3/2/15 1 Abnormal Psychology Psychology 2510 Julianne Ludlam, Ph.D. Upcoming Homework 2: due this Thursday, March 5 Exam 2: Tuesday, March 10 Substance Use Disorders l Substance Use Disorders 1. Defining Substance Disorders 2. Categories of Substances 3. Epidemiology 4. Etiology 5. Treatment Defining Substance Disorders l About 15% of U.S. population will meet criteria for a substance use disorder over the course of their lifetimes. l Costs U.S. more than $484 billion per year. l Contributes to 25% of all deaths in U.S. each year. Defining Substance Disorders l Substance: preferred term for psychoactive drugs and alcohol. l Psychoactive = brain-affecting l Caffeine, alcohol, nicotine, heroin, oxycontin, etc., etc., etc. l Legal or illegal (“licit” or illicit) Defining Substance Disorders l Why do people use drugs? “I use drugs to feel good and to stop feeling bad.” -- A heroin addict3/2/15 2 Defining Substance Disorders l Substance use: low to moderate use of a substance that does not impair functioning l Substance intoxication: acute effects of substance use; temporary Defining Substance Disorders l How do we know when substance use is a problem? l “Relationship Model” used in DSM: l Relationship between user and drug is complex l Is relationship adaptive or maladaptive? l Emphasis is on a pattern of use that causes impairment Defining Substance Disorders Can involve physiological dependence, defined by the presence of one or both of these physical symptoms: l Tolerance: Body’s adaptation to substance, as indicated by need for more to achieve same effect or by obtaining less effect with same amount l Withdrawal: Physical or psychological sxs if use is decreased or stopped. Categories of Substances l Depressants: slow or inhibit the CNS l Examples: l Alcohol l Sedative-hypnotics or sedative drugs l Opioids Categories of Substances l Stimulants: increase CNS activity l Examples: l Caffeine l Nicotine (also sedative) l Cocaine l Amphetamines3/2/15 3 Categories of Substances l Hallucinogens: produce altered states of perception and sensation, along with emotional and other experiences l Examples: l LSD l Psilocybin l Mescaline Categories of Substances l “Other”: substances that are not easily categorized and may have multiple effects. l Examples: l Marijuana l Inhalants l Steroids l PCP/Ketamine DSM-5 – Changes l “Behavioral Addictions” idea added l Gambling Disorder: persistent and recurring gambling behavior, leading to a range of life problems l Added to “Conditions for Further Study”: l Internet Use Gaming Disorder Epidemiology l Women (use associated with relationship issues and comorbidity with mental illness) l Men (more likely to be diagnosed with substance abuse disorders) l Influence of ethnicity and socioeconomic status l Education level (illicit use lowest among college graduates, 5.9%) Etiology Disease Model: Dominant approach to explaining and treating substance use disorders today l Argues that substance dependence is like other medical diseases l Has strengths and limitations Psychological Model: Views substance dependence as symptom of underlying problem Etiology l Theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence l No single explanation has gained broad support l Best explanation: a COMBINATION of factors l Will present most compelling ideas here 233/2/15 4 Etiology Sociocultural Factors: l Unemployment l Low SES l Family and environmental variables 24 Etiology Behavioral Factors: l Drugs are reinforcing (operant conditioning) l Drugs have conditioned cues (classical) Etiology Cognitive Factors: l Expectancy theory (Bandura) l Positive Outcome Expectancies: “This will make me feel great/better.” l Minimal Negative Expectancies: “Nothing will go wrong.” l Poor self-efficacy beliefs: “I can’t cope without it.” l Self-medication hypothesis Etiology Biological Factors: Genetic Factors: l Adoption and twin studies show high correlations of dependence among family members Reward System (“Pleasure Pathway”): l Almost all drugs affect the dopamine NT system in the ventral tegmental area and the nucleus accumbens. Links to many brain areas involved in addiction, including the prefrontal cortex. Other Factors Developmental Factors: l Drug involvement is progressive (use of licit drugs before using illicit drugs) l Possible impact on developing brain (Meier et al., 2012)3/2/15 5 Treatment l Substance abuse and dependence problems are very difficult to treat. l Intense, long-lasting approaches are usually preferred. Treatment Behavioral Therapies l Aversion therapy l Contingency Management: Program that involves reinforcements and punishments to shape behavior Treatment Cognitive-Behavioral Therapy l Relapse prevention l Motivational Interviewing l 5-stage model of behavioral change l Skills training Treatment Biological Therapies 1. Detoxification: medically supervised withdrawal. 2. Antagonist Treatments: Reduce cravings, make use less pleasurable or uncomfortable. (Naloxone for opioids; Antabuse for alcoholism). 3. Drug Maintenance (Agonist Substitution): Safer but similar substance provided in monitored setting (Methadone for heroin). Treatment Sociocultural Therapies l “Self-Help” Groups or 12-Step Approach l Alcoholics Anonymous, Narcotics Anonymous l Combines the principles of many theoretical approaches with a spiritual emphasis l Group format encourages sharing and sense of community l Prevention programs Long-Term Outcomes l About half of people who seek treatment for a substance-related disorder successfully control the problem. l Many people experience severe problems for much of their