Post on 04-Jan-2016
Substance Use Substance Use DisordersDisorders
Substance Use DisordersSubstance Use Disorders A maladaptive pattern of substance use A maladaptive pattern of substance use
leading to clinically significant social, leading to clinically significant social, emotional, or occupational impairment or emotional, or occupational impairment or distressdistress
Substance DependenceSubstance Dependence Tolerance, as evidenced by eitherTolerance, as evidenced by either
A need for more of the substance to achieve A need for more of the substance to achieve intoxication or the desired effectintoxication or the desired effect
Diminished effect with continued use of the same Diminished effect with continued use of the same amountamount
Withdrawal, as evidenced by eitherWithdrawal, as evidenced by either Characteristic withdrawal symptoms for the Characteristic withdrawal symptoms for the
substancesubstance The same or a different substance is taken to The same or a different substance is taken to
relieve or avoid withdrawal symptomsrelieve or avoid withdrawal symptoms
Substance DependenceSubstance Dependence
Must meet 3+ symptoms during a 12 month periodMust meet 3+ symptoms during a 12 month period
ToleranceTolerance
WithdrawalWithdrawal
Substance is taken in larger amounts or for longer periods Substance is taken in larger amounts or for longer periods than intendedthan intended
Persistent desire and unsuccessful efforts to cut downPersistent desire and unsuccessful efforts to cut down
A lot of time is spent getting, using or recovering from useA lot of time is spent getting, using or recovering from use
Important social, occupational or other activities are given Important social, occupational or other activities are given up because of useup because of use
Use is continued despite significant negative consequencesUse is continued despite significant negative consequences
Robert Downey, Jr.Robert Downey, Jr. It’s like I’ve got a gun in my mouth, It’s like I’ve got a gun in my mouth,
and my hand on the trigger and I like and my hand on the trigger and I like the taste of the gunmetalthe taste of the gunmetal
Substance AbuseSubstance Abuse
Must meet one or more symptoms during a 1 year Must meet one or more symptoms during a 1 year periodperiod
Recurrent use resulting in a failure to meet major role Recurrent use resulting in a failure to meet major role obligations at work, school, or homeobligations at work, school, or home
Recurrent use in situations where it is physically hazardousRecurrent use in situations where it is physically hazardous
Recurrent substance-related legal problemsRecurrent substance-related legal problems
Continued use despite having persistent or recurrent social Continued use despite having persistent or recurrent social or interpersonal problemsor interpersonal problems
CausesCauses Genetics (Marc Schuckitt)Genetics (Marc Schuckitt)
227 sons of alcoholics & 227 matched controls at 227 sons of alcoholics & 227 matched controls at age 20age 20
Administered alcoholAdministered alcohol Sensitivity to alcohol assessedSensitivity to alcohol assessed
Subjective rating: How High are You?Subjective rating: How High are You? Objective measure: Body SwayObjective measure: Body Sway
Interviewed 10 years later re: symptoms of alcohol Interviewed 10 years later re: symptoms of alcohol dependencedependence
GeneticsGenetics% of men who met criteria
for alcohol abuse or dependence
34%
13%
0%
10%
20%
30%
40%
Family History+ for
Alcoholism
Family History- for
Alcoholism
% of men who met criteria for alcohol abuse
or dependence43%
11%
0%
10%
20%
30%
40%
50%
20% withthe LowestResponse
20% withthe HighestResponse
CausesCauses BiologicalBiological
Areas associated with drug rewardAreas associated with drug reward Ventral Tegmental Area (VTA) in the Ventral Tegmental Area (VTA) in the
brainstem brainstem Nucleus Accumbens (NA) in the Nucleus Accumbens (NA) in the
midbrainmidbrain
VTA projects to the the NAVTA projects to the the NA
CausesCauses Drugs of Abuse produce their rewarding Drugs of Abuse produce their rewarding
effects by increasing dopamine in the effects by increasing dopamine in the Nucleus Accumbens, either byNucleus Accumbens, either by
