1
Substance Abuse Outline
Substance-related disorders: using, abusing drugs that alter patterns of
thinking, feeling, & behaving.
Substance: chemical compounds that are ingested to alter mood or behavior.
Substance Use
Substance Intoxication
Substance abuse – key – interference with the user’s life.
Substance dependence: addiction – disagreement on definition. Can
dependence exist without abuse?
Definition #1: addiction is a physiological dependence on the drug, evidencing
tolerance & negative physical reactions, & withdrawal. But… some chemicals do
not produce symptoms of withdrawal.
Definition #2: Drug-seeking behaviors.
Definition #3: DSM-IV-TR – combines physiological aspects with the behavioral
& psychological aspects.
Diagnostic Issues: early versions = sociopathy.
Drugs: Depressants, Stimulants, Opiates, Hallucinogens, Inhalants, anabolic
steroids, & Over-the-counter prescription medications.
Alcohol: Influences a number of different neuroreceptor systems such as GABA
inhibitory system; the glutamate system; the serotonin system.
LT effects of heavy drinking: withdrawal, tremors, nausea, vomiting, anxiety,
transient hallucinations, agitation, insomnia, DTs, liver disease, pancreatitis,
cardiovascular disorders, brain damage.
Brain cells = the damage may be to the connections between the neurons.
Regeneration?
Two types of serious brain syndromes = dementia & Wernicke’s disease. The
role of thiamine.
Prenatal development & alcohol = Fetal Alcohol Syndrome (FAS) = growth
retardation, cognitive deficits, behavior problems, learning difficulties,
2
characteristic facial features. Greatest risk: African Americans & Apache & Ute
Indian women.
Alcohol is metabolized via an enzyme = alcohol dehydrogenase (ADH) & there
are 3 forms of this enzyme = beta 1, beta 2, beta 3. The role of beta 3.
The history of alcoholism & drug addiction.
Diagnostic issues:
1. The issue of tolerance. “With physiological dependence”
2. Question…. Should the new diagnostic criteria continue to deemphasize
social consequences & occupational impairment as a criteria for
dependence?
3. Question… should the DSM-V offer a shorter list of criteria for
dependence?
4. Should abuse be made more distinct and not just a residual category?
Alcohol & Epidemiology:
- between 14 & 16 million Americans = alcohol abuse or dependence
- 4 & 6 million Americans dependent on illegal drugs
- > 45 million Americans dependent on nicotine
- Economic costs to the U.S. $200 billion in 1990
- Annual consumption by the average American > 2 gallons of ethanol a
year
- This figure hasn’t changed much in 140 years with 2 exceptions
Substance abuse varies with age, gender, race, ethnicity, & SES.
- men 18-44 2x the rate of women
- substance abuse rates much lower
- rates by African Americans & Hispanic Americans for both sexes higher
than Caucasians
- Prevalence rate 17% - average lifetime prevalence
- 1992 National Longitudinal Alcohol Epidemiologic Study – 43,000 US
adults > 18 years, 44% current drinkers, 22% former drinkers, 34%
lifetime abstainers
- 5-6% of the sample regularly consumed 5 or more drinks/ at least once
per week
- Men 2x more likely as women to drink 5 or > drinks at least once, and 4x
> likely to do so at least weekly.
- 1984 National Alcohol Survey
- SES factors
Family History
- Greatest predictor – family. Why? Genetics? Environment?
3
-
Inborn tolerance & level of reaction to alcohol/drugs
Peer influences
Gender differences
Societal contributions
History of abuse
Psychiatric comorbidity: 44% of men have an additional psychiatric
disorder; 65% of women have an additional psychiatric disorder.
Most common comorbid disorders: depression, anxiety, schizophrenia,
other psychoses, ADHD.
Etiology: Why is it so important to understand the factors that contribute to why
some people abuse drugs/alcohol?
What
-
-
might add to an addition potential?
Culture & subcultures
Poverty & neighborhood disorganization
The peer group
Dryfoos (1990) risk characteristics = problem behavior syndrome which
include = conduct problems, slow school achievement & truancy, age at
initiation, high peer influence & peer drug use, nonconformity, lack of
parental support, sex, parental drug use, lack of resources at home,
neighborhood, health risk behaviors.
The role of peers = gateway model = legal to illegal drugs is sequential.
Cigarettes, alcohol, marijuana, stimulants, depressants, hallucinogens,
cocaine, & heroin.
The role of social modeling
The family
The role of stress
Personality = addictive personality? Trull & Sher (1994) found distinct
personality patterns, e.g. higher neuroticism, lower extraversion, higher
openness, lower agreeableness, lower conscientiousness.
Higher openness = sensation & novelty seeking.
Genetics:
o Adoption studies – 2.5x the risk for alcoholism
o Twin studies – concordance rate > MZ than DZ twins.
cognitive aspects: sensitivity to drug effects & expectancies (Luria, 1980).