Substance Use Disorders IV

(Chapter 11)

April 9, 2014

PSYC 2340: Abnormal Psychology

Brett Deacon, Ph.D.

• Disease model of alcoholism

• Twelve step treatment

From Last Class

• Twelve Step treatment critical analysis:

• http://www.youtube.com/watch?v=8tPNgHrIkgo

• http://www.youtube.com/watch?v=5uwx2P5LJgk&feature=related

• http://www.youtube.com/watch?v=7PjpOsE3xoY

Twelve Steps of Alcoholics Anonymous

Exam Review

• Chapter 7 (Mood Disorders)

• Major depressive and manic episodes

• Nature, causes, and treatment of:• Major depressive disorder• Bipolar disorder

• Suicide

• 15 questions from this section

Exam Review

• Chapter 8 (Eating Disorders)

• No questions on Sleep Disorders

• Anorexia

• Bulimia

• Causes

• Treatment

• 9 questions form this section

Exam Review

• Chapter 11 (Substance-Related Disorders)

• No questions on Impulse Control Disorders

• Substance abuse and dependence

• Alcohol: effects, cultural patterns, disease model

• Addictive properties of different substances

• Properties and effects of different substances

• Treatments

• 16 questions from this section

Addictive Properties of Common Drugs

• Which of the following drugs is most addictive?

• 1. Nicotine

• 2. Heroin

• 3. Cocaine

• 4. Alcohol

• 5. Caffeine

• 6. Marijuana

Drug Addictiveness

Addictive Properties of Common Drugs

• Sedative, Hypnotics, & Anxiolytics

• Stimulants

• Opioids

• Hallucinogens

• Other Drugs of Abuse

Brief Review of Different Substances

Sedative, Hypnotic, or AnxiolyticSubstance use Disorders

• Drugs in this class

• Sedatives – calming (e.g., barbiturates)

• Hypnotic – sleep inducing

• Anxiolytic – anxiety reducing (e.g., benzodiazepines)

Sedative, Hypnotic, or AnxiolyticSubstance use Disorders

• Effects similar to large doses of alcohol

• Synergistic effect when combined with alcohol

• Adverse effects

• Dependence, tolerance, withdrawal, overdose

Stimulants

• Nature of stimulants• Most widely consumed class of drug in the

US• Drugs increase alertness and increase

energy• Examples include amphetamines, cocaine,

nicotine, and caffeine

Stimulants: Amphetamines

• Used for all-nighters, weight control, and high

• Effects:• Elation, vigor, reduce fatigue• Followed by extreme fatigue and depression

• Prescription stimulants (for ADHD) increasing becoming drugs of abuse

• The NY Times: When Stimulants Are Bad https://www.madinamerica.com/2012/06/the-ny-times-when-stimulants-are-bad/

Stimulants: Nicotine

• Approximately 25% of Americans smoke

• Effects:

• Stress relief, relaxation, wellness, pleasure

• Withdrawal: depression, insomnia, irritability, anxiety, increased appetite

• Highly addictive and extremely difficult to quit

• Cues that elicit urges to smoke are ubiquitous

• Users dose themselves frequently

Stimulants: Caffeine

• Used regularly by 90% of Americans

• Effects of the “gentle” stimulant

• Found in tea, coffee, cola drinks, and cocoa products

• Small doses elevate mood and reduce fatigue

• Regular use can result in tolerance and dependence

Opioids: An Overview

• Opiate – narcotic-like chemical in opium poppy

• Examples: heroin, opium, codeine, and morphine

• Effects:• Pain relief, euphoria, drowsiness, slowed

breathing• High doses can be fatal• Withdrawal symptoms can be lasting and severe• Elevates risk for HIV • High mortality rates for addicts

Hallucinogens: An Overview

• Substances that alter perceptions of the world

• Examples: Marijuana, LSD

• Effects:• Delusions, paranoia, hallucinations, and/or

altered sensory perception

Hallucinogens: Marijuana

• Active chemical is tetrahydrocannabinol (THC)

• Effects: • Heightened sensory experiences, mood

swings, paranoia, hallucinations• Varies greatly from person to person• Minimal tolerance, withdrawal, dependence• Medicinal uses and controversies

Hallucinogens: LSD

• Derivative of ergot fungus

• Effects:• Perceptual changes, depersonalization,

hallucinations• Very rapid tolerance• Withdrawal symptoms are rare• Can produce psychotic reactions

