PSYC 1st Edition Lecture 18Outline of Last Lecture I. Treatment of Sexual Dysfunctiona. Medical TreatmentsII. Paraphilia’s (Main Types)a. Fetishismb. Voyeurismc. Exhibitionismd. Transvestic fetishisme. Sexual sadism and masochismf. PedophiliaIII.Treatments for Paraphilia’sIV.What is Gender Identity?V. Perspectives on Substance-Related DisordersOutline of Current Lecture I. What is substance use?II. What is substance intoxication?III. What is substance abuse?IV. What is substance dependence?Current LectureSubstance-Related and Impulse-Control DisordersPerspectives on Substance-Related Disorders• The nature of substance-related disorders– Use and abuse of psychoactive substances– Wide-ranging physiological, psychological, and behavioral effects These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Associated with impairment and significant costs– Some important terms and distinctions– Substance use vs. substance intoxication– Substance abuse vs. substance dependence– Tolerance vs. withdrawalSubstance Use• Substance- chemical compounds ingested to alter mood or behavior• Substance use- ingestion of psychoactive substances in moderate amounts that does notsignificantly interfere with social, educational, or occupational functioning.Substance Intoxication• Substance Intoxication- A physiological reaction to ingested substances of getting high ordrunk• Intoxication depends on drug used, how much, and individual’s biological reaction.Substance AbuseABUSEDefined by how significantly it interferes with the user’s life:? disrupt job? disrupt classes? mess with relationships? Put person in dangerous situationdriving, risk-taking? Cause legal problemsABUSE IS NOT AMOUNT YOU DRINKSubstance DependenceDEPENDENCEparallel to addictionIncludes tolerance and withdrawal1. tolerance: require greater amounts ofthe drug to produce the same effect2. withdrawal: responds physically in a negative way when the substance is no longer ingested.On a continuum from headache when you don’t get your coffeeTowithdrawal delirium (dt’s)in which a person can experience hallucinations and body tremors on withdrawal from alcohol.Other withdrawal sx: nausea, chills, fever,vomiting, pain, aches.LSD and MJ have less withdrawalCocaine has anxiety and boredomDependenceSome see dependence as including behaviors like:constant drug-seekingdesperate to get morelikelihood that use will begin after abstinenceAddiction TableThe DSM criteria that are given to a substance to justify addiction.Includes chocolate and shopping; IndicatesDSM has more work to do to differentiate serious dependence from less debilitating habitsCan you use drugs without addiction?Yes, many people drink and some people use illegal drugs without dependence.We can’t predict who…..Also you can be dependent without abuse: Ca patient receiving high doses of morphine.Which are addictive?#1 is NicotineDSM-IV-TREach substance has subtypes:intoxicationabusedependencewithdrawalDistinctions help focus tx.About 75% have another psychiatric diagnosis.Which came first?Five Main Categories of Substances1. Depressants– Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)2. Stimulants– Increase alertness and elevate mood (e.g., cocaine, nicotine) 3. Opiates – Produce analgesia and euphoria (e.g., heroin, morphine, codeine)4. Hallucinogens – Alter sensory perception (e.g., marijuana, LSD)5. Other drugs of abuse– Include inhalants (airplane glue) anabolic steroids, medicationsThe Depressants: Alcohol Use Disorders • Psychological and physiological effects of alcohol– Central nervous system depressant• But initial effect seems like stimulation.– Feeling of well-being– Reduced inhibitions, become more outgoing• Inhibitory brain centers suppressed– Continued drinking depresses brain area that impede normal functioning• Motor coordination• Slurred speech• Slowed reaction time• confusionAlcohol• Alcohol ingested; passes through GI tract, absorbed in stomach and small intestine,distributed by circulatory system to every organ.Lungs vaporize it; The breathalyzer testPasses through liver, metabolized by enzymes– Influences several neurotransmitter systems – GABA (gamma-aminobutyric acid)• is particularly sensitive to alcohol and inhibits neuron-firing, making it more difficult for us to communicate with each other (despite our sense that we are being unusually great at it)– Glutamate system seems to be related to loss of memory during blackouts– Serotonin system affects mood, sleep, and eating behavior and is responsible for alcohol cravingsAlcohol withdrawal painful• After long term drinking, withdrawal:– Tremors– Nausea and vomiting– Anxiety– Transient hallucinations– Agitation– Insomnia– Withdrawal delirium at its worstLongterm use:organic damageOrgan damage depends on:genetic vulnerabilityfrequency of uselength of drinking bingesblood alcohol levels attained during bingesdid the body recover between binges?Consequences could include: pancreatitis, liver disease, cv disorders, and brain damage.• Other effects of chronic alcohol use– Seems not to be killing neurons permanently– Does affect memory – Two serious organic brain syndromes– Dementia Excessive alcohol toxicity causes general loss of intellectual abilities Wernicke’s diseaseThiamine deficiency causes confusion, loss of muscle coordination, and unintelligible speech. Heavy alcohol use interferes withy thiamine metabolism.Fetal Alcohol Syndrome:fetal growth slowscognitive deficitsbehavior problemslearning difficultiescharacteristic facialfeatures • In the United States– Most adults consider themselves light drinkers or abstainers– Over 50% of the U.S. (> 12 years age) report current use– Alcohol use is highest among Caucasian Americans– Males use and abuse alcohol more so than females– Violence is associated with alcohol• Alcohol alone does not cause aggression, but increases likelihood• Not an inevitable progression.Course to abuse more variable• Drinking at early age (11-14 years) predicts later alcohol use disorders• Common pattern of progression in chronically dependent usersSedative, Hypnotic, or Anxiolytic Substance use Disorders• Depressant category• The nature of drugs in this class– Sedatives – calming (e.g., barbiturates)– Hypnotic –