criteria for diagnosing substance abuse

one or more of the following occurs during a 12 month period, leading to significant impairment or distress

1. failure to fulfill important obligations at work, home, school
2. repeated use of the substance in situations when it is physically hazardous to do so
3. repeated legal problems as a result of substance abuse
4. continued use of the substance despite social or legal problems

criteria for diagnosing substance dependence

Maladaptive pattern of substance abuse, leading to three or more of the following:

• tolerance
• withdrawal
• substance taken in larger amounts of over long period of time than was intended
• persistent desire/unsuccessful effort to cut back
• lots of time is spent obtaining substance
• important social, occupational or recreational activities given up because of substance
• use is continued despite knowledge of it's being bad

Depressants

slow down, calm, relaxed. Depresses functioning of central nervous system

opioids, alcohol, anxiolytics, narcotics, inhalants

alcohol intoxication

Behavioral changes (alcohol=disinhibitor): increased sexual/aggressive behavior, labile (fragile) mood, impaired judgment, impaired social/occupational functioning, problems with attention with memory

Physical changes: slurred speech, uncoordination, unsteady gait, Nystagmus (dancing eyes), stupor or coma

alcohol withdrawal

• very dangerous, should be done in a medical facility. at least two of the following, developing within several hours to a few days (body overcompensates for depressant

• • Step 1: Autonomic hyperactivity (sweating, high pulse), vomiting, etc.
    
  • Step 2: grand mal seizures
    
  • Step 3: DT-Delirium tremens
    • Increased hand tremor
    • Transient hallucinations
    • disorientation
    • 10% die
      

groups at risk for alcholism

• Caucasians, more likely to use/abuse (also African American men between 30 and 39)
• Native Americans
• Males (women with dependence are more likely to: drink later in life and after stressful events, have a spouse that drinks, drink at home alone or with close friend, drink smaller amounts and not in morning)

anxiolytics, or benzodiazepines/barbiturates

similar effect as alcohol

dangerous in overdose and mixed with other substances

inhalants

can cause permanent organ and brain damage and accidental death's due to dangerous delusional behavior

Cocaine/amphetamine intoxication

• Psychological: euphoria and/or blunt affect, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, impaired judgment, impaired social or occupational functioning, hallucinations/delusions (amphetamine psychosis-much like schizophrenia for short time)
• Physical: tachycardia or bradycardia (slow heart rate), papillary dilation, elevated or lowered blood pressure(mostly up), sweating, chills, nausea or vomiting, weight loss over time, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, cardiac arrythmias, confusion, seizures, dyskinesias (bizarre movements), coma

cocaine/amphetamine withdrawal

• Dysphoric mood
• At least 2, within a few hours to several days: fatigue, vivid unpleasant dreams, insomnia OR hypersomnia, increased appetite, psychomotor retardation OR agitation

nicotene intoxication

• Sometimes stimulates (increased heart rate and blood pressure), sometimes calms (reduces aggression in rats)
• Dependence: those who want to stop but can’t

nicotine withdrawal

• four or more, within 24 hours
  
  • • Depressed
    • Insomnia
    • Irritability/anger
    • Anxiety
    • Difficulty concentrating
    • Restlessness
    • Decreased heart rate
    • Increased appetite and heart rate (slows metabolism, but eating may also have to do with oral fixation)

nicotine, who smokes?

• • 25% of Americans smoke tobacco (prof says 95% ppl in hospital smoke)
    • More people who smoke become dependent than those who drink alcohol
    • Most common form of drug dependence in the US. Least destructive psychologically, (?)most destructive physically

opioids

  herioin, opium, methadone, morphine

opioid intoxication

• Psychological: euphoria, followed by apathy and dysphoria. Psychomotor agitation/retardation, impaired judgment, impaired social or occupational functioning, impairment in attention or memory
• Physical: pupil constriction, drowsiness/coma, slurred speech

