addictive disorder (abnormal psychology)

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The Addictive Disorder

Transcript of addictive disorder (abnormal psychology)

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The Addictive Disorder

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Addictive DisorderBehavior based on the pathological need for a

substance or activity- may involve the abuse of substances such as nicotine, alcohol or cocaine.

Addictive behavior is one of the most pervasive and intransigent mental health problems, that our society is facing today.

Addictive disorder can be seen all around us; in extremely high rates of alcohol abuse and dependence, in tragic exposes of cocaine abuse among star, athletes and entertainers etc.

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The most commonly used problem substances are those drugs that affect mental functioning or are psychoactive drugs:

a. Alcoholb. Nicotinec. Barbituratesd. Tranquilizerse. Amphetaminesf. Heroing. Ecstasyh. Marijuana

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Substance abuse involves a pathological use of a substance resulting:

a. Potentially hazardous behavior such as driving while intoxicated

b. Continued use despite a persistent social, psychological, occupational or health problem

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Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing amounts of a substance to achieve the desired effects.

Dependence in these disorders means that an individual will show a tolerance for a drug or experience withdrawal symptoms when the drug is unavailable.

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Tolerance, the need for increased amounts of a substance to achieve the desired effects- results from biochemical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Withdrawal symptoms are physical symptoms such as sweating, tremors and tension that accompany abstinence from the drug.

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Alcohol Abuse and Dependence

WHO, prefers the term alcohol dependence syndrome – “a state, psychic and usually also physical, resulting from taking alcohol, characterized by behavioral and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort of its psychic effects and sometimes to avoid the discomfort of its absence, tolerance may or may not be present”.

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The term alcoholic is often used to refer to a person with a serious drinking problem, whose drinking impairs his or her life adjustment in terms of health, personal term alcoholism relationships and occupational functioning.

Alcoholism refers to a dependence on alcohol that seriously interferes with life adjustment.

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The prevalence, co-morbidity and demographic of alcohol abuse and dependence

The life span of the average alcoholic is about 12 years shorter than that of the average citizen.

Alcohol now ranks as the third major cause of death behind coronary heart disease and cancer.

Over 37 percent of alcohol abusers suffer from at-least one co-existing mental disorder.

Organic impairment, including brain shrinkage, occurs in a high proportion of alcoholics.

About 10 percent of alcoholics commit suicide and over 18 percent are found to have a history of suicide attempts.

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Research has reaffirmed the strong relationship found between substance abuse and suicide (Adam & Overholser, 1992; Murphy, 1988; Rich et al., 1988).

Alcohol abuse is associated with over half the deaths and major injuries suffered in automobile accidents each year and with about 50 percent of all murders, 40 percent of all assaults, 35 percent or more of all rapes and 30 percent of all suicides.

Alcohol abuse and dependence cuts across all ages, educational, occupational and socioeconomic boundaries.

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Alcohol’s Effects on the BrainAlcohol has complex and

contradictory effects on the brain.At the lower levels, alcohol

stimulates certain brain cells and activates the brain’s “pleasure areas”, which release opium- like endogenous opioids that are stored in the body.

At higher levels, alcohol depresses brain functioning, inhibiting one of the brain’s excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the brain.

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Inhibition of glutamate in the brain impairs:- the organism’s ability to learn - affects the higher brain centers- impairing judgment- other rational processes - lowering self-controlSome degree of motor un-coordination soon

becomes apparent and the drinker’s discrimination and perception of cold, pain and other discomforts are dulled.

The drinkers experiences a sense of warmth, expansiveness and well-being.

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In such a mood, unpleasant realities are screened out and the drinker’s feelings of self-esteem and adequacy rise.

Drinkers enter a world of unreality in which worries are temporarily left behind.

The effects of alcohol vary from different drinkers, depending on their physical condition, the amount of food in their stomach and the duration of their drinking.