• Interesting historical note: LSD and the Salem Witch Trials of 1692

Other Drugs of Abuse: Steroids

“My lawyers have advised me that I cannot answer these questions without jeopardizing my friends, my family and myself.”-Mark McGwire

Other Drugs of Abuse: Steroids

"I did take a banned substance. And for that, I

am very sorry and deeply regretful.“

-Alex Rodriguez

Other Drugs of Abuse: Steroids

• Synthesized from testosterone

• Legitimate medical uses: asthma, anemia, breast cancer, men with inadequate sexual development

• Used illegally to increase body mass

• Do not produce a high

• Long-term mood disturbances and physical problems

• Exposure/access to drug is necessary, but not sufficient, for abuse and addiction

• Use depends on social and cultural expectations

• Drugs are used because of pleasurable and/or reinforcing effects

• Reasons for drug abuse are complex

Causes of Substance-Related Disorders

Biological Influences

• Drugs affect the pleasure or reward centers in the brain

• Biological changes occur with repeated drug use

• Unlike substance use, substance abuse and dependence has a genetic component

Psychological Influences

• Positive and negative reinforcement

• Pleasurable effects

• Self-medication (cope with negative affect)

• Expectancy effects

• Expectancies influence drug use and relapse

Social and Cultural Influences

• Exposure to drugs is a prerequisite for use• Media, family, peers• Parents and the family appear critical

• Cultural factors • Influence the manifestation of substance use

and abuse

Social and Cultural Influences

• The importance of context

• 42% of Vietnam war soldiers used heroin• Half became dependent in Vietnam

• Three years after returning home, only 12% were still using heroin

Social and Cultural Influences

• Societal views about drug abuse

• Moral weakness

• Biological disease model (Twelve Steps)

• “War on drugs”

American Culture and Drug Use

• Assumptions of America’s “War on Drugs”

• 1. Illicit drug use is bad. How bad?

Criminal Offense Average Prison Sentence

Murder/manslaughter 153 months

Drugs 78 months

Rape 67 months

Burglary 51 months

Aggravated Assault 50 monthsSource: U.S. Bureau of Justice Statistics

War on Drugs

• 2. Illicit drug use is unhealthy, uncontrollable, and addictive

• 3. Prevention and treatment programs work

• Project DARE

• Lynam et al. (1999)

• 10-year follow-up of 1,000+ 10-year olds

• Received either DARE or standard drug ed

• Long-term outcomes

American Cultural and Drug Use

• 4. People are unable to choose whether or not

to take drugs or to regulate their use

• Thus, prohibition is necessary

• 5. There is an end to the drug war

• When is it over exactly?

Biological Treatments

• Agonist substitution• Substitute safer drug with similar chemical

composition • Examples – methadone, nicotine gum/ patch

• Antagonistic treatment• Blocks or counteracts pleasurable drug effects• Examples - naltrexone for opiate and alcohol

problems

Biological Treatments

• Aversive treatment• Makes drug use extremely unpleasant• Examples - Antabuse for alcoholism

• Efficacy of biological treatment• Largely ineffective when used alone

Psychosocial Treatment

• Inpatient vs. outpatient care• Comparable efficacy, not cost

• Controlled use (Sobell study)

• Project MATCH• Compared 12 sessions of twelve step

facilitation and CBT, and 4 sessions of motivational enhancement

• No differences in outcome• No control group

Psychosocial Treatment

• Community support programs• Alcoholics Anonymous and related groups• Extremely popular but little evidence of

benefits• From a 2006 literature review: “No

experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-Step approaches for reducing alcohol dependence or problems.”

Interventions

• Confrontation by family and friends

• Element of surprise, often humiliating

• Intended to break down “denial” and persuade client to enter treatment

• Confronts individuals with “cataclysmic consequences” if they do not enter treatment

Interventions

• Miller and Sovereign (1989)• Two groups: 1) confrontational strategies

2) client-centered motivational interviewing

• Clients in confrontational group exhibited MORE resistance to treatment than in client-centered group and were more likely to be drinking a year later

• G. Alan Marlatt, Ph.D: “Once you have the person on board and involved and you have a good continued care program, things will happen in a good way. But if you say, ‘Do this or else,’ you take away a person’s choice and the consequences are negative.”

Analysis of Intervention Programs

• Not empirically supported

• Studies show high rate of entry into treatment

following an Intervention, but:

• High rate of dropout

• Higher relapse following treatment

(Loneck, Garrett, & Banks 1996)