Share your thoughts regarding the relationship of biological, psychology homework help

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Share your thoughts regarding the relationship of biological, psychological, social, and cultural factors to the etiology of substance related disorders.

Reference

Comer, R. (2015). Abnormal Psychology, Ninth Edition. Worth Publishers; New York, New York. (ISBN 978-1-4641-7170-3)

American Psychiatric Association (2013). Diagnostic and statistical manual for mental disorders, (5th Ed.). American Psychiatric Publishing, Inc.; Washington, DC

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Substance Use and Addictive Disorders Chapter 12 Slides & Handouts by Karen Clay Rhines, Ph.D. American Public University System Comer, Abnormal Psychology DSM-5 Update, 8e Substance Use Disorders • Many drugs are available in our society • Some are harvested from nature, others derived from natural substances, and still others are produced in a laboratory • Some require a physician’s prescription for legal use; others, like alcohol and nicotine, are legally available to adults • Still others, like heroin, are illegal under all circumstances Comer, Abnormal Psychology, DSM-5 Update, 8e 2 Substance Use Disorders • Recent statistics suggest that drug use is a significant social problem • 22 million people in the U.S. have used an illegal substance within the past month • Almost 24% of all high school seniors have used an illegal drug within the past month Comer, Abnormal Psychology, DSM-5 Update, 8e 3 Substance Use Disorders • What is a drug? • Any substance other than food that affects our bodies or minds • • Need not be a medicine or illegal Current language uses the term “substance” rather than “drug” to overtly include alcohol, tobacco, and caffeine Comer, Abnormal Psychology, DSM-5 Update, 8e 4 Substance Use Disorders • Substances may cause temporary changes in behavior, emotion, or thought • May result in substance intoxication (literally, “poisoning”), a temporary state of poor judgment, mood changes irritability, slurred speech, and poor coordination • Some substances such as LSD may produce a particular form of intoxication, sometimes called hallucinosis, which consists of perceptual distortions and hallucinations Comer, Abnormal Psychology, DSM-5 Update, 8e 5 Substance Use Disorders • Substances can also lead to long-term problems: • • Substance use disorder: a pattern of maladaptive behaviors and reactions brought about by repeated use of substances In many cases, people become physically dependent on the substances, developing a tolerance for it (needing increasing doses to get an effect) and experiencing withdrawal reactions (unpleasant and dangerous symptoms when substance use is stopped or cut down) Comer, Abnormal Psychology, DSM-5 Update, 8e 6 Substance Use Disorders • About 9% of all teens and adults in the U.S. display substance use disorders • The highest rate in the U.S. is found among American Indians (15.5%), while the lowest is among Asian Americans (3.5%) • White Americans, Hispanic Americans, and African Americans display rates between 9 and 10% • Only 11% receive treatment from a mental health professional Comer, Abnormal Psychology, DSM-5 Update, 8e 7 Substance Use Disorders • The substances people misuse fall into several categories: • Depressants • Stimulants • Hallucinogens • Cannabis Comer, Abnormal Psychology, DSM-5 Update, 8e 8 Depressants • Depressants slow the activity of the central nervous system (CNS) • • • Reduce tension and inhibitions May interfere with judgment, motor activity, and concentration Three most widely used depressants: • • • Alcohol Sedative-hypnotic drugs Opioids Comer, Abnormal Psychology, DSM-5 Update, 8e 9 Depressants: Alcohol • The World Health Organization estimates that 2 billion people worldwide consume alcohol • In the U.S., more than half of all residents drink alcoholic beverages from time to time Comer, Abnormal Psychology, DSM-5 Update, 8e 10 Depressants: Alcohol • When people consume 5 or more drinks in a single occasion, it is called a bingedrinking episode • • 24% of all people in the U.S. over the age of 11, most of them male, binge-drink each month Nearly 7% of people over age the age of 11 binge-drink at least 5 times each month • Considered heavy drinkers, males outnumber females by more than 2:1 (around 8% to 4%) Comer, Abnormal Psychology, DSM-5 Update, 8e 11 Depressants: Alcohol • All alcoholic beverages contain ethyl alcohol • It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS • Short-term: alcohol binds to certain neurons • Alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker Comer, Abnormal Psychology, DSM-5 Update, 8e 12 Depressants: Alcohol • The first brain area affected is that which controls judgment and inhibition • Next affected are additional areas in the CNS, leaving the drinker even less able to make sound judgments, speak clearly, and remember well • Motor difficulties increase as drinking continues, and reaction times slow Comer, Abnormal Psychology, DSM-5 Update, 8e 13 Depressants: Alcohol • The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood • • A given amount of alcohol has a lesser effect on a large person than on a small one Gender also affects blood alcohol concentration • • Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood Women become more intoxicated than men on equal doses of alcohol Comer, Abnormal