SUBMITTED BY:

Hira Farooq

Hira Mehmood

Misbah Arif Siddiqui

Sunain Aneel Mumtaz

3RD YEAR (6TH SEMESTER)

SUBMITTED TO:

Dr. Mahrukh Amjad

PSYCHOPATHOLOGY II

DEPARTMENT OF PSYCHOLOGY

UNIVERSITY OF KARACHI
 TABLE OF CONTENTS
DSM-5 CRITERIA 1

ALCOHOL USE DISORDER 2

TOBACCO USE DISORDER 4

MARIJUANA 6

OPIATES 8

STIMULANTS 9

HALLUCINOGENS, ECSTASY AND PCP 11

ETIOLOGY OF SUBSTANCE USE DISORDERS 12

TREATMENT 15

PREVENTIONS 21
Substance use disorders are disorders in which drugs such as alcohol or cocaine are abused to such an

extent that behavior becomes maladaptive, social and occupational functioning is impaired, and control or

abstinence becomes impossible.

DSM-5 CRITERIA
1. Problematic pattern of use that impairs functioning.

2. Two or more symptoms within a 1 year period:

 Failure to meet obligations

 Repeated use in situations where it is physically dangerous

 Repeated relationship problems

 Continued use despite problems caused by substance

 Tolerance

 Withdrawal

 Substance taken for longer time or in greater amounts than intended

 Efforts to reduce or control use do not work

 Much time spent trying to obtain the substance

 Social/hobbies/work activities given up or reduced

 Continued use despite knowing problems caused by substance

 Craving to use the substance is strong

Previously, DSM-IV-TR had two categories: substance abuse and substance dependence. In DSM-5 both

the categories are combined into one category called substance use disorder. As in DSM-IV-TR, the DSM-5

will likely contain substance use disorder category for specific substances, including alcohol,

amphetamines, cannabis, hallucinogens, inhalants, opioids, phencyclidine, sedatives/hypnotics/anxiolytics,

and tobacco. Marijuana is most popularly used illegal drug while alcohol is the most used substance. DSM-

5 now includes gambling disorder in chapter on substance-related and addictive disorders.

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The term ‘addiction’ typically refers to a severe substance use disorder with symptoms, tolerance, and

withdrawal, by using more than intended amounts, trying unsuccessfully to stop, physical/psychological

problems made worse by drug, and problematic relationships. In DSM-5, meeting four or more diagnostic

criteria will likely to be considered as severe substance use disorder. In addition, there are two diagnostic

criteria specifier for substance use disorder:

 With Physiological dependence = presence of either tolerance or withdrawal

 Without physiological dependence = absence of tolerance and withdrawal

Tolerance is indicated by:

1. Larger doses of the substance being needed to produce the desired effect, or

2. The effects of the drug becoming markedly less if the usual amount is taken.

Withdrawal is negative physical and psychological effects that develop when a person stops taking the

substance or reduces the amount muscle pain, twitching, sweats, vomiting, diarrhea, insomnia.

Drug and alcohol use disorder are among most stigmatized disorders because terms such as addict or

alcoholic are used carelessly as if these words capture the essence of people, and not the disorder.

ALCOHOL USE DISORDER

People who are physiologically dependent on alcohol generally show more severe symptoms of tolerance

and withdrawal.

 The effects of abrupt alcohol in a heavy user may be dramatic.

 A person may feel anxious, depressed, weak, restless, and unable to sleep.

 He/she may have muscles tremors and elevated pulse rate, blood pressure and temperature.

 In rare cases, a person may experience, delirium tremens (DTs) i.e. the person becomes delirious

when alcohol level in blood suddenly drops, as well as tremulous and has hallucinations that are

primarily visual and may be tactile as well.

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  Alcohol use disorder is often associated with other drug use (polydrug abuse). It is estimated that

80-85% alcohol consumers are smokers. It is because nicotine and alcohol are cross-tolerant, that is,

it can induce tolerance for the rewarding effects of the other. Nicotine influences the way alcohol

works in the brain’s dopamine pathways associated with reward.

Prevalence:

 Alcohol use is common among college-age students. This is true for binge drinking (having 5 drinks

in a short period of time) and heavy-use drinking (having 5 drinks on the same occasion five or

more times in 30-day period). Among both males and females students, binge and heavy-use drinking

rates were 43.5% and 16% respectively, in 2009.

