Substance Use PSYC 40111-002
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This 11 page Class Notes was uploaded by Amy Turk on Saturday April 16, 2016. The Class Notes belongs to PSYC 40111-002 at Kent State University taught by Dr. Fresco in Spring 2016. Since its upload, it has received 50 views. For similar materials see Abnormal Psychology in Psychlogy at Kent State University.
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Date Created: 04/16/16
SUBSTANCE USE Alcohol Use in American Culture ● In Colonial America alcohol was viewed positively ○ A gift from God ● Believed to be associated with good health, due to a lack of clean water ○ Alcohol abstainers had to pay life insurance company rates 10% higher than rates of drinkers ● A brewery was one of harvard’s first construction projects so that a steady supply of beer could be served in the student dining halls The Temperance Movement ● 1790 = Benjamin Rush suggests that drunkenness is an uncontrollable disease ○ Alcohol itself begins to be seen as the cause of abuse ○ Many came to view it as “demon run” ● 1830 = the American Temperance Society became the Abstinence Society ○ The only way to prevent drunkenness was to eliminate the consumption of alcohol entirely ○ Any consumption is alcohol abuse The Birth of Alcoholism ● 1849 = Magnus Huss creates “alcoholism” ● 1885 = International conferences devoted to temperance activities, scientific research, and alcohol control policy begin in Antwerp ○ Research tied to the temperance movement ● Women’s Christian Temperance Union ○ 1887 ○ Major force pushing for prohibition Alcohol Prohibition ● After the Harrison Act, the political climate was ripe for alcohol prohibition ○ 1914 law against opium ○ 1920 = Prohibition the “noble experiment” begins, touted as the magical solution to the nation’s crime, violence, and other ills ● Scientific “facts” put forth by the Women’s Christian Temperance ○ Majority of beer drinkers die from dropsy ○ When alcohol passes down the throat it burns off the skin leaving it bare ○ The heart is in danger of giving out after the first dose ■ Has to take drink after drink to keep the heart going ○ Turns the blood to water The End of Prohibition ● 1933 = end ● 1.5 million barrels were consumed during the first 24 hours after ● Was prohibition a failure? ○ Yes, in preventing alcohol use and problems ○ The largest impact was to change the drinking institutions of America ■ Ended the era of saloons ■ Began the era of cocktail lounges and cabarets ■ Drinking became more sophisticated Marijuana Temperance Movement ● Harry Anslinger ○ After alcohol prohibition ended, started a campaign against marijuana ○ Claimed that it led to violence and insanity ○ Reefer madness ● AMA opposed again in 1937 but cannabis was criminalized nonetheless in the Tax Act Post Prohibition Views on Alcoholism ● Focused on the individual rather than the alcohol ● Disease model ○ Alcoholism is a disease like any other ○ Takes blame away from the individual ● Alcoholic personality ○ Alcoholism due to a defect in character The Disease Model ● Alcoholism is a disease and individuals with it must completely abstain from alcohol ● People without the disease can drink with impunity ● Acceptance ○ Late 1930s = gained widespread acceptance ■ With the help of researchers at Yale ○ 1946 = Jellinek put forth theory that only the true alcoholic manifests the inability to drink moderately ○ 1956 = American Medical Association formally endorses the disease model, reinforcing abstinence-only treatment Alcoholic’s Anonymous (AA) ● 1935 = founded by Bill W. and Dr. Bob S ● 1939 = the fellowship published the text “Alcoholics Anonymous” or the “Big Book” ● Dr. Bob was integrally involved in implementing AA in hospital settings where they remain prominent today Research on Prevailing Models of Alcoholism ● Late 1970s = both sides in the debate over controlled-drinking agree that this therapy is inapplicable to physically dependent alcoholics ● Research does, however, support controlled-drinking as the superior treatment to abstinence for less severely alcoholic clients (problem drinkers) Concern