Chapter 10
Substance-Related Disorders
Perspectives on Substance-Related
Disorders: An Overview
 The Nature of Substance-Related Disorders
 Problems related to the use and abuse of psychoactive
substances
 Produce wide-ranging physiological, psychological, and
behavioral effects
 Some Important Terms and Distinctions
 Substance use vs. substance intoxication
 Substance abuse vs. substance dependence
 Tolerance vs. withdrawal
Perspectives on Substance-Related
Disorders: An Overview (cont.)
 Five Main Categories of Substances
 Depressants – Result in behavioral sedation (e.g.,
alcohol, sedative, anxiolytic drugs)
 Stimulants – Increase alertness and elevate mood (e.g.,
cocaine, nicotine, caffeine)
 Opiates – Primarily produce analgesia and euphoria (e.g.,
heroin, morphine, codeine)
 Hallucinogens – Alter sensory perception (e.g., marijuana,
LSD)
 Other drugs of abuse – Include inhalants, anabolic
steroids, medications
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.1
Ice, LSD, chocolate, TV: Is everything addictive?
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.1 (cont.)
Ice, LSD, chocolate, TV: Is everything addictive?
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.2
Easy to get hooked on, hard to get off
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.2 (cont.)
Easy to get hooked on, hard to get off
The Depressants: Alcohol Use Disorders
 Psychological and Physiological Effects of Alcohol
 Central Nervous system depressant
 Influences several neurotransmitter systems, but mainly
GABA
 Effects of Chronic Alcohol Use
 Alcohol intoxication
 Alcohol withdrawal
 Associated brain conditions – Dementia and Wernicke’s
disease
 Fetal alcohol syndrome
 DSM-IV Criteria for Disordered Alcohol Use
The Depressants: Alcohol Use Disorders (cont.)
Figure 11.3
The path traveled by alcohol throughout the body
Alcohol: Some Facts and Statistics
 In the United States
 Most adults consider themselves light drinkers or
abstainers
 Most alcohol is consumed by 11% of the U.S. population
 Alcohol use is highest among Caucasian Americans
 Males use and abuse alcohol more so than females
 Violence is associated with alcohol, but alcohol alone
does not cause aggression
Alcohol: Some Facts and Statistics (cont.)
 Facts and Statistics on Problem Drinking
 10% of Americans experience problems with alcohol
 Most persons with alcoholism can moderate or cease
drinking on occassion
 20% of those with alcohol problems experience
spontaneous recovery
 Anhedonia – Lack of pleasure, or indifference to
pleasurable activities
 Affective flattening – Show little expressed emotion, but
may still feel emotion
Sedative, Hypnotic, or Anxiolytic
Substance use Disorders: An Overview
 The Nature of Drugs in This Class
 Sedatives – Calming
 Hypnotic – Sleep inducing (e.g., barbiturates)
 Anxiolytic – Anxiety reducing (e.g., benzodiazepines)
 Effects of Such Drugs Are Similar to Large Doses of Alcohol
 Combining such drugs with alcohol is synergistic
 All Exert Their Influence Via the GABA Neurotransmitter
System
 DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic
Substance Use Disorders
Stimulants: An Overview
 Nature of Stimulants
 Most widely consumed drug in the United States
 Such drugs increase alertness and increase energy
 Examples include amphetamines, cocaine, nicotine, and
caffeine
Stimulants: Amphetamine Use Disorders
 Effects of Amphetamines
 Produce elation, vigor, reduce fatigue
 Enhance the release of dopamine and norepinephrine,
while blocking reuptake
 Such effects are followed by a “crash” (e.g., feeling
depressed and tired)
 DSM-IV Criteria for Amphetamine Intoxication
 Psychological symptoms
 Physiological symptoms
 Ecstasy and Ice
 Produces effects similar to speed, but without the crash
 2% of college students report using Ecstasy
 Both drugs can result in dependence
Stimulants: Cocaine Use Disorders
 Effects of Cocaine
 Produce short lived sensations of elation, vigor, reduce
fatigue
 Effects result from blocking the reuptake of dopamine
 Cocaine is highly addictive, but addiction develops slowly
 Cocaine use in the United States has declined over the
last decade
 DSM-IV Criteria for Cocaine Intoxication and Withdrawal
 Psychological symptoms
 Physiological symptoms
 Most cocaine users cycle through patterns of tolerance
and withdrawal
Stimulants: Nicotine Use Disorders
 Effects of Nicotine
 Stimulates the central nervous system, specifically
nicotinic acetylcholine receptors
 Results in sensations of relaxation, wellness, pleasure
 Nicotine is highly addictive
 DSM-IV Criteria for Nicotine Withdrawal Only
 Psychological symptoms
 Physiological symptoms
 Nicotine users dose themselves to maintain a steady
state of nicotine
Stimulants: Nicotine Use Disorders (cont.)
