Effective Communication Study

SUBSTANCE DISORDERS - OUTLINE  

1. Levels of Involvement 

   1. Substance-related disorders involve problems associated with using and abusing drugs that alter patterns of thinking, feeling, and behaving.   

      1. The term substance refers to chemical compounds that are ingested in order to alter mood or behavior, and includes alcohol, nicotine, and caffeine.

   2. Psychoactive substances refers to a broad class of agents that alter mood and/or behavior which are ingested to become intoxicated or high, with abuse of such substances related to dependence and addiction.   

   3. Substance use is simply the ingestion of psychoactive substances on occasion, whereas the physiological reaction to ingested substances (e.g., drunkenness, getting high) is referred to as substance intoxication.   

      1. Intoxication depends on the drug, the amount of the drug ingested, and the person’s biological reaction.  

   4. Substance abuse is difficult to define based on the amount of substance ingested.   

      1. According to the DSM-V substance abuse is defined based on the interference with the user’s life.   

   5. Substance dependence is usually described as addiction, though there is considerable disagreement about how to define addiction.  

Dependence can exist without abuse.    

1. One definition considers addiction as physiological dependence on the drug(s), thus requiring greater and greater amounts of the drug to experience the same effect (i.e., tolerance), while responding physically in a negative way when the substance is not longer ingested (i.e., withdrawal).  

2. Tolerance and withdrawal are physiological reactions to the chemicals ingested.  Withdrawal from many substances can cause chills, fever, diarrhea, nausea and vomiting, and aches and pains.  LSD and marijuana do not produce symptoms of withdrawal. 

3. Another view focuses on drug-seeking behaviors as a measure of dependence.  Examples include repeated use of the drug, desperate need to ingest more of the substance, stealing money to buy drugs, standing outside in the freezing cold to smoke, and likelihood that use will resume after a period of abstinence.  Such reactions are sometimes referred to in terms of psychological dependence, not physiological dependence.   

4. The DSM-V definition of substance dependence combines the physiological aspects of tolerance and withdrawal with the behavioral and psychological aspects.   

• Five main categories of substances include the following: 

  1. Depressants result in behavioral sedation and include alcohol, sedative, hypnotic, and anxiolytic drugs belonging to the barbiturates and benzodiazepine classes. 

  2. Stimulants increase alertness and can elevate mood and include amphetamines, cocaine, nicotine, and caffeine. 

  3. Opiates primarily produce analgesia (i.e., reduce pain) and euphoria, and include heroin, opium, codeine, and morphine. 

  4. Hallucinogens alter sensory perception and can produce delusions, paranoia, and hallucinations, and include drugs like LSD. 

5. Cannabis 

Other drugs of abuse include inhalants, anabolic steroids, and over-the-counter prescription medications.  These drugs produce several psychoactive effects. 

II. Depressants 

1. Depressants primarily decrease central nervous system activity, reduce arousal, and help people to relax.  Included in this group are alcohol and the sedative, hypnotic, and anxiolytic drugs and those prescribed for insomnia.   

   1. These substances are among the most likely to produce symptoms of physical dependence, tolerance, and withdrawal. 

1. Alcohol use disorders  

   1. Although alcohol is a depressant, its initial effect is stimulation from a depression of inhibitory centers in the brain.  Continued drinking depresses other brain areas that interfere with functioning and include impaired motor coordination, slowed reaction time, confusion, reduced ability to make judgments, and vision and hearing can be negatively affected.  

   2. Alcohol affects many parts of the body.  Small amounts of alcohol are absorbed in the stomach, but most passes directly into the blood stream via the small intestine.  The circulatory system distributes alcohol throughout the body, where it contacts every major organ, including the heart and some goes to the lungs where it is exhaled.  As alcohol passes through the liver, it is broken down or metabolized into carbon dioxide and water.   

   3. Long-term effects of heavy drinking are often severe.  Consequences of long-term excessive drinking include liver disease, pancreatitis, cardiovascular disorders, and brain damage.   

      1. Withdrawal from chronic alcohol use includes tremors, and within several hours, nausea and vomiting, anxiety, transient hallucinations, agitation, insomnia, and at its most extreme withdrawal delirium. 

      2. Withdrawal delirium (or delirium tremens – DTs) can produce frightening hallucinations and body tremors.   

   4. It is not necessarily true that alcohol permanently kills brain cells.  Chronic use of alcohol can produce two types of serious brain syndromes: 

      1. Dementia involves a general loss of intellectual abilities and can result directly from neurotoxicity or poisoning of the brain by excessive amounts of alcohol. 

      2. Wernicke’s disease results in confusion, loss of muscle coordination, and unintelligible speech; it is believed to be caused by thiamine deficiency, a vitamin that is metabolized poorly by heavy drinkers.   

   5. Alcohol negatively affects prenatal development and can result in fetal alcohol syndrome (FAS); a condition related to a mother drinking while pregnant.  FAS is associated with growth retardation, cognitive deficits, behavior problems, and learning difficulties, and characteristic facial features.   

      1. African-Americans and Apache and Ute Indian women appear at the greatest risk of having children with FAS if they drink while pregnant.  

C. Sedative, hypnotic, or anxiolytic substance use disorders 

1. Sedative (calming), hypnotic (sleep-inducing), and anxiolytic (anxiety reducing) drugs include barbiturates for sleep and benzodiazepines to reduce anxiety.  These drugs relax muscles but may cause problems similar to alcohol at high doses.  

a. Rohypnol (i.e., “roofies” or the “date rape drug”) gained a following among teenagers in the 1990s because it had the same effect as alcohol but without the telltale odor. 

1. Large doses of barbiturates produce effects similar to heavy drinking, such as slurred speech, problems in walking, concentration, and working.  At extremely high doses, barbiturates relax the diaphragm muscles to the point of death by suffocation.  Overdose on barbiturates in a common means of suicide. 

