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ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems

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Lesson 37
ALCOHOLISM AND SUBSTANCE RELATED DISORDERS
Why do we need to study drug use?
1-We take aspirin to reduce headache.
2-We take an antibiotic to fight an infection.
3-We
take
tranquilizer
to
calm
ourselves
after
facing
a
trauma.
4- We drink coffee or tea in the morning to get going.
5- Smoke a cigarette to relax our nerves.
Examples
1- Sherlock Holmes a famous detective, a fictional character
who took drug stimulants to keep
himself alert.
2- Sportsmen take drugs to enhance their performance but in the long run their body develops drug
dependence.
The term drug applies to any substance other than food that changes our bodily and mental
functioning. There are many substances that are capable of harming the body or adversely affecting the
behavior and mood. The misuse of drugs has become one of the most disabling problems of the
society. Drug misuse may lead to a temporary mental syndrome such as intoxication but chronic
excessive use of drugs can lead to a substance use disorder.
Substance use disorder can take two forms
1- Substance abuse
2- Substance dependence
1- Substance abuse
A pattern in which people rely heavily on a drug and they structure their lives around a drug.
2- Substance dependence
In which people show all symptoms of substance abuse plus physical dependence on the drug.
It is believed that approximately 7 % of all adults in United States currently display some form of
substance use disorder.
Substance Dependence, the more severe in these two forms, refers to a pattern of repeated self-
administration of increased amounts of the drug to achieve intoxication; withdrawal, unpleasant
physical and psychological effects that the person experiences when he or she tries to stop taking the
drug; and compulsive drug-taking behavior.
The Concept of Substance Dependence
Many psychological features or problems are associated with dependence on chemical substances. One
such feature involves craving.
Craving is a forceful urge to use drugs, but the relationship between craving and drug use is actually
very complex. People who are dependent on drugs often say that they take the drug to control how they
are feeling. Some clinicians refer to this condition as psychological dependence. As the problem
progresses, it is not unusual for the person who abuses drugs to try to stop. Unfortunately, efforts at
self-control are typically short-lived and usually failed. Tolerance and withdrawal are usually interpreted
as evidence of physiological dependence.
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The explanation for drug abuse can be done by using the following perspectives
1- Biological
2- Psychodynamic
3- Behavioral
4- Socio-cultural
·
The biological view or perspective suggests that that people inherit a predisposition to drug
addiction based on their research of twin and adoptee studies.
·
The psycho dynamic perspective view that people who turn to drugs have an inordinate
dependency needs and they turn to drugs.
·
Behavioral perspective suggests that drug use is reinforced because it reduces tension and raises
spirits.
·
Socio-cultural perspective suggests that the people most likely to develop a pattern of drug abuse
are those where societies create stress and their families tolerate drug abuse.
Integrated Systems
·  We can conclude that alcoholism and other forms of addiction clearly result from an interaction
among several types of systems.
·  Various social, psychological, and biological factors influence the person's behavior at each stage in
the cycle, from initial use of the drug through the eventual onset of tolerance and withdrawal.
The drugs that we will focus in this chapter fall into three categories
1- Depressants are substances which slow the activity of central nervous system they include
·  Alcohol
·  Sedative-Hypnotic drugs
·  Opioids.
2- Stimulants are substances that increase the activity of the central nervous system, resulting in the
increased blood pressure, heart rate, intensified activity, thought processes and alertness.
The important stimulants are
·  Cocaine
·  Amphetamines
·  Nicotine
·  Caffeine
3- Hallucinogens are substances that cause changes primarily in sensory perception.
They include
·  LSD
·  Cannabis drugs
1- Depressants
a- Alcohol
·  Alcohol affects virtually every organ and system in the body.
·  After alcohol has been ingested, it is absorbed through membranes in the stomach, small intestine,
and colon.
·  The rate at which it is absorbed is influenced by many variables, including the concentration of
alcohol in the beverage, the volume and rate of consumption, and the presence of food in the
digestive system.
·  After it is absorbed, alcohol is distributed to all the body's organ systems.
·  Almost all the alcohol that a person consumes is eventually broken down or metabolized in the
liver.
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·
According to DSM-IV-TR, the symptoms of alcohol intoxication include slurred speech, lack of
coordination, an unsteady gait, nystagmus (involuntary to-and-fro movement of the eyeballs
induced when the person looks upward or to the side), impaired attention or memory, and stupor
or coma.
·
The prolonged use and abuse of alcohol can have a devastating impact on many areas of a person's
life.
i- The disruption of relationships with family and friends can be especially painful.
ii- Regular heavy use of alcohol is also likely to interfere with job performance.
iii- Many heavy drinkers encounter problems with legal authorities.
iv- On a biological level, prolonged exposure to high levels of alcohol can disrupt the functions of
several important organ systems, especially the liver, pancreas, gastrointestinal system,
cardiovascular system, and endocrine system.
In fact, over an extended period of time, alcohol dependence has more negative health
consequences than abuse of any other drug, with the exception of nicotine.
v- The misuse of alcohol leads to an enormous number of severe injuries and premature deaths in
every region of the world.
b- Sedative-hypnotic Drugs
This group of depressants includes Barbiturates and Benzodiazepines.
