Академический Документы
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Культура Документы
Seventeenth Edition
Chapter 11
Substance-Related
Disorders
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Learning Objectives (1 of 3)
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Learning Objectives (2 of 3)
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Learning Objectives (3 of 3)
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Introduction
Substance abuse
• Excessive use
Substance dependence
• Physiological need for increasing amounts
Tolerance
• Biochemical changes in the body
Withdrawal
• Physical symptoms from abstinence
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Examples of Abuse of Substances
• Nicotine
• Alcohol
• Barbiturates
• Tranquilizers
• Amphetamines
• Heroin
• Ecstasy
• Marijuana
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Alcohol-Related Disorders
Ancient cultures
• Excessive, frequent alcohol use
• Egyptians first made beer in 3000 BCE
• Italians made first wine
• Problems with alcohol use first observed
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The Prevalence, Comorbidity, and Demographics
of Alcohol Abuse and Dependence
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The Clinical Picture of Alcohol-Related
Disorders (1 of 5)
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Figure 11.1 Commonly Observed Changes over Time in
Blood Alcohol Concentration (BAC, Dashed Line) and
Alcohol Hangover Severity
Hangover severity is most pronounced when blood alcohol concentration
reaches 0 (in this example at 12–14 hours after the start of alcohol
consumption).
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The Clinical Picture of Alcohol-Related
Disorders (2 of 5)
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The Clinical Picture of Alcohol-Related
Disorders (3 of 5)
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The Clinical Picture of Alcohol-Related
Disorders (4 of 5)
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The Clinical Picture of Alcohol-Related
Disorders (5 of 5)
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Causal Factors in the Abuse of and
Dependence on Alcohol
Causal factors
• Biological
• Psychosocial
• Sociocultural
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Biological Factors in the Abuse of and
Dependence on Alcohol
Neurobiology of addiction
• MCLP center of psychoactive drug activation
• (Mesocorticolimbic Dopamine pathway)
Genetic vulnerability
• Alcohol-risk personality
• Exposure and learning
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Figure 11.2 The Mesocorticolimbic Pathway
The MCLP, Running from the
Ventral Tegmental Area to the
Nucleus Accumbens to the
Prefrontal Cortex, Is Central to
the Release of the
Neurotransmitter Dopamine
and in Mediating the
Rewarding Properties of Drugs.
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Psychosocial Causal Factors in Alcohol
Abuse and Dependence
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Sociocultural Causal Factors
Causal factors
• Religion
• Cultural tradition of aggression
• Geographic location
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Use of Medications in Treating Alcohol
Abuse and Dependency
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Psychological Treatment Approaches
Group therapy
• Person is forced to confront problem
Environmental intervention
• Halfway houses
Behavioral and cognitive-behavioral therapy
• Aversive conditioning, skills training, self-control
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Treatment of Alcohol-Related
Disorders (1 of 2)
Other approaches
• Controlled drinking rather than abstinence
• Alcoholics Anonymous
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Treatment of Alcohol-Related
Disorders (2 of 2)
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Opium and Its Derivatives
Opium
• Morphine
• Heroin
• Codeine
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Biological Effects of Morphine and
Heroin (1 of 2)
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Biological Effects of Morphine and
Heroin (2 of 2)
Long-term effects
• Physiological craving for the drug
• Withdrawal symptoms
• Gradual deterioration of well-being
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Social Effects of Morphine and Heroin
Other characteristics
• Maladaptive behaviors
• Antisocial personality
• Narcotics subculture
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Causal Factors in Opiate Abuse and
Dependence
• Pleasure
• Curiosity
• Peer pressure
• Stress relief
• Personal maladjustment
• Sociocultural conditions
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Neural Bases for Physiological Addiction
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Addiction Associated with Psychopathology
Comorbities
• 50% have other forms of substance abuse
• 36% have a history of trauma
• Depression
• Anxiety
• Other
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Treatments and Outcomes (1 of 2)
Treatment
• Initially similar to that for alcohol addiction
• Methadone and buprenorphine program
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Stimulants
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Cocaine (1 of 2)
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Cocaine (2 of 2)
Treatment
• Medications
– Naltrexone
– Methadone
• Outcomes
– Cognitive-behavior treatment (CBT)
– Contingency management (CM)
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Amphetamines (1 of 2)
Amphetamines
• “Wonder pills” to stay awake, alert
• Weight loss
• Schedule II drug
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Amphetamines (2 of 2)
Abuse
• Leads to hazardous fatigue
• Psychologically and physically addictive
• Brain damage, “amphetamine psychosis”
Treatment
• Withdrawal from drug
• May lead to depression, GI symptoms, personality
deterioration
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Methamphetamine (1 of 2)
Methamphetamine
• Highly addictive stimulant drug
• Increases level of dopamine in brain
• Known by some as “poor people’s cocaine”
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Methamphetamine (2 of 2)
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Stimulants: Caffeine and Nicotine
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Sedatives
Barbiturates
• Central nervous system depressants that are similar to
depressant effects of alcohol
• Once widely used to induce sleep
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Causal Factors in Barbiturate Abuse and
Dependence
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Treatments and Outcomes (2 of 2)
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Hallucinogens
Hallucinogens
• LSD
• Mescaline
• Psilocybin
• Ecstasy
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LSD
LSD experience
• Changes in sensory perception (approx. 8 hours)
• Range of experiences: pleasurable, terrifying
• Flashback at some later point
• Popularity has waned, but part of “wave culture”
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Mescaline and Psilocybin
Reality distortion
• Mescaline
– Peyote cactus
• Psilocybin
– Mushrooms
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Ecstasy (1 of 2)
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Ecstasy (2 of 2)
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Marijuana (1 of 3)
Effects
• Euphoria
• Increased feelings of well-being
• Heightened perceptual acuity
• Relaxation
• Hallucination
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Marijuana (2 of 3)
Treatment
• Psychological treatment methods
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Marijuana (3 of 3)
Synthetic cannabinoids
• Mimic effects THC, active plant-derived substance in
marijuana
• “Spice,” “K2,” “Blaze”
• Serious adverse side effects
Synthetic cathinones
• Mimic cocaine and amphetamines
• “Bath salts”
• Serious adverse side effects
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Gambling Disorder
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Unresolved Issues
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Copyright
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