substance use disorders todd kashdan, ph.d. gerstein and harwood (1990)
TRANSCRIPT
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Substance Use Disorders
Todd Kashdan, Ph.D
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Gerstein and Harwood (1990)
0 5 10 15 20 25 30 35
Productivity Losses
Crime Victim Losses
Law Enforcement
Economic Productivity Losses
Drug Prevention and Treatment
Drug-Related AIDS
33.35.5
12.8
17.6
1.7
1
In Billions
Economic Costs of Substance Abuse
Total Costs: $71.9 Billion
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Prevalence of drug use
What makes marijuana the most
frequently used illicit drug among
people aged 12 and older?
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Terminology
Psychoactive Substance: ingested to alter mood, behavior or both to become intoxicated/high
Use vs. Intoxication
Tolerance vs. Withdrawal
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Profiles of DSM‐IV and DSM‐5 Alcohol Use Disorders
Alcoholism: Clinical and Experimental Researchpages E305-E313, 13 SEP 2012 DOI: 10.1111/j.1530-0277.2012.01930.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1530-0277.2012.01930.x/full#acer1930-fig-0001
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Etiology of Dependence
Developmental Framework
Initiation and continuation
Escalation and transition to abuse
Development of tolerance and withdrawal
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Types of commonly abused substances:
Depressants: Behavioral Sedation Alcohol, Sedatives, Anxiolytic substances
Stimulants: Increases alertness and elevates mood Coffee, nicotine, cocaine, amphetamines
Opiates: Pain relief and euphoria, numbing effect Heroin, morphine, codeine, opium
Hallucinogens: Alter sensory perception Marijuana, LSD
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Licit vs. Illicit drugs Nicotine, Alcohol, Caffeine (Available without
prescription ) Anxiolytic Drugs such as Benzodiazepines
(Valium and Xanax) and Certain opiates (e.g. morphine and methadone) (Available with a prescription from a physician)
Stimulants (e.g., cocaine, amphetamines) Opiates (e.g., heroin) Hallucinogens (e.g., LSD)
Cannabis (e.g., marijuana and hashish
Leg
al
Illeg
al
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Why are Some Addictive Drugs Illegal?
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Depressants
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Depressants Primarily decrease CNS system activity. Reduces physiological arousal Most likely to produce physical dependence,
tolerance, and withdrawal
Ex: Alcohol, anxiolytic drugs, sedatives
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Depressants - Sedative Drugs Barbiturates: sedatives that act on GABA
system in a manor similar to alcohol Ex: Amobarbital, Pentobarbital, and Secobarbital
Benzodiazepines: sedatives that can be responsibly and effectively used for the short-term Ex: Valium, Xanax, and Halcion
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Impairment due to Sedatives overall sedation Tolerance potential for overdose Death Withdrawal symptoms (similar to alcohol) Common users:
59 % Women Anglo Greater education
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Depressant - Alcohol
Alcohol - CNS depressant
initial effect may be to stimulate, but its a physiological and psychological depressant.
Changes in mood and social behavior, judgment, and motor coordination. (cerebellum)
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Depressant - AlcoholWithdrawal: Hand tremors, anxiety, nausea etc. Extreme cases: Delirium Tremens
Associated Brain Conditions: Dementia
ETOH appears to damage neural connections vs. neurons
Liver disease, Fetal Alcohol Syndrome
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Drinking Practices
Binge Drinking – Consuming 5 or more drinks in one sitting, for women, reduced to 4 (2 hours)
Note: does not refer to a bender that is a period of two or more days of sustained heavy drinking.
Examples? Experiences?
Stories?
o“A” Students have ~ 3 drinks a week;
o“D” and “F” students ~ 11 drinks a week.
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Lifetime Prevalence of Alcoholism (ECA)
14% (combining abuse and dependence)
Men > women with chronic alcohol problems
12-month point prevalence rates for alcohol dependence 11 % men 4% women
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Psychological Models of ETOH
1. Expectancy Theory: predicting positive reinforcement.
Negative expectancies?
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Common Alcohol Expectations
transforms experiences in positive way (“make future seem brighter”)
enhances social and physical pleasure enhances sexual performance increases power and aggression reduces tension increases social assertiveness
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Alcohol Expectancies
Social learning in youth
Predicts future drinking behavior
Positive expectancies > negative expectancies
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Psychological Models of ETOH cont.
2. Tension Reduction Theories
Drinking to cope
Stress Response Dampening
Primary effects are physiological Self-regulation is dependent on person x situation
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Note:
Drinking to cope or reduce tension is a
?
Predictor of AUDs than Drinking for Positive Affect
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Deception in ExpectanciesAbsolut® Memory Distortions N = 148 “Tonic” or “Tonic & Vodka” groups
Observations?
Results?
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Biological Factors Initial physiological reactions affect early
drinking experiences. Some people are unable to tolerate even small amounts of alcohol
Aldehyde Dehydrogenase (ALDH-I & ALDH II) breaks down alcohol.
Asians, Asian-Americans and ALDH-I Result: “flush”, palpitations, muscle weakness,
and illness
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Twin Studies
When proband has AUD in treatment (Heath and Martin,
1997)
M: MZ = 56% DZ = 33% W: MZ = 30% DZ = 17%
Higher concordance rates in male twins reflect higher rates of alcoholism in men
2/3 of variance due to genetic factors
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Adoption Studies
Proband had biological parent with AUD
Proband adopted away at an early age and raised by adoptive parents
Method allows separation of G and E effects
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Cultural Factors
What factors contribute to countries having greater tolerance levels compared
to others?
