PSYC 3230 Abnormal Psychology Cyterski Exam 2 Reading Notes UGA
PSYC 3230 Abnormal Psychology Cyterski Exam 2 Reading Notes UGA Psych 3230
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Chapter 10: Substance Abuse and Addictive Disorders 1962 – 4 million people in the US had ever used marijuana, cocaine, heroin or another illegal substance Today – 94 million 24% of all high school seniors have used an illegal drug within the last month Drug: any substance that affects our bodies or minds Hallucinosis: perceptual distortions and hallucinations Substance Use Disorders: patterns of maladaptive behaviors and reactions brought about by repeated use of a substance, sometimes also including tolerance for the substance and withdrawal symptoms o Sufferers may come to crave a substance and/or rely on it excessively o Tolerance: the adjustment that the brain and body make to the regular use of certain drugs so that even larger doses are needed to achieve the earlier effects or “same high” o Withdrawal: unpleasant, sometimes dangerous, reactions that may occur when people who use a drug regularly stop taking or reduce their usage of a drug Cramps, anxiety attacks, sweating, nausea etc. In any given year, 8.9% of teens and adults display substance abuse disorders o Highest rate found among American Indians o Lowest rate found among Asians Only 11% of people with substance abuse disorders receive treatment from a mental health professional 10.1 Depressant Substances Slow the activity of the central nervous system Reduce tension and inhibitions, judgement, motor activity and concentration 10.1.1 Alcohol Alcohol: any beverage containing ethyl alcohol—including beer, wine and liquor Binge-drinking: consuming 5 or more drinks on a single occasion o 24% of people in the US binge drink every month Males outnumber females in what is considered being “heavy drinkers” (binge drinking 5+ times per month Alcohol slows the CNS by binding to certain neurons o GABBA carries an inhibitory message, alcohol helps GABBA shut down neurotransmitters, so the drinker relaxes Alcohol first depresses the areas of the brain that control judgement and inhibition, then makes speech less careful/less clear, weakens memory, heightens emotions With continued consumption, motor difficulties arise, reaction times slow, vision blurs, sense of hearing weakens Size of person and gender affect absorption o women have less alcohol-dehydrogenase and are more likely to become intoxicated than men from equal doses of alcohol BAC levels o 0.06 – drinker becomes relaxed o 0.09 – drinker becomes intoxicated o 0.55> – death 1,000+ people die each year due to a dangerously high BAC Effects of alcohol subside after body has broken down, or metabolized, by the liver (a rate of 25% of an ounce/hr) Alcohol Use Disorder Alcohol is one of the most dangerous recreational drugs 41% of high schoolers drink alcohol monthly, 3% report drinking every day 7.4% of adults over a one year period display alcohol use disorder 13% of adults display alcohol use disorder in their lifetime Rates are higher generally among men and American Indians, lower among women and Asians Clinical Picture Generally, people with alcohol use disorder consume large amounts of alcohol, regularly, and rely on it quite heavily Eventually alcoholism interferes with their personal lives—family, friends, work etc. MRI studies of alcoholic’s brains show damage to various areas of the brain o Resulting in corresponding short-term memory impairment, reduced thinking speed, reduced attention skills and poor balance People vary individually in patterns of alcoholism Tolerance and Withdrawal People with alcohol use disorder often experience symptoms of withdrawal and tolerance o Needing more and more alcohol to feel the effects o Shakes, sweating, increased blood pressure etc. when they stop drinking Delirium Tremens (“the DT’s”): dramatic withdrawal reactions—confusion, clouded consciousness, terrifying visual hallucinations, begin within 3 days of when a person stops/reduces drinking, usually run their course in 2-3 days o People who experience DT’s may also experience seizures, lose consciousness, have a stroke, or die What is the Personal and Social Impact of Alcoholism? Destroys families, social relationships, careers Medical treatment, lost productivity of workers, and losses due to deaths can cost billions every year Plays significant role in crime rates and car accidents o 12,000 deaths a year from drunk driving Home life for children of alcoholics is likely to have a lot of conflict and include some sort of abuse o Children of alcoholics present with lower self-esteem, poor communication skills, poor social skills and marital problems in adulthood Health complications o Long term, excessive drinking can also cause cirrhosis: condition where liver is overworked and becomes scarred and dysfunctional Cirrhosis accounts for 29,000+ deaths a year o Korsakoff’s Syndrome: alcohol related disorder and a vitamin B deficiency, marked by confusion, memory impairment and other neurological symptoms Sufferers cannot remember the past, learn new information May fill in gaps by confabulating: reciting made-up events o College campus binge-drinking 40% of students binge drink one a year+ 83% of campus arrests are alcohol related “the No. 1 public health hazard” for full-time college students o Fetal Alcohol Syndrome: caused by alcohol use during pregnancy, causing low birth weight, irregularities in the development of hands and face, intellectual deficits, heart defects and hyperactivity 1 out of 1,000 babies born a year have fetal alcohol syndrome Heavy drinking during pregnancy can also lead to miscarriage 10.1.2 Sedative-Hypnotic Drugs Sedative-Hypnotic/Anxiolytic Drugs: drugs used in low dozes to calm and reduce anxiety and in higher doses to help people sleep This category includes barbiturates and benzodiazepines Barbiturates First discovered in Germany, more than 100 years ago Barbiturates: one group of sedative-hypnotic drugs that help reduce anxiety and produce sleep Largely replaced by benzodiazepines which are generally safer Several thousand accidental/suicidal overdoses a year Available in pill or capsule Works the same way as alcohol—binds to GABBA to help inhibit neurons o People can become intoxicated on barbiturates just like alcohol Sedative-Hypnotic Use Disorder: similar to alcohol use disorder, just centered around barbiturates o Users spend much of the day intoxicated, irritable, non-productive o Lethal dose does not increase as tolerance builds o Withdrawals are similar to alcohol withdrawals, can also include convulsions Benzodiazepines Benzodiazepines: most common group of antianxiety drugs, includes valium, ativan and Xanax Bind to GABBA to reduce neural activity Reduce anxiety without