Stimulating the VTA to release dopamine onto Stimulating the VTA to release dopamine onto the cells of the NAthe cells of the NA
Directly exciting the receptors in the NA Directly exciting the receptors in the NA
Blocking reuptake of Dopamine in the NABlocking reuptake of Dopamine in the NA
CausesCauses Social LearningSocial Learning
Vicarious Learning Vicarious Learning Learn Learn about the consequencesabout the consequences of a behavior by of a behavior by
observing a model engage in the behavior and observing a model engage in the behavior and experience consequencesexperience consequences
Outcome ExpectanciesOutcome Expectancies Learned association between a specific behavior Learned association between a specific behavior
and a specific consequence ORand a specific consequence OR Belief about the consequences of a behaviorBelief about the consequences of a behavior
CausesCauses Positive ExpectanciesPositive Expectancies
Belief that substance use will result in positive Belief that substance use will result in positive outcomes outcomes Increased or continued substance use Increased or continued substance use
Negative ExpectanciesNegative Expectancies Belief that substance use will result in negative Belief that substance use will result in negative
outcomes outcomes decreased or discontinued substance decreased or discontinued substance useuse
CausesCauses Operant ConditioningOperant Conditioning
Behaviors that are followed by reinforcement are Behaviors that are followed by reinforcement are repeatedrepeated
Initial substance use is reinforced by its effectsInitial substance use is reinforced by its effects HighHigh RelaxationRelaxation Social disinhibitionSocial disinhibition Elevated moodElevated mood
CausesCauses Drugs are powerful reinforcersDrugs are powerful reinforcers
Role model uses drugs Role model uses drugs gets high; less stressed gets high; less stressed + + expectancy developedexpectancy developed
Opportunity arises Opportunity arises Use drug Use drug get high; reduce get high; reduce stress stress + expectancies reinforced + expectancies reinforced repeat behavior repeat behavior
CausesCauses Classical ConditioningClassical Conditioning
Substance use becomes associated with internal Substance use becomes associated with internal and environmental cuesand environmental cues
E.G., People, Places, Things, Thoughts, & FeelingsE.G., People, Places, Things, Thoughts, & Feelings More frequent pairing results in a stronger More frequent pairing results in a stronger
associationassociation Exposure to these cues triggers thoughts about Exposure to these cues triggers thoughts about
using and cravingusing and craving Opiates, Alcohol, Nicotine Opiates, Alcohol, Nicotine compensatory response compensatory response Cocaine Cocaine anticipatory response anticipatory response
TreatmentTreatment
MedicationMedication AlcoholAlcohol
Disulfiram (antabuse) Disulfiram (antabuse) Naltrexone Naltrexone Acamprosate (campral) Acamprosate (campral)
NicotineNicotine Nicotine ReplacementNicotine Replacement BupropionBupropion
MedicationMedication OpiatesOpiates
MethadoneMethadone Buprenorphine/NaloxoneBuprenorphine/Naloxone
CocaineCocaine No effective medicationsNo effective medications
MarijuanaMarijuana No effective medicationsNo effective medications
BehavioralBehavioral Self-HelpSelf-Help
AA/NAAA/NA Rational RecoveryRational Recovery
Contingency ManagementContingency Management Offer rewards that compete with the reinforcing Offer rewards that compete with the reinforcing
effects of the drugeffects of the drug
BehavioralBehavioral Cognitive Behavioral TherapyCognitive Behavioral Therapy
Substance Use represents maladaptive coping Substance Use represents maladaptive coping strategystrategy
Treatment involvesTreatment involves Identifying High Risk Situations Identifying High Risk Situations Teaching skills for coping with those High Risk Teaching skills for coping with those High Risk
SituationsSituations Differentiating Slips/Lapses from RelapsesDifferentiating Slips/Lapses from Relapses
High Risk
Situation
Cope Don’t Use IncreaseSelf-Efficacy
Risk of Relapse
Decreases
Don’tCope
Pos. Expectancies
of Use triggered
LapseOr Slip
AbstinenceViolation
Effect
Risk of Relapse Increases