chapter 12 substance use and impulse control

alter mood, behaviour, or both; include:

• commonplace legal drugs, such as alcohol, nicotine found in tobacco, the caffeine in coffee and tea

• ingestion of psychoactive substances in moderate amounts

• does not significantly interfere with social, educational, or occupational functioning

our physiological reaction to ingested substances-drunkenness or getting high

• interaction of variables: type of drug taken, amount ingested, persons individual biological reaction

• intoxication experienced as impaired judgment, mood changes and lowered motor ability

disorder described as an addiction

• physiological dependence: tolerance, withdrawal

• psychological dependence

• polysubstance use (using multiple substances)

greater amounts of drug needed to experience same effect

negative physical response when the substance is no longer ingested

behavioural reactions to substance dependence

• dependence can be present without misuse

• substance use might occur concurrently with other disorders

• drug intoxication and withdrawal cause increased risk taking

• mental health disorders cause substance use disorder

• at least two symptoms in the 12 month period

• mild 2-3 symptoms

• moderate: 4-5 symptoms

• severe: 6 or more symptoms

1. alcohol

2. nicotine

3. caffeine

• depressants

• opioids

• stimulants

• hallucinogens

• other drugs

alcohol use marked by tolerance, withdrawal, and a drive to continue problematic use:

• people who are physically dependent on alcohol tend to have more severe symptoms of the disorder

• reverse tolerance

• often part of polysubtance/polydrug use

when regular users experience more pleasure from the drug after repeated use

depressant, inhibitory centres in the brain are depressed, or slowed

• low-dose: reduces inhibition

• high-dose: acts as a potent sedative continued drinking depresses more areas of the brain

• impaired motor coordination, slower reaction time, confused, poor judgments, reduces self-awareness and self control, vision and hearing affected, memory blackouts

1. ingestion

2. stomach

3. small intestine

4. heart

5. liver

• influences several neuroreceptor systems

• GABA, inhibitory neurotransmitter

• glutamate systems-memory blackouts

• DA systems-pleasurable feelings

• releases natural analgesics

chronic drinking causes severe biological damage and psychological deterioration

• almost every tissue and organ is adversely affected:

• malnutrition

• cirrhosis of the liver

• damage to the endocrine glands and pancreas

• heart failure, hypertension, stroke, and capillary hemorrhages, which in turn can produce brain damage`

• dementia: general loss of intellectual abilities

• Wenicke-Korsakoff syndrome: confusion, loss of muscle coordination, and incomprehensional speech

affects child whose mother drank while she was pregnant

hand tremors, nausea, or vomiting, anxiety, hallucinations, agitation, insomnia

frightening hallucinations and body tremors

• fluctuations between heavy drinking and abstinence

• early consumption can predict dependence/abuse in later years-people who do not develop the sedative symptoms, slurred speech, staggering, etc. are more likely to abuse it in the future

calming

sleep-inducing

anxiety-reducing

• barbiturates: synthesized sedatives (seconal)

• benzodiazepines: anxiety-reducing (valium, xanax)

• act on GABA NT system mode of action--> diff

• (downers) relax muscles, induce sleep

• low doses produce mild feeling of well-being

• large doses - effects similar to heavy drinking

• overdosing is common means of suicide

• calming, induce sleep

• tolerance and dependence with repeated use

• similar to alcohol related disorders

• maladaptive behaviours, variable moods, impaired judgment, impaired social or occupational functioning, impaired motor functioning, slurred speech

natural chemicals in opium poppy having a narcotic effect (heroin, morphine, codeine, oxycodone)

• temporarily lessen pain and anxiety; high doses quality; produce a feeling of pleasure that is almost like floating on a cloud or being in a dream like state

• constricts pupils, slow breathing, and cause lethargy

• sleep-inducing, pain-relieving (analgesic)

"uppers" leading to a "down" and crash

• behavioural symptoms: euphoria or affective blunting anxiety, tension, tension, anger, impaired judgment, and impaired social or occupational functioning

• physiological symptoms: heart rate or blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, chest pain, seizures, or coma

(the most abused form of amphetamines) intense exhilaration followed by euphoria that can last for 12-16 hours and carries a high risk of overdose and dependence

recreational drug that stimulates the CNS, produces euphoria and can lead to hallucinations and delusions

increases alertness, blood pressure; causes insomnia; produces a quick rush of euphoria, indifference to pain and sense of well-being; a crash of agitated depression occurs within 15 to 30 minutes after neurotransmitter levels drop

nicotine in tobacco is a psychoactive substance which produces dependence, tolerance, withdrawal