What do you think would
happen if you got pulled
over in Pakistan or
Saudi Arabia and you had a
0.08 BAC limit?
How do you interpret the data,
what do you notice first?
© 2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.
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Social Factors and Alcoholism
Experimentation with drugs most likely to occur among adolescents whose peers and parents model or encourage it.
Parents more important for alcohol
Peers more important for marijuana and other drugs
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Social Factors and Alcoholism
Modeling Adoption studies?
How do parents influence children’s drinking? By influencing attitudes and expectations By providing access and monitoring use less
closely By creating a negative emotional climate
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Back to initial slide…
Significant reduction in substance abuse at age 26.
What role incompatibilities may be a cause of this reduction?
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Alcohol is the most widely used and socially accepted
drug.
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Stimulants
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Stimulants Stimulant – Promotes alert and active
state as well as elevates mood.
Examples:
Caffeine Cigarettes Cocaine (crack) Amphetamines
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Stimulants : Caffeine most widely used and socially accepted drug.
75 % of caffeine ingested through coffee
Average American drinks – 2 cups per day; Cup of coffee has about 100 mgs of caffeine
Caffeine stimulates CNS increasing levels of dopamine, norepinephrine, and serotonin.
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Stimulants : Caffeine
Symptoms include: Restlessness, nervousness, excitement, insomnia, flushed face, frequent urination, stomach upset, muscle twitching, rambling flow of thought or speech, rapid heartbeat, periods of inexhaustibility, psychomotor agitation.
Withdrawal Symptoms: (Provisional diagnosis in DSM-IV) marked fatigue or drowsiness, marked anxiety or depression, nausea or vomiting
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Can you get a DSM diagnosis from drinking too much coffee? Yes! – “Caffeine Intoxication”
Over 250 mg/day (~ 2 cups) Symptoms: Restlessness, nervousness, excitement,
flush, GI disturbance, etc.
Over 1 gm/ day (~8 cups) Symptoms: Can get arrhythmia, agitation, rambling
speech
Over 10 gm/ day (~80 cups) Symptoms : Seizures, death
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Stimulants : Nicotine Nicotine creates high levels of addiction (≥
cocaine, heorin)
≥ 90 % of smokers want to quite, but < 10% who try are actually successful Ex: Distress tolerance study
Produces significant physical problems (long-term)
In DSM – no abuse, only dependence and withdrawal.
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Impact of smoking
25% of Americans Smoke (was 42% in the 60’s) No decline among college age (33% smoke)
Nicotine takes 7 – 19 seconds to reach the brain Increase alertnessor relaxation Linked with negative affect
Relapsers indicate negative mood as cause
http://www.youtube.com/watch?v=WI25DmCoWvI
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Stimulant : Cocaine Derived from the leaves of the coca plant In small amounts produces behavioral or
psychological changes:
Increases alertness Increases blood pressure and pulse Produces euphoria Causes insomnia and loss of appetite
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Stimulant : Cocaine cont.
Upon entering the brain, cocaine molecules block the reuptake of dopamine. This causes repeated stimulation of the next neuron.
Withdrawal produces feelings of apathy and boredom.
Cocaine vs. Crack
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Hallucinogens
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Hallucinogens
Altered sensory perceptions including: Delusions, paranoia, hallucinations
Examples: Cannabis (marijuana, hashish) Hallucinogens (LSD, peyote, mescaline,
psilocybin)
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Hallucinogen : Marijuana
Active chemical- tetrahydrocannabinol (THC) Most regularly used illegal substance Evidence for Tolerance is mixed Withdrawal sxs
E.g., irritability, anger, depressed mood, headaches, restlessness, lack of appetite, & craving
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Marijuana and Functional Impairment
Persistent memory loss, impairment of attention, learning skills, and motor movement
AddictionPhysical health problemsMedicinal purposesWithdrawal symptoms
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Epidemiology of Marijuana
Most frequently used (14.8 million users)
More common among males (8.3%)
versus females (4.3%)
-Average age of first use 18
-Men greater risk
-Prevalence of use stable from 1991 to 2002
-Abuse and dependence has increased
Why do you believe males are more likely to use
marijuana than females?
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Study: Marijuana Use and Panic
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Treatment of Substance-Abuse and Dependence: Therapy
CBT-Avoidance of stimulus (fellow drug users, drug paraphernalia)
-Relapse prevention (identify antecedents and consequences of drug use, and develop ways to reduce the risk of future use)
Motivation enhancement therapyBehavioral therapiesTwelve-step approaches
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Treatment of Substance Use Disorder: Biological Treatments
Detoxification
Nicotine replacement therapyAntagonist treatmentsAversive treatmentsVaccines
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Controlled Drinking?
the evidence1. Mark and Linda Sobell
conducted a research study on controlled drinking with people who were alcoholics receiving both behavioral treatment and learning skills.
Fact: findings suited to individuals with less severe drinking problems, reviewed as harm reduction; however, it may be best to allow client to choose.
Evidence: Although abstinence is still for some the only treatment option, researchers hope to provide alternatives.
© 2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.