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Abnormal Psychology Chapter 11 Substance-Related and Addictive Disorders Perspectives on Substance-Related Disorders and Addictive Disorders -Substance-related disorders - Use and abuse of psychoactive substances - Significant impairment - Costs - Polysubstance use - Impulse-control disorders - Inability to resist acting on drives or impulses Perspectives on Substance-Related Disorders and Addictive Disorders - Levels of involvement - Substance use - Substance intoxication - Substance abuse - Substance dependence - Psychoactive substances alter mood, behavior, or both Perspectives on Substance-Related Disorders and Addictive Disorders- Dependence and “addiction” -Tolerance - Withdrawal - “Drug seeking behaviors” Diagnostic Issues - The DSM-5 term substance-related disorders include 11 symptoms that range from relatively mild (e.g., substance use results in a failure to fulfill major role obligations) to more severe (e.g., occupational or recreational activities are given up or reduced because of substance use) - Substance-related disorders and anxiety and mood disorders are highly prevalent Main Categories of Substances - Main categories - Depressants - Stimulants - Opiates - Hallucinogens - Other drugs of abuse - Inhalants - Anabolic steroids - Medications - Gambling disorder Abnormal Psychology Alcohol-Related Disorders - Clinical description - CNS depressant - Inhibitory centers - Global - Neurotransmitter systems - GABA - Glutamate - Serotonin Alcohol-Related Disorders Alcohol-Related Disorders - Effects of chronic alcohol use - Intoxication - Withdrawal - Delirium tremens - Dementia - Wernicke-Korsakoff disorder Alcohol-Related Disorders - Fetal alcohol syndrome (FAS) - Growth retardation - Cognitive deficits - Behavior problems - Facial abnormalities - Role of alcohol dehydrogenase (ADH) - Statistics on Use and Abuse - Use - Most adults: light drinkers or abstainers - Current use = ~50% - Binge drinking = 22.6% - Dependence = 3 million - Males > Females Progression of Alcohol Related Disorders - Spontaneous remission - 20% - Jellinek’s four stage model - prealcoholic stage (drinking occasionally with few serious consequences) - prodromal stage (drinking heavily but with few outward signs of a problem) - crucial stage (loss of control, with occasional binges) - chronic stage (the primary daily activities involve getting and drinking alcohol)  Limited empirical support Progression of Alcohol Related Abnormal Psychology Disorders - Course of dependence = progressive - Course of abuse = variable Alcohol and Violence - Links with aggression - Overlap versus causality Multiple factors - Quantity - Timing - History of violence - Expectations - Consequences Sedative, Hypnotic, or Anxiolytic Related Disorders - Barbiturates - Benzodiazepines - Effects = similar to alcohol - GABA - Synergistic in combination Sedative, Hypnotic, or Anxiolytic Related Disorders Sedative, Hypnotic, or Anxiolytic Related Disorders - DSM criteria - Maladaptive behavior changes - Sexual - Aggressive - Variable moods - Impaired judgment - Impaired function - Physiological effects - Speech - Coordination - Gait Sedative, Hypnotic, or Anxiolytic Related Disorders - Statistics - 1% of people with substance problems - Female - Caucasian - Over the age of 35 Stimulant-Related Disorders - Nature of stimulants - Most widely consumed drug (U.S.) - Increase alertness and energy Abnormal Psychology - Examples: - Amphetamines - MDMA - Cocaine - Nicotine - Caffeine Stimulant-Related Disorders Amphetamine - Effects of amphetamines - “Up” - Elation - Vigor - Reduced fatigue - “Crash” - Extreme fatigue - Depression Amphetamine - DSM criteria - Behavioral symptoms - Changes in sociability - Interpersonal sensitivity - Anxiety, tension, anger - Stereotyped behaviors - Impaired judgment - Impaired function - Physiological symptoms Amphetamine - Designer drugs - MDMA (Ecstasy) - Effects similar to speed - Minimal “comedown” - Methamphetamine - Purified, crystallized form of speed - Longer half-life - Incredible potential for dependence Amphetamine - CNS effects of amphetamines - Significant agonist and reuptake blocking effects - Norepinephrine - Dopamine - Link with hallucinations and delusions Cocaine - Effects of cocaine - Blocks dopamine reuptake - Euphoria Abnormal Psychology - Feelings of power and confidence (short term) - Increased blood pressure/pulse - Insomnia - Decreases appetite - Paranoia Cocaine - Statistics - Worldwide, almost 5% of adults - ER admissions for cocaine - 23% Caucasian males - 29% African American males - 18% Caucasian females - 12% African American females - 17% also used crack cocaine Cocaine - Dependence - Highly addictive -Develops slowly - Tolerance - Atypical withdrawal - Cyclical pattern Tobacco-Related Disorders - Effects of nicotine - Stimulates nicotinic acetylcholine receptors - Sensations of relaxation, wellness, pleasure - Highly addictive - Relapse rates = alcohol and heroin Tobacco-Related Disorders Tobacco-Related Disorders - “Dosing” - Maintain a steady level of nicotine in the bloodstream - Examples: - Before sleep - After waking Tobacco-Related Disorders - Psychological symptoms - Depressed mood - Irritability - Anxiety - Difficulty concentrating - Physiological symptoms - Restlessness - Increased appetite - Weight gain Abnormal Psychology Caffeine Use Disorders - Effects of caffeine - Used by over 90% of Americans - Tea, coffee, cola, and cocoa products - Blocks adenosine reuptake - Small doses - Elevate mood - Reduce fatigue - Regular use - Tolerance - Dependence Caffeine Use Disorders - Withdrawal symptoms - Psychological - Irritability - Unpleasant mood - Physiological - Drowsiness - Headaches Caffeine Use Disorders Opioids - Opioid-related disorders - Nature of opiates and opioids - Opiates - Opioids - Referred to as analgesics - Examples: heroin, opium, codeine, and morphine Opioids - Effects of opioids - Activate enkephalins, beta-endorphins, and dynorphins - Low doses - Euphoria - Drowsiness - Slow breathing - High doses = fatal Opioids - Withdrawal symptoms (6 to 12 hours) - Excessive yawning - Nausea and vomiting - Chills - Muscle aches - Diarrhea - Insomnia - High mortality rates Abnormal Psychology - Increased HIV risk Opioids Cannabis-Related Disorders - Marijuana - Most frequently used drug - Tetrahydrocannabinol (THC) - Variable, individual reactions - Euphoria Mood swings - Paranoia - Hallucinations - Tolerance = questionable Withdrawal and dependence = uncommon -Cannabis-Related Disorders - 5-15% use in western countries - “K2” or “Spice” - Controversy surrounds the use of cannabis for medicinal purposes Cannabis-Related Disorders Hallucinogen-Related Disorders - Nature of hallucinogens - Alter sensory perception - Can produce delusions, paranoia, hallucinations - Examples: marijuana, psilocybin, LSD - Hallucinogens use disorder Hallucinogen-Related Disorders - LSD and other hallucinogens - LSD = most common hallucinogenic drug - Tolerance = rapid - Withdrawal symptoms = uncommon - Intoxication - Altered sensory perceptions - Depersonalization - Hallucinations - Mystical experiences - Many other plant hallucinogens Hallucinogen-Related Disorders - Occurring naturally in a variety of plants: - Psilocybin (found in certain species of mushrooms) - Lysergic acid amide (found in the seeds of the morning glory plant) - Dimethyltryptamine (DMT) (found in the bark of the Virola tree, which grows in South and Central America) - Mescaline (found in the peyote cactus plant) - Phencyclidine (or PCP) Abnormal Psychology Hallucinogen-Related Disorders Other Drugs of Abuse - Nature of inhalants - Found in volatile solvents - Breathed into the lungs directly - Rapid absorption - Examples: spray paint, hair spray, paint thinner, gasoline, nitrous oxide - Effects similar to alcohol intoxication - Produce tolerance and prolonged withdrawal symptoms - Several negative physiological effects Other Drugs of Abuse Anabolic–Androgenic Steroids -Nature of anabolic-androgenic steroids -Derived or synthesized from testosterone - Used medicinally or to increase body mass - No associated high - “Cycling” or “stacking” patterns of use - Long-term mood disturbances - Physical problems Designer Drugs - Dissociative anesthetics and designer drugs - “Club drugs” - Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”), Heightened sensory perception - Popular in nightclubs, raves, or large gatherings - All can produce tolerance and dependence - Gamma-hydroxybutyrate (GHB) Causes of Substance-Related Disorders - Once thought to be moral weakness - Combination of factors - Biological - Psychological Biological Dimensions - Familial and genetic influences - Twin, family, and adoption studies - Use = environmental influences - Abuse and dependence = polygenetic vulnerability Neurobiological Influences - Pleasure or reward centers - Dopaminergic system - Midbrain - ventral tegmental area - Frontal cortex – nucleus accumbens - GABA - Inhibition yields more dopamine activation Abnormal Psychology - Rewards system - Serotonin and norepinephrine - P300 amplitude Neurobiological Influences Psychological Dimensions - Positive reinforcement - Repeated pairings with rewards - Negative reinforcement - Escape from unpleasantness - Self-medication - Tension reduction - Coping mechanism for negative affect Psychological Dimensions - Opponent-process theory - Increase in positive - Increase in negative - Remedy is to use more of same drug Cognitive Factors - Expectancy effects - Beliefs about drugs and effects - Cravings - Cues - Environmental triggers Social Dimensions - Exposure to drugs - Prerequisite for use - Media - Peers - Family - Monitoring - Peer groups - Societal views - Moral weakness - Disease model Cultural Dimensions - Contextual normative framework - Expectations about use in specific culture - Gene-environment interactions - Values of specific culture Treatment of Substance-Related Disorders Biological - National Institute on Drug Abuse recommends 13 Principles of effective treatment for illicit drug abuse Treatment of Substance-Related Disorders Biological Abnormal Psychology Treatment of Substance-Related Disorders Biological - Agonist substitution - Safer drug - Similar chemical composition - Methadone and nicotine gum or patch - Antagonistic treatment - Block or counteract pleasurable effects - Naltrexone for opiate and alcohol Treatment of Substance-Related Disorders Biological - Aversive treatment - Make use of drugs extremely unpleasant - Antabuse for alcoholism Treatment of Substance-Related Disorders Biological - Medications - Cope with withdrawal symptoms - Efficacy - Limited when used alone - Better with psychosocial therapy - Other biological approaches - Clonidine - Benzodiazepines Treatment of Substance-Related Disorders Biological Treatment of Substance-Related Disorders Psychosocial - Inpatient facilities - Expensive - Efficacy is equal to outpatient - Alcoholics anonymous (12 step) - Most popular - Social support - Limited research - Effective for highly motivated Treatment of Substance-Related Disorders Psychosocial Treatment of Substance-Related Disorders Psychosocial - Controlled use - Controlled drinking - Moderation - Possible benefits - Limited research Abnormal Psychology Treatment of Substance-Related Disorders Psychosocial - Component treatment - Comprehensive - Individual and group therapy - Aversion therapy - Covert sensitization - Contingency management Treatment of Substance-Related Disorders Psychosocial - Community reinforcement - Involvement of collateral -Behavioral analysis -Antecedents and consequences - Social service assistance - New recreational activities Treatment of Substance-Related Disorders Psychosocial Relapse prevention - Learned aspects of dependence - Address distorted cognitions - Identify negative consequences - Increase motivation to change - Identify high risk situations - Reframe relapse - failure of coping skills, not person Treatment of Substance-Related Disorders Psychosocial - Prevention approaches - Education-based (DARE) - Limited efficacy - Comprehensive (skills training) - Promising preliminary results - Cultural change - Media Gambling Disorder - Pathological gambling - 1.9% of adult Americans - Biological influences - Poor impulse regulation - Dopamine - Serotonin - Treatment - Similar to substance dependence Gambling Disorder Impulse-Control Disorders Abnormal Psychology - DSM-5 - Intermittent explosive disorder - Kleptomania - Pyromania - Commonalities - Increased tension/anxiety before - Relief after - Social and occupational impairment Impulse-Control Disorders - Intermittent explosive disorder - Frequent aggressive outbursts - Injury and/or destruction of property - Biological - Serotonin, norepinephrine, testosterone - Psychosocial - Stress, disrupted family life, parenting CBT is most promising treatment Impulse-Control Disorders - Kleptomania - Failure to resist urge to steal unnecessary items - High comorbidities - Mood disorders - Substance abuse & dependence - Treatments - Behavioral interventions - Antidepressants Impulse-control Disorders - Pyromania - Irresistible urge to set fires - 3% of arsonists - Little etiological and treatment research - CBT Chapter 12 Personality Disorders An Overview Personality Disorders - Personality disorders - A persistent pattern of emotions, cognitions and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships Abnormal Psychology An Overview