Alcohol users may gradually build up a tolerance for the drug so that ever increasing amounts may be needed to produce the desired effects.

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Development of Alcohol Dependence

Excessive drinking can be viewed as progressing from early-to-middle-to-late-stage alcohol abuse disorder.

Many investigators have maintained that alcohol is a dangerous systemic poison even in small amount, but others believe that in moderate amounts it is not harmful to most people.

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The Physical Effects of Chronic Alcohol Use

Alcohol ingested in the body may affect the liver, as liver has to work hard and eventually suffer irreversible damage.

Alcohol is a high calorie drug.A pint of whiskey enough to make about eight to ten

ordinary cocktails, provides about 1200 calories, which is half the ordinary caloric requirement for a day.

Consumption of alcohol reduces a drinker’s appetite for other food.

Alcohol has no nutritional value, the excessive drinker can suffer from malnutrition.

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Heavy drinking impairs the body’s ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins.

Many alcohol abusers also experience increased gastrointestinal symptoms such as stomach pains.

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Psychological Effects of Alcohol Abuse and Dependence

Excessive drinker suffers from chronic fatigue, oversensitivity and depression.

The excessive use of alcohol eventually becomes counterproductive and can result in impaired reasoning, poor judgment and gradual personality deterioration.

Behavior typically becomes coarse and inappropriate and the drinker assumes increasingly less responsibility, loses pride in personal appearance, neglects spouse and family and becomes generally touchy irritable and unwilling to discuss the problem.

As judgment becomes impaired, an excessive drinker may be unable to hold a job and generally becomes unqualified to cope with new demands that arise.

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Psychosis associated with Severe Alcohol Abuse

People who drink excessively over a long period of time or who have a reduced tolerance for alcohol for other reasons, shows acute reactions such as confusion, excitement and delirium.

These disorders are often called “alcoholic psychosis” because they are marked by a temporary loss of contact with reality.

Who drink excessively for a long time, a reaction called “alcohol withdrawal delirium”, formerly known as “delirium tremens” may occur.

Slight noises or suddenly moving objects may cause considerable excitement and agitation.

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The full-blown symptoms include:

i. Disorientation of time and place For Example: a person may mistake the hospital for a

church or jail, no longer recognize friends etc.

ii. Vivid hallucinations, particularly of small, fast-moving animals like snakes, rats and cockroaches.

iii. Acute fear, in which these animals may change in form, size or color in terrifying ways.

iv. Extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested.

v. Marked tremors of the hands, tongue and lips.vi. Other symptoms including perspiration, fever a rapid

and weak heartbeat, a coated tongue and foul breathe.

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A second alcohol-related psychosis is “alcohol amnesic disorder” formerly known as “korsakoff’s syndrome”.

The symptoms is a memory defect which is sometimes accompanied by falsification of events.

Persons with this disorder may not recognize pictures, faces, rooms and other objects that they have just seen, although they may feel that these people or objects are familiar.

These individuals may appear to be distorted, delirious, delusional and disoriented for time and place.

They also show other cognitive impairments such as planning deficits, intellectual deficits and emotional deficits and judgment.

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Biological Factors in the Abuse of and Dependence on Alcohol and Other Substances

Genes and biochemical factors is also the leading cause of drinking problem.

Two important factors are apparently involved in alcohol dependence:

i. The ability of most addictive drugs to activate areas of the brain that produces intrinsic pleasure and sometimes immediate powerful reward.

ii. The person’s biological makeup including his/her inheritance and the environmental influences that enters into the need to seek mind-altering substances to an increasing degree as use continues.

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Psychosocial Causal Factors in Alcohol Abuse and Dependence

a) Failures in parental guidance.b) Psychological vulnerability.c) Stress, tension reduction and

reinforcement.d) Expectations of social success.e) Marital and other intimate

relationships

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Socio-cultural FactorsAlcohol use is a pervasive component

in the social life in western civilization and in eastern countries.

