Abnormal Psychology Chapter 9: Substance Use Disorders
Terms in this set (37)
A chemical that alters mental ability, mood, or behavior; commonly called drugs
- Frequent use can develop into a substance use disorder
substance use disorders
Psychological disorders that are characterized by loss of control over urges to use a psychoactive substance, even though such use may impair functioning or cause distress
- Psychoactive substance is taken repeatedly either because of its effect on mood, behavior, or cognition or because it prevents uncomfortable symptoms if the person stops taking the drug
The REVERSIBLE dysfunctional effects on thoughts, feelings, and behavior that arise from the use of a psychoactive substance
- Specific effects depend on substance and whether a person uses it occasionally or chronically; effects attributable to recent ingestion or exposure
- Clinically significant problematic behavioral or psychological changes attributable to effect of substance on central nervous system, and develop during, or shortly after, use of substance. Signs and symptoms are not attributable to another medical condition and are not better explained by another disorder, including substance intoxication with another substance
- Contrasted with substance use which indicates simply that a person has used a substance. Does not indicate the extent or effect of the exposure to the substance
- Intoxication refers to DIRECT effects of using a substance
A general term that indicates simply that a person has used a substance. Does not indicate the extent or effect of the exposure to the substance
Similarity between definition of addiction and DSM-5 definition of substance use disorder
Focus on behaviors related to obtaining and using a drug, as well as the consequences of that use.
- Unlike intoxication (refers to direct results of using a substance), criteria of a substance use disorder focuses both on indirect effects of repeated use (such as unmet obligations or risky behavior while using substances) and the cravings and biological changes that can occur with repeated use or stopping use
The compulsion to seek and then use a psychoactive substance either for its pleasurable effects or, with continued use, for relief from negative emotions such as anxiety or sadness. These compulsive behaviors persist, despite negative consequences
- Some mental health clinicians and researchers have avoided using the term because of its negative moral connections. Addiction also overused. However, other clinicians are in favor of using it.
Strong desire or urge to use the substance
The biological response that arises from repeated use of a substance such that more of it is required to obtain the same effect
- Neurologically based symptom of substance use disorder that can contribute to diagnosis
- With regular use of alcohol and some drugs, the body adapts and tries to compensate for the repeated influx of the substance
- People given certain medications for medical problem, such as some pain relievers, may develop tolerance even when taking the medications as prescribed; in such cases, tolerance NOT considered symptom of substance use disorder
The set of symptoms that arises when a regular substance user decreases or stops intake of an abused substance
- Neurologically based symptom of substance use disorder that can contribute to diagnosis
- Arises because body has compensated for the repeated influx of a drug, and the neurological compensatory mechanisms are still in place when the person stops taking the drug, but the drug is no longer there to compensate for them
- Can make it difficult for habitual users of some substances to cut back or stop use. As they cut back, they may experience uncomfortable or even life-threatening symptoms that are temporarily alleviated by resuming use of substance. In most cases, substances that can lead to tolerance with regular use are also likely to produce withdrawal symptoms if stopped or taken at lower doses.
- People taking certain medications for medical problem may experience withdrawal symptoms if medication is stopped or dosage lowered; in such cases, withdrawal NOT considered a symptom of substance use disorder
Is substance use disorder a category or a continuum?
- DSM-5 uses categorical decision; habitual drug user either is or is not diagnosed with substance use disorder
- Research suggests more meaningful way to conceptualize harmful substance use, at least of alcohol, is a continuum of severity. Substance use disorder anchors on one end of continuum, and unproblematic substance use anchors the other end. Continuum can be defined by frequency, quantity, and duration of use, as well as effects of use on daily functioning. More frequent use, larger quantity, or longer the use has been going on, more likely the use is to become substance use disorder.