Barbiturates
i- They relax the muscles
ii- Produce feeling of well being and
iii- They are used to induce sleep.
Example
Marilyn Monroe's death is attributed to excessive use of alcohol and barbiturates.
Benzodiazepines or Antianxiety drugs
They reduce anxiety.
Example: valium.
c- Opioids
·  These include Opium and drugs derived from it such as heroine and morphine.
·  Opium is a substance derived from the sap of the opium poppy seed.
·  It was widely used in the past because of its ability to reduce both physical and emotional pain.
·  Morphine, its name is derived from Morpheus the Greek god of sleep.
·  It is an effective pain reliever and helps to put person to sleep.
·  In USA its use accelerated during civil war when wounded soldiers received its injections but it
soon became clear that its repeated administrations lead to addiction.
·  Heroine
·  Morphine was converted into a new pain reliever called heroine for years heroine was viewed as the
wonder drug.
·  Used as medicine but due to its addictive qualities it is illegal in USA under all circumstances.
·  The various Opioid drugs are known collectively as narcotics.
·  Narcotics can be smoked, inhaled and injected.
·  Worries, tensions and pain subside but the person becomes unconcerned about the food and bodily
needs.
·  The person becomes lazy and lethargic.
2- Stimulants
Stimulants are substances that increase the activity of the central nervous system, resulting in the
increased blood pressure, heart rate, intensified activity, thought processes and alertness.
Some important stimulants are
a- Cocaine
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b- Amphetamines
c- Nicotine tobacco products such as cigarettes.
d- Caffine such as in coffee, chocolate and many soft drinks.
a- Cocaine
·  Cocaine is the central active ingredient of the coca plant it is the most powerful natural stimulant.
People use to chew coca leaves for energy and alertness.
·  Processed cocaine is an odorless, fluffy white powder.
·  It can be inhaled or injected
·  Smoking coca base in pipe or cigarette.
·  Serious side effects the users can become irritable, depressed, paranoid and unable to control their
emotions.
·  It can even create fatal heart problems heart beating rapidly and irregularly.
·  It can even cause the breathing function and heart function to come to sudden halt.
b- Amphetamines
·  Amphetamines are stimulant drugs. They were first used in treatment of asthma.
·  These drugs soon became popular amongst people trying to loose weight.
·  Athletes seeking an extra bust of energy.
·  Soldiers, truck drivers and pilots trying to stay awake.
·  Students studying for exams throughout night.
·  Amphetamines are most often taken in pill or capsule or injection form.
·  People using amphetamines reduce their appetite and weight.
c- Nicotine
·  Nicotine is the active ingredient in tobacco, which is its only natural source.
·  Nicotine is almost never taken in its pure form because it can be toxic.
·  The effects of nicotine on the peripheral nervous system include increases in heart rate and blood
pressure.
d- Caffeine
·  It is called the gentle stimulant used by some 90% of the people.
·  It is found in tea, coffee and cola drinks.
i- It elevates mood
ii- Reduces fatigue
iii- When denied it causes headaches, drowsiness and unpleasant mood.
·  In the central nervous system, nicotine has pervasive effects on a number of neurotransmitter
systems.
·  Nicotine has a complex influence on subjective mood states.
·  Nicotine is one of the most harmful and deadly addicting drugs.
3- Hallucinogens
·  Hallucinogens are substances that cause changes primarily in sensory perception.
·  The sight, sound, smell, feelings and even taste are distorted sometimes in dramatic ways when in
under the effect of Hallucinogens.
·  They include
a- LSD
b- Cannabis drugs
a- Lysergic acid diethylamide or LSD
Lysergic acid diethylamide or LSD it is a naturally occurring derivates of the grain fungus but it can
be synthetically produced. It causes a profound perceptual changes and hallucinations.
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b- Cannabis
·  Cannabis is a hemp plant from where we get hashish and marijuana.
·  Both impair motor and cognitive functions.
·  It contributes to lung disease.
Treatment for substance abuse disorders
Treatment for substance abuse disorders include
1-Biological therapy
2-Insight therapy
3-Behavioral techniques (Aversive therapy and Relapse prevention training)
4- Self help groups
5-Therapeutic communities
The goals of treatment for substance use disorders are a matter of controversy.
1- Some clinicians believe that the only acceptable goal is total absence from drinking or drug use.
2- Others have argued that, for some people, a more reasonable goal is the moderate use of legal drugs.
1- Biological Therapy
a- Detoxification
·  Alcoholism and related forms of drug abuse are chronic conditions and their treatment is typically
accomplished in a sequence of stages, beginning with a brief period of detoxification--the
removal of a drug on which a person has become dependent--for 3 to 6 weeks.
b- Medications
·  Following the process of detoxification, treatment efforts are aimed at helping the person to
maintain a state of remission.
·  Several forms of medication are used to help the person refrain from drinking.
·  If a person who is taking medicine consumes even a small amount of alcohol, he or she will
become severely ill.