Psychology, DSM-5 Update, 8e 14 Depressants: Alcohol • Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood: • BAC = 0.06: Relaxation and comfort • BAC = 0.09: Intoxication • BAC > 0.55: Death • Most people lose consciousness before they can drink this much Comer, Abnormal Psychology, DSM-5 Update, 8e 15 Depressants: Alcohol • The effects of alcohol subside only after alcohol is metabolized by the liver • The average rate of this metabolism is 25% of an ounce per hour • You can’t increase the speed of this process! Comer, Abnormal Psychology, DSM-5 Update, 8e 16 Alcohol Use Disorder • Though legal, alcohol is one of the most dangerous recreational drugs • Its effects can extend across the life span • Alcohol use is a major problem on college campuses Comer, Abnormal Psychology, DSM-5 Update, 8e 17 Alcohol Use Disorder • Surveys indicate that 7.4% of all adults in the U.S. display alcohol use disorder over a one-year period while over 13% display it at some point in their lives • Men outnumber women 2:1 • Many teenagers also experience the disorder Comer, Abnormal Psychology, DSM-5 Update, 8e 18 Alcohol Use Disorder • The prevalence of alcoholism in a given year is about the same (7% to 9%) for White Americans, African Americans and Hispanic Americans • • The men in these groups show strikingly different age patterns American Indians, particularly men, tend to display a higher rate of alcohol use disorders than any of these groups • Overall 15% of them have the disorder Comer, Abnormal Psychology, DSM-5 Update, 8e 19 Alcohol Use Disorder • Generally, Asians have lower rates of alcohol disorders than do people from other cultures • As many as one-half of these individuals have a deficiency of alcohol dehydrogenase; thus, they have a negative reaction to even modest alcohol intake Comer, Abnormal Psychology, DSM-5 Update, 8e 20 Alcohol Use Disorder • Clinical Picture • In general, people with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious • • Eventually the drinking interferes with social behavior and the ability to think and work Individual patterns of alcoholism abuse vary Comer, Abnormal Psychology, DSM-5 Update, 8e 21 Alcohol Use Disorder • Tolerance and Withdrawal • For many individuals, alcohol use disorder includes the symptoms of tolerance and withdrawal reactions • • • As their bodies build up a tolerance for alcohol, they need to drink greater amounts to feel its effects They may experience withdrawal symptoms, including nausea and vomiting, when they stop drinking A small percentage of these people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”) • Alcohol withdrawal can be fatal Comer, Abnormal Psychology, DSM-5 Update, 8e 22 Depressants: Alcohol • What is the personal and social impact of alcoholism? • Alcoholism destroys families, social relationships, and careers • Losses to society total many billions of dollars annually • Plays a role in suicides, homicides, assaults, rapes, and accidents • Has serious effects on the children (some 30 million) of persons with this disorder Comer, Abnormal Psychology, DSM-5 Update, 8e 23 Depressants: Alcohol • What is the personal and social impact of alcoholism? • Long-term excessive drinking can seriously damage physical health • • Long-term excessive drinking can cause major nutritional problems • • Especially damaged is the liver (cirrhosis) Example: Korsakoff’s syndrome Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) and increased risk of miscarriage Comer, Abnormal Psychology, DSM-5 Update, 8e 24 Depressants: Sedative-Hypnotic Drugs • • Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness • At low doses, they have a calming or sedative effect • At high doses, they function as sleep inducers or hypnotics Sedative-hypnotic drugs include barbiturates and benzodiazepines Comer, Abnormal Psychology, DSM-5 Update, 8e 25 Depressants: Barbiturates • First discovered more than 100 years ago, barbiturates were widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep • Although still prescribed, they have been largely replaced by benzodiazepines • They can cause many problems, not the least of which is misuse Comer, Abnormal Psychology, DSM-5 Update, 8e 26 Depressants: Barbiturates • Barbiturates are usually taken in pill or capsule form • At low doses, they reduce excitement in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate • Also similar to alcohol, barbiturates are metabolized by the liver Comer, Abnormal Psychology, DSM-5 Update, 8e 27 Depressants: Barbiturates • At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death Comer, Abnormal Psychology, DSM-5 Update, 8e 28 Depressants: Barbiturates • Repeated use of barbiturates can quickly result in sedative-hypnotic use disorder • A great danger of barbiturate tolerance is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects • Barbiturate withdrawal is particularly dangerous because it can cause convulsions Comer, Abnormal Psychology, DSM-5 Update, 8e 29 Depressants: Benzodiazepines • Benzodiazepines are often prescribed to relieve anxiety • Most popular sedative-hypnotics available • Class includes Xanax, Ativan, and Valium Comer, Abnormal Psychology, DSM-5 Update, 8e 30 Depressants: Benzodiazepines • Benzodiazepines have a depressant effect on the CNS by binding to GABA receptors and increasing GABA activity • Unlike barbiturates and alcohol, however, benzodiazepines relieve anxiety without causing drowsiness • They are also