Abnormal Notes Week 7
Abnormal Notes Week 7 PSYC 3560
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This 9 page Class Notes was uploaded by Ashlyn Masters on Friday March 4, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 19 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 03/04/16
Alcohol Use Disorders 3/1/16 History • Substance: any natural or synthesized product with psychoactive effects o Changes perceptions, thoughts, emotions, behaviors • Use: the ingestion of psychoactive drugs or substances in moderate amounts that do not interfere with functioning o Not a disorder! o Use does not equal abuse • Made from the fermentation of carbohydrates o Fermented in every culture on earth at some point in time • Oldest evidence of consumption of all drugs • Beers and wines since about 6400 BC o Berries, apples and honey • Early use for spiritual ceremonies • First brewery in Egypt 3700 BC • In the US o Was condoned to point of drunkenness o Illegal in 1920s due to 18 amendment st th o 21 repealed 18 in 1933 • Forms o Naturally fermented (14%) § Beer § Wine § Mead o Distilled (up to 95%) § Whiskey (40%) § Gin (40%) § Vodka (40%) § Tequila (40%) § Everclear (95%) o Proof: British army used “proof” as a measure of concentration • Pharmacology • Alcohol is soluble in both water and fat and diffuses easily across al membranes • Most absorption takes place in the stomach and upper intestinal tract (30-90 minutes for full absorption) • iClicker: what is the volume of a “standard drink” of beer (3.2% ABV) à 12oz • Standard drink (that’s what the lines on a red solo cup delineate) o Beer – 12oz (3.2% ABV) o Wine – 5oz (12% ABV) o Liquor – 1.5oz (40% ABV) • Concentration-Effect relationship o 0.02-0.03 per standard drink (very loose estimate) Prevalence • 2013 NSDUH survey o Criteria § Binge use – 5 or more drinks on the same occasion on at least 1 day in the past 30 § Heavy use – five or more drinks on the same occasion on each of 5 or more days in the past 30 • Use amongst persons aged 12 or older o 52.2% - reported being current drinkers o 23% - reported participating in binge drinking at least once in a 30 day period o 6.3% - reported heavy drinking • Young adults aged 18-25 o Males – 62.3% current drinkers o Females – 56.9% current drinkers • White people tend to drink the most Negative Outcomes • Yearly costs in US o $300 billion overall ($71 billion direct costs) o 22,000 deaths + 2,000,000 injuries o 4,600,000 damaged vehicles o 15% - 25% healthcare budget § 90% of liver disease § 72% of pancreatitis § 41% of seizure disorders § 13% of breast cancers • Negative Health Effects o Exacerbates ulcers o Can cause cancer o Liver disease (fatty liver, fibrosis, cirrhosis) o Cardio Vascular disease o Accidents and violence • Positive health benefits o Protective against CVD – increases HDL o Stress inoculation? o Bone mineral density o How much is to drink for these good benefits § Men – 3 or less/day § Women – 2 or less/day § Never more than 5 • College Student drinking o Prevalence of periodic heavy or high-risk drinking is greatest among young adults aged 18-24m whether they are in college, the military or the workforce o About 5,000 underage drinkers die per year, 1700 are college students o Perceived vs. Actual Norms § Often, actual alcohol use differs significant from perceived alcohol use § Individuals believe others use alcohol much more than they do • Alcohol Consequences o Variety of consequences o In addition, can also lead to dangerous situations, such as drunk driving § Driving after any alcohol (national vs. Auburn) à 23.9% vs. 34.4% § Driving after 5+ drinks (national vs. Auburn) à 2.8% vs. 9.4% o School work and other obligations § 33% neglected responsibilities § 26% not able o Interpersonal relationships o Dangerous situations § 61% were a passenger in a car with a driver who may have been over the legal limit § 49% have driven when they were over the legal limit o Signs of alcohol dependence Abuse/Dependence • DSM-5: substance use disorder o 2 or more of the following in the past 12 months § Substance used more than intended § Unsuccessful quit attempts § Time consuming § Cravings for substance § Failure to fulfill important obligations § Continued use despite social problems § Giving up other activities § Repeated use in dangerous situations § Tolerance § Withdrawal o Includes severity specifiers § Mild (2-3 symptoms) § Moderate (4-5 symptoms) § Severe (6+ symptoms) • Biological Causal Factors o Although there are genetic influences, precise relationships are not well understood o Gene-environment interaction? o Learning plays an important role § Must be exposed to the substance (parental use, peer pressure, etc.) • Psychosocial Causal Factors o Parenting § Lack of stable family relationships and parental guidance § Lack of monitoring § Chaotic environments § Family involvement and parental modeling can serve as a protective factor even when other risk factors are present • Sociocultural Factors o Social events in western culture often revolve around alcohol o Incidence of alcoholism is minimal among Muslims and Mormons, whose religious views prohibit the use of alcohol o The incidence of alcoholism is high among Europeans (15% in France) Treatment • Brief Motivational Interventions • 12-step programs • Cognitive-behavioral therapy o Teach stress coping mechanisms o Teach how to avoid alcohol situations o Reinforced abstinence § Random, frequent testing § Reinforcers delivered for alcohol free tests o