1 / 41

The Spectrum of Use and the Historical Context

The Spectrum of Use and the Historical Context. Lecture 2 Chapter 1 & 2. Drugs Are Old. Drugs have been around since the dawn of time… Probably. Coming on the Scene. Alcohol as early as 6400 years BC (Middle East) Cannabis 3000 years BC (Middle East) Opium 5000 BC (China)

mira
Download Presentation

The Spectrum of Use and the Historical Context

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Spectrum of Use and the Historical Context Lecture 2 Chapter 1 & 2

  2. Drugs Are Old Drugs have been around since the dawn of time… Probably

  3. Coming on the Scene • Alcohol as early as 6400 years BC (Middle East) • Cannabis 3000 years BC (Middle East) • Opium 5000 BC (China) • Tobacco 100 BC (Mexico) • Coca 3000 BC • Cocaine Extracted 1855 • Heroin 1874 • MDMA (XTC) 1912 • LSD 1938

  4. Despite the Laws People Still Use

  5. Does Use Mean Abuse?

  6. The Spectrum of Use • Use – Periodic non-problematic use • Misuse – Periodic Use • Abuse – A pattern of misuse • Dependence – Compulsive problematic use often with physiological dependence

  7. Use • Many drugs can be used relatively safely • Most people who use drugs do not develop problems, however this depends on the drug • Drugs are used for many reasons • Social • Religious • Coping • Experimentation

  8. Misuse • Periodic circumscribed negative consequences • College students and alcohol • “It only happened once.” • Sometimes the consequences are catastrophic

  9. DSM-IV Abuse 1.Failure to fulfill major role obligations 2. Use in hazardous situations 3. Legal Problems 4. Use despite problems 17

  10. DSM-IV Dependence 1. Tolerance 2. Withdrawal 3. Larger amounts/longer period than intended 4. Inability to, or persistent desire to, cut down or control 5. A great deal of time spent obtaining, using, or recovering 6. Important activities given up or reduced 7. Use despite problems caused or exacerbated by use 18

  11. How Does One Move Through the Spectrum?

  12. Public Health Model • Agent Factors – Properties of the drug or substance • Host Factors – Characteristics of the person • Environment Factors – Context/Situation

  13. Perspectives on Substance-RelatedDisorders: An Overview (cont.) • Five Main Categories of Substances • Depressants – Result in behavioral sedation • Stimulants – Increase alertness and elevate mood • Opiates – Primarily produce analgesia and euphoria • Hallucinogens – Alter sensory perception • Other drugs of abuse – Include inhalants, anabolic steroids, medications

  14. The Depressants: Alcohol Use Disorders • Psychological and Physiological Effects of Alcohol • Central Nervous system depressant • Affects several neurotransmitter systems • Specific target is GABA • Effects of Chronic Alcohol Use • Alcohol intoxication & withdrawal • Associated conditions – Dementia & Wernicke’s disease • Fetal alcohol syndrome

  15. Alcohol: Some Facts and Statistics • In the United States • Most adults view themselves light drinkers or abstainers • Over 50% of the U.S. (> 12 years age) report current use • 15 million Americans are alcohol dependent • Rates are highest among Caucasian & Native Americans • Males use and abuse alcohol more than females • Violence is associated with alcohol • Alcohol alone does not cause aggression

  16. Stimulants: An Overview • Nature of Stimulants • Most widely consumed drug in the United States • Such drugs increase alertness and increase energy • Examples include amphetamines, cocaine, nicotine, and caffeine

  17. Stimulants: Amphetamine Use Disorders • Effects of Amphetamines • Produce elation, vigor, reduce fatigue • Effects are followed by extreme fatigue and depression • DSM-IV-TR Criteria for Amphetamine Intoxication • Ecstasy and Ice • Produces effects similar to speed, but no “comedown” • 2% of college students report using Ecstasy • Both drugs can result in dependence • Amphetamines stimulate CNS by • Enhancing release of norepinephrine and dopamine • Reuptake is subsequently blocked

  18. Stimulants: Cocaine Use Disorders • Effects of Cocaine • Short lived sensations of elation, vigor, reduce fatigue • Blocks reuptake of dopamine • Highly addictive, but addiction develops slowly • DSM-IV-TR Criteria for Cocaine Intoxication and Withdrawal • Psychological symptoms • Physiological symptoms • Most Cycle Through Patterns of Tolerance and Withdrawal