Turns to Illicit Drugs ● The 60s and 70s saw the emergence of marijuana as a widely used recreational drug ○ LSD and speed to lesser degrees ○ Associated with the counter culture and protest against the war in Vietnam ● Nixon commissioned a scientific report on marijuana ○ Shafer Commission concluded marijuana was relatively benign ○ Nixon buried his report because it did not support his position Drug Epidemics of Past 30 Years ● Powder cocaine = 80s ● Crack cocaine = 90s ● Crystal Meth and Ecstasy = past 15-20 years ● The most recent epidemic ○ Marijuana ■ Use tripled among 8th graders ■ Use doubled among 10th graders ■ Use nearly doubled among 12th graders ○ MDMA (ecstasy) ■ Use has roughly doubled in all age groups ○ Crack ■ Use nearly doubled ○ Heroin ■ Use doubled to tripled History of DSM Classification ● DSM I = alcohol and drug dependence classified as a subset of sociopathic personality disturbance ○ 1952 ○ The idea of an addictive personality was a popular one in research and clinical practice ● DSM II = diagnosis remained the same ○ 1968 ● DSM III and beyond ○ Substance use disorders became a separate diagnostic category ■ Demoralization of these disorders ■ 1980 ○ Separate criteria for abuse and dependence ■ Very little impact on the treatment of these different diagnostic groups Substance-Related Disorders ● Use vs intoxication ● Abuse vs dependence ● Tolerance vs withdrawal ● Five main categories of substances ○ Depressants = result in behavioral sedation ■ Alcohol ■ Sedative ○ Stimulants = increase alertness and elevate mood ■ Cocaine ■ Nicotine ■ Caffeine ○ Opiates = primarily produce analgesia and euphoria ■ Heroin ■ Morphine ■ Codeine ○ Hallucinogens = alter sensory perception ■ marijuana ■ LSD ○ Other drugs ■ Inhalants ■ Steroids ■ Medications Short-term Actions of Alcohol ● Acts within brain to… ○ Stimulate GABA receptors ■ Reduce tension ○ Increases serotonin levels ■ pleasurable ■ Cravings ○ Inhibits glutamate receptors ■ Cognitive actions ● Tolerance and withdrawal reactions… ○ Anxiety ○ Depression ○ Weakness ○ Inability to sleep ○ Delirium Tremens (DTs) = severe alcohol withdrawal reaction that includes hallucinations ○ Alcohol tolerance is common in alcohol dependence (alcoholism) Long-term Actions of Alcohol ● Alcoholics reduce their food intake when consuming alcohol ○ Alcohol has no nutritional value ○ Impairs food digestion ○ Vitamin deficiency (B-complex) ■ Can lead to brain damage and amnesia ○ associated brain conditions ■ Korsakoff’s syndrome ■ Wernicke’s disease ○ Fetal alcohol syndrome Sedatives, Hypnotics, and Anxiolytics ● The nature of drugs in this class ○ Sedatives = calming ○ Hypnotic = sleep inducing ○ Anxiolytic = anxiety reducing ● Effects of these drugs are similar to large doses of alcohol ● All exert their influence via the GABA neurotransmitter system Stimulants ● Widely consumed ● Increase alertness and energy ● Cocaine ● Nicotine ● Caffeine ● Amphetamines ○ Produce vigor, reduce fatigue ○ Enhance the release of dopamine and norepinephrine, while blocking reuptake ● Ecstasy and Ice ○ Produce effects similar to speed, but without the crash ● Effects of cocaine ○ Produce short lived sensations of vigor, reduce fatigue ○ Effects result from blocking the reuptake of dopamine ● Effects of nicotine ○ Stimulates the central nervous system ○ Results in sensations of relaxation, wellness, and pleasure ● Effects of caffeine ○ Blocks the reuptake of the neurotransmitter adenosine ○ Small doses elevate mood and reduce fatigue ○ Regular use can result in tolerance and dependence Alcohol and Nicotine ● Initial use of both is highly influenced by peers ● Continued use of both is more strongly related to a strong shared genetic influence ● Possible mechanisms for this comorbidity ○ Abusers may have high reactivity to stress which is self-medicated by both substances ○ Smoking may reduce sensitivity to the effects of alcohol, necessitating more drinking for same effect Opioids ● Induce relaxation ● Provide relief from pain ● Opiate = natural chemical in the opium poppy with narcotic effects ● Opioids = refers to a class of natural and synthetic substances