less likely to slow breathing and lead to death by overdose Comer, Abnormal Psychology, DSM-5 Update, 8e 31 Depressants: Benzodiazepines • Once thought to be a safe alternative to other sedative-hypnotic drugs, benzodiazepines can cause intoxication and lead to an addictive pattern of use • As many as 1% of U.S. adults display a sedativehypnotic use disorder that centers on benzodiazepines at some point in their lives Comer, Abnormal Psychology, DSM-5 Update, 8e 32 Depressants: Opioids • This class of drug includes both natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds and is known collectively as “narcotics” • Each drug has a different strength, speed of action, and tolerance level Comer, Abnormal Psychology, DSM-5 Update, 8e 33 Depressants: Opioids • Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”) • Injection seems to be the most common method of use, although other techniques have been increasing in recent years • An injection quickly brings on a “rush” – a spasm of warmth and ecstasy that is sometimes compared with orgasm • This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”) Comer, Abnormal Psychology, DSM-5 Update, 8e 34 Depressants: Opioids • Opioids create these effects by depressing the CNS • • • Opioids bind to the receptors in the brain that ordinarily receive endorphins (NTs that naturally help relieve pain and decrease emotional tension) When these sites receive opioids, they produce pleasurable and calming feelings, just as endorphins do In addition to reducing pain and tension, opioids can cause nausea, narrowing of the pupils, and constipation Comer, Abnormal Psychology, DSM-5 Update, 8e 35 Depressants: Opioids • Heroin use exemplifies the problems posed by opioids: • After just a few weeks, users may become caught in a pattern of abuse (and often dependence) • Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it • Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration Comer, Abnormal Psychology, DSM-5 Update, 8e 36 Depressants: Opioids • Such individuals soon need the drug just to avoid experiencing withdrawal, and they must continually increase their doses in order to achieve even that relief • Many users must turn to criminal activity to support their “habit” and avoid withdrawal symptoms Comer, Abnormal Psychology, DSM-5 Update, 8e 37 Depressants: Opioids • Surveys suggest that close to 1% of adults in the U.S. display opioid use disorder at some time in their lives Comer, Abnormal Psychology, DSM-5 Update, 8e 38 Depressants: Opioids • What are the dangers of opioid use ? • Once again, heroin provides a good example: • The most immediate danger is overdose • The drug closes down the respiratory center in the brain, paralyzing breathing and causing death • • Death is particularly likely during sleep Ignorance of tolerance is also a problem • People who resume use after having avoided it for some time often make the fatal mistake of taking the same dose they had built up to before Comer, Abnormal Psychology, DSM-5 Update, 8e 39 Depressants: Opioids • What are the dangers of opioid use? • Each year approximately 2% of persons addicted to heroin and other opioids die under the drug’s influence • In addition, users run the risk of getting impure drugs • • Opioids are often “cut” with noxious chemicals Dirty needles and other equipment can spread infection Comer, Fundamentals of Abnormal Psychology, 7e 40 Stimulants • Stimulants are substances that increase the activity of the central nervous system (CNS) • • • Cause increases in blood pressure, heart rate, and alertness Cause rapid behavior and thinking The four most common stimulants are: • • • • Cocaine Amphetamines Caffeine Nicotine Comer, Abnormal Psychology, DSM-5 Update, 8e 41 Stimulants: Cocaine • Derived from the leaves of the coca plant, cocaine is the most powerful natural stimulant known • 28 million people in the U.S. have tried cocaine • 1.6 million people are currently using it Comer, Abnormal Psychology, DSM-5 Update, 8e 42 Stimulants: Cocaine • Cocaine produces a euphoric rush of wellbeing • It seems to work by increasing dopamine at key receptors in the brain and overstimulating them • Also appears to increase norepinephrine and serotonin Comer, Abnormal Psychology, DSM-5 Update, 8e 43 Stimulants: Cocaine • High doses of cocaine can produce cocaine intoxication, whose symptoms include mania, paranoia, and impaired judgment • • Some people also experience hallucinations and/or delusions, a condition known as cocaine-induced psychosis As the stimulant effects of the drug subside, the user experiences a depressionlike letdown, popularly called “crashing” Comer, Abnormal Psychology, DSM-5 Update, 8e 44 Stimulants: Cocaine • Cocaine use in the past was limited by the drug’s high cost • Since 1984, newer, more powerful, and sometimes cheaper versions of the drug have become available, including: • A “freebase” form where the drug is heated and inhaled with a pipe • “Crack,” a powerful form of freebase that has been boiled down for smoking in a pipe Comer, Abnormal Psychology, DSM-5 Update, 8e 45 Stimulants: Cocaine • What are the dangers of cocaine? • Aside from its behavioral effects, cocaine poses significant physical danger • The greatest danger of use is the risk of overdose • Excessive doses depress the brain’s respiratory function, and stop breathing • Cocaine use can also cause heart failure • Pregnant women who use cocaine have an increased