• single most preventable cause of premature death (1 in every 5 deaths)

• stimulates pleasure pathwaya`

"gentle stimulant" found in tea, coffee, many soda drinks, cocoa products. caffeine elevates mood, decreases fatigue, but can cause insomnia

• caffeine use disorder: problematic caffeine use that causes significant distress and impairment

psilocybin (mushrooms), lysergic acid amide, dimethyltryptamine (DMT), mescaline (Peyote), phencyclidine (PCP

• perceptual changes: subjective intensification of perceptions, depersonalization, and hallucinations

• physical symptoms: pupillary dilation, rapid heartbeat, sweating, blurred vision

1. persistent psychosis: a long lasting psychotic like state after the trip has ended

2. hallucinogen persisting perception disorder (HPPD or Flashbacks: a re-experiencing of the sensations originally produced by the LSD hours, weeks, or even years after its initial use

dried and crushed leaves and flowering tops of cannabis sativa; major active chemical is delta-9-tetrahydrocannabinol (THC); causes impairment in memory, concentration, motivation, self-esteem, relationship with others

• reverse tolerance with repeated use

feeling more relaxed and sociable, can dull attention, fragment thoughts and impair memory; extremely heavy doses can induce hallucinations

specific cannabinoid receptors in brain (CB) have been located in various brain regions; receptors in hippocampus may account for short term memory loss effects following marijuana use

recurrent use and constant craving of inhalents such as spray paint, paint thinner, amylnitrate

• genetic vulnerability to drug abuse, alcoholism

• genes on chromosomes 1, 2, 7, 11

• psychoactive drugs activate reward centre of the brain

• dopamine system and the opioid releasing neurons known as MOP-r implicated

• sensitization

• negative reinforcement

repeated exposure to stimulant drugs leads to increased dopamine release when taking the drug

• positive reinforcement: psychoactive drugs provide a pleasurable experience, use increase leads to tolerance increase

• negative reinforcement: psychoactive drugs provide escape from physical pain, stress, panic or anxiety

• an increase in positive feelings will be followed by an increase in negative feelings a short time after

• an increase in negative feelings will be followed by a period of positive feelings

what people expect to experience when they use drugs influence their reaction

a state of shortsightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behaviour and emotions

• underscores need to jointly consider biological processes and environmental stimuli

• based on notion that tolerance is a learned response

• environmental cues present influence behaviours because these cues come to be associated with substance use (classical conditioning)-signal the drug effect is coming

• Shep Seigel

regulatory responses made in anticipation of a drug; we learn to anticipate drug effect even before they actually occur

1. moral weakness view

2. disease model of physiological dependence

multiple influences interact to account for substance use disorders

• access to a drug; exposure

• psychological influences and stressors

• biological influences

• social and cultural expectations

• drug use, abuse, dependence

• agonist substitution: chemical makeup of a drug similar to addictive drug (methadone, buprenorphine, nicotine substitution)

• antagonist treatments: block or counteract the effects of psychoactive drugs (naltrexone=opioid-antgonist drugs)

• sedatives to minimize discomfort for people withdrawing

• desipramine: increases abstinence rates for cocaine

• inpatient facilities: detoxification

• alcoholics anonymous: 12 step philosophy; effective with motivated individuals

• cognitive and behavioural treatments

• aversion therapy: prescribed drugs make ingesting abused substances extremely unpleasant

• covert sensitization: imagining unpleasant scenes

• contingency management: clinical and client select behaviour that needs to change and decides on reinforcers to reward reaching goals

• community reinforcement approach: establishing relationships with people who is not a substance user

• motivational enhancement therapy (MET): increase motivation to change behaviour

• relapse prevention: helping people remove any ambivalence about stopping their drug

• harm reduction: controlled use of a substance rather than abstinence (not a cure) or prevention (education-based programs)

persistent and recurrent problematic gambling behaviour -> significant distress or impairment

• tolerance, withdrawal, craving; job loss, bankruptcy, arrests

aggressive impulses resulting in serious assaults, destruction of property

recurrent failure to resist urges to steal things; rare; stigma associated

having an irresistible urge to set fires

CBT