 More men than women have problems with alcohol. Women begin to drink at a later age than men,

but they can become physiologically dependent as quickly as men do.

 European American and Hispanic adolescents/adults more likely to binge drink than African

American.

 Alcohol dependence was most prevalent in Native American and Hispanics and least prevalent

among Asian American and African American.

 Alcohol use disorders are comorbid with personality disorders, mood disorders, schizophrenia, and

anxiety disorders (and other drug use).

Short-Term Effects of Alcohol:

 Alcohol after being swallowed and reaching the stomach beings to be metabolized by enzymes,

enters small intestine and is absorbed into blood. It is then primarily broken down in liver, which can

metabolize 1 ounce or 100-proof (50%) liquor per hour.

 Absorption of alcohol can be quick but removal is slow.

 The effects of alcohol vary with its concentration in the bloodstream which depends in the amount

ingested in a particular time, presence of food in the stomach, weight and body fat of a person, and

liver efficiency.

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  Women achieve higher blood alcohol concentrations after adjustments for body weight due to

differences in body water content between men and women.

 Alcohol stimulates GABA receptors (reduces tension), increases levels of serotonin and dopamine

(pleasurable effects), inhibits glutamate receptors *causes cognitive effects (slowed thinking,

memory loss)

Long-Term Effects of Prolonged Alcohol Abuse:

 Long term alcohol consumption may impair digestion of food and absorption of vitamins.

 The deficiency of B-complex vitamins can cause amnestic syndrome (severe loss of memory for

recent and long-past events)

 Alcohol use plus reduction in protein intake leads to development of cirrhosis of the liver. Liver cells

become engorged with fat and protein, impeding their function.

 Damage can occur to endocrine glands, brain, pancreas, heart failure, erectile dysfunction,

hypertension, stroke and capillary hemorrhages which is responsible for swelling and redness in face.

 Fetal alcohol syndrome can occur, that is, growth of fetus is slowed, production of cranial, facial

and limb abnormalities as a result of heavy alcohol consumption while pregnant

 Benefits: physiological (increases coronary blood flow), psychological (less-driven lifestyle and

diminished hostility)

 Low-moderate consumption of red wine may lower bad cholesterol and raise good cholesterol.

TOBACCO USE DISORDER

Tobacco is either smoked, chewed, or ground into small pieces and inhaled as snuff. Nicotine is the

addicting agent of tobacco which activates neural pathways that stimulate dopamine neurons in mesolimbic

area.

Prevalence and Health Consequences:

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  Smoking is the single most preventable cause of premature death in the US as well as other parts of

the world.

 One of every six deaths in US occurs due to smoking. Lung cancer is the most prevalent.

 People in US who are most likely to smoke are those with a psychological disorder.

 Consequences: emphysema, cancer of larynx/esophagus/pancreas/bladder/cervix/stomach, pregnancy

complications, sudden infant death syndrome, periodontitis, cardiovascular disorders.

 Tobacco contains harmful components: nicotine, carbon monoxide, tar, which are knows as

carcinogens.

 There rates of smoking are:

 Similar among adolescent males/females

 Higher among Hispanic and white adolescents than African/Asia American

 African Americans retain nicotine in their blood longer, that is, they metabolize it more slowly which

is why they are less likely to quit and more likely to get lung cancer. Another reason is that they

smoke more menthol.

 Those who smoke menthol cigarettes inhale more deeply and hold smoke in for a longer time

 Asians have lower rates of lung cancer than whites and Latinos because they metabolize less nicotine

from cigarettes.

Secondhand Smoke:

Secondhand smoke is smoke coming from the burning end of the cigarette, also known as environmental

tobacco smoke (ETS). It contains higher concentration of ammonia, carbon monoxide, nicotine, and tar than

the inhaled smoke. ETS has been classifies as carcinogen by The National Institute of Health. Health

consequences of ETS includes:

1. Lung damage – those living with smokers are at greater risk

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 2. Babies of women exposed to secondhand smoke during pregnancy more likely to be born

prematurely, lower birth weight and defects

3. Children of smokers more likely to have upper respiratory infections, asthma, bronchitis, inner-ear

infections, SIDS (sudden infant death syndrome)

There is no safe level of exposure to secondhand smoke.