likelihood of miscarriage and of having children with abnormalities Comer, Abnormal Psychology, DSM-5 Update, 8e 46 Stimulants: Amphetamines • Amphetamines are stimulant drugs that are manufactured in the laboratory • Most often taken in pill or capsule form • Some people inject the drugs intravenously or smoke them for a quicker, more powerful effect Comer, Abnormal Psychology, DSM-5 Update, 8e 47 Stimulants: Amphetamines • Like cocaine, amphetamines: • Increase energy and alertness and reduce appetite when taken in small doses • Produce a rush, intoxication, and psychosis in high doses • Cause an emotional letdown as they leave the body • stimulate the CNS by increasing dopamine, norepinephrine, and serotonin Comer, Abnormal Psychology, DSM-5 Update, 8e 48 Stimulants: Amphetamines • One kind of amphetamine, methamphetamine, has had a major surge in popularity in recent years • • • Almost 6% of all persons over the age of 11 in the US have used this stimulant at least once Most of the nonmedical meth is made in “stovetop laboratories” Meth is about as likely to be used by women as men and has gained popularity as a “club drug” Comer, Abnormal Psychology, DSM-5 Update, 8e 49 Stimulant Use Disorder • Regular use of either cocaine or amphetamine may lead to stimulant use disorder • • • The stimulant comes to dominate the individual’s life Tolerance and withdrawal reactions may also develop In a given year, 0.5% of all people over the age of 11 display stimulant use disorder centered on cocaine and 0.25 display it centered on amphetamines Comer, Fundamentals of Abnormal Psychology, 7e 50 Stimulants: Caffeine • Caffeine is the world’s most widely used stimulant • Around 80% of the world’s population consumes it daily • Most consumption is in the form of coffee; the rest is in the form of tea, cola, energy drinks, chocolate, and over-the-counter medications • Around 99% of ingested caffeine is absorbed by the body and reaches its peak concentration within an hour Comer, Abnormal Psychology, DSM-5 Update, 8e 51 Stimulants: Caffeine • Caffeine acts as a stimulant in the CNS, producing a release of dopamine, serotonin, and norepinephrine in the brain • More than 2 to 3 cups of brewed coffee can lead to caffeine intoxication • Seizures and respiratory failure can occur at doses greater than 10 grams of caffeine (about 100 cups of coffee) Comer, Abnormal Psychology, DSM-5 Update, 8e 52 Stimulants: Caffeine • Many people who suddenly stop or cut back their usual intake experience withdrawal symptoms, including headaches, depression, anxiety, and fatigue • Studies suggest correlations between high doses of caffeine and heart rhythm irregularities, high cholesterol levels, and risk of heart attacks • High doses during pregnancy also increase the risk of miscarriage Comer, Abnormal Psychology, DSM-5 Update, 8e 53 Hallucinogens, Cannabis, and Combinations of Substances • Other kinds of substances may also cause problems for users and for society • Hallucinogens • • Cannabis • • Produce delusions, hallucinations, and other sensory changes Produces sensory changes, but have both depressant and stimulant effects Many individuals take combinations of substances Comer, Abnormal Psychology, DSM-5 Update, 8e 54 Hallucinogens • Hallucinogens, also known as psychedelic drugs, cause powerful changes in sensory perceptions (sometimes called “trips”) • • Include natural hallucinogens • Mescaline • Psilocybin And laboratory-produced hallucinogens • Lysergic acid diethylamide (LSD) • MDMA (Ecstasy) Comer, Abnormal Psychology, DSM-5 Update, 8e 55 Hallucinogens • LSD is one of the most famous and powerful hallucinogens • Within two hours of being swallowed, it brings on a state of hallucinogen intoxication (hallucinosis) • • Increased and altered sensory perception Hallucinations may occur • • • • The drug may cause different senses to cross, an effect called synesthesia May induce extremely strong emotions May have some physical effects Effects wear off in about six hours Comer, Abnormal Psychology, DSM-5 Update, 8e 56 Hallucinogens • LSD produces these symptoms by binding to serotonin receptors • These neurons help control visual information and emotions, thereby causing the various effects of the drug on the user Comer, Abnormal Psychology, DSM-5 Update, 8e 57 Hallucinogens • More than 14% of Americans have used hallucinogens at some point in their lives • Tolerance and withdrawal are rare • But the drugs do pose dangers • • Users may experience a “bad trip” – the experience of enormous unpleasant perceptual, emotional, and behavioral reactions Another danger is the risk of “flashbacks” • Can occur days or months after last drug use Comer, Abnormal Psychology, DSM-5 Update, 8e 58 Cannabis • The drugs produced from varieties of the hemp plant are, as a group, called cannabis • They include: • • • Hashish, the solidified resin of the cannabis plant Marijuana, a mixture of buds, crushed leaves, and flowering tops The major active ingredient in cannabis is tetrahydrocannabinol (THC) • The greater the THC content, the more powerful the drug Comer, Abnormal Psychology, DSM-5 Update, 8e 59 Cannabis • When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects • • • At low doses, the user feels joy and relaxation • May become anxious, suspicious, or irritated • This overall “high” is technically called cannabis intoxication At high doses, cannabis produces odd visual experiences, changes in body