with narcotic effects ○ Often referred to as analgesics ■ Heroin ■ Opium ■ Codeine ■ Morphine ● Effects of Opioids ○ Activate body’s enkephalins and endorphins ○ Withdrawal symptoms can be lasting and severe Hallucinogens ● Change the way the user perceives the world ● May produce delusions, paranoia, hallucinations, and altered sensory perception ● Marijuana, LSD, mescaline, ecstasy, and phencyclidine ● Marijuana ○ Dried and crushed leaves of the help plant ○ Results in ■ Relaxation ■ Shifts in attention ■ Impaired memory ○ Active chemical is THC ○ Major signs of withdrawal and dependence do not typically occur ○ Interferes with cognitive function including loss of short-term memory (hippocampus) ○ Pain reduction ● LSD ○ Subjective time is slowed ○ Rapid shifts in mood ○ Effects depend on set and setting ○ Psychotic delusional and hallucinatory symptoms can be problematic ● PCP ○ Cheap, easily available, and often mixed with other substances ○ Behavioral toxicity ● Designer drugs ○ Ecstasy ○ Heighten auditory and visual perception ○ Sense of taste/touch Anabolic Steroids ● Derived or synthesized from testosterone ● Used medicinally or to increase body mass ● Users may engage in cycling or stacking ● Do not produce a high ● Can result in long-term mood disturbances and physical problems Developmental Transitions ● Factors that account for the adolescent transition into alcohol and drug use ● Stress ● Lack of coping skills ● Parental and peer use ● Lack of parental support ● Failure in school ● Acting out behaviors ● Alcohol norms ● Perceived risks of use ● Parental and peer modeling ● Media ● Drug use rarely starts in college Binge Drinking in College ● Increased in the last 10 years ● Drink with lower frequency and in greater quantity ● Most college students mature out of heavy drinking after college ● Developmental transitions ○ Marriage ○ Employment ○ Other adult responsibilities Dispositional Disease Model ● Alcoholism is a unitary disease ○ You have it or you don’t ● Alcoholism is genetic/biological in nature ● Loss of control is the cardinal characteristic ● Alcoholism is irreversible ● Implications of the disease model ○ Moderation is not possible if loss of control is truly a central feature ○ Substance use for the addict is progressive such that abuse will lead to dependence without intervention ○ Confrontation is appropriate because the disease renders them unable to act in their own best interests ● Dependence is relatively chronic ● A significant number of individuals with substance use disorders spontaneously recover ● Abuse rarely progresses to dependence over a 5 year period ● Confrontational approaches have been unsuccessful ● Alternatives… ○ Public health model ■ Agent, host, and environment ■ Not just a clinical problem but a societal problem ○ Free will model ■ Substance use disorders are under the control of the individual ■ Efficacy and motivation for self-change are all that is necessary Family and Genetic Influences ● Genetic differences in alcohol metabolism ● Multiple genes are involved in substance abuse ● Alcoholism as a form of depression ● No differences in heritability of genetic risk for men and women Parental Alcohol Disorder ● Deviance proneness model ○ These children have difficult temperaments and are exposed to poor parenting ■ Low emotional support ■ Low monitoring ○ This leads to distress and failure in school ○ This leads to affiliation with a deviant peer group that encourages alcohol use ● Negative affectivity model ○ These children are temperamentally reactive to stress and experience high levels of stress in their environment ○ Leads to high levels of negative affect ○ Leads to drinking to alleviate negative affect ● Alcohol sensitivity model ○ Children respond psychologically to alcohol in one of two different ways that make it more likely that they will drink excessively ■ They lack sensitivity to alcohol’s intoxicating effects ■ They have a heightened sensitivity to alcohol’s anxiety reducing effects Alcohol and Prevention ● Good family organization ● Daily routines and celebration of holidays ● Feeling close to and loved by at least one