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  • Substance-Related Disorders Substance dependence Substance abuse Substance intoxication Substance withdrawal

    alcohol amphetamines caffeine cannabis cocaine hallucinogens inhalants nicotine opioids phencyclidine sedative/hypnotic/anxiolytic

  • Criteria for Substance DependenceA maladaptive pattern of substance abuse, leading to impairment or distress as manifested by 3 or more symptoms within a 12-mo. period tolerance a need for markedly increased amount of substance markedly diminished effect with same amount of substance withdrawal characteristic withdrawal syndrome for substance taking same substance to relieve withdrawal symptoms larger amounts over longer period than intended persistent desire or unsuccessful efforts to cut down time spent in acquiring, using, & recovering important activities given up/reduced continued use despite persistent physical or psychological problem caused by substance

  • Substance DependenceSpecifyers: with physiological dependence (evidence of tolerance or withdrawal) without physiological dependence (no evidence of tolerance or withdrawal)

  • Cocaine and Physiological Brain Changes use dopamine agonists that flood synapses with DA and overshadow normal rewarding activities

    attempt to restore homeostasis

    downregulating DA receptors on post-synaptic neurons

    upregulating MAO

    lower levels of DA in synapses during non-use periods

    craving for more of the dopamine-agonist substance

  • Criteria for Substance AbuseA maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one or more of the following: recurrent substance use resulting in failure to fulfill major role obligations at work, school, or home recurrent substance use in which it is physically hazardous recurrent substance-related legal problems continued substance use despite having persistent interpersonal problems caused by substanceSymptoms have never met criteria for Substance dependence for this drug

  • Criteria for Substance IntoxicationThe development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance.B. Clinically significant maladaptive behavioral or psychological changes due to effect of substance on central nervous system belligerence mood lability cognitive impairment impaired judgment impaired social/occupational functioningC. Symptoms are not due to a medical condition or mental disorder

  • Criteria for Alcohol IntoxicationA. Recurrent ingestion of alcohol

    B. Significant maladaptive behavioral or psychological changes inappropriate sexual behavior inappropriate aggression mood lability impaired judgmentC. One or more of the following signs shortly after ingestion: slurred speech incoordination unsteady gait nystagmus (involuntary eye movements) impairment in attention or memory stupor or comaD. The symptoms are not better accounted for by a medical condition or by another mental disorder.

  • Criteria for Alcohol WithdrawalA. Cessation of alcohol use that has been heavy and prolonged.B. Two or more of the following developing after cessation: autonomic hyperactivity (e.g., sweating, pulse over 100) increased hand tremor insomnia nausea or vomiting transient hallucinations or illusions psychomotor agitation anxiety grand mal seizuresC. Symptoms cause significant distress or impairment in social/ occupational functioningD. The symptoms are not better accounted for by a medical condition or by another mental disorder.

  • Bad Stuff Associated with Alcohol AbuseShort-term: 25,000 highway deaths per year industrial accidents, public transportation accidents over one-half of all murders involve alcohol child and spouse abuse one-half of all suicides involve alcohol fetal alcohol syndromeLong-term: increased risk of heart disease increased risk of throat and stomach cancer cirrhosis of the liver Korsakov Syndrome (amnestic disorder) depression marital breakup loss of job and school failure

  • Why Do People Drink?(Cooper et al., 1995)To enhance positive feelingscelebrations, social gatheringsincrease arousal, energy, joy desire for psychomotor activationassociated with extraversion, sensation-seekingB. To cope with negative feelings reduce anxiety, depression avoidance or denial negative life event forget problems avoidance of responsibility associated with neuroticism, low self-esteem

  • Why Do People Drink?Dual-Pronged Method of Actioninteracts with mesolimbic dopamine and opioid systemsinitial buzz (and psychomotor activation)feelings of mild euphoria, self-confidence, sociability interacts with glutamate and GABA systemsdecreases glutamateincreases GABAdecreases anxiety and self-consciousnessdecreases negative mood and irritabilitysuppresses CNS activationNote that there is a dose-dependent response to alcohol

  • Is There a Genetic Basis to Alcoholism? twin studies and adopted away studies indicate a genetic component adopted away SOMAs 4 times as likely to be alcoholic as adopted nonSOMAs twin studies show inheritance in males

    polygenetic

  • Cloningers Type I and Type II AlcoholicsType I later onset more likely to be triggered by specific event more environmental influence equal number of males and femalesType II early onset physical problems much larger heritability associated with antisocial acts more likely to be aggressive much more common in males

  • Factors Affecting Alcoholism

  • societys attitude toward drinking peer pressure (group ID) media portrayal low SES high availability high EE in familiesSocial/Cultural Factors Affecting Alcoholism

  • Psychological Factors Affecting Alcoholism anxiety-proneness lack of other coping mechanisms expectancies sensation-seeking

  • Biological Factors Affecting Alcoholism genetic predisposition low frontal arousal Aldehyde dehydrogenase (ALDH) deficit HR reactivity to alcohol MAO abnormalities

  • Is Alcohol a Disease?Disease model asserts that alcoholism is caused by a physiological defect similar to diabetes.Alternate model characterizes alcoholism as a character flaw Advantages of Disease Model brought problem to public awareness got funding to study alcoholism removes stigma got treatment developed and fundedDisadvantages of Disease Model reduces addicts accountability removes incentive to abstain places addict in victim role inconsistent with data that say controlled use may be achieved self-fulfilling prophesy

  • Treatment of AlcoholismBiological detoxification (benzodiazapines) disulfiram (Antabuse) Naltrexone acamprosate (Campral)

    Psychological Alcoholics Anonymous Cognitive Behavioral treatments Controlled DrinkingSocial token economy

  • The COMBINE StudyJAMA (2006) Best outcome: Naltrexone plus medical managementor 10-20 session CBT plus medical management

  • 1. Do you feel that alcoholism is a disease or a failure of will power and self-control? Why?Questions of the Week:Recommended Movie of the Week:

    Days of Wine and Roses starring Jack Lemon Lee Remick2. Can alcoholics successfully achieve controlled drinking, or is total abstinence the only option? Justify your answer with information from the readings and lecture.

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