image, and hallucinations Most of the effects of cannabis last 2 to 6 hours • Mood changes may continue longer Comer, Abnormal Psychology, DSM-5 Update, 8e 60 Cannabis • Cannabis Use Disorder • In the 1970s, use of marijuana rarely led to cannabis use disorder • Today many users are developing this disorder • Some users develop tolerance and withdrawal, experiencing flulike symptoms, restlessness, and irritability when drug use is stopped • About 1.7% of people in the U.S. displayed marijuana abuse or dependence in the past year • Between 4 and 5% will fall into these patterns at some point in their lives Comer, Abnormal Psychology, DSM-5 Update, 8e 61 Cannabis • Cannabis Use Disorder • One theory about the increase in cannabis use disorder is the change in the drug itself • The marijuana available today is significantly more potent than the drug used in the early 1970s Comer, Abnormal Psychology, DSM-5 Update, 8e 62 Cannabis • Is marijuana dangerous? • As the strength and use of the drug has increased, so have the risks of using it • May cause panic reactions similar to those caused by hallucinogens • Because of its sensorimotor effects, marijuana has been implicated in accidents • Marijuana use has been linked to poor concentration and impaired memory Comer, Abnormal Psychology, DSM-5 Update, 8e 63 Cannabis • Is marijuana dangerous? • Long-term use poses additional dangers • May cause respiratory problems and lung cancer • May affect reproduction • In males, it may lower sperm count • In women, abnormal ovulation has been found Comer, Abnormal Psychology, DSM-5 Update, 8e 64 Cannabis • Cannabis and Society: A Rocky Relationship • For centuries, cannabis played a respected role in medicine, but its use fell out of favor and was criminalized • In the late 1980s, several interest groups campaigned for the medical legalization of marijuana Comer, Abnormal Psychology, DSM-5 Update, 8e 65 Cannabis • Cannabis and Society: A Rocky Relationship • In 2009, the US Attorney General directed federal prosecutors to not pursue cases against medical marijuana users complying with state laws • In 2011 and 2012, several state and city-level officials petitioned the government to reclassify marijuana as a drug with acceptable medical usage Comer, Abnormal Psychology, DSM-5 Update, 8e 66 Cannabis • Cannabis and Society: A Rocky Relationship • • In 2012, residents of Colorado and Washington voted to legalize marijuana for use of any kind, although such state measures can be blocked by the federal government In the meantime, both the Netherlands and Canada permit its use for medical purposes Comer, Abnormal Psychology, DSM-5 Update, 8e 67 Combinations of Substances • People often take more than one drug at a time, a pattern called polysubstance use • Researchers have studied the ways in which drugs interact with one another, focusing on cross-tolerance and synergistic effects Comer, Abnormal Psychology, DSM-5 Update, 8e 68 Combinations of Substances • Cross-tolerance • Sometimes two or more drugs are so similar in their actions on the brain and body that as people build a tolerance for one drug, they are simultaneously developing a tolerance for the other (even if they have never taken it) • Users who display this cross-tolerance can reduce the symptoms of withdrawal from one drug by taking the other • Example: alcohol and benzodiazepines Comer, Abnormal Psychology, DSM-5 Update, 8e 69 Combinations of Substances • Synergistic effects • When different drugs are in the body at the same time, they may multiply, or potentiate, each other’s effects • This combined impact is called a synergistic effect, and is often greater than the sum of the effects of each drug taken alone Comer, Abnormal Psychology, DSM-5 Update, 8e 70 Combinations of Substances • Synergistic effects • One kind of synergistic effect occurs when two or more drugs have similar actions • Example: alcohol, barbiturates, benzodiazepines, and opioids • All depressants, these drugs may severely depress the CNS when mixed, leading to death Comer, Abnormal Psychology, DSM-5 Update, 8e 71 Combinations of Substances • Synergistic effects • A different kind of synergistic effect results when drugs have opposite (antagonistic) effects • Example: stimulants or cocaine with barbiturates or alcohol • May build up lethal levels of the drugs because of metabolic issues (stimulants impede the liver’s processing of barbiturates and alcohol) Comer, Abnormal Psychology, DSM-5 Update, 8e 72 Combinations of Substances • Each year tens of thousands of people are admitted to hospitals because of polysubstance use • May be accidental or intentional • As many as 90% of people who use one illegal drug are also using another to some extent Comer, Abnormal Psychology, DSM-5 Update, 8e 73 What Causes Substance Use Disorders? • Clinical theorists have developed sociocultural, psychological, and biological explanations for substance abuse and dependence • No single explanation has gained broad support • Best explanation: a COMBINATION of factors Comer, Abnormal Psychology, DSM-5 Update, 8e 74 Causes of Substance Use Disorders: Sociocultural Views • A number of theorists propose that people are more likely to develop substance use disorders when living in stressful socioeconomic conditions • Example: higher levels of unemployment correlate with higher rates of alcohol use • Example: people of lower SES have higher rates of substance use in general