Teach responsible drinking § Teach BAC discrimination § Teach slowed drinking • Motivational interviewing o Based on stages of change model o Focuses on 4 strategies (O.A.R.S.) § Open ended questions § Affirmations – acknowledge difficulties client experiences § Reflective listening (repeating, rephrasing, paraphrasing, or reflection of feeling) § Summarize o Four principles § Express empathy § Develop discrepancy § Roll with resistance § Support self-efficacy • Medical treatment o Antabuse (disulfiram) § Blocks alcohol dehydrogenase, therefore preventing the breakdown of alcohol § Causes the buildup of acetaldehyde, which causes an immediate “hangover” § Can last up to 30 minutes o Naltrexone § Blocks reward receptors § Can be taken daily or as a monthly injection o Harm reduction § Abstinence is not a goal for everyone § Focuses on reducing harms associated with alcohol consumptions § Reorienting individuals on how to drink while minimizing risk for negative outcomes § Recognizes that drinking is going to happen, and focuses on teaching an individual how to drink in a safe manner • Tips for maintaining positive aspects of drinking o Be sure you know what you’re drinking § A standard drink isn’t always what you get § A mixed drink can contain up to 4oz of liquor o Think about how drinking impacts other life areas § Academics § Health § Relationships o How does drinking relate to your long-term goals? o How else could you spend the time you currently spend drinking and recovering? o Don’t drink on an empty stomach o Drink slowly o Plan your night in advance and decide how many drinks you can handle o Be safe about where you drink and who you drink with o Don’t drink and drive o Aspirin and Acetaminophen impair your body’s ability to process the metabolic chemical that gives you a hangover § Hydration is key Drug Use Disorders 3/3/16 DSM-5 Recap • Same general diagnostic criteria across substances (including alcohol) o BUT withdrawal symptoms vary widely among substance categories • Prevalence • Likely underestimated • 2009 study found that 7 million Americans met lifetime criteria for a drug use disorder • Higher among adolescents/young adults 4 major categories of substances • Sedatives/anti-anxiety o Alcohol o Barbiturates o Benzodiazepines o Inhalants • Stimulants o Cocaine § Effects • Euphoria, alertness, confidence, excitement • Headache, dizziness, restlessness • Chronic use often leads to psychosis • Tolerance, withdrawal • Secondary health risks (e.g., damage to nasal passage) § o Amphetamines o Nicotine § Highly addictive, protracted withdrawal syndrome § Cigarette smoking • 400,000 deaths in the US per year § 63% of women and 53% of men have never smoked § Current use – other factors • Education o No high school – 33.6% o High school graduate – 27.7% o Some college – 25.5% o College graduate – 11.2% • Employment o Unemployed – 40% o Part time or full time – 23% § o Caffeine § Normal vs. Abnormal • 80-90% of Americans use caffeine regularly § But, can lead to unpleasant symptoms § Caffeine use disorder added in DSM-5 • Withdrawal = headache, drowsiness, depressed mood, trouble concentrating, flu-like symptoms o >200mg caffeine can lead to withdrawal o Daily usage: <600mg by FDA • § • Opiates o Heroin, morphine • Hallucinogens (includes cannabis) o Don’t usually “create” sensory images but distort them § Lysergic Acid Diethylamide (LSD) • Very potent hallucinogen • Results in about 8 hours of… o Change in sensory perception o Mood swings o Feelings of depersonalization and detachment o Trips and flashbacks • § MDMA (Ecstasy) • Hallucinogenic and stimulant properties • Tablets vary widely in strength, and often contain other drugs • Rush, feeling of calm energy/well-being, intensified feelings, colors, sounds • Empathy, sensation of understanding/accepting others • Nausea, sweating, clenched teeth, muscle cramps, blurred vision • Memory impairment and depression indicated, yet long- term effects unknown § Cannabis (marijuana, hashish) • Hallucinogenic effects less extreme • Effects: o Mild euphoria, sense of well-being, pleasant relaxation o Intensification of senses, distorted sense of time o Short-term memory deficits o Higher doses can lead to talkativeness, hilarity or anxiety and depression o Lethargy, passivity, functional impairment • Two main subspecies of marijuana o Cannabis indica § Physical high • Strong analgesic effect • Couch-locking § Origin: Morocco, Afghanistan, Nepal, Turkey § Size: shorter plants (3ft) o Cannabis sativa § Mental high • Increased creativity § Origin: Colombia, Mexico, Thailand, African nations § Size: taller plants (6ft) o • Cannabis controversy o For legalization § Medicinal marijuana § Prohibition doesn’t stop consumers from consuming drugs § No risk of overdose or extremely impaired judgment § Collapse in the illegal drug industry, and a reduction in crimes § Make money off of taxes ($53 million in CO) o Driving while intoxicated o Correlates such as low achievement o “Gateway drug” o Memory impairment with regular use • § Psilocybin (mushrooms) § Phencyclidine (PCP) § Ketamine (Special K) o • Illicit Substance Treatment o Approaches/components § Detoxification § Motivation building (often involves feedback) § Cognitive-behavioral therapy § Relapse prevention § Group therapy, support groups (e.g., NA) § Medications, replacement therapies (e.g., methadone, nicotine patch) o Treatment drop-out and relapse rates generally high
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