Chapter 10 -- Substance Use Disorders

I. Substance Use Behaviors
A. Most used are alcohol (52%), cigarettes (28%), and marijuana (7%) in past month
B. Tolerance – larger amounts of a substance needed over time to have desired effect
C. Addiction – inability to stop use and presence of tolerance and withdrawal      

II. Substance Use Disorder
A. Problematic use that impairs functioning
B. Two or more symptoms within one year period
1. Failure to meet obligations
2. Repeated use where physically dangerous
3. Repeated relationship problems
4. Continued use despite problems caused by substance
5. Tolerance
6. Withdrawal
7. More substance taken than intended
8. Efforts to reduce do not work
9. Much time spent to obtain the substance
10. Social, hobbies, or work activities reduced
11. Continued use despite knowing problems caused by substance
12. Craving to use is strong

III. Intoxication (specific symptoms for each substance)
A. Significant problem behaviors or psychological changes (mood lability and impaired judgment)
B. One or more specific symptoms from use (impaired attention or memory)

IV. Withdrawal (specific symptoms for each substance)
A. Cessation of prolonged use
B. Symptoms after cessation (anxiety or nausea)

V. Alcohol Use
A. Lifetime Prevalence; 17% Use Disorder
B. Binge drinking; 5 drinks within an hour has 43.5% prevalence among college students
C. Heavy Use drinking; 5 drinks, 5 or more times in a 30-day period has a 16% prevalence in college students
D. Ethnic differences - White and Hispanic adolescents and adults more likely to binge drink than African Americans and Asian Americans

VI. Alcohol Effects
A. Smaller amounts (4 or less drinks)
1. Stimulates GABA receptors and reduces tension
2. Increases dopamine and serotonin to produce pleasurable effects
3. Inhibits glutamate receptors to produce cognitive difficulties (e.g., slowed thinking, memory loss)
B. Larger amounts (5 or more drinks)
1. Significant motor impairment
2. Poor decision making
3. Poor awareness of errors made
C.Long-term Effects
1. Malnutrition; calories lack nutrients
2. Cirrhosis of the liver
3. Heart failure
4. Stroke
5. Erectile disorder
6. Destruction of brain cells important for memory

VII. Alcoholism Etiology
A.Genetic; (genes on chromosomes 1, 2, 7, and 11) increase risk to twice as much for children
B. Positive reinforcement (to feel good, pleasure), stimulates dopamine system
C. Negative reinforcement (to feel better, self-medication) avoids negative feelings
D. Positive expectancies of improved social and physical functioning
E. Cultural expectations about celebrating and binge drinking in U.S. and Korea

VIII. Alcoholism Treatment
A. 17 million needed it, 1.5 million received it 2009 (1 in 4 dependent ever treated)
B. Biological
1. Antianxiety drugs to help detoxification and prevent delirium tremens
2. Antabuse inhibits metabolism of alcohol and causes vomiting if alcohol consumed
3. Naltrexone reduces pleasure
C. Alcoholics Anonymous (AA) (12 step programs) give support, acceptance, and a routine
D. Psychological
1. Relapse Prevention Therapy (cognitive therapy to view lapses as learning trials not failure)
2. Cue Exposure Method (drink small doses and then stop to extinguish cravings)
3. Motivational enhancement with future goals
4. Family Therapy (improve communication and assign responsibility to drinker to change)
5. Community Reinforcement Approach (functional analysis, find other reinforcement, provide education and job services)

IX. Tobacco, Cocaine, Amphetamines
A. Stimulant Characteristics
1. Increase energy, talkativeness, and self-confidence
2. Withdrawal includes depression, hunger, cravings
3. Continued use may cause delusions and hallucinations
4. Used in dieting, attention deficit, narcolepsy
B. Types
1. Tobacco has addictive nicotine, 440,000 deaths yearly
2. Cocaine has immediate and short-lived high, blocks reuptake of dopamine
3. Amphetamines (Benzedrine, Dexedrine, and Methedrine) reduce appetite, increase energy

X. Marijuana (Cannabis)
A. Induces relaxation, hunger, sensual feelings, and impairs attention and memory
B. Long term effects include sinus inflammation, lung damage, lower sperm counts, and delayed ovulation
C. Most commonly used illegal drug (about 1/3 above age 12 have used, 17 million used in 2010)

XI. Sedatives, Hypnotics, Anxiolytics
A. Sedatives (muscle relaxants and sleeping pills like Ambien)
1. Induce relaxation and sleep
2. Tolerance and withdrawal occur quickly
B. Hypnotics
1. Quaaludes
2. Antihistamines
C. Anxiolytics
1. Valium
2. Clonopin

XII. Opiates
A. Derivatives of the opium poppy
B. Induce feelings of euphoria and act as pain-killers
C. Often used intravenously and help spread HIV
D. Tolerance, physical dependence, and withdrawal occur quickly
E. Types
1. Heroin (most chronically used illegal drug)
2. Morphine (commonly used painkiller)
3. Methadone (substitute for heroin)
4. Hydrocodone (Vicodin, 5.7 million)
5. Oxycodone (Oxycontin)

XIII. Hallucinogens, Ecstasy, PCP
A. Characteristics
1. Induces feelings of euphoria and visual hallucinations
2. Prolonged use may lead to flashbacks and negative mood
B. Types
1. Lysergic acid diethylamide (LSD)
2. Mescaline used in American Indian rituals
3. Ecstasy enhances mood and intimacy
4. PCP overdose may lead to coma, convulsions, and death

XIV. Substance Use Treatment
A. Biological
1. Methadone blocks pleasure and eliminates withdrawal for heroin dependence
2. Naltrexone produces withdrawal effects from heroin
B. Psychological
1. Contingency management with rewards for negative drug tests
2. Relapse prevention focuses on cognitive restructuring
C. Social
1. Anonymous groups (Narcotics Anonymous, Cocaine Anonymous)
2. Therapeutic Community (Recovering addicts resocialize residents, confrontational to take responsibility and express emotions)

XX. Substance Use Prevention
A. Enhancing self-esteem
B. Social skills training
C. Peer pressure resistance training
D. Parental involvement in school programs
E. Warning labels on alcohol bottles
F. Education regarding alcohol impairment
G. Testing for drugs and alcohol at school or work
H. Correction of beliefs and expectations
I. Inoculation against mass media messages
J. Peer leadership