MARIJUANA
Marijuana consists of dried and crushed leaves and flowering tops of hemp plant Cannabis sativa. It is

either smoked, chewed, prepared as tea, or eaten in baked goods. Hashish, much stronger than marijuana,

produced by removing and drying resin exudate of the tops of cannabis plants. In DSM-5, cannabis use

disorder will likely to be a category name that includes marijuana.

Prevalence:

• Most frequently used illicit drug, nearly 17 million people over the age of 12 reportedly use

marijuana.

• Most commonly used drug across all age groups.

• Higher prevalence among men than women, nearly twice as many men (8.6%) than women (48%)

• More common among Native American and European American, and less common among Africans

American, Hispanics, and Asian Americans.

• Greater use in United States, Australia, and New Zealand than in European Union, Africa, Asia,

South American, and Canada

Effects:

 Major active chemical: delta-9-tetrahydrocannabinol (THC)

 Marijuana is now more potent than it used to be 30 years ago and users smoke more now than in the

past

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 Psychological Effects:

 Depend on potency and dose size.

 Feel relaxed and sociable.

 Rapid shifts in emotion, dull attention, fragment thoughts, impaired memory, sense that time

moves slowly.

 Extreme doses can induce hallucinations, extreme panic.

 May take up to 30 minutes for effects to appear.

 Can interfere with cognitive functioning: planning, decision making, working memory, problem

solving

 Being high impairs psychomotor skills necessary for driving

 Physical Consequences:

 Bloodshot and itchy eyes

 Dry mouth/throat

 Increased appetite

 Reduced pressure within the eye

 Raised blood pressure

 Long-term use can impair lung structure and function

 People smoke less cigarettes than tobacco smokers, but inhale more deeply and it retains in lungs

longer. 1 marijuana cigarette equivalent to 5 tobacco cigarettes in CO content, 4 in tar intake and

10 in terms of damage to cells lining the airways.

 Marijuana has effects on receptors of hippocampus called cannabinoid brain receptors i.e. CB1

and CB2, which effects memory & learning of a person

 Increased blood flow to brain regions associated with emotion (amygdala, anterior cingulate)

 Decreased blood flow to temporal lobe (auditory attention)

 Habitual use does produce tolerance (addictive evidence)

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  Withdrawal symptoms can occur such as restlessness, anxiety, tension, stomach pain, and

insomnia.

 Therapeutic Effects:

 Reduction in nausea and loss of appetite that accompany chemotherapy for some people with

cancer, glaucoma, chronic pain, muscle spasms, seizures, discomfort from AIDS.

OPIATES
Opiates are group of addictive sedatives which includes opium and its derivatives: morphine, heroin and

codeine. In moderate doses can relieve pain and induce sleep. They are considered as sedatives but has a

separate category, opiates use disorder, from sedative/hypnotic/anxiolytic use disorder in DSM-5.

Prevalence of Abuse and Dependence:

Mostly taken as prescribed pain medications but is later used for non-medical purposes and abused,

Overdoses are common. Death by overdose of opiates is a serious problem.

Psychological and Physical Effects:

 Produce euphoria, drowsiness, lack of coordination.

 Produce a “rush” – feeling of warm, suffusing ecstasy immediately after injection.

 Shed worries and fears, great self-confidence 4-6 hours, followed by a severe letdown.

 Stimulate neural receptors of the body’s opioid system (endorphins and enkephalins). Heroin

converted to morphine in the brain, binds to opioid receptors

 Affect the nucleus accumbens (or possibly dopamine system)

 Show tolerance and withdrawal. Withdrawal may begin within 8 hours of last injection with

symptoms muscle pain, sneezing, sweating, and tearful yawns. High tolerance is built up. Withdrawal

symptoms becomes more severe after 36 hours such as muscle twitching, cramps, chills/sweating,

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 rise in heart rate, unable to sleep, vomiting and diarrhea. Symptoms persist for 72 hours and diminish

gradually over 5-10 days period.

 Drug and process of obtaining it become center of the person’s existence

 Costs upwards of $200/day

 Needle sharing leads to exposure to infectious agents (e.g. HIV)

STIMULANTS
Stimulants act on the brain and sympathetic nervous system to increase alertness and motor activity

 Synthetic: amphetamines, Natural: cocaine (coca leaf)

Amphetamines (synthetic stimulant):

 E.g. Benzedrine, Dexedrine, methedrine – produce effects by causing release of norepinephrine and

dopamine, block reuptake

 Orally or intravenously taken, addicting.

