Most Americans use some form of psychoactive drugs, which are substances
that alter psychological state
Legal drugs can be as harmful as illegal drugs
Psychoactive drugs can be very helpful
Some drugs are part of social and religious rituals
Drugs have become major focus of social concern
In many cases more than one drug is used
The Nature of Substance Dependence and Abuse
Clear and consistent terminology does not exist for discussing
drug abuse
Physiological need and psychological need were differentiated
Addiction refers to state when body requires drug in
order to feel normal
Psychological dependence refers to user's tendency to center
life on the drug
All psychoactive drugs have both physiological and psychological
effects that cannot be separated
Distinction between substance dependence and substance abuse hinges
on way person uses drug and problems the person experiences as result
of drug use.
Substance dependence must meet three of several criteria
Preoccupation with drug
Unintentional overuse
Tolerance--the usual dose no longer produces desired effect
Withdrawal--when drug level is reduced, psychological and
physical disruptions occur
Persistent desire or efforts to control drug use
Abandonment of important social, occupational, or recreational
activities
Continued drug use despite serious drug-related problems
Substance abuse refers to drug-use pattern that has not progressed
to dependence and meets one of several criteria
Recurrent, drug-related failure to fulfill major role obligations
Recurrent drug use in physically dangerous situations
Drug-related legal problems
Continued drug use despite social or interpersonal problems
Alcohol Dependence
Alcohol is most widely used of all psychoactive drugs
Can be purchased legally in most parts of United States
The Social Cost of Alcohol Problems
Impossible to calculate social cost of alcohol problems
Easier to calculate monetary cost of alcohol problems
Decreased work productivity cost $70 billion
Treatment and support services for alcoholics cost $20 billion
Alcohol-related automobile accidents cost $13.8 billion in
1994
Effects of alcohol dependent on blood alcohol level
Blood alcohol level expressed in terms of amount of alcohol
in relation to specific volume of blood
Gender differences seen in blood alcohol level
Blood alcohol level of 0.10% considered to be intoxication;
as level rises, impairments increase
Most men killed in accidents were drunk at the time
Relationship exists between bad driving record and alcohol
abuse; alcohol increases likelihood of injuries on job
The Personal Cost of Alcohol Dependence
The Immediate Effects of Alcohol
Alcohol is depressant
Initial effect of alcohol may be to stimulate rather than
to depress
Changes in mood and social behavior
Changes in judgment
Actual changes are related to expectations regarding effects
of alcohol and to context in which drinking occurs.
The Long-Term Effects of Alcohol Abuse
Alcohol often used to cope with stress
Abuse can cause problems that lead to more stress and more
drinking
Physical problems can occur, such as cirrhosis of the liver,
malnutrition, Korsakoff's psychosis
Delirium tremens are rare and are part of withdrawal
The Development of Alcohol Dependence
There is variability in development of dependence
Dependence typically develops slowly, through social drinking,
blackouts, sneaking drinks, and morning drinking
Most dependents experience trouble stopping themselves once
they start drinking and go on sprees and benders
Groups at Risk for Alcohol Abuse and Dependence
Different groups have different patterns of alcohol consumption
Gender
Men are more involved with alcohol than women
There are gender differences in the patterns of use and
abuse
It is unclear if these differences reflect social role
or biological differences
Race, Ethnicity, and Religion
There are racial differences, but they are often confounded
by age and gender
There are ethnic patterns of alcohol use and abuse; gender
and age also influence patterns
Native Americans are especially at risk, and risk may
be related to cultural norms, destruction of their way of
life, and poverty
Religion also related to alcohol abuse, with conservative
Protestants very resistant to alcohol problems
Catholics have high percentage of alcohol use and abuse
Age
Adults are drinking less, young people drinking more
Almost half of all college students binge drink
Advertisement and mixed messages may play role
Treatment of Alcohol Dependence
Treatment of alcohol dependence begins with detoxification,
which is getting alcohol out of person's system and getting him/her
through withdrawal
Detoxification can take place at home, under outpatient care,
or in the hospital
Multimodal Treatments
Effective multimodal treatments include occupational therapy,
relaxation training, group and individual therapy, family
and marital therapy, and job counseling
