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Chapter 11summary - Summary Abnormal Psychology: an Integrative Approach
Abnormal Psychology (Psyc 435)
Athabasca University
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Chapter 11
CHAPTER 11: Substance-Related, Addictive, and Impulse-Control Disorders DSM 5 changes: they’ve lumped together what used to be the impulse-control disorders and substance- related disorders Gambling looks a lot like an addictive behaviour. It has the same sorts of biochemical changes that occur. It looks more and more like an addiction and has been treated in addiction centers for a long time as an addiction So now this new category lumps all those 3 things together
Addictive and Impulse-Control Disorders problems related to the use and abuse of psychoactive substances o wide-ranging physiological, psychological, and behavioural effects gambling also included in this category includes impulse-control disorders o intermittent explosive disorder, kleptomania, pyromania
Important Terms and Distinctions substance use versus substance intoxication o involves some kind of impairment o usually has to do with how much you have taken of the drug o but you can be an intoxicater and not be an abuser of the drug o abuse needs to get in the way of functioning – get in the way of some of your roles in society or something. There needs to be a regular pattern substance abuse versus substance dependence o dependence = you need it to get through your day, drinking to feel normal o that comes from tolerating the substance tolerance versus withdrawal o aspect of physiological dependence o textbook differentiates between physiological and psychological dependence o you don’t have psychology without the hardware, the physiology. o You don’t have psychological dependence without tolerance and withdrawal
Substance Use Disorders Tolerance, defined as either: a need for increased amounts of the substance to achieve desired effect, or diminished effect with continued use of the same amount of the substance
Withdrawal, manifested as either: the characteristic withdrawal syndrome for the substance (typically opposite to the drug effects. If you’re taking a sedative for example, when you stop it, you get anxious and wound up) OR Using the same (or a closely related) substance to relieve or avoid withdrawal symptoms o you may not actually experience the withdrawal syndrome o DSM 4 you used to have to specify whether somebody with this disorder met criteria
Five Main Categories of Substances depressants behavioural sedation (anything that’s a downer) o e., alcohol, sedatives, anxiolytic drugs stimulants increase alertness and elevate mood (anything that’s an upper) o e., cocaine, nicotine, caffeine (these all have different mechanisms of action)
opiates analgesia and euphoria (they are used for pain killing and making you feel better) o e., heroin, morphine, codeine, oxycotin hallucinogens alterations in sensory perception ( o e., marijuana, LSD, mushrooms, (club drugs like MDMA fit in between opiates and hallucinogens) other drugs of abuse include inhalants (e., “poppers”, “huffing”) and anabolic steroids (e., “juice”) o solvants that people are inhaling, ... anything that doesn’t really fit into one of the other categories
Substance Use Disorders DSM-IV used to have two separate disorders: o Substance dependence o Substance abuse o “the idea that once you’re a pickle you can’t go back to being a cucumber” o now we’ve combined the symptoms and now you’ve got a symptom count to have a specifier o so now it’s easier to get diagnosed with one than it was before o they took out the “legal problems” one and added the “experience of craving a drug” DSM 5 combined the categories o Number of symptoms indicates severity o 2 to 3 = mild substance use disorder o 4 to 5 = moderate substance use disorder o 6+ = severe substance use disorder
Substance Use Disorders failure to fulfill a .... CHECK THIS SLIDE. I think there are 4 things here
Substance Use Disorders using MORE of the substance, or using for more time, than intended persistent desire, or unsuccessful efforts to, cut down or control use spending a lot of time obtaining, using or recovering from the effects of a substance
Canadian Costs of Substance Abuse SEE THIS SLIDE Figure 1: Costs attributable to substance abuse by cost category in Canada, 2002 if we can get ride of these law enforcement costs by funneling them right into a health care program if you reduce recidivism rates, they stop returning to the justice system the biggest costs is indirect, it’s productivity losses (people screwing up their jobs – coming to work hungover, etc) direct health care costs (health care problems that can occur from alcohol abuse for instance) it costs society a lot of money, these problems
Depressants (alcohol is a dirty drug. Affects a lot of different things) physiological effects o NMDA receptor blocked, requiring up-regulation of glutamatergic system May be responsible for withdrawal symptoms (e., agitation) o Facilitates 5-HT receptor function which may be involved in dopaminergic reward o Increases inhibitory function of GABA (GABA is responsible for sedation. If you have too much GABA, it gets in the way of creating memory. That’s why you get blackouts) May account for sedation and memory impairments