drowsiness Less likely to slow breathing less likely to cause death in an overdose Can still become addictive 10.1.3 Opioids Opioid: opium or any of the drugs derived from opium, including morphine, heroin and codeine Derived from poppy seeds 65% purer and stronger today compared to 5% pure just 3 decades ago All variations of opium were considered to be safe after their development, but all lead to particularly addictive patterns, thereby reducing how commonly they are used Opium: highly addictive substance made from the sap of the opium poppy seed Morphine: derived from opium, highly effective in relieving pain (1804) o “soldier’s misuse”: nickname given to morphine misuse—used to be so widely used that tons of soldiers during the Civil War received morphine injections for battle wounds Heroin: addictive substance derived from opium, pain reliever (1898) 1917—US congress passed laws making all opioids illegal except for medical purposes All drugs, synthetic (methadone) and natural, derived from opium are collectively called narcotics Narcotics can be smoked, inhaled, snorted, injected under the skin (“skin- popping”) or into veins o Injection is most common—provides the user a “rush” Opioids depress the CNS, particularly emotion centers Attach to receptor sites for endorphins, tricking the brain into producing constant feelings of euphoria Can cause nausea, narrowing of the pupils and constipation Opioid Use Disorder Cause by repeated ingestion for just a few weeks Severe social and occupational function disruption Tolerance builds quickly and withdrawals are common o After extended use, withdrawals can also include severe twitching, weight loss (of up to 15 lbs.) and high blood pressure o Withdrawals usually peak by day 3 and disappear by day 8 An estimated 400,000 people in the US are currently addicted to opioids What are the Dangers of Opioid Use? Immediate danger is overdose—closes down respiratory function areas of the brain, often causing death (especially during sleep) Often mixed with cheaper drugs or things like battery acid or cyanide Dirty needles pose threat of AIDS, hepatitis C, and skin abscesses 10.2 Stimulant Substances Stimulants increase the activity of the central nervous system o Raise blood pressure and heart rate o Heightened alertness o Speed up behavior and thinking 10.2.1 Cocaine Cocaine: addictive stimulant obtained from the coca plant, most powerful natural stimulant known 1865—drug first separated from the plan Processed, cocaine in an odorless, white, fluffy powder o Most often snorted, can be smoked or injected Originally thought to be generally safe other than possibility of intoxication or temporary psychosis Using brings a euphoric rush of well-being and confidence, can be “almost orgasmic” Stimulates higher centers of CNS, increasing excitement, energy, making users more talkative Stimulates other parts of CNS—increased heart rate, higher blood pressure, faster/deeper breathing, increased arousal and wakefulness Increases dopamine activity in the brain that overstimulates the neurons o Also increases norepinephrine and serotonin in some areas of the brain Peak high occurs about 5 minutes after injection Cocaine Intoxication: High doses of cocaine, symptoms include poor muscle coordination, grandiosity, anger, aggression, compulsive behavior, bad judgement, anxiety and confusion, and even hallucinations or delusions “Crashing” from a cocaine high induces a depression-like state that subsides within around 24 hours for occasional users and may include fainting, dizziness and headaches o extended use = extended crash o higher doses may cause a deep sleep or coma during crash Ingesting Cocaine cocaine used to be extremely expensive, which curtailed its use o ingested by snorting—less powerful than smoking or injecting 1984—newer, more powerful, cheaper ways to ingest coke came around o Free-basing: pure cocaine basic alkaloid is chemically separated from the processed cocaine, vaporized and fumes are inhaled o Crack: powerful, ready-to-smoke form of freebase cocaine, cocaine is boiled down into crystalline balls, then smoked in a pipe What are the Dangers of Cocaine? Harmful effects on behavior, cognition, and emotion Physical dangers o Overdose—excessive doses have serious effects on respiratory centers of the brain, at first stimulating and then depressing them, which can stop breathing o Can cause major heard irregularities and seizures o When used during pregnancy, cocaine can cause immune functioning abnormalities, attention and learning deficits, abnormal thyroid size, and dopamine/serotonin activity dysfunction in the brain of babies 10.2.2 Amphetamines Amphetamines: stimulant drugs that are manufactured in a library First produced in the 1930’s to help treat asthma o Soon became used for weight loss, an extra burst of energy for athletes, soldiers, truck drivers and pilots to stay awake and students studying for exams Tobacco, Nicotine and Addiction o ~34% of Americans 11 years old and up regularly smoke tobacco o 19% of all American high schoolers have smoked tobacco in the last month o 440,000 people die each year in the US as a result of smoking More than 1,000 people a day o Nicotine – active substance in tobacco that is a stimulant to the CNS, is as addictive as heroin o Nicotine acts on the same neurotransmitters and reward center as amphetamines and cocaine o Aversion therapy for smoking— (behavioral therapy) smoking a whole pack very quickly in a controlled environment until the smoker feels ill, thus associating feeling ill with smoking o Nicotine Gum/Nicotine Patches—(biological therapy) ways of weening a smoker off of their addiction to nicotine Some antidepressants can be used to help ween smokers off of nicotine o Quit-lines: telephone based support programs that offer counseling and access to biological treatments o Past-smoker’s risk of disease and death decreases steadily the longer they avoid smoking Amphetamines are most often taken in a pill or capsule form, though some people do inject them or smoke them for quicker effects Increase energy, alertness, reduce appetite in small doses, produce psychosis and intoxication in high doses Increase activity of dopamine, serotonin and norepinephrine throughout the brain Makes people feel hypersexual and also uninhibited, leading to a higher risk of contracting HIV Methamphetamine (“crank”): a powerful amphetamine dug that has experienced a surge in popularity in recent years o 0.2 percent of people use meth currently in the US o Crystal form (“ice” / “crystal meth”) is smoked o Most meth in the US is made in small “stovetop laboratories” which typically operate in a remote location and move to a new place every few days – think Breaking Bad Labs are extremely dangerous, producing dangerous fumes and residue