May include Antabuse, which interferes with metabolic
processing of alcohol causing unpleasant reactions; patient
may stop taking drug
Support Groups: Alcoholic Anonymous
Social support provides reminder that help is available
Most widely known is Alcoholics Anonymous (AA)
AA: once an alcoholic, always an alcoholic
AA: an alcoholic can never go back to normal drinking
Regular meetings, sponsor system, and Twelve Steps are
important to recovery
AA has extremely high dropout rate; those who stay with
it do get better
Those who are highly motivated, most confident, and
most active in coping likely to continue and benefit
Outpatient and Brief Treatments
Residential, outpatient, and day-hospitals expanding
Appears to be no difference in relapse between inpatient
and outpatient programs
Brief treatments such as motivational interviewing
increases motivation of person to change; follows several
principles; FRAMES describes treatment process
Relapse Prevention
Relapse prevention important since most alcoholics
who stop drinking eventually relapse
Relapse prevention approach has created treatment programs
for addictions often used in conjunction with other models
of treatment
Relapse begins with high-risk situations that generate
internal reactions
Effective coping skills protect person from relapse
Abstinence violation effect causes slips to turn into
relapse
Matching
Treatment may be more effective by matching where
patients are directed to programs that best fit their characteristics
Motivation level, demographics, intelligence, severity
of abuse are used in matching patients to programs
Project MATCH's results question matching
Nicotine Dependence
Nicotine dependence refers to those who want to stop smoking but
cannot
Nicotine has paradoxical effects on the nervous system
Nicotine can stimulate nervous system
Nicotine can have a calming effect
The Antismoking Movement
Surgeon General's Report in 1964 started public concern over smoking's
health hazard
Secondhand smoke is a health hazard as well
Cigarette advertisements have been banned on radio and television;
warning labels have been placed on packaging; smoking banned in many
public places
Tobacco companies have vigorously opposed antismoking legislation
Proportion of Americans who smoked has decreased from 45% in 1954
to 25% in 1997
Fewer people are starting to smoke
Some are using smokeless tobacco, which is linked to cancer
Legal Remedies
Tobacco companies pressured by federal and state governments
Agreement between federal government and tobacco companies requires
payment and more federal control with disallowing lawsuits
Many argue that agreement was not enough
Nicotine Dependence: Theory and Therapy
Learning or Addiction?
Behaviorist sees tobacco addiction as learned habit maintained
by reinforcers
Research found that smokers smoke to avoid withdrawal, suggesting
there is physiological addiction
Smokers self-regulate nicotine levels to prevent withdrawal
from occurring
Treatment
High relapse rates seen in treatment programs; even higher
among those who try to quit on their own
A number of new treatments have been developed, such as cognitive
behavioral therapy and chewing gum
A number of motivational, cognitive, social factors predict
who will remain abstinent
Self-efficacy predicts continued abstinence
Use of coping mechanisms predicts abstinence
Antidepressants are being tried as a smoking-cessation
aid
Bad moods weaken resistance
Environmental effects such as advertisements and smoker's
immediate environment affect likelihood of relapse
Other Psychoactive Drugs
Drugs have been available for many years legally and illegally
Use of illegal drugs has been variable
Use of legal drugs has remained fairly constant
Depressants
Depressant is a drug that reduces pain, tension, anxiety,
and slows intellectual and motor reactivity
Opiates, sedatives, and tranquilizers
Tolerance develops; withdrawal symptoms occur; high dosages
depress vital systems
Opiates
Opiates are drugs that induce relaxation and reverie and provide
relief from anxiety and pain
Opium is a chemically active substance derived from
opium poppy
Morphine is used as an analgesic and is dangerously
addictive
Heroin is much stronger than morphine
Methadone is a synthetic chemical and differs from
other opiates
Effective when taken orally
It is longer-lasting and takes effect slowly
Satisfies craving without an equivalent euphoria
Heroin is most widely abused opiate in United States
Normally taken by injection
There is a rush and euphoria
iii. Addiction and tolerance develop
iv. Withdrawal can be very unpleasant
Drug use represents means of adapting to stress
Barbiturates
Barbiturates have a sedative effect, relieving tension
and bringing relaxation and sleep
Used by suicide attempters and can have synergistic effect
when taken with alcohol