Social events often revolve around alcohol use and alcohol use before and during meals is common.

Alcohol is seen as “social lubricant” or tension reducer that enhances social events.

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Treatment of Alcohol Abuse Disorders

Treatment objectives usually include:DetoxificationPhysical rehabilitationControl over alcohol-abuse behaviorThe individual’s realizing that he or she

can cope with the problems of living and lead a much more rewarding life without alcohol

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a) Use of medications in treating alcohol abusers.

b) Medications to block the desire to drink, Disulfiram (Antabuse).

c) Medications to reduce the side effects of acute withdrawal.

d) Psychological treatment approaches.

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Nicotine Dependence

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Nicotine Dependence The DSM-IV TR includes addiction of two legally

available and widely used drugs: caffeine and nicotine. These substances create important physical mental

health problems in our society for several reasons:i. These drugs are easy to abuse. It is easy to become

addicted to them because they are widely used and most people are exposed to them early in life.

ii. These drugs are readily available to anyone who wants to use them, in fact because of peer pressure, it is usually difficult to avoid using them in our society.

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iii. It is difficult to quit these drugs because of their addictive properties and they are so embedded in the social context.

iv. The extreme difficulty most people have in dealing with the withdrawal symptoms when trying to “break the habit” often produces considerable frustration.

v. The health problems and side effects of these drugs, particularly nicotine, have been widely noted. One in seven deaths in the country is associated with cigarette consumption.

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The poisonous alkaloid nicotine is the chief active ingredient in tobacco, it is found in such items as cigarettes, chewing tobacco and cigars and it is even used as an insecticide.

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Nicotine dependence syndrome always begins during the adolescent years and may continue into adult life as a difficult to break and health endangering habit.

The “nicotine withdrawal disorder” results from ceasing or reducing the intake of nicotine containing substances after an individual has developed physical dependence on them.

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The diagnostic criteria for nicotine withdrawal include:

i. The daily use of nicotine for at least several weeks.

ii. The following symptoms after nicotine ingestion is stopped or reduced:

Craving for nicotine Irritability, frustration or anger Anxiety Difficulty in concentration Restlessness Decreased heart rate Increased appetite or weight gain

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Several other physical concomitants are associated with withdrawal from nicotine including decreased metabolic rate, headaches, insomnia, tremors, increased coughing and impairment of performance on tasks requiring attention.

These withdrawal symptoms continues for several days to several weeks, depending on the extent of the nicotine habit.

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Treatment of Nicotine Withdrawal

Numerous treatment programs have been developed to help smokers quit, including:

- social support groups- various pharmacologic agents that replace cigarette

consumption with safer forms of nicotine such as candy or gum

- self-directed change which involves giving individuals guidance in changing their own behaviors

- professional treatment using psychological procedures such as behavioral or cognitive-behavioral interventions

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Other Psychoactive DrugsPsychoactive drugs commonly involved in drug

abuse are as follows:Classification Drug Effect• Sedatives Alcohol (ethanol)

BarbituratesNembutalSeconal Veronal Tuinal

•Reduce tension •Facilitate social interaction “Blot Out” feelings or events.

• Stimulants AmphetaminesBenzedrineDexedrineMethedrineCocaine

•Increase feelings of fatigue and confidence•Stay awake for long periods •Increase endurance, stimulate sex drive

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• Narcotics Opium and its derivativesOpium morphineCodeineHeroinMethadone

•Alleviate physical pain•Induce relaxation and pleasure•Alleviate anxiety and tension•Treatment of heroin dependence

• Psychedelics and Hallucinogens

CannabisMarijuanaHashish MescalinePsilocybinLSD (Lysergic acid Diethylamide-25)PCP (Phencyclidine)

•Induce changes in mood, thought and behavior•Expand one’s mind •Induce stupor (state of unconsciousness)

• Antianxiety drugs LibriumMilltownValiumXanax

•Alleviate tension and anxiety•Induce relaxation and sleep

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