this section

  5. Exam Review • Chapter 8 (Eating Disorders) • No questions on Sleep Disorders • Anorexia • Bulimia • Causes • Treatment • 9 questions form this section

  6. Exam Review • Chapter 11 (Substance-Related Disorders) • No questions on 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 • 16 questions from this section

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

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

  13. 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

  14. Stimulants: Amphetamines • Used for all-nighters, weight control, and high • Effects: • Elation, vigor, reduce fatigue • Followed by extreme fatigue and depression • Prescription stimulants (for ADHD) increasing becoming drugs of abuse • The NY Times: When Stimulants Are Bad https://www.madinamerica.com/2012/06/the-ny-times-when-stimulants-are-bad/

  15. 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

  16. 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

  17. 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

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

  19. Hallucinogens: Marijuana • Active chemical is tetrahydrocannabinol (THC) • Effects: • Heightened sensory experiences, mood swings, paranoia, hallucinations • Varies greatly from person to person • Minimal tolerance, withdrawal, dependence • Medicinal uses and controversies

  20. Hallucinogens: LSD • Derivative of ergot fungus • Effects: • Perceptual changes, depersonalization, hallucinations • Very rapid tolerance • Withdrawal symptoms are rare • Can produce psychotic reactions • Interesting historical note: LSD and the Salem Witch Trials of 1692

  21. 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

  22. Other Drugs of Abuse: Steroids "I did take a banned substance. And for that, I am very sorry and deeply regretful.“ -Alex Rodriguez

  23. 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

  24. 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

  25. 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

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

  27. 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

  28. 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

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

  30. American Culture and Drug Use • Assumptions of America’s “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

  31. 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

  32. 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?

  33. 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

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

  35. Psychosocial Treatment • Inpatient vs. outpatient care • Comparable efficacy, not cost • Controlled use (Sobell study) • Project MATCH • Compared 12 sessions of twelve step facilitation and CBT, and 4 sessions of motivational enhancement • No differences in outcome • No control group

  36. 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.”

  37. 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

  38. 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 person’s choice and the consequences are negative.”

  39. 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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