o Methamphetamine popularity is on the rise since 1989 o Men and women are equally likely to use—~40% of current users are women o Common in biker gangs, rural Americans, urban gay communities, and “rave” settings o Prolonged use damages nerve endings 10.2.3 Stimulant Use Disorder Caffeine is the most widely used stimulant in the world—about 80% of the world’s population consumes it daily Stimulant Use Disorder: when a certain stimulant comes to dominate a person’s like, and the person may remain under the drug’s effects for most of each day and also function poorly socially/professionally Regular stimulant use may cause short-term memory and attention problems Tolerance and withdrawal reactions may develop o Withdrawal symptoms may last weeks or even months after stopping use 10.3 Hallucinogens, Cannabis and Combinations of Substances Hallucinogens produce delusions, hallucinations and other sensory changes Cannabis produces sensory changes, depressant effects and stimulant effects Some people consume combinations of different substances 10.3.1 Hallucinogens Hallucinogen: substances that cause powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations o Also called psychedelic drugs o A high on hallucinogens is called a “trip” Can be exciting OR frightening LSD, mescaline, psilocybin and MDMA are all hallucinogens o Some are natural, some are produced in a lab LSD (lysergic acid diethylamide): a hallucinogenic drug derived from ergot alkaloids o Developed by a Swiss chemist, became popular in the 1960’s o Within two hours of ingestion, LSD brings on a state of hallucinogen intoxication (or hallucinosis) General strengthening of perceptions (particularly visual) as well as psychological and physical changes People may focus on small details—individual blades of grass or skin pores Colors may be enhanced or take on a shade pf purple Objects may appear to move, breathe or speak Hearing sounds more clearly Numbness or tingling in the legs, confuse hot and cold sensations May cause synesthesia: the mixing or confusion of different senses Can cause extreme emotions, slowing of the perception of time Sweating, palpitations, blurred vision, poor coordination o Trips last around 6 hours o LSD binds to some serotonin receptor sites (at visual and emotional control sites) and changing serotonin activity at those sites o People don’t usually develop a tolerance or experience withdrawal symptoms o Flashbacks: a recurrence of the sensory and emotional changes experienced after ingesting LSD that may occur days or months after the drug has left their system MDMA o Popular “club drug” that has been around since 1910 but gained popularity in the last 25 years or so o Stimulant and hallucinogen o Can cause significant memory impairment o Can cause anxiety, depression, sleep difficulties and paranoia that can last weeks after ingestion o Muscle tension, nausea, high blood pressure, extended periods of time of clenching/grinding teeth o Reduced sweat production—can cause a heat stroke or hypothermia Some people try to avoid this by drinking a lot of water, but the body can’t expel excess water and can slip into “water intoxication” or hyponatremia o Damages liver o Rapidly increases then decreases the release of serotonin and dopamine in the brain and interferes with the ability to produce new serotonin Extended use can reduce the brains ability to produce serotonin at all 10.3.2 Cannabis Cannabis: drug produced by the hemp plant that causes a mixture of hallucinogenic, depressant and stimulant effects Marijuana: one of several cannabis drugs, derived from buds, leaves and flowering tops of the hemp plant Hashish: most powerful form of a cannabis drug Tetrahydrocannabinol (THC): the main active ingredient in cannabis Strength depends on the climate the plant is grown in, how it is prepared and the manner/duration of its storage When smoked, cannabis produces a mixture of hallucinogenic, depressant and stimulant effects Low doses: smoker feels relaxed, joy, may become either quiet or talkative Some smokers become anxious, irritable, and suspicious Some smokers report heightened senses and a slower perception of time, with distances and sizes seeming larger than they actually are Physical symptoms: reddening of eyes, fast heartbeat, increased appetite dry mouth, dizziness and drowsiness In high doses, cannabis may produce hallucinations or changes in body image o Smokers may become confused/impulsive o Paranoia High lasts 2-6 hours Cannabis Use Disorder Until 1970’s, there was no such thing as cannabis use disorder ~1.7% of people have displayed this disorder in the last year and between 4% and 5% develop cannabis use disorder at some point in their lives Why is cannabis use disorder more common now? Because marijuana of today is at least 4x more powerful than that of the early 1970’s (THC content is now around 8% compared to 2% before) because it is now grown in hot, dry climates Is Marijuana Dangerous? Increased THC levels can result in panic reactions that typically last for 3-6 hours Marijuana interferes with sensorimotor tasks and cognitive functioning, making the risk of automobile accidents higher Can inhibit ability to recall learned information Prolonged use can affect the blood flow of brain arteries, may contribute to lung disease o Studies show that smoking weed reduces the lungs ability to expel air even more than smoking tobacco does May cause lower sperm counts and abnormal ovulation Cannabis and Society: A Rocky Relationship Marijuana has been used and respected in the medical field for over 2,000 years 1980’s—THC was first extracted from the plant in a laboratory, reinventing how the medical field uses it but people started campaigning for legalized medical use of marijuana as it acts faster than laboratory-produced THC capsules Gov’t resisted, ongoing battle today 10.3.3 Combinations of Substances Polysubstance Use: a pattern of taking more than one drug at a time Synergistic Effect: an increase of effects that occurs when more than one substance is acting on the body at the same time o When two drugs have similar effects (ex. alcohol and opioids) and are taken even in very small doses, their effects can be enormously multiplied (extreme depression of the CNS/intoxication, coma or even death) o When drugs have opposite or antagonistic actions (i.e. when taking a stimulant and a depressant) the stimulant interferes with the liver’s ability to process the depressant, which could result in a lethal buildup of depressant drugs in the body As many as 90% of people who use one illegal drug are also using another to some extent 10.4 What Causes Substance Use Disorders? No single explanation has gained broad support, but is usually viewed as a combination of factors 10.4.1 Sociocultural Views People that live in