parent ● Being treated fairly at school ● Good cognitive coping skills Neurobiological influences ● Drugs affect the pleasure or reward centers in the brain ● The pleasure center…. ○ Dopamine ○ Midbrain ○ Frontal cortex ○ GABA turns off reward-pleasure system ○ Neurotransmitters responsible for anxiety/negative affect may be inhibited Alcohol and Craving ● Many individuals dependent upon alcohol describe feeling a subjective sense of craving (urge to drink) ● Craving is central to understanding loss of control over drinking and relapse ● Appetitive classical conditioning model of craving ○ Neutral stimuli (CS) in the environment (beer, bottle, bar) are repeatedly paired with alcohol UCS and its pleasant associated effects (UCR) ○ Exposure to these stimuli (CS) without consuming alcohol results in craving to experience alcohol’s positive effects (CR) ● Classical conditioning model of craving involving compensatory response/tolerance ○ Neural stimuli (CS… living room, certain emotions) are repeatedly paired with alcohol (UCS) ○ Alcohol consumption leads to physiological changes to counteract the effect of the drug (UCR) ○ Exposure to CS without consuming alcohol results in craving to avoid the physiological changes resulting from the conditioned compensatory response (CR) ● Classical conditioning model of craving involving withdrawal ○ Neutral stimuli (CS… hospital) are paired with abstinence from alcohol (UCS) and its unpleasant associated effects (UCR… sweating) ○ Exposure to the CS results in craving to avoid the unpleasant symptoms of withdrawal that are elicited (CR) Beliefs about Alcohol ● People develop beliefs about alcohol’s effects through ○ Direct experience ○ Media and culture ○ Parents and peers ● These beliefs affect drinking behavior Motivation to Drink ● Mood Enhancement Model = people high in sensation-seeking who believe that alcohol enhances mood will be motivated to drink ● External motivators = enhanced status in certain social groups ○ Avoidance of rejection due to not drinking in certain contexts ● Stress Reduction Model ○ Negative emotions coupled with a belief that alcohol reduces distress and an avoidant coping style for dealing with problems increase motivation to drink to cope with dress Social and Cultural Dimensions ● Exposure to drugs is a prerequisite for use of drugs ○ Media ○ Family ○ Peers ● Societal views about drug abuse ○ Sign of moral weakness = drug abuse is a failure of self-control ○ Sign of a disease = drug abuse is caused by some underlying process ● The role of cultural factors ○ Environment supports and even promotes the use of substances as an escape ○ Poverty An Integrative Model ● Exposure or access to a drug is necessary, but not sufficient ● Drug use depends on social and cultural expectations ● Drugs are used because of their pleasurable effects ● Drugs are abused for reasons that are more complex ○ The premise of equifinality ○ Stress may interact with sociological, genetic, social, and learning factors Biological Treatments ● Agonist substitution ○ Safe drug with similar chemical composition ■ Methadone for heroin ■ Nicotine gum or patch ● Antagonistic treatment ○ Drugs that block or counteract the positive effects of substances ■ Naltrexone for opiate and alcohol problems ● Aversive treatment ○ Drugs that make the injection of abused substances extremely unpleasant ■ Antabuse for alcoholism ■ Silver nitrate for nicotine addiction ● Efficacy of biological treatment ○ Generally not effective when used alone Psychosocial Treatments ● Detoxification ○ Getting alcohol out of the person’s system and seeing him or her through the withdrawal symptoms ○ Inpatient vs. outpatient care ● Community support programs ○ Seem helpful and are strongly encouraged ● Debate over controlled use vs complete abstinence as treatment goals Psychosocial Treatments ● Components of comprehensive treatment and prevention programs ○ Individual and group therapy ○ Aversion therapy and covert sensitization ○ Contingency management ○ Community reinforcement ○ Relapse prevention ○ Preventative efforts via education
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