 Heightens wakefulness, intestinal functions inhibited, appetite reduced (used in dieting), increased

heart rate, blood vessels and mucous membranes constrict.

 Person becomes alert, euphoric, outgoing, boundless energy and self-confidence

 Large dose make a person nervous, agitated, confused, palpitations, headaches, dizziness,

sleeplessness.

 Tolerance develops rapidly (after 6 days of repeated use)

 Methamphetamine:

 Derivate of amphetamine.

 Most commonly abused stimulant

 More often used by men

 Used in small towns more than big cities

 Taken orally, intravenously, nasally

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  Crystal meth – when in clear crystal form

 Craving lasts for several years after discontinuing use

 Immediate rush that lasts for hours followed by a crash (tweaking)

 Have both tolerance and withdrawal symptoms

 Long term use affects dopamine and serotonin systems of the brain and smaller the

volume of

 hippocampus

 Lower brain activation in several areas especially during decision making tasks

which predicted relapse 1 year after treatment.

Cocaine:

 Comes from leaves of coca shrub, crack comes in rock-crystal form (heated, melted then

smoked)

 Crack is cheaper than cocaine, used in urban areas

 Used by men more often than women

 Cocaine use declined between 2002-09, dropping from 1.4% from 2%.

 Acts rapidly on brain, blocking reuptake of dopamine in mesolimbic areas.

 Increased sexual desire and feelings of self-confidence, well-being, and indefatigability.

 Overdoes: chills, nausea, insomnia, paranoia, hallucinations

 Long-term use: heightened irritability, impaired social relationships, paranoid thinking,

eating/sleeping disturbances

 Some develop tolerance, others become more sensitive to effects (can lead to death) o Severe

withdrawal symptoms

 Cocaine is a vasoconstrictor – causes blood vessels to narrow which is why people often die of

overdose leading to heart attack.

 Increases risk for stroke, causes cognitive impairments.

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  Lower volumes of grey matter in prefrontal cortex if exposed prenatally.

 Freebase cocaine produces powerful effects, absorbed so rapidly (heated by ether)

 Induces an intense 2-minute high followed by restlessness and discomfort.

HALLUCINOGENS, ECSTASY AND PCP

LSD and Other Hallucinogens:

Hallucinogen is a drug or chemical, such as LSD, psilocybin, or mescaline, whose effects include

hallucinations; often called as psychedelic.

 It is used more by men than women.

 LSD (lysergic acid diethylamide) has no evidence of withdrawal. Tolerance appears to develop

rapidly. It can alter sense of time (seems to pass slowly), sharp mood swings, expanded

consciousness. Many users experience intense anxiety because the perceptual

experiences/hallucinations can provoke fears that they are going crazy.

 People who use LSD more frequently in stress, illness, fatigue may experience flashbacks, that is,

visual recurrences of perceptual experiences after physiological effects of the drug have worn off.

 Other hallucinogens stimulate serotonin receptors.

Ecstasy and PCP:

Ecstasy is made from MDMA (methylenedioxymethamphetamine). It became illegal in 1985.

 It contains compounds from hallucinogen and amphetamine families.

 It is popular on college campuses and in clubs

 It is taken in pill form, often mixed with other substances making the effects vary dramatically.

 It contributes to both release and reuptake of serotonin.

 It may have neurotoxic effects on serotonin system.

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  It enhances intimacy and insight, improves interpersonal relationships, elevates mood and self-

confidence, promotes aesthetic awareness

 It can cause muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills, sweating,

anxiety, depression, depersonalization, confusion

PCP (phencyclidine) or “angel dust”, is another drug that is not easy to classify.

 It causes serious negative reactions, severe paranoia, violence, coma and death.

 People who abuse PCP are more likely to have used other drugs before or concurrently with PCP.

ETIOLOGY OF SUBSTANCE USE DISORDERS

Positive attitude  Experimentation  Regular Use  Heavy Use  Dependence or Abuse

Developmental Approach:

 First group began drinking in early adolescence, increased drinking throughout high school and

adulthood.