especially stressful socioeconomic conditions are more likely to develop substance use disorders Poorer people have a higher instance of substance use disorders than wealthier people Unemployed people have a higher rate of substance use disorders than employed people o 17% of unemployed people o 8% of full-time employed people o 11.5% of part-time employed people Substance use disorders are more likely to appear in social situations where substance abuse is accepted or even valued lower among protestants and Jews and higher among the Irish and eastern Europeans 10.4.2 Psychodynamic Views idea that people with substance use disorders have powerful dependency needs that can be traced back to childhood o parents failed to satisfy child’s need to be nurtured theory of a substance abuse personality that can be identified in personality inventories o tendency to be more dependent, antisocial, impulsive, novelty seeking and depressive o these are only correlations, no causational data has been discovered, though several studies have linked impulsive behavior to a later development of alcoholism in animals and humans o major weakness: sooo many personality traits have been “linked” as “key” traits to the development of alcoholism that researchers don’t seem to agree on any of them 10.4.3 Cognitive-Behavioral Views idea that operant conditioning may play a role in the development of substance use disorders temporary reduction in tension or stimulation of a drug produces a rewarding effect, reinforcing its use substance expectancy: expectance that the use of a substance will be rewarding which may motivate individuals to increase use during times of stress (basically to “self-medicate”) o studies show people do, in fact, consume more substances during times of tension o After working on a difficult anagram, participants were asked to participate in an “alcohol taste test.” Participants that were unfairly criticized during the anagram task drank more than those who weren’t 22% of individuals who suffer from a psychological disorder have displayed substance abuse disorders in the last year Classical conditioning may also play a role in the development of substance use disorders o Objects present in the environment at the time of drug use may act as a stimuli that produces the same feelings later on Sight of a needle, drug buddy or regular supplier has been known to help reduce withdrawal symptoms for heroin addicts 10.4.4 Biological Views Genetic Predisposition Breeding experiments have been conducted for years to try to identify a genetic predisposition for alcoholism o Typically, animals that prefer alcohol that are bred produce offspring that prefers alcohol as well o Research on human twins also suggests that people may inherit a predisposition to alcoholism Identical twins are more likely to both be either alcoholic or not alcoholics than fraternal twins Again, this data is correlational and does not necessarily provide evidence for causation o Studies on adopted children Children adopted by non-alcoholic parents from alcoholic biological parents show a higher instance of alcoholism in adulthood Genetic linkage studies and molecular biology techniques provide more direct evidence of a possible genetic predisposition existing o Abnormal form of dopamine-2 receptor gene is found in a majority of alcoholics but in less than 20% of non-alcoholic research participants o Other studies have linked other genes in a similar way to alcoholism Biochemical Factors When a drug that is ingested increases the activity of certain neurotransmitters whose normal purpose is to cam, reduce pain, lift mood or increase alertness, on a regular/prolonged basis, the brain apparently stops producing that neurotransmitter on its own—explains tolerance o As more of the drug is ingested, the brain produces less, creating a need for more and more of drug to get same effects o Withdrawal symptoms persist until the brain resumes normal production of the neurotransmitter o Which neurotransmitter that is effected depends on the drug being ingested Benzodiazepines—GABBA Opioids—endorphins Amphetamines—dopamine THC—anandamide Some brain imaging studies suggest that many (maybe all) drugs activate a reward center or “pleasure pathway,” which could be why they are so addictive o Reward center: a dopamine rich pathway in the brain that produces feelings of pleasure when activated o Some drugs (cocaine and amphetamines) stimulate dopamine production directly, others (alcohol, opioids, marijuana) set of chemical reactions that eventually, indirectly, stimulate dopamine production o Further studies show that after being repeatedly stimulated by substances, these reward centers become hypersensitive to the substances Reward-Deficiency Syndrome: a condition, suspected to be present in some individuals, where the brain’s reward centers are not readily activated by usual events in their lives, do they turn to drugs for the same stimulation that people with normally functioning reward centers receive naturally o Dopamine-2 receptor gene has been cited as a cause for this condition 10.5 How are Substance Use Disorders Treated? Sometimes, treatment for substance use disorders are very successful, but they are usually only moderately helpful Inpatient, outpatient, or a combination Most common form of treatment: self-help groups 10.5.1 Psychodynamic Therapies Typically, psychodynamic theorists guide their clients to uncover and work through underlying needs and conflicts that are believed to have led to substance use disorder Has not been found to be particularly effective o Typically more effective when used in combination with other treatments It may be that though underlying problems may have caused addiction, that it becomes its own problem and must be directly treated in order for sufferers to become drug free 10.5.2 Behavioral Therapies Aversion Therapy: a treatment in which clients are repeatedly presented with an unpleasant stimuli while performing undesirable behaviors, such as taking a drug. After repeated pairings, they are expected to react negatively to the substance and lose their craving for it o Based on the principles of classical conditioning o Aversion therapy for alcoholism often pairs drug induced nausea or vomiting after alcohol consumption, or imagining extremely repulsive or upsetting scenes while drinking (imagining maggots in your beer) Contingency Management: incentives/rewards that are contingent on the submission of drug-free urine o Effective in the short run Behavioral treatments have limited success when used alone 10.5.3 Cognitive-Behavioral Therapies These therapies help clients identify and change their behaviors and cognitions that contribute to continuing their patters of substance misuse and develop more effective coping