Personality Disorders - High comorbidity - Poorer prognosis - Therapist reactions - Countertransference - 10 specific personality disorders - 3 clusters Categorical and Dimensional Models - Categorical vs. dimensional models - “Kind” vs. “Degree” - Dimensions instead of categories - By a dimensional model individuals would not only be given categorical diagnoses but also would be rated on a series of personality dimensions - “Emerging measures and models” Categorical and Dimensional Models - Five factor model of personality (“Big Five”) - Openness to experience - Conscientiousness - Extraversion - Agreeableness - Emotional stability - Cross-cultural research establishes the universal nature of the five dimensions Personality Disorder Clusters - Cluster A - Odd or eccentric - Paranoid, schizoid, schizotypal - Cluster B - Dramatic, emotional, erratic - Antisocial, borderline, histrionic, narcissistic Personality Disorder Clusters - Cluster C - Fearful or anxious - Avoidant, dependent, obsessive-compulsive Personality Disorder Clusters Statistics and Development - Prevalence = 6%, may be closer to 10% - Origins and course - Begin in childhood --Chronic course -Can remit but is replaced by other personality disorder -High comorbidity Abnormal Psychology Statistics and Development Gender Differences - Men diagnosed with a personality disorder tend to display traits characterized as more - Aggressive, structured, self-assertive and detached - Women tend to present with characteristics that are - More submissive, emotional and insecure Gender Differences - Clinician bias - Assessment bias - Criterion gender bias - Histrionic = extreme “stereotypical female” - No “macho” disorder - Ford and Widiger (1889) Comorbidity - Comorbidity - Personality disorders- 10% Personality Disorders Under Study - Categories of disorders - Sadistic - Passive aggressive Personality Disorders Under Study Personality Disorders Under Study -Cluster A: Paranoid Clinical description - Mistrust and suspicion - Pervasive - Unjustified - Few meaningful relationships - Volatile - Tense - Sensitive to criticism Cluster A: Paranoid - Causes - Possible relationship to schizophrenia - Possible role of early experience - Trauma - Learning - People are malevolent and deceptive - Cultural factors - Prisoners - refugees - people with hearing impairments - older adults Abnormal Psychology Cluster A: Paranoid - Treatment - Unlikely to seek on own - Crisis - Focus on developing trust - Cognitive therapy - Assumptions - No empirically-supported treatments - Poor improvement rate Cluster A: Paranoid Cluster A: Schizoid - Clinical description - Appear to neither enjoy nor desire relationships - Loner --Limited range of emotions -Appear cold, detached -Appear unaffected by praise, criticism - Unable or unwilling to express emotion - No thought disorder Cluster A: Schizoid - Causes - Limited research - Precursor: childhood shyness - Possibly related to: - Abuse/neglect - Autism -Cluster A: Schizoid - Treatment Unlikely to seek on own - Crisis - Focus on relationships - Social skills therapy - Empathy training - Role playing - Social network building - Empirically-supported treatments limited- Cluster A: Schizoid - Cluster A: Schizoid Cluster A: Schizotypal - Clinical description - Psychotic-like symptoms - Magical thinking - Ideas of reference - Illusions - Odd and/or unusual - Behavior Abnormal Psychology - Appearance - Socially isolated - Suspicious Cluster A: Schizotypal - Causes - Schizophrenia phenotype - Lack full biological or environmental contributions - Cognitive impairments - Left hemisphere - More generalized Cluster A: Schizotypal - Treatment - Treatment of comorbid depression 30 – 50% - Multidimensional approach - Social skill training - Antipsychotic medications - Community treatment Cluster A: Schizotypal Cluster B: Antisocial - Clinical description - Noncompliance with social norms - “Social Predators” - Violate rights of others - Irresponsible - Impulsive - Deceitful - Lack a conscience, empathy, and remorse Cluster B: Antisocial - Nature of psychopathy - Glibness/superficial charm - Grandiose sense of self-worth - Pathological lying - Conning/manipulative - Lack of remorse - Callous/lack of empathy Cluster B: Antisocial - DSM-5 - More trait based approach - Overlap with ASPD, criminality - Intelligence -Cluster B: Antisocial - Developmental considerations Early histories of behavioral problems - Conduct disorder - childhood-onset type Abnormal Psychology - adolescent-onset