  19. Opioids: An Overview • The Nature of Opiates and Opioids • Opiate – Narcotic like chemical in the opium poppy • Opioids – Substances that produce narcotic effects • Often referred to as analgesics (i.e., help relieve pain) • Examples include heroin, opium, codeine, and morphine • Effects of Opioids • Activate body’s enkephalins and endorphins • Low doses – Euphoria, drowsiness, and slow breathing • High doses can be fatal • Withdrawal symptoms can be lasting and severe

  20. Other Drugs of Abuse: Designer Drugs • Designer Drugs • Drugs produced by pharmaceutical companies for diseases • Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples • All heighten auditory and visual perception (taste and touch) • Popular in nightclubs, raves, or large social gatherings • All designer drugs can produce tolerance and dependence

  21. Causes of Substance-Related Disorders: Family and Genetic Influences • Results of Family, Twin, and Adoption Studies • Substance abuse has a genetic component • Much of the focus has been on alcoholism • Genetic differences in alcohol metabolism • Multiple genes are involved in substance abuse

  22. Causes of Substance-Related Disorders:Neurobiological Influences • Results of Neurobiological Research • Drugs affect the pleasure or reward centers in the brain • The pleasure center – Dopamine, midbrain, frontal cortex • GABA turns off reward-pleasure system • Inhibition of neurotransmitters for anxiety / negative affect

  23. Causes of Substance-Related Disorders:Psychological Dimensions • Role of Positive and Negative Reinforcement • The self-medication and the tension reduction hypotheses • Substance abuse as a means to cope with negative affect • Opponent-Process Theory • Why the crash after drug use fails to stop drug use • Role of Expectancy Effects • Expectancies influence drug use and relapse

  24. Causes of Substance-Related Disorders:Social and Cultural Dimensions • Exposure to Drugs is a Prerequisite for Use of Drugs • Media, family, peers • Parents and the family appear critical • Societal Views About Drug Abuse • Sign of moral weakness – Failure of self-control • Sign of a disease – Caused by underlying processes • The Role of Cultural Factors • Influence the manifestation of substance abuse

  25. An Integrative Model of Substance-Related Disorders • Exposure or Access to a Drug • Is necessary, but not sufficient for abuse and addiction • Drug Use Depends on Social and Cultural Expectations • Drugs Are Used Because of their Pleasurable Effects • Drugs Are Abused for Reasons that are More Complex • The premise of equifinality • Stress may interact with psychological, genetic, social, and learning factors

  26. From A Psychological Standpoint • Drug abuse and dependence are disorders of behavior • Not only do each have health implications, abuse and dependence have extreme psychosocial implications • People make changes in their alcohol/drug abuse behavior in the same way they make changes in all other behaviors • Much alcohol and drug abuse/dependence is related to psychopathology • Most people stop on their own

  27. Substance Abuse Treatment • “Self-Help” (AA NA CA Rational Recovery) • Psychosocial Interventions • Medications

  28. Self-Help 12 Step Fellowships • Alcoholics Anonymous Narcotics Anonymous • View of Problem: Spiritual disease • Tools: 12 steps to recovery • Mechanism: Powerful social support • Issues: Effective for those who stick. Can be difficult to stick

  29. Psychosocial Interventions • Behavioral and Cognitive Behavioral • View of Problem: Behavioral disorder. • Tools: Functional analysis, contingency management and cognitive interventions as well as relapse prevention • Mechanisms: Skills improvement, attitude change, coping w/psychopathology • Issues: Highly researched treatments. Very effective. Not sure how they work actually.

  30. Psychosocial Interventions • Motivational Interviewing • Alternative to confrontational approach • Designed to move individual through stages of change • Brief (1-4 sessions) • Effective as stand-alone and a booster to treatment

  31. Pharmacotherapy • Alcohol Dependence • Antabuse • Naltrexone • Drug Dependence • Methadone & Naltrexone (Heroin) • Antidepressants (Cocaine) • Cocaine vaccine?????

  32. Outcome • Abstinence vs. Harm Reduction • AA/NA, CBT, MI are all effective • Meds can be as well • Stage-matched interventions • The longer people stick the better they do • Most often takes multiple treatments • Social support after treatment is critical • Treatment works better than jail in the short and long run

More Related