3 Ways Substance Use Disorders Can Be Developed
1) Substance use disorders can arise unintentionally, as can occur through environmental exposure (ex: gasoline at the gas station)
2)Substance use disorders can develop when the psychoactive element is a side effect, and the substance is taken for medicinal reasons unrelated to psychoactive effect
3) Substance use disorders can develop as result of intentional use of a substance for its psychoactive effect. May know the risks of using substance but nonetheless underestimate his or her own level of risk.
common liabilities model
The model that explains how neurological, psychological, and social factors make a person vulnerable to a variety of problematic behaviors, including substance use disorders; also called problem behavior theory
- One of two models that explains how substance use disorders can develop as result of intentional use of a substance for its psychoactive effect; slide from use to disorder
- Developed in response to results from study following students from grades 7-9 into adulthood. Found that adolescents who exhibited "problem behaviors," such as drug and alcohol use, early sexual intercourse, and delinquent behaviors (such as stealing and gambling) were likely later in life to develop substance use disorder. Proposed that these various problem behaviors at different ages may stem from same underlying factors, called common liabilities.
- One particularly important common liability is a problem with impulsivity, especially with difficulty restraining urges to engage in potentially harmful behaviors, which also underlies a variety of other disorders that involve compulsive behaviors, such as gambling.
The proposal that use can become a use disorder when "entry" drugs, such as cigarettes and alcohol, serve as a gateway to (or the first stage in a progression to) use of "harder" drugs, such as cocaine, or illegal use of prescription medication
- Teens are unlikely to experiment with marijuana unless they first experimented with legal-but restricted-substances such as alcohol
- Adolescents and young adults don't generally try other illegal substances without having tried marijuana
- Stage theory/progression-people who develop a substance use disorder often passed through particular progression of stages of drug use: initiation, experimentation, casual use, regular use, and then substance use disorder. Not everybody progresses to the end of sequence, and gateway hypothesis is NOT a blueprint for all users; rather, it is a way to understand how people who use substances can end up having a substance use disorder
Comorbidity with Substance Use Disorder
- Many people with psychological disorders abuse substance, developing one or more symptoms of a substance use disorder--particularly alcohol, marijuana, cocaine, and opiates
- Common comorbid disorders include mood disorders (most frequently depression), posttraumatic stress disorder (PTSD), schizophrenia, and attention-deficit/hyperactivity disorder (ADHD) a disorder marked by problems sustaining attention or by physical hyperactivity
- People who have a non-substance-related psychological disorder have a greater risk of substance use turning into a use disorder. When substance use disorder develops after another psychological disorder has developed, clinicians may infer that the person is using substances in an attempt to alleviate symptoms of the other disorder--to self-medicate.
- Almost half of the people with alcohol use disorder (name for substance use disorder when substance is alcohol) also had another psychological disorder, and almost 3/4 of those with a different type of substance use disorder had another psychological disorder
A behavior pattern of abusing more than one substance
- Dangerous because of the ways that drugs can interact: One lethal combination occurs when someone takes a drug that slows down breath, such as barbiturates (which are often used as sleeping pills), along with alcohol.
- Combination of alcohol and cigarettes (nicotine) seldom recognized. Cigarettes are the biggest killer of all drugs, and this is particularly true among alcoholics. Most alcoholic more likely to die from nicotine-related medical consequences, such as cardiovascular disease, than from alcohol-related ones.