 Second group drank less in early adolescence, increased drinking in middle school & again in

high school.

 Boys were more likely to follow the trajectory of the first group whereas girl were more likely to

follow the trajectory of the second group.

 Developmental studies does not account for all cases.

Genetic Factors:

 Much research has addressed the possibility of high genetic contribution of alcohol use disorder (also

true for smoking, marijuana and other drugs in general)

 Behavioral genetics indicate that both genetic and shared environmental risk factors appear to be the

same no matter what the drug is, and this appears to both the genders.

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  There may be difficulty to build tolerance if a person has inherited deficiency in alcohol

dehydrogenase (enzymes involved in alcohol metabolism). Mutations in ADH2 and ADH3 genes

linked with alcohol use disorders

 Research has found that nicotine stimulate dopamine release and inhibit its reuptake, and people who

are more sensitive to effects of nicotine are more likely to get addicted.

 Research has also examined a link between Gene SLC6A3 and reuptake regulation of dopamine. One

of form of this gene has been related to lower likelihood of smoking and a greater likelihood of

quitting.

 Research has also found that genes, such as CYP2A6, contributes to body’s ability to metabolize

nicotine, with some people able to do this quickly and others slowly. Slower nicotine metabolism

means it stays longer in brain. Other evidence found that people with reduced activity in the CYP2A6

gene are less likely to become nicotine dependent.

Neurobiological Factors:

 The most studied neurobiological factors are brain system associated with dopamine pathways- the

major reward pathways in the brain.

 Some research evidence suggests that people dependent on drugs have a deficiency in the dopamine

receptors.

 Researches also shows that the problems in the dopamine pathways is whether increase vulnerability

to substance dependence (vulnerability model) or are the consequence of substance dependence

(toxic effect model).

 People take drugs to avoid bad feelings associated with withdrawal which is why relapse is so

common.

 Investigators proposed the incentive-sensitization theory which considers both the craving for drugs

and the pleasure that comes with taking the drugs. Dopamine system is linked to pleasure/liking,

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 becomes supersensitive to the drug and to cues associated with it (needles, spoons, rolling paper).

Sensitivity to cues induces craving. Overtime, liking decreases and wanting remains intense

 Brain imaging studies show that cues for a drug activate the reward & pleasure areas of the brain

involved in drug use. Greater activation in basal ganglia, infer frontal gyrus, and pre-motor areas

shows better inhibition of a response when needed.

 Self-reports of liking and wanting are important for predicting drinking behavior.

Psychological Factors:

Three types of psychological factors may contribute to the etiology of substance use disorder.

1) Mood Alteration:

 One of the main psychological motives for using the drug is to change the mood. Drug use is

reinforced because it enhances positive mood or diminishes negative ones.

 Tension reduction is the only aspect of the possible effect of drugs on mood. Some people

may use drugs to reduce negative affect, whereas others may use drugs to increase positive

affect when they are bored.

2) Expectancies about Alcohol and Drug Effects:

 People who expect alcohol to reduce anxiety and stress are more likely to be frequent users.

 People who believe that drug intake will have positive effects are more likely to become

frequent users

 The greater perceived risk of a drug, the less likely it is to be use.

3) Personality Factors:

 It may help to explain why certain people are more likely to abuse or become drug or alcohol

dependent.

 Personality factors that predict the later onset of substance use disorder includes:

 High levels of negative affect – neuroticism/negative emotionality

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  Persistent desire for arousal along with increased positive affect

 Constraint which is the cautious behavior, harm avoidance, conservative moral standards.

 One longitudinal study shows that people low in constraint and high in negative emotionality

were more likely to develop substance use disorder.

 Another study shows that kindergarten children high in anxiety & novelty seeking more likely

to get drunk, smoke & use drugs in adolescence.

Sociocultural Factors:

 Sociocultural factors play a widely varying role in substance use disorder.

 Interest in and access to drugs influenced by peers, the media, and cultural norms.

 Alcohol is the most commonly abused substance, followed by marijuana.

 High alcohol consumption often found in wine-drinking societies such as France, Spain, Italy.

 Men consume more alcohol than women (differs by country).

 Easy accessibility affects usage.

 Family factors: parental use, marriage conflict, lack of parental monitoring (drug), lack of

emotional support from parents (cigarettes, marijuana, alcohol)

 Social Network: Having peers who drink influences drinking behaviors (social influence).