Comer, Abnormal Psychology, DSM-5 Update, 8e 75 Causes of Substance Use Disorders: Sociocultural Views • Other theorists propose that substance use disorders are more likely to appear in families and social environments where substance use is valued or accepted • Example: rates of alcohol use vary among cultures Comer, Abnormal Psychology, DSM-5 Update, 8e 76 Causes of Substance Use Disorders: Psychodynamic Views • Psychodynamic theorists believe that people with substance use disorders have powerful dependency needs that can be traced to their early years • Caused by a lack of parental nurturing • • Some people may develop a “substance abuse personality” as a result Limited research does link early impulsivity to later substance use, but the findings are correlational and researchers cannot presently conclude that any one personality trait or group of traits stands out in substance-related disorders Comer, Abnormal Psychology, DSM-5 Update, 8e 77 Causes of Substance Use Disorders: Cognitive-Behavioral Views • According to behaviorists, operant conditioning may play a key role in substance abuse • They argue that the temporary reduction of tension produced by a drug has a rewarding effect, thus increasing the likelihood that the user will seek this reaction again • Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion Comer, Abnormal Psychology, DSM-5 Update, 8e 78 Causes of Substance Use Disorders: Cognitive-Behavioral Views • Cognitive theorists further argue that such rewards eventually produce an expectancy that substances will be rewarding, and this expectation is sufficient to motivate individuals to increase drug use at times of tension Comer, Abnormal Psychology, DSM-5 Update, 8e 79 Causes of Substance-Related Disorders: Cognitive-Behavioral Views • In support of these views, studies have found that many subjects do in fact drink more alcohol or seek heroin when they feel tense • In a manner of speaking, this model is arguing a “self-medication” hypothesis Comer, Abnormal Psychology, DSM-5 Update, 8e 80 Causes of Substance-Related Disorders: Cognitive-Behavioral Views • If true, one would expect higher rates of substance use among people with psychological problems • More than 22% of all adults who suffer from psychological disorders have displayed substance use disorders within the past year Comer, Abnormal Psychology, DSM-5 Update, 8e 81 Causes of Substance-Related Disorders: Cognitive-Behavioral Views • Other behaviorists have proposed that classical conditioning may play a role in these disorders • Objects present at the time drugs are taken may act as classically conditioned stimuli and come to produce some of the pleasure brought on by the drugs themselves • Although classical conditioning may be at work, it has not received widespread research support as the key factor in such patterns Comer, Abnormal Psychology, DSM-5 Update, 8e 82 Causes of Substance Use Disorders: Biological Views • In recent years, researchers have come to suspect that drug misuse may have biological causes • Studies on genetic predisposition and specific biochemical processes have provided some support for this model Comer, Abnormal Psychology, DSM-5 Update, 8e 83 Causes of Substance Use Disorders: Biological Views • Genetic predisposition • Research with “alcohol-preferring” animals has demonstrated that their offspring have similar alcohol preferences • Similarly, research with human twins has suggested that people may inherit a predisposition to misuse substances • Concordance rates in identical (MZ) twins: 54% • Concordance rates in fraternal (DZ) twins: 28% Comer, Abnormal Psychology, DSM-5 Update, 8e 84 Causes of Substance Use Disorders: Biological Views • Genetic predisposition • Clearer support for a genetic model may come from adoption studies • Studies compared adoptees whose biological parents abuse alcohol with adoptees whose biological parents do not • By adulthood, those whose biological parents were dependent showed higher rates of alcoholism themselves Comer, Abnormal Psychology, DSM-5 Update, 8e 85 Causes of Substance Use Disorders: Biological Views • Genetic predisposition • Genetic linkage strategies and molecular biology techniques provide more direct evidence in support of this hypothesis • An abnormal form of the dopamine-2 (D2) receptor gene was found in the majority of research participants with substance use disorders, but in less than 20% of participants who do not display such disorders Comer, Abnormal Psychology, DSM-5 Update, 8e 86 Causes of Substance Use Disorders: Biological Views • Biochemical factors • Over the past few decades, investigators have pieced together several biological explanations of drug tolerance and withdrawal • Based on NT functioning in the brain • • The specific NTs affected depend on which drug is used Recent brain imaging studies have suggested that many (perhaps all) drugs eventually activate a reward center or “pleasure pathway” in the brain Comer, Abnormal Psychology, DSM-5 Update, 8e 87 Causes of Substance Use Disorders: Biological Views • Biochemical factors • • The reward center apparently extends from the ventral tegmental area of the brain to the nucleus accumbens and on to the frontal cortex The key NT appears to be dopamine • • Certain drugs stimulate the reward center directly • • When dopamine is activated at this reward center, a person experiences pleasure Examples: cocaine, amphetamines, caffeine