Used by the young sporadically and generally for recreational
purposes
Used by older people as way of relieving insomnia
Effects are very similar to alcohol
Tranquilizers and Nonbarbiturate Sedatives
Tranquilizers used in treatment of anxiety disorders and stress-related
physical disorders
Nonbarbiturate sedatives replaced barbiturates as prescription
sleeping medication
Have same problems as the barbiturates
Dependence on nonbarbiturate sedatives often begins with sleeping
problem
Initial use may bring relief
ii. Tolerance develops after about two weeks
May cause drug-induced insomnia and suppression of
REM leading to REM rebound
iv. Addiction develops
Stimulants
Stimulants provide energy, alertness, and feelings of confidence
Amphetamines
Amphetamines are group of synthetic stimulants
Most common are benzedrine, dexedrine, and methedine
Irregular use and low doses appear not to pose any behavioral
or psychological problems
Problems arise from regular use and high doses
Tolerance develops and higher doses become necessary
Effects of amphetamine abuse and paranoid schizophrenia are
similar
Cocaine
Cocaine is a natural stimulant and is active ingredient in
coca plant
Became fashionable in 1970s and peaked in mid-1980s
Can be injected, smoked, but usually snorted
Crack cocaine is within buying power of more people
Cocaine intoxication includes excitement, euphoria
Tolerance develops with regular use of cocaine and heavy withdrawal
symptoms
First phase is the crash
Withdrawal is second phase
iii. Extinction is final phase
Hallucinogens
Hallucinogens act on CNS to cause distortions in sensory
perception
Achieve effect without substantial changes in arousal
LSD
LSD (lysergic acid diethylamide) was synthesized in
1938
Interferes with processing of information
Effects include perceptions of colors and images, changes
in body images, and alteration of time and space perception
May be negative for people whose grasp on reality is not firm
LSD can produce bad trips and flashbacks
PCP
PCP (phencyclidine) is known as angel dust
Often mixed with other substances
Overdose common and extremely toxic
Behavioral toxicity refers to tendency of users to harm themselves
Use has declined since later 1970s
Marijuana and Hashish
Marijuana and hashish are classified as hallucinogens
Effects are more mild than other hallucinogens
Use of marijuana and hashish is more common
Marijuana and hashish derived from cannabis and are usually smoked
and eaten
The active ingredient is THC, which is not physiologically addictive
Causes accelerated heart rate
Causes reddening of whites of the eye
Behavioral effects studied in variety of situations
Effects on simple behavior are mild or nil
As task becomes more complex, required response speed increases,
more accuracy required, impairment becomes more apparent
Reactions include a feeling of being spaced out
Reactions can also heighten unpleasant experiences
Is Marijuana Dangerous?
Effect of prolonged heavy marijuana use on blood levels of
male sex hormone testosterone
Chronic marijuana use impairs function of one part of immune
system
Chronic marijuana use may injure the lungs
Prolonged use of marijuana may result in psychological effects
Few users make transition to narcotics
Amotivational syndrome does exist, but may be an accentuation
of preexisting behavior patterns
Marijuana as a Medical Treatment
Marijuana is useful in treating certain medical disorders
Decreases nausea and increases appetite in cancer patients
undergoing chemotherapy
May help glaucoma and AIDS patients
Public appears to allow physicians to weigh risks and benefits
Groups at Risk for Abuse of Illegal Drugs
Illegal substance highly related to race, class, education level,
gender, and socioeconomic status
Those individuals who are medically ill, with mental disorders,
and with chronic pain are at greater risk
Substance Dependence: Theory and Therapy
The Psychodynamic Perspective
Perspectives focus on homeostatic function of drugs
Drugs and Conflict
Drugs can ease adaptation in the short run
Drug abuse seen as self-medication
Acquiring Self-Care
Therapy aims to provide self-care skills
Goal is to build up patients' intrapsychic strength and improve
their relationships with others
The Behavioral Perspective
Psychological and Biochemical Rewards
Behaviorist viewed alcohol dependence as habit maintained
by antecedent and consequent reinforcers
Excessive drinking creates further psychological distress,
which will be alleviated by more drinking
Tension-reduction hypothesis received support from animal
research
Contemporary approaches view drinking as creating pleasant
states
Chemical rewards are the prime reinforcers of excessive drinking
Learning Not to Abuse Drugs
Early behavioral programs used aversion conditioning
Drug was paired with unpleasant stimulus
Programs did nothing to alter conditions that elicit
and maintain behavior