Individuals also choose friends with drinking patterns similar to their own (social selection)

 Media showing television commercials, billboard advertisement, magazine advertisement.

TREATMENT
 First step to successful treatment is admitting there is a problem.

 Many treatment programs require individuals to begin by stopping use, which can exclude many

individuals.

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Treatment of Alcohol Use Disorder:

 Only 24% who are physiologically dependent on alcohol ever receive treatment.

1) Impatient Hospital Treatment:

 The first step in treatment for many substance use disorders is detoxification which involves

medical supervision of painful withdrawal.

 Withdrawal can be difficult, both physiologically and psychologically.

 Inpatient treatments are more expensive as it requires longer hospital stay and not necessarily

more effective, but sometimes needed if individual lacks social support.

 Outpatient treatment is more common.

2) Alcoholics Anonymous (AA):

 It is the largest and most widely known self-help group.

 AA chapter runs regular and frequent meetings, newcomers rise to announce that they are

alcoholics and give testimonials, share stories of how their lives are better now without

alcohol.

 The group provides emotional support, understanding and close counseling, plus a social

network.

 Members are urged to call on one another around the clock when they need encouragement

not to relapse.

 AA tries to instill a belief in every member that alcohol dependence is a disease that can

never be cured, continuing vigilance is necessary to resist taking even a single drink.

 According to AA tenets an alcoholic is always an alcoholic, carrying the disease even if it is

currently under control.

 AA provide a 12 step program of spiritual aspect that belief in the philosophy linked to

achieving abstinence.

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  One of the approach is rational recovery which focuses on promoting renewed self-reliance

rather than reliance on a higher power.

 AA has high dropout rates

3) Couples Therapy:

Couple therapy has found to achieve reduction in problem drinking even a year after treatment has

ended and improve overall couple distress.

4) Cognitive and Behavioral Treatments:

 Contingency management therapy is a cognitive behavioral therapy for alcohol and drug use

disorders that involves teaching people to reinforce behaviors inconsistent with drinking. It is

based on belief that environmental contingencies can play a role in encouraging/discouraging

drinking. Vouchers are provided for not using a substance and can exchange earned tokens for

desirable objects. The therapy also includes teaching, job hunting and social skills, assertiveness

training for refusing drinks.

 Relapse prevention is another CBT whose goal is to help people avoid relapsing once they have

stopped substance use.

5) Motivational Interventions:

 The intervention contained two parts:

 A comprehensive assessment that included the Timeline Follow Back (TFB) interview, which

carefully assesses drinking in the past 3 months, and

 A brief motivational treatment that included individualization feedback about a person’s drinking

in relation to community and national averages, education about the effects of alcohol, and tips

for reducing harm and moderating drinking.

6) Moderation in Drinking:

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  One of the domain of alcohol treatment is controlled drinking which refers to a pattern of

alcohol consumption that is moderate and avoiding the extremes of total abstinence and

inebriation.

 The teaching of moderation to people with alcohol use disorder is called the guided self-change.

The basic assumption is that people have more potential control over their immoderate drinking

than they typically believe and that heightened awareness of the costs of drinking to excess &

benefits of abstaining or cutting down can help.

7) Medications:

 Antabuse (disulfiram) a drug that discourages drinking by causing violent vomiting if alcohol is

ingested. It is not an effective treatment for long run.

 The Food and Drug Administration (FDA) has approved opiate antagonist, naltrexone for

alcohol use disorder which blocks the activity of endorphins stimulated by alcohol, thus reducing

its craving. It is effective when combined with CBT.

 Acamprosate is another drug approved by FDA which impacts the glutamate and GABA

neurotransmitter system and thereby reducing cravings.

Treatments for Smoking:

 People are more likely to quit smoking of other people around them quit.

 Peer pressure to quit seems to be equally as effective as it was to start.

1) Psychological Treatments:

 The most common psychological treatment is being told to stop by a physician.

 Another treatment approach is scheduled smoking in which users agree to increase the time in

between cigarettes that limits on amount of cigarettes per day. Smoker can only smoke on

schedule, not as a result of craving to smoke.