o fatty deposits cirrhosis o 8x more prevalent in alcohol dependence o heavy drinking women more at risk than heavy drinking men
Harmful Effects of Chronic Consumption the nervous system o e., Wernicke-Korsakoff syndrome due to thiamin deficiency o cancer mouth, throat and liver at risk particularly when combined with smoking o reproduction male chronic consumption impotence, shrunken testes, loss of sexual interest there is a feminizing hormone that occurs as part of a metabolism of alcohol. It feminizes the male body
Harmful Effects of Chronic Consumption fetal alcohol syndrome (FAS) o mental retardation, poor coordination, and muscle tone, slow growth, organ malformation, peculiar facial characteristics (more details about that in the textbook)
Sex Differences women are generally more vulnerable to the harmful physiological effects of alcohol than men o smaller body size o more body fat more fat means less water in body less water in body means higher BAC o less sensitive to sedating effects of alcohol, depending on where she is in her menstrual cycle makes it harder to gauge her level of intoxication
Standard Drink a standard drink contains 13 of alcohol one standard drink is approximately: one 355 ml (12 ounce) can of 5% beer or one 146 ml (5 ounce) glass of 10% to 12% wine or one 44 ml (1 ounce) of 40% hard liquor or spirits
If he wants to keep his health risk low, what’s the maximum number of drinks per week an otherwise healthy, average man should have? Low risk: intake is unlikely to be associated with harm males LESS THAN 21 standard drinks per week females LESS THAN 14 standard drinks per week only 2 per day, and you should take one day off. So really it’s closer to 12. That’s unlikely to be associated with medically serious harm The number of drinks goes up with the number of levels
Hazardous drinking intake likely to increase risk of developing alcohol related to .... SEE THIS SLIDE Harmful drinking (alcohol misuse) intake associated with the development of phsycical or psychological harm
males > 50 standard drinks per week females > 35 ... SEE THIS SLIDE
binge drinking = five or more standard drinks during a drinking episode – during two hours, technically more common in youth adolescence to age 24
Alcohol Use in Canada most Canadian adults drink in moderation o 23% exceed low risk guidelines o 17% drink at high risk levels men more likely than women to drink, and are also more likely to drink heavily
Alcohol Use Problems: 9% of Canadian drinkers have problems o 3% of Canadians may be dependent drinkers most people with alcohol use problems can moderate or cease drinking on occasion as many as ¾ of people with alcohol problems recover without help a lot of people with problems with alcohol CAN stop drinking from time to time you can still have alcohol problems, even if you can stop occasionally there is such a thing as spontaneous recovery. People who get over their alcohol problems without any professional help at all o ¾ of people could recover without help at all o there are some myths about alcohol use disorders that are still floating around. “once an alcoholic, always an alcoholic” etc.
Sedatives, Hypnotics, or Anxiolytics sedative = calming hypnotic = sleep inducing o e. barbiturates anxiolytic = anxiety reducing o e., benzodiazepines Effects of these drugs are similar to large doses of alcohol o Combining these drugs with alcohol is synergistic o Synergistic = the effects are not simply additive; they interact to produce more effect than either drug alone All exert their influence via their effects on GABA (inhibitory neurotransmitter, basically chills people out. It also changes consciousness)
Sedatives, Hypnotics, or Anxiolytics since 1960, barbiturate use has decreased and benzodiazepine use has increased o they produce the effects of alcohol without the smell of alcohol o you can get the same alcohol-type effects without smelling like booze o benzo use has increased... I’m not sure why that is. Could be that they are prescribed more widely and are more available signs of intoxication: o slurred speech o incoordination o unsteady gait o nystagmus (eyes aren’t focusing on the right spot)
molly = methylenedioxymethamphetamine (MDMA), which is classified as hallucinogen and amphetamine o pills that are marketed as ecstasy... it used to be pure MDMA when it was first introduced as a club drug. But drug dealers would find ways to make it cheaper o you may have also experienced some of the effects of meth
Stimulants MDMA also increases dopamine, norepinephrine, and serotonin o May result in memory impairments, over time o Risk of death associated with low sodium levels and hyperthermia that result from use o Drink water when you are using MDMA
The book: BUZZED: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy
Stimulants excessive use of amphetamine can lead to psychosis methamphetamine has effects similar to amphetamine o increases dopamine, norepinephrine and serotonin o less susceptible to breakdown by MAO, so it lasts longer
Stimulants: Amphetamines amphetamine increases norepinephrine and dopamine by both increasing their presynaptic release AND by blocking their reuptake see this slide for the chart....