skills Relapse-prevention Training: treatment where alcoholics are taught to keep track of their drinking behavior, apply coping strategies in situations that typically trigger excessive drinking and plan ahead for risky situations and reactions o Goal is to gain control over substance use behaviors, identify high risk situations, change their dysfunctional lifestyles and learn from mistakes/relapses Strategies used in relapse-prevention training o Therapists have clients keep track of drinking behaviors Writing down time, location, emotions, bodily changes etc. o Therapists teach clients alternative coping strategies Spacing drinks or sipping them slower Relaxation techniques o Therapists teach clients to plan ahead of time Predetermined # of drinks that is appropriate, what to drink, under what circumstances to drink Relapse-prevention training has been found to lower the frequency of intoxication and binge-drinking in some individuals Young drinkers with low tolerance and no withdrawals tend to do best with this treatment 10.5.4 Biological Treatments Various goals of biological treatments: help people withdraw, abstain from use, maintain level of use without increasing Rarely bring long term improvement on their own Detoxification Detoxification: systematic and medically supervised withdrawal from a drug Some detox programs are offered in hospitals, others in outpatient clinics (along with individual/group therapy options—a “full service” institutional approach) Two detox approaches o Gradually withdraw by taking smaller and smaller doses of a drug o Give clients other drugs that reduce the symptoms of withdrawals (usually medically preferred) Antianxiety drugs can reduce delirium tremens and seizures Relapse is high among people who fail to get some sort of follow-up treatment Antagonist Drugs Antagonist drugs: drugs that block or change the effects of an addictive drug o Given as an aid to resisting temptation o Antabuse—given to people trying to stay away from alcohol Produces intense nausea and vomiting when person on Antabuse ingests alcohol Most helpful with people who are motivated to change their habits o Narcotic antagonists are used for opioid addicts (naloxone)—they attach to endorphin receptor sites, making opioid ingestion ineffective in boosting the consumer’s mood Must be prescribed very carefully because they can put people into withdrawal overdrive Drug Maintenance Therapy Methadone Maintenance Program: an approach to treating heroin- centered substance abuse in which clients are given legally and medically supervised doses of a substitute drug, methadone Methadone is used as a substitute drug for heroin addicts People then become addicted to methadone but it is a controlled and supervised addiction to a drug taken orally, once a day Many addicts claim that a methadone addiction is not a solution, but only another complication to their already complex addiction problems Methadone can be harder wo withdraw from (withdrawals last longer) New interest has been sparked in recent years as a reaction to the spreading of HIV as it eliminates the need for needles o Many methadone programs include AIDS education This treatment is most effective when used in combination with other therapies (education, psychotherapy, family therapy and employment counseling) 10.5.5 Sociocultural Therapies Self-Help and Residential Treatment Programs Self-help movement dates back to 1935 o Alcoholics Anonymous (AA): A self-help organization that provides support and guidance for persons with alcoholism o Peer support along with moral and spiritual guidelines o Idea that participants must stop drinking completely AA directly opposes the controlled-drinking approach in relapse prevention training Abstinence vs controlled drinking is an issue that has been debated for years o Research shows that both approaches can be helpful depending on the nature of the drinking problem Abstinence may be best for long-standing alcoholism problems where controlled drinking may be more effective in young drinkers (where tolerance and withdrawals are not present) Residential Treatment Centers or Therapeutic Communities: a place where formerly addicted persons live, work and socialize in a drug free environment while undergoing individual, group and family therapies and making a transition back to community life o Ex. Daytop Village and Phoenix House Individual testimonials provides most support for self-help programs o Limited studies done Culture-Sensitive and Gender-Sensitive Programs Treatment programs developed recently are sometimes built to be more sensitive to participants who are poor, homeless and/or members of a minority group Therapists that are more sensitive to their client’s specific life challenges can do more to address the stressors that will likely lead to relapse There are also programs that focus on the gender differences in treatment, like physical and psychological reactions to medications, pregnancy and childrearing Community Prevention Programs First drug-prevention programs were conducted in schools Now offered in work-places, community centers and even through the media o Around 77% of adolescents have reported seeing/hearing a substance abuse prevention message in the last year Prevention programs may focus on the individual (education about negative side effects), the family (teaching parenting skills), a peer group (by teaching peer pressure resistance), a school (setting up enforcement of drug policies), or the community at large Two of the leading prevention programs o TheTruth.com o Above the Influence 10.6 Other Addictive Disorders The DSM-5 has significantly broadened the scope of diagnosable addictive disorders 10.6.1 Gambling Disorder Gambling Disorder: a disorder marked by persistent and recurrent gambling behavior, leading to a range of life problems o 2.3% of adults and 3-8% of teenagers Clinicians must be careful to distinguish social gambling from gambling disorder Time or money spent on gambling is less of a factor than whether the behavior has an addictive nature Sufferers are preoccupied with gambling, typically cannot walk away from a bet and may lie to cover up gambling Gambling continues even in the face of social, occupational, educational or health problems Gambling is typically more common when the individual is distressed Increasing amounts of money to gamble with are typically needed need achieve the same level of excitement and sufferers may feel restless and irritable when they try to stop gambling Causes: similar to those of substance use disorders…. o An inheritance of a genetic predisposition to develop the disorder o The presence of experience heightened dopamine activity and operation of the brain’s reward center o A tendency towards impulsive, novelty-seeking behaviors (among