Substance-Related Disorders

1. Substance-Related Disorders Madiha Anas Institute of Psychology Beaconhouse National University

2. To many people, the word drug has connotations of danger, yet most of us use some form of • Psychoactive drug • a drug that alters one’s psychological state. • Painkillers: Aspirin etc. • Substance • is a chemical that alters a person’s mood or behavior when it is smoked, injected, drunk, inhaled, snorted or swallowed in form of a pill. • Substance related disorders • are disorders of intoxication, dependence, abuse and substance withdrawal caused by various substances

3. Substance Abuse vs. Substance Dependence • SUBSTANCE DEPENDENCE • Tolerance • Withdrawal • Taken in larger amts or over longer periods of time than intended • Desire to cut down / Unsuccessful attempts • Great deal of time is spent obtaining • Activities are given up • SUBSTANCE ABUSE • Recurrent use resulting in failure to meet obligations • Recurrent use in hazardous situations • Recurrent use-related legal problems • Cont. use despite impact on social situation (e.g., family)

4. Substance Intoxication vs. Substance Withdrawal • Substance Intoxication: • temporary maladaptive experience of behavioral or psychological changes due to the accumulation of the substance in the body. • Substance Withdrawal: • A person in the state of substance withdrawal experiences significant distress or impairment at home, at work, or in other important life contexts.

5. Substance Tolerance • The dependent user desires the substance ("craving") and needs more of the substance to achieve the effect that a lesser amount of the substance induced in the past.

6. Main Categories of Substances • Depressants – • Result in behavioral sedation • (e.g., alcohol, sedative, anxiolytic drugs) • Stimulants – • Increase alertness and elevate mood • (e.g., cocaine, nicotine, caffeine) • Opiates – • Primarily produce analgesia and euphoria • (e.g., heroin, morphine) • Hallucinogens – • Alter sensory perception • (e.g., marijuana, LSD)

7. 1. Depressants Alcohol Sedatives Hypnotics Anxiolytics

8. Alcohol-related disorders • groups of disorders that can result in persons who are long-term users of alcohol. • can affect • metabolism, gastrointestinal tract, • nervous system, bone marrow (the matter in bones) • can cause endocrine (hormone) problems. • can result in nutritional deficiencies. • People with anxiety, depression, or bipolar disorder may consume alcohol for temporary relief from their symptoms.

9. Sedatives, Hypnotics, or Anxiolytics • The Nature of Drugs in This Class • Sedatives – Calming • Hypnotics – Sleep inducing (e.g., barbiturates) • Anxiolytics – anti-Anxiety(e.g benzodiazepines) • Effects of Such Drugs Are Similar to Large Doses of Alcohol

10. Sedatives • Sedatives are compounds that cause physiological and mental slowing of the body. • They have many legitimate medical uses. • However, people who use them improperly may develop symptoms of abuse, dependence, and withdrawal. • Sedatives are often referred to as tranquilizers • Other classes of compounds, produce effects and disorders similar to those of sedatives • sleep-promoting drugs (hypnotics) • anti-anxiety (anxiolytic) drugs

11. Sedatives • The most widely prescribed and best-studied sedatives belong to a group called benzodiazepines. • Prescription benzodiazepines and their relatives include • Alprazolam (Xanax) • Diazepam (Valium)

12. How Depressants work • These drugs work in the brain by increasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA). • Neurotransmitters help to regulate the speed at which nerve impulses travel. • When the amount of GABA increases, the speed of nerve transmissions decreases. • Thus these drugs depress the nervous system and cause reduced pain, sleepiness, reduced anxiety, and muscle relaxation.

13. 2. Stimulants Amphetamine Cocaine Nicotine Caffeine

14. Stimulants • Most widely consumed drug in the United States • Such drugs increase • Alertness • energy

15. Amphetamines • Effects of Amphetamines • Produce elation, vigor, reduce fatigue • Such effects are followed by a “crash” (e.g., feeling depressed and tired) • DSM-IV Criteria for Amphetamine Intoxication • Psychological symptoms • Physiological symptoms

16. Amphetamines • were initially produced for medical use, and were first used in nasal decongestants and bronchial inhalers. • Early in the 1900s, they were also used to treat several psychiatric conditions • attention-deficit disorders, • Obesity • depression. • They are still used to treat these disorders today. • some over-the-counter drugs used as appetite suppressants also have amphetamine-like action • Affects Dopamine in the mesolibmic system of brain which affects reward and desire

17. Case Example:Amphetamine • Catherine is a 23 years old salesperson who tried for three years to lose weight. Her physician prescribed amphetamines but cautioned her about the possibility that she might become dependent on them. She did begin to lose weight, but she also discovered that she liked the extra energy and good feelings caused by the diet pills. When Catherine returned to her doctor after having lost the desired weight, she asked him for a refill of her prescription to help her maintain her new figure. When he refused, Catherine asked around among her friends until she found the name of a physician who was willing to accommodate her wishes for ongoing refills of the prescription. Over the course of a year, Catherine has developed a number of psychological problems, including depression, paranoid thinking, and irritability. Despite the fact that she realizes that something is wrong, she feels driven to continue using the drug.