Stimulants: Cocaine cocaine use produces short-lived sensations of elation, vigour, and reduction of fatigue used by ~1% of adults, ~6% of students crack = cocaine that has been dissolved and then boiled in a mixture of water and ammonia or baking soda until it forms lumps or rocks signs of intoxication and withdrawal are the same as for amphetamine intoxication
Stimulants: Cocaine SEE THIS SLIDE for chart.. cocaine increases dopamine by blocking its reuptake they used to really think that cocaine was a wonder-drug that it had no ill-effects, that it would just make you energetic “free of terrible side-effects!” there is no drug like that. Every drug comes with a bit of a cost
Stimulants: Nicotine stimulates the central nervous system, specifically nicotinic acetylcholine receptors results in sensations of relaxation, wellness, pleasure nicotine uses dose themselves to maintain a steady state of nicotine
Video: Hurd/ Herd Studios : Tobacco Dependence youtube/watch?v=gCT9msDT9RM
Stimulants: Nicotine signs of withdrawal: o dysphoric or depressed mood
o insomnia o irritability, frustration, or anger o anxiety o difficulty concentrating o restlessness o decreased heart rate o increased weight gain
Stimulants: Caffeine found in tea, coffee, cola drinks and cocoa products caffeine is an adenosine antagonist o adenosine inhibits neurotransmitter release small doses elevate mood and reduce fatigue used by over 80% of North Americans regular use can result in tolerance and dependence no DSM-IV criteria for caffeine dependence or abuse, only caffeine intoxication o we don’t talk about dependence or abuse in DSM 5 (those are old categories) o we talk about substance use disorder specific to that class of substance, and then specify mild, moderate or severe
Stimulants: Caffeine Signs of intoxication: o Restlessness o Nervousness o Excitement o Insomnia o Flushed face o Diuresis o GI disturbance o Muscle twitching o Rambling flow of thought and speech o Tachycardia or cardiac arrhythmia o Periods of inexhaustibility o Psychomotor agitation
Hallucinogens substances that change the way the user perceives the world may produce delusions, paranoia, hallucinations, and altered sensory perception examples include LSD, PCP, psilocybin (mushrooms), mescaline (peyote), ketamine
Hallucinogens LSD is most common form of hallucinogenic drug Tolerance tends to be rapid, and withdrawal symptoms are uncommon Psychotic delusional and hallucinatory symptoms can be problematic Mechanisms of action for hallucinogens (e., ketamine, PCP) can be complicated
Cannabis active ingredient is tetrahydrocannabinol (THC)
o GABA inhibits dopaminergic neurons Increased activation of the dopaminergic reward parthway leads to the euphoria and “high” associated with heroin use Opidoids: Heroin picture of how it works WILL WE EVER HAVE TO LABEL SOMETHING LIKE THIS ON A TEST?
Opioidss > signs of intoxication Drowsiness Slurred speech Problems with attention and memory
Opioids signs fo withdrawal: dysphoric mood nausea or vomiting muscle aches lacrimation or rhinorrhea pupillary dilation, piloerection, or sweating diarrhea yawning fever insomnia Associated with allergic reactions or the flu. You feel muscle achey, diarrhea, ... people colloquially refer to this as “getting sick” so they try to avoid it by taking more drug
Inhalants substances found in volatile solvents that are breathed into the lungs directly o examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide rapidly absorbed with effects similar to alcohol intoxication tolerance and prolonged symptoms of withdrawal are common frequently first drug used by young people risk of severe, long-term damage to the brain, liver and kidneys SEE SLIDE for this last point
Anabolic Steroids steroids are derived or synthesized from testosterone o used medicinally or to increase body mass users may engage in cycling or stacking o cycling = using steroid in eight to 12 week cycles o SEE THIS SLIDE...
Pathological Gambling Dopamine system implicated o Includes a withdrawal syndrome Usually treated in addiction treatment settings o Most people who present for treatment have trouble with machine gambling (e., VLTs) o Prevalence rates are higher where gambling machines are available In US, people with PG tend to be not white, male, less educated, lower income, unmarried, unemployed
In Canada, Aboriginal people at elevated risk o Up to 16 times more prevalent Highly comorbid with nicotine dependence and other substance use disorders
Prevalence of Addictive Disorders pathological gambling o ~2% in US alcohol use disorder ~14% of US men and ~4% of US women tobacco use disorder o ~13% of US adults cannabis use disorder o ~2% of US adults
Chapter 11summary - Summary Abnormal Psychology: an Integrative Approach
Course: Abnormal Psychology (Psyc 435)
University: Athabasca University
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