other personality traits) o Repeated cognitive mistakes such as misjudging or inaccurate expectations of their emotions and bodily states Several substance use disorder treatments have been adapted to treat gambling disorder o Cognitive-behavioral approaches—relapse-prevention training o Biological approaches—narcotic agonists o Self-help programs exist—Gambler’s Anonymous (attendees of GA groups seem to have a heightened recovery rate) 10.6.2 Internet Use Gaming Disorder: Awaiting Official Status Internet Use Disorder or Internet Addiction or Problematic Internet Use: an uncontrollable need to be online At least 1% of all people Sufferers spend most of their waking hours online—shopping, tweeting, browsing, emailing, gaming, watching porn etc. Symptoms are similar to substance use disorder symptoms—loss of outside interest, possible withdrawal reactions, unintentional sacrifice of their jobs, social relationships or education Suggested treatments range from psychotropic drugs to cognitive behavioral therapies o Self-help groups meet---some even meet online DSM-5 has recommended that internet use gaming disorder receive further research and could possibly be included in the next addition Internet Use Gaming Disorder: a disorder marked by persistent, recurring and excessive internet activity, particularly gaming Chapter 11: Disorders of Sex and Gender Sexual feelings are crucial to development and daily functioning and is tied to our basic needs Two general kinds of sexual disorders: sexual dysfunctions and paraphilic disorders DSM-5 now includes gender dysphoria 11.1 Sexual Dysfunctions Sexual Dysfunctions: a disorder marked by a persistent inability to function normally in some area of the sexual response cycle 31% of men and 43% of women Typically very distressing and may lead to frustration, guilt, and loss of self-esteem May patients that experience one dysfunction often experience another Sexual cycle o Four phases Desire Excitement Orgasm Resolution – relaxation and reduction in arousal that follows an organism o Sexual dysfunctions typically affect one or more of the first 3 phases of the sexual cycle o Normal sexual cycle for males vs females 11.1.1 Disorders of Desire Desire phase: the phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies and sexual attraction Two main disorders of the desire phase: male hypoactive sexual desire disorder and female sexual interest/arousal disorder Male Hypoactive Sexual Desire Disorder: a male dysfunction marked by a persistent reduction in interest in sex and hence a low level of sexual activity o When these men do have sex, their responses may be normal and it may even be an enjoyable experience for them o Found in as many as 16% of men Female Sexual Interest/Arousal Disorder: a female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity o Overlaps the desire/excitement phases as the two overlap a lot in women o As many as 33% of women Sex drive is determined by a combination of biological, psychological, and sociocultural factors Biological Causes of Low Sexual Desire High levels of prolactin can reduce sex drives in men and women Low testosterone can reduce sex drive Especially high OR low levels of estrogen can reduce sex drive o Birth control can affect sex drive Long term illness may reduce sex drive, indirectly and/or directly Certain pain medications, psychotropic drugs and illegal drugs (cocaine, marijuana, amphetamines and heroin) can also reduce sex drive Low BAC may increase sex drive due to lowered inhibitions but high BAC may reduce sex drive Psychological Causes of Low Sexual Desire Anxiety, depression, anger may reduce sex drive in men and women People with low sexual desire often have particular attitudes, fears or memories that contribute to their sexual dysfunction o Some people are so afraid that they will lose control over their sexual urges that they resist them completely o Some people fear pregnancy Some psychological disorders may also contribute to a low sex drive o Depression o OCD—contact with another person’s bodily fluids is not pleasant Sociocultural causes of Low Sexual Desire Attitudes/fears/psychological disorders that contribute to low sex drives often appear in social settings Situational pressures can reduce sex drive: divorce, death in the family, job stress, relationship problems (unhappiness, loss of affection, feeling dominated in a relationship), infertility problems If one person in a happy relationship is an unskilled or unenthusiastic lover, the other may lose interest in sex Societal views o Beauty is often equated with a certain body shape or youthfulness, people may lose sexual interest in each other/themselves with age or weight gain Sexual abuse victims may have low sex drives 11.1.2 Disorders of Excitement Excitement Phase: the phase of the sexual response cycle marked by changes in the pelvic region, general physical arousal and increases in heart rate, muscle tension, blood pressure and rate of breathing In men: blood pools in the pelvis, causing an erection In women: clitoris and labia swell and vaginal lubrication appears Erectile Disorder Erectile Disorder: a dysfunction in which a man persistently fails to attain or maintain an erection during sexual activity, disrupts the excitement phase only Can affect up to 10% of the general male population Most men are 50+ years old (many cases are associated with other ailments/diseases of older adults) According to surveys, 50% of men experience erectile dysfunction at some times Biological Causes Same hormonal balance that can cause hypoactive sexual desire disorder can cause erectile dysfunction (ED) Vascular problems are more commonly the cause of ED o Heart disease, clogged arteries Nervous system damage can also cause ED o Diabetes, spinal cord injuries, MS, kidney failures, dialysis Certain medications and substance abuse can also cause ED Medical procedures have been developed to diagnose ED o Nocturnal Penile Tumescence (NPT): erection during REM sleep Healthy men may have several erections throughout the night Abnormal or absent nightly erections may indicate a physical rather than psychological cause for ED Electronic ways to test this, older test involved a “snap band” – broken band indicated erections in the night, unbroken indicated to erections o Viagra is often prescribed to patients with ED without much evaluation of their problem Psychological Causes Any causes of male hypoactive sexual desire disorder can also lead to ED 90% of men suffering from severe depression experience some degree of erectile dysfunction Cognitive-Behavioral theories: William Masters and Virginia Johnson (1970) o Performance Anxiety: the fear of performing inadequately and a related tension experienced during sex o Spectator Role: a state of mind that some people