type - Families history of: - Inconsistent parental discipline - Variable support - Criminality - Violence Cluster B: Antisocial Causes of Antisocial Personality - Gene-environment interaction - Genetic predisposition - Environmental triggers - Arousal hypotheses - Underarousal - Fearlessness Causes of Antisocial Personality - Gray’s model of brain functioning - Behavioral inhibition system (BIS) - Low - Reward system High - Fight/flight system Causes of Antisocial Personality - Interactive, integrative model - Genetic vulnerability - Neurotransmitters - Environmental factors - Family stress and dysfunction - Reinforcement of antisocial behaviors - Alienation from good role models - Poor occupational/social function Antisocial Personality Disorder - Treatment - Unlikely to seek on own - High recidivism - Incarceration - Early intervention - Prevention - Parent training - Rewards for pro-social behaviors - Skills training - Improve social competence Cluster B: Borderline - Clinical description -1 – 2% of population - Patterns of instability - Intense moods Abnormal Psychology - Turbulent relationships - Impulsivity - Very poor self-image - Self-mutilation - Suicidal gestures Cluster B: Borderline Cluster B: Borderline - Comorbid disorders - Depression – 20% - Suicide – 6% - Bipolar – 40% - Substance abuse – 67% - Eating disorders - 25% of bulimics have BPD Cluster B: Borderline - Causes - Genetic/biological components - Serotonin - Limbic network - Cognitive biases - Early childhood experience - Neglect - Trauma - Abuse - An Integrative Model Cluster B: Borderline - Treatment - Highly likely to seek treatment - Antidepressant medications - Dialectical behavior therapy - Reduce “interfering” behaviors - Self-harm - Treatment - Quality of life - Outcomes Cluster B: Histrionic - Clinical description - Center of attention - Sexually provocative - Shallow shifting emotions - Physical appearance-focused - Impressionistic - Overly dramatic - Suggestible - Misinterprets relationships Abnormal Psychology Cluster B: Histrionic Cluster B: Histrionic - Causes - Little research - Links with antisocial personality - Sex-typed alternative expression Cluster B: Histrionic - Treatment - Problematic interpersonal relationships - Attention seeking - Long-term consequences of behavior - Little empirical support Cluster B: Narcissistic - Clinical description - Exaggerated and unreasonable sense of selfimportance - Grandiosity - Require attention - Lack sensitivity and compassion - Sensitive to criticism - Envious - Arrogant Cluster B: Narcissistic Cluster B: Narcissistic - Causes - Deficits in early childhood learning - Altruism - Empathy - Sociological view - Increased individual focus - “Me generation” Cluster B: Narcissistic - Treatment focuses on: - Grandiosity - Lack of empathy - Hypersensitivity to evaluation - Co-occurring depression - Little empirical support Cluster C: Avoidant - Clinical description - Extreme sensitivity to opinions - Avoid most relationships - Interpersonally anxious - Fearful of rejection Cluster C: Avoidant Cluster C: Avoidant -Causes - Schizophrenia-related disorders - Difficult temperament Abnormal Psychology - Early parental rejection - Interpersonal isolation and conflict Cluster C: Avoidant - Treatment - Similar to social phobia - Increase social skills - Therapeutic alliance - Moderate empirical support Cluster C: Dependent - Clinical description - Rely on others for major and minor decisions - Unreasonable fear of abandonment - Clingy - Submissive - Timid - Passive - Feelings of inadequacy - Sensitivity to criticism - High need for reassurance Cluster C: Dependent Cluster C: Dependent - Causes - Little research - Early experience - Death of a parent - Rejection by caregiver - Attachment - Genetic influences Cluster C: Dependent - Treatment - Limited empirical support - Caution: dependence on therapist - Gradual increases in: - Independence - Personal responsibility - Confidence Cluster C: Obsessive-Compulsive - Clinical description - Fixation on doing things the “right way” - Rigid - Perfectionistic - Orderly - Preoccupation with details - Poor interpersonal relationships - Obsessions and compulsions are rare Abnormal Psychology Cluster C: Obsessive-Compulsive Cluster C: Obsessive-Compulsive - Causes - Limited research - Weak genetic contributions - Predisposed to favor structure Cluster C: Obsessive-Compulsive - Treatment - Similar to OCD - Address fears related to the need for orderliness - Limited efficacy data