opioid withdrawal

•  
  • Withdrawal: three of the following, developing within three days of cessation or antagonist therapy. Will NOT kill you
    • Dysphoric mood
    • Nausea or vomiting
    • Muscle aches
    • Lacrimation or rhinorrhea – nose, eyes running
    • Papillary dilation, piloerection (hair standing on end), sweating
    • Diarrhea
    • Yawning
    • Fever
    • insomnia

ecstacy

• • Classified as methamphetamine
  • No formal intoxication or withdrawal syndrome
  • Features of both methamphetamine and hallucinogens
    • Produces general feeling of happiness and well-being
    • May cause or trigger psychosis
    • Designer drug look-alikes

hallucinogen intoxication

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• intensification of perceptions, depersonalization, derealization, hallucinations/illusions, synesthesias (ex-taste a sound; feel a color; perceive things in different sensory modality)
• psychological: anxiety or depression, ideas of reference, fear of losing one’s mind, paranoid ideation, impaired judgment, impaired social or occupational functioning
• At least 2 of the following: pupillary dilation, tachycardia, sweating, palpilations, blurring of vision, tremors, uncoordination (often they are mixed with amphetamines that are mixed in, may be reason for many of symptoms)

Hallucinogen Persisting Perceptual Disorder

• Flashbacks: reexperiencing perceptual symptoms experienced during intoxication
• Cause significant distress or impairment

cannibus intoxication

• Psychological: impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal
• Physical (at least 2): conjuctival injection (red eyes), increased appetite, dry mouth, tachycardia

PCP

similar to hallucinogens

depersonalization, feelings of unreality, involuntary movements

club drugs

LSD, ecstacy, amphetamine, GHB, ketamine, rohypnol

biological theories of substance abuse

• psychoactive substances have powerful effects on parts of the brain that register reward and pleasure. repeated use of a substance may sensitize the system, leading to more craving.
• genetics - behavioral undercontrol

behavioral theories of alcoholism

people are reinforced or punished by other people for their alcohol-related behaviors and model alcohol-related behaviors from parents and important others

treating substance-related disorders

• step 1: detox. may involve antidepressants or antagonist drugs.
• step 2: psychotherapy: behavior therapies, social learning, AA (might be better suited for men), prevention programs

relapse prevention

                                                              i.      Cognitive-behavioral model

                                                            ii.      Identify high-risk situations

                                                          iii.      Increase coping skills

                                                          iv.      Fight abstinence violation effect-idea that person will slip and have a drink, then give up because they feel like failures

alcohol-induced persisting amnestic disorder

a permanent cognitive disorder caused by damage to the central nervous system, consisting of two syndomes:

1. Wernicke's encephalopathy: mental confusion, disorientatin, severe cases: coma
2. Korsakoff's Psychosis: loss of memory for recent events and problems in recalling distant events

*Alcohol-induced dementia: loss of intelectual abilities, memory, abstract thinking..accompanied by personality changes such as paranoia. approx 9% alcohol abusers

benzodiazepines

xanax, valium, halcion, librium, klonopin

barbiturates

Quaalude

amphetamines

Dexedrine, Benzedrine

harm reduction model

focus on the psychological and sociocultural factors that led to substance abuse, and on helping people gain control of their use of stubatsnace through behavioral and cognitive interventions

does NOT presume people should avoid use of all substances

antagonist drugs

block or change the effects of the addictive drug, reducing the desire for the drug

opioid antagonists: neltrexone, naloxone (also works for alcohol)

alcohol: disulfiram (Carrol Mc)

aversive classical conditioning

take antagonist drugs, then you learn to not like the substance, and you stop taking it

weakens with time - need for "booster" sessions

covert sensitization therapy

use imagery to create bad associations with alcohol

cue exposure and response prevention

forced to smell alcohol in controlled environment but not allowed to take a sip...eventually learn to not do it

this is coupled with learning how to avoid dangerous situations

absinence violation effect

2 steps:

guilty over the drink

blames drinking on lack of self-control and helplessness