Substance Disorders

Psychoactive = alters behavior/mood

• Use

= ingesting psychoactive substances in moderate amounts

- no life impairment

- not a disorder

• Intoxication

= physiological reaction to ingesting excess substance

• Abuse

= recurrent & maladaptive pattern of use (life impairment/distress)

• Dependence/addiction

a) Physical

- tolerance = increasingly greater amounts of drug needed for same desired effect

- withdrawal = severe negative physiological reaction to removal of substance, alleviated by the substance

b) Psychological addiction

- drug-seeking behaviors

Types of Psychoactive Substances

• Depressants

= decrease CNS activity

- often physical dependence

- death by decreased vital organ functioning& by withdrawal

• Opioids = narcotics

(reduce pain & induce sleep)

- death by decreased respiration

- very unpleasant withdrawal

but not life-threatening

• Stimulants

= increase CNS activity

- most common

• Hallucinogenics/Psychodelics

= change perception

- no evidence of withdrawal

- psychological dependence

- quick tolerance to most

- reverse tolerance to marijuana

Alcoholism

• 10-14% U.S. adults (dependence or abuse)

• 1983 cost of alcoholism = $117 billion

• 1/3 medical problems/inpatient care

• 50-80% traffic injuries & deaths

History

• 17th c. US - heavy drinking commonplace

• 18th & 19th c. - Change in view of alcohol

“Demon Rum”

Levine’s socioeconomic theory

• Colonials thought behavior shaped by church (external locus of control)

• Less blame for person

• Industrialism => rise of individual(internal locus of control)

• Alcoholism = loss of self-control

Gusfield

• Colonial Am. = rich elite & poor masses

• Industrialization = middle class & “empowering of mass”

• Temperance movement = keep elite in control

• Alcohol is evil

• Today: more moderate

• Alcohol seen as direct cause of deviantbehavior

Models of Alcoholism

I. Alcoholism as a Disease

A. Rush, M.D. – 18th c.

alcoholism as disease & moral problem

• Alcohol causes drunkenness (external LOC)

• Alcoholism is a disease

• Result = lose control of behavior

- not from person’s immorality

- from alcohol’s addictive nature

• Abstinence is only cure -> prohibition

B. 1960 - Jellinek

Most prevalent type includes physicaltolerance & dependence/withdrawal

- the individual (internal LOC)

- alcoholics are different

- loss of control as key

C. Alexander (1988)

Genetic Env. Stress

Predisposition

Susceptibility Addiction Life Problems

Upbringing Exposure to Drugs

(Env. Predisp) & Access

• AA: Life problems -> bottoming outEither die or recover

• The current, dominant model

• Disease model allows for tx, reduces stigma (& responsibility)

II. Cognitive Model of Alcoholism

- Loss of control due to expectancies

- AA/mainstream model leads to failure

“One drink, one drunk”

3.Behavioral Models of Alcoholism

a. Positive Reinforcement

- drugs make us feel good

- Addiction = recurrent use to recapture

the feeling

BUT - not all evidence supports

b. Negative Reinforcement

- drugs to escape unpleasant experiences

=> tension reduction/self-med

Once physically dependent,withdrawal -> increased use

But evidence does not support

c. Associative learning (cues)

- to maintain problem

4.Neural Sensitization - Current theory- Brain cells become sensitized to drug from

repeated exposure- Mesolimbic system is involved in

motivation- So increased motivation for drug- Systems cause wanting, not liking

Initial use -> liking

-> wanting (incentive value)

Treatment of Alcoholism

1.Biological Treatment

a. Agonist substitution

- use other, similar drug

- can develop tolerance

- can become addicted

b. Antagonist drugs

- block or counteract drug

- can reduce craving

BUT - must be motivated

- can cause withdrawal

c. Aversive Treatment

- Drugs that cause unpleasantnessif take the addictive drug

- Again, must be motivated

- Can include behavioral methods

d. Classical/associative conditioning

- change cues for drinking

2.Alcoholics Anonymous - popular

- Self-help group of lay people who providesupport

- Alcoholism = loss of control from allergy - Solution: total abstinence

Results from AA• Positive response• Negative response

Fosters dependency & reduces responsibility• Research: little & difficult to conduct

more positive outcome

however, 75% drop out by 1 year

3.Cognitive/Behavioral Treatment

A. Controlled Drinking

- Teach some alcoholics to drink in alimited, social way

- Expectancies lead to outcomes

- Research = better than abstinence

B. Relapse Prevention – Current

- failure of coping skills

- tx = change beliefs

& focus on negative consequences

- identify high-risk situations& develop strategies

• Overall picture for treatment: 70-80% nothelped long-term by any approach