Other drugs stimulate the reward center in roundabout ways • Examples: alcohol, opioids, marijuana Comer, Abnormal Psychology, DSM-5 Update, 8e 88 Causes of Substance Use Disorders: Biological Views • Biochemical factors • A number of theorists believe that when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances • This theory, called the incentive-sensitization theory, has received considerable support in animal studies Comer, Abnormal Psychology, DSM-5 Update, 8e 89 Causes of Substance Use Disorders: Biological Views • Biochemical factors • Other theorists believe that people who abuse substances suffer from a reward-deficiency syndrome • Their reward center is not readily activated by “normal” life events so they turn to drugs to stimulate this pleasure pathway, particularly in times of stress • Defects in D2 receptors have been cited as a possible cause Comer, Abnormal Psychology, DSM-5 Update, 8e 90 How Are Substance Use Disorders Treated? • Many approaches have been used to treat substance use disorders, including psychodynamic, behavioral, cognitive-behavioral, and biological, along with sociocultural therapies • Although these treatments sometimes meet with great success, more often they are only moderately helpful • Today treatments are typically used in combination on both an outpatient and inpatient basis Comer, Abnormal Psychology, DSM-5 Update, 8e 91 How Are Substance Use Disorders Treated? • The value of treatment for substance use disorders can be difficult to determine • • • • Different substance use disorders pose different problems Many people with such disorders drop out of treatment early Some people recover without any intervention at all Different criteria are used by different clinical researchers Comer, Abnormal Psychology, DSM-5 Update, 8e 92 Psychodynamic Therapies • • Psychodynamic therapists first guide clients to uncover and work through the underlying needs and conflicts that they believe led to the disorder then try to help them change their styles of living Research has not found this model to be very effective • Tends to be of greater help when combined with other approaches in a multidimensional treatment program Comer, Abnormal Psychology, DSM-5 Update, 8e 93 Behavioral Therapies • A widely used behavioral treatment is aversion therapy, an approach based on classical conditioning principles • Individuals are repeatedly presented with an unpleasant stimulus at the very moment they are taking a drug • After repeated pairings, they are expected to react negatively to the substance itself and to lose their craving for it Comer, Abnormal Psychology, DSM-5 Update, 8e 94 Behavioral Therapies • Aversion therapy is most commonly applied to alcoholism • In one version, drinking behavior is paired with drug-induced nausea and vomiting • Another version of this approach requires people with alcoholism to imagine extremely upsetting, repulsive, or frightening scenes while they are drinking • The pairing is expected to produce negative responses to liquor itself Comer, Abnormal Psychology, DSM-5 Update, 8e 95 Behavioral Therapies • A behavioral approach that has been successful in the short-term is contingency management • This procedure makes incentives contingent on the submission of drug-free urine specimens Comer, Abnormal Psychology, DSM-5 Update, 8e 96 Behavioral Therapies • Behavioral interventions have usually had onlhy limited success when used alone • They work best when used in combination with either biological or cognitive approaches Comer, Abnormal Psychology, DSM-5 Update, 8e 97 Cognitive-Behavioral Therapies • Cognitive-behavioral treatments for substance use disorders help clients identify and change the patterns and cognitions contributing to their patterns of substance misuse Comer, Abnormal Psychology, DSM-5 Update, 8e 98 Cognitive-Behavioral Therapies • The most prominent of these approaches is relapse-prevention training • The overall goal is for clients to gain control over their substance-related behaviors • • Clients are taught to identify and plan ahead for highrisk situations and to learn from mistakes and lapses This approach is used particularly to treat alcohol use; also used to treat cocaine and marijuana abuse Comer, Abnormal Psychology, DSM-5 Update, 8e 99 Biological Treatments • Biological approaches may be used to help people withdraw from substances, abstain from them, or simply maintain their level of use without further increases • These approaches have limited long-term success when used alone, but can be helpful when combined with other approaches Comer, Abnormal Psychology, DSM-5 Update, 8e 100 Biological Treatments • Detoxification • Systematic and medically supervised withdrawal from a drug • • Can be outpatient or inpatient Two strategies: • Gradual withdrawal by tapering doses of the substance • Induce withdrawal but give additional medication to block symptoms Comer, Abnormal Psychology, DSM-5 Update, 8e 101 Biological Treatments • Detoxification • Detoxification programs seem to help motivated people withdraw from drugs • For people who fail to receive psychotherapy after withdrawal, however, relapse rates tend to be high Comer, Abnormal Psychology, DSM-5 Update, 8e 102 Biological Treatments • Antagonist drugs • As an aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance • Example: disulfiram (Antabuse) for alcohol • Example: naloxone for opioids, naltrexone for alcohol Comer, Abnormal