experience during sex, focusing on their sexual performance to such an extent that their performance and enjoyment are reduced No longer a participant in the sexual encounter, becomes an observer and judge, which prolongs the problem of erectile dysfunction Sociocultural Causes Job loss, financial stress, marital stress etc. Two common relationship patterns: o Wife doesn’t provide enough physical stimulation for her aging husband who (because of normal aging processes) requires more intense, direct and lengthy stimulation for erection to occur o A couple believes that only intercourse can give the woman an orgasm, thus increasing the pressure on the man to get an erection (orgasm can be reached manually or orally, thus reducing pressure and likelihood of erectile dysfunction) 11.1.3 Disorders of Orgasm Orgasm Phase: the phase of the sexual cycle during which an individual’s sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically o In men: semen is ejaculated o In women: the outer 1/3 of the vaginal wall contracts Early Ejaculation Early/Premature/Rapid Ejaculation: a dysfunction in which a man persistently reaches orgasm and ejaculates within one minute of beginning sexual activity with a partner and before he wishes to As many as 30% of men in the united states experience this dysfunction at some time o Commonly experienced by younger men Most supported explanations are psychological and behavioral o Sexually unexperienced men o Hurried masturbation experiences o Poor recognition of one’s own sexual arousal Three biological theories have emerged but have limited investigations into them o A genetic predisposition o Underactive and overactive serotonin receptors in the brains of men who suffer from early ejaculation o Greater sensitivity/nerve conduction in the penis Delayed Ejaculation Delayed Ejaculation: a male dysfunction characterized by persistent inability to ejaculate or very delayed ejaculations during sexual activity with a partner o Previously called male orgasmic disorder or inhibited male orgasm) o Occurs in 8% of the male population o Typically causes a great deal of distress Potential causes: o Low testosterone o Certain neurological diseases o Some head and spinal injuries o Substances that slow the sympathetic nervous system (alcohol, some blood pressure medications, some psychotropic medications) o Serotonin-enhancing antidepressants effect ejaculation in around 30% of men who take them o Masturbation habits—if a man is used to masturbating with sheets or pillows etc. he may not become aroused enough to ejaculate without those sensations Leading causes seem to be performance anxiety and spectator role Female Orgasmic Disorder Female Orgasmic Disorder: a dysfunction in which a woman persistently fails to reach orgasm, experiences orgasms of low intensity or has very delayed orgasms As many as 24% of women have this problem to some degree o More than 1/3 of post-menopausal women o 10% of women have never had an orgasm More common among single women than married women or women living with a partner Biological Causes Nerve damage caused by diabetes MS and other neurological diseases The same drugs that interfere with male ejaculation Post-menopausal changes in skin/sensitivity of the clitoris, vaginal walls or labia Psychological Causes Psychological causes of female sexual arousal/interest disorder may also cause female orgasmic disorder Depression Childhood traumas/relationships Sociocultural Causes Overly strict upbringings, childhood punishment for masturbation, “nice girl’s don’t” Particularly stressful events that produce negative memories or attitudes regardless of sexually restrictive history Studies show that the likelihood of reaching orgasm may be tied to the emotional involvement a woman had during her first experience of intercourse and how long that relationship lasted 11.1.4 Disorders of Sexual Pain Genito-Pelvic Pain/Penetration Disorder: a sexual dysfunction disorder characterized by significant physical discomfort during intercourse Experienced by women much more often than men Vaginismus: involuntary muscle contractions around the outer third of the vagina, when prevents penile entry to the vagina o Occurs in fewer than 1% of all women o These women enjoy sex and can reach orgasm through clitoral stimulation but fear the discomfort of penetration Most clinicians agree with the cognitive-behavioral approach to these disorders—that they are a learned fear response and expectation that sex will be painful o Anxiety/ignorance about intercourse o Unskilled lover who forces himself into a woman not yet aroused o Childhood sexual abuse or adult rape Can also have biological causes o Vaginosis, UTI o Herpes simplex o Physical effects of menopause Dyspareunia: severe vaginal or pelvic pain during intercourse that is not caused by involuntary muscle contractions o As many as 14% of women suffer to some degree from this problem o Sufferers enjoy sex and can get aroused but their sexual activity is limited by their pain o Usually caused by injury to the vaginal muscles during childbirth ~16% of women experience sexual pain for up to a year after giving birth o Can also be caused by penis colliding with remaining part of hymen, wiry pubic hair, tumors, cysts, allergic reactions to chemicals in creams or condoms or the protein in semen Psychological factors may, to some degree, contribute to this problem, but are rarely the sole cause o Heightened anxiety or relationship problems o Could be the result of actually having female sexual interest/arousal disorder and the insertion of an unaroused, unlubricated vagina is painful Around 3% of men qualify for a diagnoses of genito-pelvic pain/penetration disorder due to genital pain during intercourse 11.2 Treatments for Sexual Dysfunctions Leading approach in the first half of the 20 century was psychodynamic therapy o Clinicians assumed sexual dysfunction was a result of not developing properly through the psychosexual stages of development o Free association and therapist interpretation was used widely o Psychodynamic therapy was typically unsuccessful The 1950s and 1960s brought about new treatment for sexual dysfunctions o Goal was to reduce fears believed to be causing dysfunction o Relaxation training and systematic desensitization o These approaches had some success, but not in cases where the problem was misinformation, negative attitude or lack of effective sexual technique Publication of William Masters and Virginia Johnson’s book, Human Sexual Inadequacy (1970), revolutionized the treatment of sexual disorders o Sex therapy model was introduced Includes parts of various models (particularly cognitive- behavioral), couple and family systems therapies, and drug therapies 11.2.2 What Techniques are applied to Particular Dysfunctions? Disorders