18. Cocaine • Effects of Cocaine • Produce short lived sensations of elation, vigor, reduce fatigue • Cocaine use in the United States has declined over the last decade • Cocaine is highly addictive, but addiction develops slowly

19. Cocaine • extracted from the coca plant, which grows in Central and South America. • Cocaine is dangerously addictive, and users of the drug experience a "high"— • a feeling of euphoria or intense happiness, along with hyper-vigilance, increased sensitivity, irritability or anger, impaired judgment, and anxiety. • a whitish crystalline powder : most common form • In powder form, it is most commonly inhaled or "snorted.“ • It may also be dissolved in water and injected. • Crack • form of cocaine that can be smoked • produces an immediate, more intense, and more short-lived high.

20. Nicotine • Effects of Nicotine • Stimulates the central nervous system • Results in sensations of relaxation, wellness, pleasure • Nicotine is highly addictive

21. Nicotine disorders • are caused by the main psychoactive ingredient in tobacco. • Nicotine is a physically and psychologically addictive drug. • most influential dependence producing drug worldwide • can be absorbed through the skin, the lining of the mouth and nose, and the moist tissues lining the lungs.

22. Caffeine • Effects of Caffeine – The “Gentle” Stimulant • Used by over 90% of Americans • Found in tea, coffee, cola drinks, and cocoa products • Small doses elevate mood and reduce fatigue • Regular use can result in tolerance and dependence

23. Caffeine • can be consumed from a number of different sources, including coffee, tea, caffeinated soda, weight loss aids. • Even half a cup of coffee can bring about slight improvements in the mood, alertness and clarity of thought. • If people know that caffeine has psychological effects then why they consume it regularly? • To avoid the unpleasant withdrawal symptoms i.e., headache, decreased arousal, fatigue, anxiety, nausea, muscle tension and irritability.

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25. Opiates/Opioids Heroin Opium Morphine

26. Opioids • The Nature of Opiates and Opiods • Opiate (natural) • Natural chemical in the opium poppy with narcotic effects (i.e., pain relief) • Opiods (synthetic) • Refers to a class of natural and synthetic substances with narcotic effects • Such drugs are often referred to as analgesics • Examples include heroin, opium, and morphine • Effects of Opiods • Low doses induce euphoria, drowsiness, and slowed breathing • High doses can result in death • Withdrawal symptoms can be lasting and severe

27. Opioiods: Pakistan Chapter • Opioids preparation in Pakistan include • madak (opium hookah) • inhalation of the fumes • or by injection

28. Heroin • Heroin, the most abused opioid, is synthesized from opium. • Heroin is usually injected, either intravenously (into a vein) or subcutaneously (under the skin), but can be smoked or used intranasally (i.e., "snorted"). • The immediate positive effects of heroin are twofold. • First is the rush lasting 5 to 15 minutes. • As one addict described it, “imagine that every cell in your body has a tongue and they are licking honey.” • The second effect is a simple state of satisfaction.

29. Opium • Comes from the poppy plant • sold on the street as a powder or dark brown solid and is smoked, eaten, or injected. • Initially used in medicines, very popular in the Islamic Empire (Ar-Razi), traveled to parts of Europe as a medicine of choice.

30. Morphine • Comes from Morpheus (Greek god of Dreams) • Also exists in nature as a natural endocrine product in humans and other animals. • acts directly on the CNS to relieve pain • is highly addictive when compared to other substances; • tolerance, physical and psychological dependences develop very rapidly.

31. Hallucinogens Cannabis: Marijuana and Hash LSD

32. Hallucinogens • Nature of Hallucinogens • Substances that change the way the user perceives the world • May produce delusions, paranoia, hallucinations, and altered sensory perception • can be found naturally in some plants, and can be synthesized in the laboratory. • Most are abused as recreational drugs. • also called psychedelic drugs.

33. Cannabis : Marijuana • Cannabinoids • substances that are derived from the cannabis plant. • When the upper leaves, tops and stems of the plant are cut, dried and rolled into cigarettes, the product is usually called marijuana. • Hashish is the dried stuff that seeps from the top and undersides of cannabis leaves. • In Pakistan • it is known as bhang or charas or hashish or ganja. • It is frequently used by young men although its use is becoming common in girls.

34. Marijuana • Marijuana • Active chemical is tetrahydrocannabinol (THC) • In the usual dosage, marijuana impairs short-term memory, concentration, judgment and perception. • Although it creates a sense of well-being, relaxation, mild sleepiness and euphoria, sometimes unpleasant sensory experience and hallucinations may occur • It causes psychological but no physical dependence. • The features are craving, fatigue, lethargy, restlessness, agitation, low mood insomnia, apathy, depression, etc.

35. LSD: lysergic acid diethylamide • LSD is most common form of hallucinogenic drug • Tolerance tends to be rapid, and withdrawal symptoms are uncommon • Psychotic delusional and hallucinatory symptoms can be problematic