Figure 11.8
Relapse rates for nicotine compared to alcohol and heroin
Stimulants: Caffeine Use Disorders
 Effects of Caffeine – The “Gentle” Stimulant
 Found in tea, coffee, cola drinks, and cocoa products
 Caffeine blocks the reuptake of the neurotransmitter
adenosine
 Small doses elevate mood and reduce fatigue
 Used by over 90% of Americans
 Regular use can result in tolerance and dependence
 DSM-IV Criteria for Caffeine Intoxication
 Psychological symptoms
 Physiological symptoms
Opiods: An Overview
 The Nature of Opiates and Opiods
 Opiate – Natural chemical in the opium poppy with
narcotic effects (i.e., pain relief)
 Opiods – Refers to a class of nature and synthetic
substances with narcotic effects
 Such drugs are often referred to as analgesics
 Examples include heroin, opium, codeine, and morphine
 Effects of Opiods
 Activate body’s enkephalins and endorphins
 Low doses induce euphoria, drowsiness, and slowed
breathing
 High doses can result in death
 Withdrawal symptoms can be lasting and severe
Opiods: An Overview (cont.)
 DSM-IV Criteria for Opiod Intoxication and Withdrawal
 Psychological symptoms
 Physiological symptoms
 Mortality rates are high for opiod addicts
Hallucinogens: An Overview
 Nature of Hallucinogens
 Substances that change the way the user perceives the
world
 May produce delusions, paranoia, hallucinations, and
altered sensory perception
 Examples include marijuana, LSD
 Marijuana
 Active chemical is tetrahydrocannabinol (THC)
 May produce several symptoms (e.g., mood swings,
paranoia, hallucinations)
 Impairment in motivation is not uncommon (i.e.,
amotivational syndrome)
 Major signs of withdrawal and dependence do not
typically occur
Hallucinogens: An Overview (cont.)
 LSD and Other 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
 DSM-IV Criteria for Marijuana and Hallucinogen Intoxication
 Psychological and physiological symptoms are similar
Other Drugs of Abuse: Inhalants
 Nature of Inhalants
 Substances found in volatile solvents that are breathed
into the lungs directly
 Examples include spray paint, hair spray, paint thinner,
gasoline, nitrous oxide
 Such drugs are rapidly absorbed with effects similar to
alcohol intoxication
 Tolerance and prolonged symptoms of withdrawal are
common
 DSM-IV criteria for inhalant intoxication
Other Drugs of Abuse: Anabolic Steroids
 Nature of Anabolic-Androgenic Steroids
 Steroids are derived or synthesized from testosterone
 Used medicinally or to increase body mass
 Users may engage in cycling or stacking
 Steroids do not produce a high
 Steroids can result in long-term mood disturbances and
physical problems
Other Drugs of Abuse: Designer Drugs
 Designer Drugs
 Drugs produced by pharmaceutical companies for
diseases
 Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine
(“special K”) are examples
 Such drugs heighten auditory and visual perception,
sense of taste/touch
 Becoming popular in nightclubs, raves, or large social
gatherings
 All designer drugs can produce tolerance and
dependence
Causes of Substance-Related Disorders:
Family and Genetic Influences
 Results of Family, Twin, and Adoption Studies
 Substance abuse has a genetic component
 Much of the focus has been on alcoholism
 Genetic differences in alcohol metabolism
 Multiple genes are involved in substance abuse
Causes of Substance-Related Disorders:
Neurobiological Influences
 Results of Neurobiological Research
 Drugs affect the pleasure or reward centers in the brain
 The pleasure center – Dopamine, midbrain, frontal cortex
 GABA turns off reward-pleasure system
 Neurotransmitters responsible for anxiety/negative affect
may be inhibited
Causes of Substance-Related Disorders:
Psychological Dimensions
 Role of Positive and Negative Reinforcement
 The self-medication and the tension reduction hypotheses
 Most see substance abuse as a means to cope with
negative affect
 Opponent-Process Theory
 Explains why the crash after drug use fails to keep people
from using
 Role of Expectancy Effects
 Expectancies influence drug use and relapse
Causes of Substance-Related Disorders:
Social and Cultural Dimensions
 Exposure to Drugs is a Prerequisite for Use of Drugs
 Media, family, peers
 Parents and the family appear critical
 Societal Views About Drug Abuse
 Sign of moral weakness – Drug abuse is a failure of selfcontrol
 Sign of a disease – Drug abuse is caused by some
underlying process
 The Role of Cultural Factors
 Influence the manifestation of substance abuse
An Integrative Model of Substance-Related Disorders
 Exposure or Access to a Drug Is Necessary, but not
Sufficient
 Drug Use Depends on Social and Cultural Expectations
 Drugs Are Used Because of Their Pleasurable Effects
 Drugs Are Abused for Reasons That Are More Complex
 The premise of equifinality
 Stress may interact with psychological, genetic, social,
and learning factors
An Integrative Model of
Substance-Related Disorders (cont.)
Figure 11.11
An integrative model of substance related disorders
Biological Treatment of Substance-Related Disorders
 Agonist Substitution
 Safe drug with a similar chemical composition as the
abused drug
 Examples include methadone for heroin addiction, and
nicotine gum or patch
 Antagonistic Treatment
 Drugs that block or counteract the positive effects of
substances
 Examples include naltrexone for opiate and alcohol
problems
Biological Treatment of
Substance-Related Disorders (cont.)
 Aversive Treatment
 Drugs that make the injection of abused substances
extremely unpleasant
 Examples include antabuse for alcoholism and silver
nitrate for nicotine addiction
 Efficacy of Biological Treatment
 Such treatments are generally not effective when used
alone
Psychosocial Treatment of Substance-Related Disorders
 Debate Over Controlled Use vs. Complete Abstinence as
Treatment Goals
 Inpatient vs. Outpatient Care
 Data suggest little difference in terms of overall
effectiveness
 Community Support Programs
 Alcoholics Anonymous and related groups
 Seem helpful and are strongly encouraged
Psychosocial Treatment of
Substance-Related Disorders (cont.)
 Components of Comprehensive Treatment and Prevention
Programs
 Individual and group therapy
 Aversion therapy and convert sensitization
 Contingency management
 Community reinforcement
 Relapse prevention
 Preventative efforts via education
Summary of Substance-Related Disorders
 DSM-IV and DSM-IV TR Substance Related Disorders Cover
Four Classes
 Depressants, stimulants, opiates, and hallucinogens
 Specific diagnoses include dependence, abuse,
intoxication, or withdrawal
 Most Psychotropic Drugs Activate the Dopaminergic
Pleasure Pathway in the Brain
 Psychosocial Factors Interact with Biological Influences to
Produce Substance Disorders
 Treatment of Substance Dependence Is Largely
Unsuccessful
 Highly motivated persons do best when part of combined
treatment programs
 Substance-Related Disorders Are 100% Preventable
Summary of Substance-Related Disorders (cont.)
Figure 11.x1
Exploring substance-related disorders
Summary of Substance-Related Disorders (cont.)
Figure 11.x1 (cont.)
Exploring substance-related disorders
Summary of Substance-Related Disorders (cont.)
Figure 11.x2
Exploring substance-related disorders, treatment
Summary of Substance-Related Disorders (cont.)
Figure 11.x2 (cont.)
Exploring substance-related disorders, treatment