The Process of Addiction
Three stages:
1. Experimental and social use of drugs and alcohol
2. Abuse
3. Dependency/Addiction
a. DSM-V Criteria
i. Mild – 2/3 symptoms
ii. Moderate – 4/5 symptoms
iii. Severe – 6+ symptoms
4. Can add - in early remission, in sustained remission on maintenance therapy, or in a
controlled environment.
Five critical components of effective treatment
1. Assessment – use diagnostic instruments and processes to determine an individual’s
needs and problems.
2. Patient-Treatment Matching – ensure that an individual receives the type of treatment
corresponding with their personality, background, mental condition, etc.
3. Comprehensive Services – range of services needed in addition to specific alcohol or
drug treatment.
4. Relapse Prevention – based on assessing an individual’s triggers that rekindle the need
for drugs.
5. Accountability – of treatment program, the need for its integrity and results.
Model treatment program includes:
 Assessment
 Same day intake
 Documenting finding and treatment
 Prevention and primary medical care
 Testing for infectious diseases
 Weekly random drug testing
 Pharmacotherapeutic interventions
 Group counseling interventions
 Practical life skills counseling
 General health education
 Peer/support groups
 Social and athletic activities
 Alternative housing
 Relapse prevention
 Outcome evaluation
Treatment Approaches
 Pharmacological Modalities
 Behavioral Modalities
The Neurobiology of Addiction
Nervous System Process of Stimulus and Response
1. Sensory Response
2. Interconnection
3. Motor Response
Three Structures: Brain, Spinal Cord, Peripheral Nerves
 Two Major Parts
o Central Nervous System – brain and spinal cord
o Peripheral Nervous System – nerves that branch from the CNS
 Two Subdivisions
o Somatic System – cranial and spinal nerves that connect the CNS to skin and
skeletal muscles
o Autonomic System – CNS to organs
 Sympathetic – prepares body for activities which expend energy
 Parasympathetic – aids body in returning to normal after a period of
expending energy
Neuron – basic unit of nervous system
Dendrites – fibers that send nerve impulses towards cell body
Axons – carries impulses away from cell body
 Psychoactive drugs do not act primarily on the axon with the exception of local
anesthetics
 Depressant drugs tend to thicken the medium, thus slowing down the transmission
 Stimulant drugs tend to thin the medium, thus causing more rapid transmission
 Marijuana fills the gap, thus preventing transmission from occurring
Process
1. A nerve impulse reaches the synaptic knob
2. The neurotransmitter substance is released into the synaptic cleft
3. The neurotransmitter substance is diffused across the synaptic cleft
4. The neurotransmitter reacts with the membranes of the dendrite on the other side of the
cleft
5. The nerve impulse is reestablished in the dendrite and transmission is continued through
the cell
6. The neurotransmitter substance breaks down to prevent continued stimulation of the
dendrite
Acetylcholine – an excitatory neurotransmitter released by axons
Norepinephrine – a neurotransmitter found in the brain, associated with arousal reactions and
moods
Dopamine – a neurotransmitter found in the brain, associated with body movement and pleasure
Serotonin – a brain transmitter associates with regulation of sensory perception, sleep and body
temperature
 Alterations in the serotonin functioning have been found to be related to mental illness
and certain drug induced hallucinations
Gamma-aminobutyric acid or GABA – an inhibitory neurotransmitter substance (one that blocks
the transfer or nerve impulse to an adjourning neuron in the brain
 When the normal function of GABA is disrupted, convulsions may occur
Glycine – an inhibitory neurotransmitter substance found in the spinal cord
Enkephalins & endorphins – extracted from the brain and pituitary gland; have pain killing
properties more powerful than morphine.
 Endorphins 40x more powerful than enkephalins and 100x more powerful than morphine
Precursors to neurotransmitters are often amino acids that are derived from proteins in the diet.
 Synthesis is helped by enzymes
1. In some cells a process of reuptake takes place
2. With others, enzymes present in the synapse metabolize or break down molecules
(dopamine)
Examples of Drug Interactions
 The medulla oblongata
o Some drugs can so severely depress these centers that death may occur, often due
to respiratory failure. Such drugs include opiates and barbiturates.
o Alcohol and other depressants block normal activity in the ARAS, while
amphetamines increase ARAS activity. If ARAS is increased to intensify alertness
beyond normal limits, hallucinations often occur.
 Midbrain
o Psychedelic drugs work here to create visual or auditory hallucinations
 Cerebellum
o When depressed by psychoactive drugs, especially by alcohol intoxication, there
is a loss of muscle coordination, staggering and loss of balance.
 Hypothalamus
o It is the prime site of action of many psychoactive drugs
 Limbic System
o Many tranquilizing drugs, especially Librium and Valium, depress the limbic
system resulting in a calming effect for the relief of anxiety
Stimulants increase neuron activity, sometimes to the point of hallucinations.
Depressants decrease nerve cell function, affecting concentration as well as the perceptiojn of
other stimuli.
Chapter 3: Drugs of Abuse – Alcohol
By definition a drug is anything that alters the normal course of the body functioning. A
psychoactive drug is something that not only changes the way the body works, but also alters the
mood, emotions, and psychological process of the brain.
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Methyl, Methanol, or wood alcohol – can cause blindness because it leaves the body
more slowly than ethanol. The breakdown element is actually formaldehyde, thus its
toxic effect.
Isopropyl, Isopropanol, or rubbing alcohol – causes serious gastrointestinal distress as
well as damage to the lungs. Eight ounces of pure isopropyl can be fatal.
Butyl alcohol – made from molasses of beets – used in lacquer, tanning products, film
production.
Denatured alcohol – ethyl alcohol with addicrtives that make it “undrinkable” used as a
solvent.
Basic Definitions
 Alcohol use – the consumption of beverage alcohol within some socially prescribed or
ritualistic context
 Alcohol misuse – unintentional or inappropriate use of beverage alcohol resulting in the
impaired physical, mental, emotional, or social well being of the user.
 Alcohol abuse – deliberate or unintentional use of beverage alcohol which results in any
degree of physical, mental, emotional, or social impairment of the user, the user’s family,
or society in general.
 Alcohol dependence – psychological and/or physical need for beverage alcohol;
characterized by compulsive use, tolerance, and physical dependence manifest by
withdrawal syndrome.
Acute Effects of Alcohol
 Absorption – approximately 20% is absorbed through tiny blood vessels in the stomach.
The rest is absorbed in the small intestine. Food and mixed drinks slow absorption
meaning peak BAC won’t be reached for several hours.
 Distribution – organs with higher concentrations of water, or dense networks of blood
vessels and a richer blood supply ( brain, kidneys, liver, and lungs) reaches the same
BAC of the blood very rapidly.
 Elimination -