of Desire Male Hypoactive Sexual Desire Disorder and Female Sexual Arousal/Interest Disorder are the most difficult sexual dysfunctions to treat because they have many causal factors Affectual Awareness: patients visualize sexual scenes in order to discover any feelings of anxiety, vulnerability or other negative emotions they have about sex Self-instruction Training: technique where client is taught to replace their negative statements during sex with positive statements Clients may be instructed to keep “desire diaries” to record sexual thoughts and feelings May be encouraged to read erotic books or view erotic films or fantasize about sex Pleasurable shared activities (dancing or walking together) are encouraged Patient may be encouraged to remember/talk about/work through an experience of sexual abuse/assault until the memories no longer elicit fear Few controlled studies have been done Hormone treatments have also been used in treating disorders of desire, especially in women Erectile Disorder Treatments for ED focus on reducing the man’s performance anxiety, increasing stimulation, or both Tease Technique: used during sensate-focus exercises, woman keeps caressing the man but if he gets an erection, she stops until he loses it, thus reducing the pressure to perform every time he gets and erection Couples may be instructed to use manual or oral sex to bring woman to orgasm, thus reducing pressure to perform Viagra is prescribed to induce erections by increasing blood flow to the penis o Viagra appears to be safe except for men with some heart conditions/on some heart medications (nitroglycerin in particular) o Viagra/Cialis/Levitra effectively restore erections in 75% of the men who take them “second line” treatments (used before Viagra came around)are still used when there are health complications from taking Viagra or it is ineffective o Gel suppositories, drug injections into the penis, vacuum erection devices Early Ejaculation Commonly treated with behavioral therapies Stop-Start Approach: the penis is manually stimulated until aroused, the couple them pauses until arousal subsides and then stimulation is resumed, occurring several times before the stimulation leads to ejaculation (eventually practiced with vaginal penetration) Some clinicians treat early ejaculation with SSRI’s, as they reduce sexual arousal o Studies shoe these drugs to be an effective early ejaculation treatment Delayed Ejaculation Techniques designed to reduce performance anxiety and increase stimulation Man may be asked to masturbate in the presence of his partner to orgasm or to insert penis into the vagina just before ejaculation o As time goes on, man is instructed to insert the penis at even earlier stages of masturbation When the cause of delayed reaction is physical, drug therapies may be used to increase arousal of the sympathetic nervous system Female Orgasmic Disorder Treatments include cognitive-behavioral techniques, self-exploration, enhancement of bodily awareness and directed masturbation training Treatments are especially effective for women that have never had an orgasm before Biological treatments (Viagra) but research doesn’t show that they are helpful Directed Masturbation Training: a sex therapy approach that teaches women with female arousal or orgasmic disorders how to masturbate effectively and eventually reach orgasm during sexual encounters o Diagrams/reading material, private self-stimulation, sensate focus, sexual positions that provide clitoral stimulation o Over 90% of patients learn to orgasm during masturbation o About 80% during caressing by their partners o About 30% during intercourse Genito-Pelvic Pain/Penetration Disorder Treatment for involuntary muscle spasms (vaginismus) typically include two approaches o Woman practicing tightening and relaxing her vaginal muscles until she gains more voluntary control of them o Gradual exposure treatment to overcome fear of penetration o Most women treated this way eventually have pain-free intercourse Botox injections into the vaginal muscles have also been tried with no systematic research into its success Pain management procedures may be tried Medical treatments (topical creams to surgery) are sometimes used in combination with other treatments Experts agree a team of medical professionals is the most effective way to treat genito-pelvic pain/penetration disorder 11.2.3 What are the Current Trends in Sex Therapy? Today’s sex therapists now treat couples who are living together but not married Sexual dysfunctions that arise from psychological disorders (depression, mania, schizophrenia etc.) are now treated Severe marital discord, elderly, medically ill, physically handicapped and gay clients are no longer denied treatment Therapists are starting to pay more attention to hypersexuality/sexual addiction Therapists are beginning to raise concerns about the wild rise in prescription drugs and medical interventions used for sexual dysfunctions 11.3 Paraphilic Disorders Paraphilias: patterns in which individuals have recurrent and intense sexual urges, fantasies, or behaviors involving nonhuman objects, children, nonconsenting adults or experiences of suffering/humiliation Some people with paraphilic disorders can ONLY become aroused when a paraphilic stimulus is present, fantasized about or acted out Others only need a paraphilic stimulus during times of stress People whose paraphilias involve nonconsenting adults or children often come to the attention of others as a result of inappropriate actions Paraphilic Disorder: when a person’s paraphilia causes great distress, interferes with social or occupational activities OR places the individual or others at risk of harm, either currently or in the past There is currently little evidence to support the various proposed explanations for paraphilic behaviors nor is there much research support for the various treatments currently employed Some practitioners use antiandrogens to lower the production of testosterone and reduce the sex drives of patients with paraphilic disorders o This can disrupt normal sexual behavior and create a new problem to treat o Typically only employed with paraphilic behaviors are dangerous SSRI’s are also being used to treat paraphilic disorders to reduce compulsive behaviors related to their paraphilias and lower sexual arousal 11.3.1 Fetishistic Disorder Fetishistic Disorder: a paraphilic disorder consisting of recurrent and intense sexual urges, fantasies or behaviors that involve the use of a nonliving object or non-genital body parts, often to the exclusion of all other stimuli Begins in adolescence Far more common in men than women Objects may be stolen, touched, smeller, worn or used in some other way while the p
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