Chapter 10 Notes Abnormal Psychology 10 1 Perspectives on Substance Related Disorders 8 percent of the general population is believed to use illegal drugs Catholic Church 1992 drugs and drinking sins universal catechism Polysubstance us the use of multiple mind and behavior altering substances such as drugs 10 1a Levels of Involvement Substance chemical compounds that are ingested to alter mood or behavior Psychoactive substances substances such as a drug that alter mood or behavior Substance Use the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social educational or occupational functioning Substance Intoxication A physiological reaction such as impaired judgment and motor ability as well as mood change resulting from the ingestion of a psychoactive substance Substance Abuse a pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles and in hazardous situations DSM IV defines substance abuse in terms of how significantly it interferes with the user s life Substance dependence addiction a maladaptive pattern of substance characterized by the need for increased amounts to achieve the desired effect negative physical effects when the substance is withdrawn unsuccessful efforts to control its use and substantial effort expended to seek it or recover its effects Also known as addiction Tolerance the need for increased amounts of substance to achieve the desired effect and a diminished effect with continued use of the same amount Withdrawal a severely negative physiological reaction to removal of a psychoactive substance which can be alleviated by the same or a similar substance You don t go through severe physical withdrawal when you stop taking LSD Drug Seeking Behaviors measure of dependence The repeated use of a drug and a desperate need to ingest more of the substance stealing money to buy drugs etc and the likelihood that use will resume after a period of abstinence are behaviors that define the extent of drug dependence Dependence definition is work in progress Many people can be considered dependent on activities such as sex work etc dependence can be present without abuse e g cancer patients who take morphine for pain may become dependent on the drug build up a tolerance and go through withdrawal if it is stopped without abusing it The most addictive drugs Nicotine Methamphetamine Crack Cocaine 10 1b Diagnostic Issues Early additions of DSM alcoholism and drug abuse not separate disorders called sociopathic personality disturbances Since 1980 they have been acknowledged as separate problems Substance related disorders several subtypes of diagnoses for each substance including dependence abuse intoxication withdrawal or a combo of those 3 quarters of people in addiction treatment centers have an additional psychiatric disorder with mood disorders e g major depression observed in more than 40 percent and anxiety disorders and PTSD in more than 25 of cases If symptoms seen in schizophrenia or in extreme states of anxiety appear during intoxication or within 6 weeks after withdrawal from drugs they are not considered signs of a separate psychiatric disorder Individuals who are severely depressed before they used stimulants and those whose symptoms persist more than 6 weeks after they stop might have a separate disorder Depressants a psychoactive substance that results in behavioral sedation such substances include alcohol and the sedative hypnotic and anxiolytic drugs Stimulants a psychoactive substance that elevates mood activity and alertness such substances include amphetamines caffeine cocaine and nicotine Opiates an addictive psychoactive substance such as heroin opium or morphine that causetemporary euphoria and analgesia pain reduction Hallucinogens any psychoactive substance such as LSD or marijuana that can produce delusions hallucinations paranoia and altered sensory perception Other Drugs of Abuse Other substances that are abused but don t fit into the categories above inhalants anabolic steroids and other over the counter and prescription medications e g nitrous oxide 10 2 Depressants Decrease central nervous system activity and reduce levels of physiological arousal to help us relax Alcohol sedative hypnotic and anxiolytic drugs insomnia meds Among the most likely to produce symptoms of physical dependence tolerance and withdrawal Alcohol Use Disorders A cognitive biological behavioral and social problem associated with alcohol use and abuse Alcohol is a depressant but its initial effect is an apparent stimulation Motor coordination is impaired reaction time slowed and vision hearing can be negatively effected Clinical Description Effects 1 After alcohol is ingested it passes through the esophagus and into the stomach 2 where small amounts are absorbed most of it travels to the small intestine 3 easily absorbed into the bloodstream the circulatory system distributes the alcohol throughout the body where it contacts every major organ including the heart 4 Some of the alcohol goes to the lungs where it vaporizes and is exhaled a phenomenon that is the basis for a breathalyzer test 5 As Alcohol passes through the liver It is broken down or metabolized into carbon dioxide and water by enzymes Alcohol influences neuro depressant A psychoactive substance that results in behavioral sedation GABA gammaaminobutyric System is particularly sensitive to alcohol it is an inhibitory neurotransmitter major role is to intefere with the firing o the neuron it attaches to Alcohol reinforces the movement of chloride ions Glutamate system excitatory helping neurons fire Involves learning and memory may be the avenue through which alcohol affects our cognitive abilities Serotonin system also sensitive to alcohol which affects mood sleep and eating behavior and thought to be responsible for cravings Withdrawal Delirium or delirium tremens the DTs the frightening hallucinations and body tremors that result when a heavy drinker withdraws from alcohol Whether alcohol will cause organic damage depends on 1 genetic vulnerability 2 frequency of use 3 length of drinking binges 4 blood alcohol levels attained during drinking periods 5 whether the body is given time to recover between binges Consequences of long term excessive drinking liver disease pancreatitis cardiovascular disorders and brain damage Organic Brain Syndromes resulting from long term alcohol use 1 Dementia general