2. Benzodiazepines likewise produce a calming effect, a pleasant high, and reduction of inhibition, similar to effects of alcohol.  Continued use of benzodiazepines can result in tolerance and dependence and withdrawal effects are similar to those experienced with alcohol. 

3. DSM-IV-TR criteria for sedative, hypnotic, and anxiolytic drug use disorders do not differ much from those for alcohol use disorders.  Both include maladaptive behavioral changes such as inappropriate sexual or aggressive behavior, variable moods, impaired judgment and social or occupational functioning. 

III. Stimulants 

1. Stimulants are the most widely consumed drug in the U.S., and include caffeine, nicotine, amphetamines, and cocaine.   

   1. Amphetamines are manufactured and were used as a treatment for asthma, nasal congestion, and weight loss.  Amphetamines are also prescribed for persons with narcolepsy and attention deficit/hyperactivity disorder.  Such drugs increase alertness and increase energy.   

a. The danger of amphetamines and other stimulants are in the negative side effects.  Severe intoxication or overdose can cause hallucinations, panic, agitation, and paranoid delusions.  Symptoms of withdrawal are similar to depression.   C. Cocaine use disorders 

1. Amphetamine use disorders 

   1. At low doses, amphetamines can produce elation, vigor, reduce fatigue, followed by a crash accompanied by feeling depressed and tired. 

   2. DSM-IV diagnostic criteria for amphetamine intoxication include significant behavioral symptoms such as euphoria or affective blunting, changes in sociability, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviors, impaired judgment, and impaired social or occupational functioning.  

   3. Physiological symptoms can include heart rate and blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, muscular weakness, respiratory depression, chest pain, seizures, or coma.   

1. Cocaine replaced amphetamines as the stimulant of choice in the 1970s.  

Cocaine is derived from the leaves of the coca plant, indigenous to South America.  Until 1903, Coca-Cola contained about 60mg of cocaine per 8-ounce serving.   

1. Like amphetamines, small amounts of cocaine increase alertness, euphoria, blood pressure and pulse, and causes insomnia and loss of appetite.  The effects of cocaine are short-lived. 

2. Cocaine use across most age groups has declined over the past decade and a half.  About 0.2% of Americans report trying crack.   

3. The effects of cocaine resemble that of the amphetamines and tend to block dopamine reuptake.  The result is increased stimulation of the dopamine neurons in the pleasure pathway, resulting in the high associated with cocaine use. 

4. Many thought that cocaine was not addictive, but we know that this is not the case.  Cocaine dependence develops slowly and typically, people only find that they have a growing inability to resist taking more.   

1. Few short-term negative effects are noticed initially, but with continued use sleep is disrupted, higher doses are required, and paranoia and other symptoms set it.   

2. Cocaine abusers go through patterns of tolerance and withdrawal comparable to abusers of other psychoactive substances. 

1. Opiods 

   1. The word opiate refers to the natural chemical in the opium poppy that has a narcotic effect (i.e., relieve pain and induce sleep).  The broader term 

opiods refers to a family of substances that include natural opiates, synthetic variations (i.e., methadone, pethidine), and comparable substances that occur naturally in the brain (e.g., enkephalins, betaendorphins, and dynorphins).  Heroin, opium, codeine, and morphine are included in this group.   

1. Opiates induce euphoria, drowsiness, and slowed breathing.  High doses can lead to death if respiration is completely depressed.  Opiates are also analgesics (i.e., substances that help relieve pain such as morphine).   

2. Withdrawal symptoms include excessive yawning, nausea and vomiting, chills, muscle aches, diarrhea, and insomnia that may disrupt work, school, and social functioning.  Such symptoms can persist for 1 to 3 days, and withdrawal usually runs its course in about 1 week. 

3. Opiate users tend to be secretive, making estimates of prevalence difficult.  Because such drugs are usually injected intravenously, users are at increased risk for HIV infection and therefore AIDS. 

4. Life of an opiate addict is bleak, with about 28% dying prematurely, with almost half of deaths due to homicide, suicide, and accident, and about 33% of these resulting from overdose. 

5. The high comes from activation of the body’s natural opiod system that includes enkephalins and endorphins that together provide narcotic effects.   

1. Hallucinogens 

   1. Hallucinogens are substances that change the way the user perceives the world, and may produce delusions, paranoia, hallucinations, and altered sensory perception. 

1. Marijuana is the name given to the dried parts of the cannabis or hemp plant (cannabis sativa). 

   1. Reactions to marijuana include mood swings, heightened sensory experiences, paranoia, hallucinations, dizziness, and impairment of memory, concentration, impairment in motivation (i.e., amotivational syndrome), self-esteem, and interpersonal and occupational relationships.   

      1. It is not uncommon for someone to report having no reaction to the first use of the drug, and it appears that people can turn off the high if they are sufficiently motivated. 

   2. Evidence for marijuana tolerance is contradictory, with reports of tolerance in chronic heavy users and reverse tolerance (i.e., regular users experience more pleasure from the drug after repeated use).   

   3. Major signs of withdrawal do not occur with marijuana, or when they do they are not severe.  No evidence exists that marijuana users experience craving and psychological dependence characteristic of other substances. 

   4. Marijuana smoke may contain carcinogens and long-term use contributes to diseases such as lung cancer. 

   5. Most users inhale the drug by smoking it; others use preparations such as hashish.   

   6. Marijuana contains over 80 types of chemicals called cannabinoids, which are believed to alter mood and behavior.  The most common chemical is tetrahydrocannabinol (THC).   

      1. The brain seems to produce its own version of THC via a neurochemical called anandamide (ananda from the Sanskrit word meaning “bliss”).