Prevalence and Costs of Substance Use Disorders
- Various types of substance use disorders among the most common psychological disorders
- Generally, men are more likely than women to be diagnosed with a substance use disorder, although women are more likely to be diagnosed with a substance use disorder related to legally obtained prescription medications
- Prevalence of drug use and substance use disorders varies across ethnic and racial groups in the US, however, significant variations occur WITHIN each broad ethnic or racial category (ex: Cuban Americans 1-month prevalence rate of heavy drinking is 1.7% but for Mexican Americans it is 7.4%). Prevalence rates for racial and ethnic groups provide only a GENERAL overview, and they do so ONLY at a particular moment in time
- Affects not only the user but also family members and friends, coworkers, and colleagues. Associated with violence toward family members and neglect of children. Parents who abuse substances may feel guilty and ashamed about substance abuse, which ironically may lead them to increase substance use to cope with feelings. Children of parents who abuse substances may find themselves shouldering adult tasks and responsibilities; are at increased risk of developing emotional and behavioral problems
Culture and Context of Drug Use and Abuse
- Line between use and abuse shifts over time and across cultures and ethnic groups. (ex: cocaine used legally as remedy for many ills in second half of 19th century, but now illegal for decades)
- Various cultures use psychoactive substances for different purposes (ex: some Native American tribes use peyote or psilocybin mushrooms, which when eaten, produce vivid hallucinations, as part of sacred rituals. Such cultural use strongly regulated and there are penalties for abusing those substances, including being put to death)
Substances that stimulate the central nervous system, causing increased activity and arousal
- Include restricted-nicotine and amphetamines as well as illegal substances-cocaine, crack, and MDMA (Ecstasy, or "e")
- At low doses, can make user feel alert, less hungry, and more energetic, mentally and physically
- Coffee, tea, and cigarettes are all legal stimulants. Illegal are cocaine and crack. Some drugs have both legal and illegal uses- amphetamines, methamphetamines, Ritalin, and MDMA
Stimulant derived from the coca plant and acts as a local anesthetic.
- Was once a popular medicine for various ailments in 18th century Europe and North America, but use declared illegal at the beginning of the 20th century, after it became clear that the drug was being abused and leading to tolerance and withdrawal
- When obtained in form of powder, it is typically inhaled, or "snorted". When snorted, leaves user's nose feeling numb due to anesthetic properties. Repeated snorting can lead to diminished sense of smell and difficulty swallowing
- When obtained as crack, which is a crystalline form, it is smoked
- First few experiences may provide a heightened sense of well-being that can last for up to an hour, but this positive state becomes increasingly harder to attain as tolerance develops
- Leads to a sense of well-being, energy, and mental clarity.
Higher Doses of Cocaine
Bring about many negative effects:
- Paranoia to the point of delusions
- Hallucinations, such as feeling insects crawling on body when there are none. Hallucinations occur because cocaine causes sensory neurons to fire spontaneously
- Compulsive, repetitive behaviors such as teeth grinding
- Increased heart rate and blood pressure, with the accompanying risk of heart attack and sudden death
- Loss of appetite, so people who have cocaine use disorder may develop malnutrition
- Often also have alcohol use disorder. When these two substances are used at the same time, risk of sudden death increases
- Acts more quickly than snorted cocaine and has more intense effects
- Like snorting cocaine, leads to a sense of well-being, energy, and mental clarity, BUT this "high" usually lasts only minutes.
- As with other stimulants, when high from crack is over, it leaves in its wake a sense of depression and craving for more of the drug. These aftereffects may lead user to take more of the drug and may lead to tolerance or withdrawal. Whereas tolerance of or withdrawal from cocaine may take months or even years of use to develop, such symptoms can develop extremely rapidly when people take crack--within weeks.
A type of stimulant that typically produces the same effects as does cocaine (sense of well-being, energy, and mental clarity), BUT effects last longer
- Benzedrine, Dexedrine, Adderall
- Usually available as pills, which typically are swallowed, although contents of the pill may be snorted or diluted and injected.
- Legally used to treat some disorders, particularly ADHD and narcolepsy (sleep disorder in which sufferer spontaneously falls asleep for brief periods of time
Repeated use of amphetamines
- May become hostile toward others, develop sense of grandiosity, or exhibit disorganized thinking or behavior
- Tolerance develops, so repeat users may take high doses, which can cause amphetamine psychosis
- Amphetamine use disorder can have IRREVERSIBLE effects, including problems with memory and physical coordination that arise from enduring changes in neurons and REVERSIBLE effects of irritability and violent behavior.