2- Insight Therapy
·  Insight therapies try to help the clients become aware of and address the psychological factors that
contribute to their pattern of drug use.
3- Behavioral Techniques
a- Cognitive Behavior Therapy
·  Cognitive behavior therapy teaches people to identify and respond more appropriately to
circumstances that regularly precipitate drug abuse.
·  One element of cognitive behavior therapy involves training in the use of social skills, which might
be used to resist pressures to drink heavily.
·  Most people who have been addicted to a drug will say that quitting is the easy part of treatment.
·  The more difficult challenge is to maintain this change after it has been accomplished.
b- Relapse Prevention Model
·  Alan Marlatt, a clinical psychologist at the University of Washington, and his colleagues have
proposed a cognitive behavioral view of the relapse process.
·  The relapse prevention model addresses several important issues that confront the addict in trying
to deal with the challenges of life without drugs.
·  Another important feature of the relapse prevention model is concerned with the guilt and
perceived loss of control that the person feels whenever he or she slips and finds himself or herself
having a drink (or a cigarette or whatever drug is involved) after an extended period of absence.
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c- Aversive Therapy
Aversive conditioning in which an unpleasant stimulus is paired with the drug that the person is
taking.
4-Self-Help Groups:
Alcoholics Anonymous
·  Alcoholics Anonymous (AA) is maintained by alcohol abusers for the sole purpose of helping other
people who abuse alcohol become and remain sober.
·  AA is not officially associated with any other form of treatment or professional organization.
·  The viewpoint espoused by AA is fundamentally spiritual in nature.
·  In this 12 step procedure in which the first step is the person must acknowledge that he or she is
powerless over alcohol and unable to manage his or her drinking.
·  The remaining steps involve spiritual and interpersonal matters such as accepting "a Power greater
than ourselves" that can provide the person with direction; recognizing and accepting personal
weaknesses; and making amends for previous errors, especially instances in which the person's
drinking caused hardships for other people.
5- Therapeutic communities
·  Therapeutic communities or residential therapeutic communities where addicts live, work and
socialize in a drug free environment.
·  There is social and cultural disapproval and unacceptability for drinking, smoking and use of drugs
because it has become one of the most disabling problems of the society.
·  Just say no to drugs.
·  It feels good.
·
YOU can get help in saying no to drugs from your own self, family, friends and others.
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Table of Contents:
  1. ABNORMAL PSYCHOLOGY:PSYCHOSIS, Team approach in psychology
  2. WHAT IS ABNORMAL BEHAVIOR:Dysfunction, Distress, Danger
  3. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Supernatural Model, Biological Model
  4. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Free association, Dream analysis
  5. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Humanistic Model, Classical Conditioning
  6. RESEARCH METHODS:To Read Research, To Evaluate Research, To increase marketability
  7. RESEARCH DESIGNS:Types of Variables, Confounding variables or extraneous
  8. EXPERIMENTAL REASEARCH DESIGNS:Control Groups, Placebo Control Groups
  9. GENETICS:Adoption Studies, Twin Studies, Sequential Design, Follow back studies
  10. RESEARCH ETHICS:Approval for the research project, Risk, Consent
  11. CAUSES OF ABNORMAL BEHAVIOR:Biological Dimensions
  12. THE STRUCTURE OF BRAIN:Peripheral Nervous System, Psychoanalytic Model
  13. CAUSES OF PSYCHOPATHOLOGY:Biomedical Model, Humanistic model
  14. CAUSES OF ABNORMAL BEHAVIOR ETIOLOGICAL FACTORS OF ABNORMALITY
  15. CLASSIFICATION AND ASSESSMENT:Reliability, Test retest, Split Half
  16. DIAGNOSING PSYCHOLOGICAL DISORDERS:The categorical approach, Prototypical approach
  17. EVALUATING SYSTEMS:Basic Issues in Assessment, Interviews
  18. ASSESSMENT of PERSONALITY:Advantages of MMPI-2, Intelligence Tests
  19. ASSESSMENT of PERSONALITY (2):Neuropsychological Tests, Biofeedback
  20. PSYCHOTHERAPY:Global Therapies, Individual therapy, Brief Historical Perspective
  21. PSYCHOTHERAPY:Problem based therapies, Gestalt therapy, Behavioral therapies
  22. PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy
  23. PSYCHOTHERAPY:Humanistic Psychotherapy, Client-Centered Therapy, Gestalt therapy
  24. ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
  25. ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias
  26. MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders
  27. MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors
  28. SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE
  29. STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior
  30. STRESS:Psychophysiological Responses to Stress, Health Behavior
  31. ACUTE AND POSTTRAUMATIC STRESS DISORDERS
  32. DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS
  33. DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS
  34. PERSONALITY DISORDERS:Causes of Personality Disorders, Motive
  35. PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis
  36. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Poly Drug Use
  37. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems
  38. SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms
  39. SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia
  40. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:DELIRIUM, Causes of Delirium
  41. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:Amnesia
  42. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  43. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  44. PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders
  45. LIFE CYCLE TRANSITIONS AND ADULT DEVELOPMENT:Aging