Psychology, DSM-5 Update, 8e 103 Biological Treatments • Drug maintenance therapy • A drug-related lifestyle may be a greater problem than the drug’s direct effects • • Example: heroin addiction Methadone maintenance programs are designed to provide a safe substitute for heroin • • Methadone is a laboratory opioid with a long half-life, taken orally once a day Programs were roundly criticized as “substituting addictions” but are regaining popularity, partly because of the spread of HIV/AIDS Comer, Abnormal Psychology, DSM-5 Update, 8e 104 Sociocultural Therapies • Three sociocultural approaches have been applied to substance use disorders: • Self-help programs • Culture- and gender-sensitive programs • Community prevention programs Comer, Abnormal Psychology, DSM-5 Update, 8e 105 Sociocultural Therapies • Self-help and residential treatment programs • Most common: Alcoholics Anonymous (AA) • Offers peer support along with moral and spiritual guidelines to help people overcome alcoholism • It is worth noting that the abstinence goal of AA directly opposes the controlled-drinking goal of relapse prevention training and several other interventions for substance misuse – this issue has been debated for years Comer, Abnormal Psychology, DSM-5 Update, 8e 106 Sociocultural Therapies • Self-help and residential treatment programs • Many self-help programs have expanded into residential treatment centers or therapeutic communities • People formerly addicted to drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies Comer, Abnormal Psychology, DSM-5 Update, 8e 107 Sociocultural Therapies • Culture- and gender-sensitive programs • A growing number of treatment programs try to be sensitive to the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of ethnic minority groups • Similarly, therapists have become more aware that women often require treatment methods different from those designed for men Comer, Abnormal Psychology, DSM-5 Update, 8e 108 Sociocultural Therapies • Community prevention programs • Perhaps the most effective approach to substance use disorders is to prevent them • Some prevention programs argue for total abstinence from drugs, while others teach responsible use • Prevention programs may focus on the individual, the family, the peer group, the school, or the community at large • The most effective of these prevention efforts focuses on multiple areas to provide a consistent message about drug use in all areas of life Comer, Abnormal Psychology, DSM-5 Update, 8e 109 Gambling Disorder • It is estimated that as many as 2.3% of all adults and 3-8% of teens and college students suffer from gambling disorder • • Clinicians are careful to distinguish between this disorder and social gambling Gambling disorder is defined less by the amount of time or money spent than by the addictive nature of the disorder • People with the disorder are preoccupied with and cannot walk away from a bet Comer, Fundamentals of Abnormal Psychology, 7e 110 Gambling Disorder • The explanations posed for gambling disorder often parallel those offered for substance use disorders • These include possible genetic predisposition, heightened dopamine activity, impulsive personality styles, and cognitive errors • Research, however, has been limited thus far Comer, Fundamentals of Abnormal Psychology, 7e 111 Gambling Disorder • Similarly, the leading treatments for substance use disorder have been adapted for use with gambling disorder • These include cognitive-behavioral approaches and biological approaches • In addition, the self-help group program Gamblers Anonymous is available Comer, Fundamentals of Abnormal Psychology, 7e 112 Internet Use Disorder • As people increasingly turn to the Internet for activities that used to take place in the “real world”, a new psychological problem has emerged: an uncontrollable need to be online • This pattern has been called Internet use disorder, Internet addiction, and problematic Internet use Comer, Fundamentals of Abnormal Psychology, 7e 113 Internet Use Disorder • For people who display this pattern, the Internet has become a black hole • Sufferers – at least 1% of all people – spend all or most of their waking hours texting, tweeting, networking, gaming, Internet browsing, emailing, blogging, visiting virtual worlds, shopping online, or viewing online pornography • Specific symptoms of this pattern parallel those found in substance use disorders and gambling disorder Comer, Fundamentals of Abnormal Psychology, 7e 114 Internet Use Disorder • Although clinicians, the media, and the public have shown enormous interest in this problem, DSM-5 has not listed it as a disorder • Instead, it has recommended that the pattern receive further study for possible inclusion in future editions Comer, Fundamentals of Abnormal Psychology, 7e 115
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Running Head: SUBSTANCE ABUSE

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Substance Abuse
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SUBSTANCE ABUSE

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Substance Abuse

Substance abuse disorders never seem to arise because of one specific factor. I agree with the
experts and researchers who say that a drug addiction problem is a result of a combination of factors.
From most to least, I think that the factors are psychological factor...


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