- Withdrawal symptoms may include depression, fatigue, anxiety, and irritability
A condition characterized by paranoid delusions and hallucinations (symptoms similar to those of paranoid schizophrenia) as a result of taking high doses due to tolerance
A stimulant that is related to amphetamines, but has a greater and longer-lasting effect on the central nervous system
- "Meth" or "speed"
- Can be inhaled, swallowed, smoked, or injected. In all cases, leads to intense "rush" of pleasure
- Use RAPIDLY becomes use disorder
- Can cause irritability, heart problems, hallucination and paranoia at high doses
- Use can adversely affect functioning of neurotransmitters dopamine and serotonin, which leads to motor problems, impaired memory, and emotional dysregulation. Increased blood pressure that results from taking drug can cause strokes
-Some, BUT NOT ALL, of the brain damage inflicted by methamphetamine abuse is reversible with long-term abstinence
Ritalin (methylphenidate hydrochloride)
A stimulant that is frequently prescribed for ADHD
- Neurological effect is similar to, but slower than, that of cocaine; heightened alertness, increased attention, and decreased appetite
- People who abuse it take it in any of 3 ways: 1) swallowing pills, which does not usually lead to use disorder; 2) inhaling or snorting crushed pill, which leads to a quicker "high" and causes lung problems; or 3) injecting the drug in liquid form, which produces an effect similar to that of cocaine
- Both inhaling and injecting can lead to use disorder.
- People who do not have ADHD may occasionally swallow Ritalin pills for stimulant effects (heightened alertness, increased attention, and decreased appetite). This does not meet criteria for use disorder, but still carries risk of adverse medical side effects, including heart problems and stroke.
Stimulant that is chemically similar to both methamphetamine and to the hallucinogen mescaline and has effects of both types of drugs: stimulant effect of increased energy and the hallucinogenic effect of distorted perceptions
- Methylenedioxymethamphetamine or "e"
- Usually taken in tablet form
- When first using it, people report heightened feelings of well-being, empathy, and warmth toward others, and greater sensitivity to touch. This experience is less pervasive with subsequent use.
- Also experience reduced anxiety and distorted time perception
- Abuse can result in poor mood and difficulty regulating emotions, as well as anxiety and aggression, sleep problems, and decreased appetite. Can develop impaired cognitive functioning, especially problems with memory, after drug wears off. Cognitive deficits more severe when drug is abused.
- Frequent users may experience tolerance and withdrawal symptoms. Often report withdrawal symptoms including poor concentration, depression, decreased appetite, and fatigue
- Side effects similar to other stimulants: increased blood pressure and heart rate. Excessive sweating, another side effect, can cause acute dehydration and hyperthermia (abnormally high body temperature). Effects may be difficult to predict in part because tablets often contain other drugs, such as ketamine, cocaine, or other stimulants.
dopamine reward system
The system of neurons, primarily in the nucleus accumbens and ventral tegmental area, that relies on dopamine and gives rise to pleasant feelings
The desire for the gratifying effects of using a substance
The desire for the temporary emotional relief that can arise from using a substance
The stimuli associated with drug use that come to elicit conditioned responses through their repeated pairings with use of the drug
delirium tremens (DTs)
The symptoms of alcohol withdrawal that include uncontrollable shaking, confusion, convulsions, visual hallucinations, and fever
Medically supervised discontinuation of substances for those with substance use disorders; also referred to as detox
A medication for treating alcohol use disorder that induces violent nausea and vomiting when it is mixed with alcohol
stages of change
A series of five stages that characterizes how ready a person is to change problematic behaviors: precontemplation, contemplation, preparation, action, and maintenance
motivational enhancement therapy
A form of treatment specifically designed to boost a patient's motivation to decrease or stop substance use by highlighting discrepancies between stated personal goals related to substance use and current behavior; also referred to as motivational interviewing
A treatment that involves an entire family or some portion of a family