 Project EX is a school based program which includes training in coping skills and

psychoeducational component about harmful effects

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 2) Nicotine Replacement Treatments and Medications:

 The goal of NRT is reducing a smoker’s craving for nicotine by providing it in a different way

(gum, patches, inhalers)

 Nicotine gum is absorbed much more slowly and steadily than that in tobacco that help smoker

cut back and eliminate reliance. High doses can cause cardiovascular changes.

 Patches slowly release the drug into the bloodstream transdermally and then to the brain. A

person only need 1 patch per day. Treatment can be effective after about 8 weeks, with use

smaller patches as treatment progresses.

 NRT more effective when combined with antidepressant use (such as buproprion) or

psychological treatment.

Treatment of Drug Use Disorders

The first way which therapist try is detoxification, withdrawal from the drug itself and it is central for

treatment.

1) Psychological Treatments:

 A study shows that CBT is more effective than antidepressants for those with high degree of drug

dependence. People learn how to avoid high-risk situations, recognize lure of the drug, and

develop alternatives to drug usage. They also learn strategies to cope with the craving and

resistance of use.

 Contingency management with vouchers (CBT with vouchers most likely to remain abstinent)

has shown promise for cocaine, heroin, and marijuana use disorder.

 A treatment called motivational enhancement therapy, which involves combination of CBT

and helping clients generate solutions for alcohol and drug use disorders, has shown great

promise.

 Another psychological approach is self-help residential homes that have a high dropout rate.

Rehabilitation homes have the following features:

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  Separation of people from previous social contacts (relationships helped maintain drug use

disorder).

 Comprehensive environment in which drugs are not available and support is offered.

 Charismatic role models – formerly dependent on drugs meet life’s challenges without drugs.

 Direct confrontation in group therapy where people accept responsibility for problems and take

charge of life.

 Respectful setting where there is no stigmatization as failures or criminals.

 Proposition 36 enacted to law as Substance Abuse and Crime Prevention Act that allows

nonviolent drug offenders to be sent to drug treatment rather than prison.

2) Drug Replacement Treatments and Medications:

 Two widely used programs for heroin use disorder involve the administration of

1. Heroin substitutes, drugs chemically similar to heroin that can replace the body’s craving

for it.

 Methadone, levomethadyl acetate, and burpreophine, are synthetic narcotics which

are addicting on its own, essentially converts the person’s heroin dependency on a

different substance.

 This conversion occurs because synthetic narcotics are cross-dependent with

heroin; that is, by acting on the same CNS receptors, they become a substitute for

the original dependency.

 They have less severe withdrawal reactions.

 Side effects: insomnia, constipation, excessive sweating, diminished sexual

functioning

2. Opiate antagonists, drugs that prevent the use from experiencing the heroin high.

 Involves naltrexone.

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  People are gradually weaned from heroin, receiving increasing doses of

naltrexone.

 Opiates molecules occupy receptors to which opiates usually bind, without

stimulating them.

 It requires frequent visits to a clinic (motivation required)

 Have less intense high

 Effective at relieving withdrawal symptoms

 Drug replacement therapy does not seem to be effective for cocaine use disorders. Vaccine are

required to prevent the high associated with cocaine that contains tiny amounts of cocaine

attached to harmless pathogens. Body responds by developing antibodies. Not all users develop

enough antibodies to keep cocaine from reaching the brain.

 Methamphetamine Treatment Project – Matrix treatment involves 16 CBT group sessions,

12 family education sessions, 4 individual therapy sessions, 4 social support sessions. Positive

short-term results, long-term results were equally comparable to treatment as usual (TAU) –

consists of best available treatment currently offered at eight outpatient clinics.

PREVENTIONS
 Half of adult smokers began before age 15, nearly all before age 19, thus the top priority of

researches is to discourage youth from experimenting with tobacco

 Family interventions

 Statewide comprehensive tobacco control programs: increasing taxes on cigarettes, restricting

advertising, conducting public education campaigns, creating smoke free environments.

 New health warnings including graphic images on packaging.

 School programs sharing following components:

 Peer-pressure resistance training – learn to say no.

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 Correction of beliefs and expectations – believe it is more prevalent than it

actually is.

 Inoculation against mass media messages – media makes smoking look

positive.

 Truth campaign – aims to share health and social consequences of smoking.

 Peer leadership – involved peers of recognized status, which adds the impact

of the messages being conveyed.

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