Contemporary behavioral programs attempt to remedy broad adjustment
problems using combination of cognitive and behavioral techniques
Taught to identify cues and situations that lead to drug
taking and alternative responses
ii. Taught new ways to cope with stress
Contingency management techniques used and involved earning
points and then redeeming points
Patients underwent therapy
Taught how to find nondrug recreational activities
iii. Taught how to avoid high-risk situations
Program worked for some alcoholics with vouchers, keeping
patients in program
The Interpersonal Perspective
Behavioral Couple Therapy
Behavioral couple therapy used for treatment of alcohol dependence
May be very effective in reducing problems in relationship
Most wife-beaters meet criteria for alcohol dependence
Behavioral couple therapy reduces violence and reductions
in drinking
Behavioral couple therapy tried with other kinds of drug abusers
with gain that tended to diminish during follow-up period
Family Therapy
Most drug-dependent people live with their parents or have
daily contact with parents
Family therapy seems promising in teenage drug abusers
The Cognitive Perspective
Thinking About Drugs
Expectations play a role in effects of alcohol
Alcohol expectations do not explain why some people become
alcohol dependent
Cognitive-Behavior Therapy
Abstinence violation effect is reduced through cognitive-behavior
therapy
Slips now seen as part of recovery
Goal is to control cognitive responses to slip to prevent
it from becoming a full-blown relapse
Several factors are related to relapse
Individual factors include negative emotional states
Environmental factors include social support, interpersonal
conflict
Physiological factors include withdrawal cravings
An effective treatment will combine these factors
The Neuroscience Perspective
Genetic Studies
Findings suggest that some people inherit predisposition to
alcohol dependence
Japanese, Koreans, and Taiwanese show facial flushing
and signs of intoxication, whereas Caucasians do not with
same amount of alcohol
Sensitivity to alcohol is related to genetic factors
Sons and brothers of severely alcohol-dependent men run 25
to 50% risk of becoming alcohol-dependent themselves
Concordance rate for monozygotic (MZ) twins is 55% compared
to 28% for dizygotic (DZ) twins
Susceptibility to alcoholism inherited in two ways
Type 1 susceptibility affects both men and women and
follows diathesis-stress model
Type 2 susceptibility is passed from father to son and
is independent on environmental influences
Susceptibility types differ
Type 1 susceptibility has onset in adulthood; rarely
associated with criminal behavior; individuals tend to be
dependent, quiet-living
Type 2 susceptibility has onset in adolescence; individuals
tend to be impulsive and aggressive; more prone to depression
and suicide
"P" rats, alcohol-preferring rats, have been bred, suggesting
heritability of alcoholism
Biochemical Studies
Endorphins
Nerve cells in brain have opiate receptors to which opiates
attach themselves
Enkephalins are very similar to morphine and fit the
opiate receptors
Stimulation of certain parts of brain can produce endorphins
Pain-relieving drugs may be linked with endorphin production
Endorphins may also explain dependency and withdrawal
symptoms
Dopamine
Most of abused drugs stimulate dopamine-producing neurons
in median forebrain bundle
Increased dopamine production creates drug's positive
effects
Dopamine-suppressing chemical blocks stimulant effects
of alcohol
Drug Treatment for Drug Dependence
Medication is prescribed to reduce craving and withdrawal
symptoms
Alcoholics receiving Revia reported fewer cravings and
lower relapse rates
Methadone, while highly addictive, does not produce
extreme euphoria of heroin but does satisfy craving and prevent
withdrawal
Methadone maintenance switches people from dependence
on heroin to dependence on methadone
Methadone maintenance programs have been successful
Methadone does not prevent user from becoming dependent
on other drugs
The Sociocultural Perspective
Drugs and Poverty
Drug abuse is related to racism and poverty, which create
environment for illegal drugs
Dramatic decline in standard of living among urban poor since
1990
Spread of AIDS by injecting drugs intravenously
Relationship between drugs and crime
Harm Reduction
Harm reduction is set of interventions that concentrate on
controlling the harm that drug dependency does to society at large
Needle-exchange programs developed out of harm reduction approach
Attempts to legalize drugs based on harm reduction
Opponents say that it will encourage addiction
Proponents say that it is the only way to prevent addicts
from doing harm to society and to themselves
Harm reduction policies have been slow to catch on in United
States
Prevention of drug abuse is supported
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