Site MapHelpFeedbackChapter Outline
Chapter Outline
(See related pages)



  1. Introduction
    1. Most Americans use some form of psychoactive drugs, which are substances that alter psychological state
      1. Legal drugs can be as harmful as illegal drugs
      2. Psychoactive drugs can be very helpful
      3. Some drugs are part of social and religious rituals
    2. Drugs have become major focus of social concern
    3. In many cases more than one drug is used
  2. The Nature of Substance Dependence and Abuse
    1. Clear and consistent terminology does not exist for discussing drug abuse
      1. Physiological need and psychological need were differentiated
        1. Addiction refers to state when body requires drug in order to feel normal
        2. Psychological dependence refers to user's tendency to center life on the drug
        3. All psychoactive drugs have both physiological and psychological effects that cannot be separated
      2. Distinction between substance dependence and substance abuse hinges on way person uses drug and problems the person experiences as result of drug use.
    2. Substance dependence must meet three of several criteria
      1. Preoccupation with drug
      2. Unintentional overuse
      3. Tolerance--the usual dose no longer produces desired effect
      4. Withdrawal--when drug level is reduced, psychological and physical disruptions occur
      5. Persistent desire or efforts to control drug use
      6. Abandonment of important social, occupational, or recreational activities
      7. Continued drug use despite serious drug-related problems
    3. Substance abuse refers to drug-use pattern that has not progressed to dependence and meets one of several criteria
      1. Recurrent, drug-related failure to fulfill major role obligations
      2. Recurrent drug use in physically dangerous situations
      3. Drug-related legal problems
      4. Continued drug use despite social or interpersonal problems
  3. Alcohol Dependence
    1. Alcohol is most widely used of all psychoactive drugs
    2. Can be purchased legally in most parts of United States
    3. The Social Cost of Alcohol Problems
      1. Impossible to calculate social cost of alcohol problems
      2. Easier to calculate monetary cost of alcohol problems
        1. Decreased work productivity cost $70 billion
        2. Treatment and support services for alcoholics cost $20 billion
        3. Alcohol-related automobile accidents cost $13.8 billion in 1994
          1. Effects of alcohol dependent on blood alcohol level
          2. Blood alcohol level expressed in terms of amount of alcohol in relation to specific volume of blood
          3. Gender differences seen in blood alcohol level
          4. Blood alcohol level of 0.10% considered to be intoxication; as level rises, impairments increase
          5. Most men killed in accidents were drunk at the time
          6. Relationship exists between bad driving record and alcohol abuse; alcohol increases likelihood of injuries on job
    4. The Personal Cost of Alcohol Dependence
      1. The Immediate Effects of Alcohol
        1. Alcohol is depressant
        2. Initial effect of alcohol may be to stimulate rather than to depress
          1. Changes in mood and social behavior
          2. Changes in judgment
        3. Actual changes are related to expectations regarding effects of alcohol and to context in which drinking occurs.
      2. The Long-Term Effects of Alcohol Abuse
        1. Alcohol often used to cope with stress
        2. Abuse can cause problems that lead to more stress and more drinking
        3. Physical problems can occur, such as cirrhosis of the liver, malnutrition, Korsakoff's psychosis
        4. Delirium tremens are rare and are part of withdrawal
      3. The Development of Alcohol Dependence
        1. There is variability in development of dependence
        2. Dependence typically develops slowly, through social drinking, blackouts, sneaking drinks, and morning drinking
        3. Most dependents experience trouble stopping themselves once they start drinking and go on sprees and benders
      4. Groups at Risk for Alcohol Abuse and Dependence
        1. Different groups have different patterns of alcohol consumption
        2. Gender
          1. Men are more involved with alcohol than women
          2. There are gender differences in the patterns of use and abuse
          3. It is unclear if these differences reflect social role or biological differences
        3. Race, Ethnicity, and Religion
          1. There are racial differences, but they are often confounded by age and gender
          2. There are ethnic patterns of alcohol use and abuse; gender and age also influence patterns
          3. Native Americans are especially at risk, and risk may be related to cultural norms, destruction of their way of life, and poverty
          4. Religion also related to alcohol abuse, with conservative Protestants very resistant to alcohol problems
          5. Catholics have high percentage of alcohol use and abuse
        4. Age
          1. Adults are drinking less, young people drinking more
          2. Almost half of all college students binge drink
          3. Advertisement and mixed messages may play role
      5. Treatment of Alcohol Dependence
        1. Treatment of alcohol dependence begins with detoxification, which is getting alcohol out of person's system and getting him/her through withdrawal
        2. Detoxification can take place at home, under outpatient care, or in the hospital
        3. Multimodal Treatments
          1. Effective multimodal treatments include occupational therapy, relaxation training, group and individual therapy, family and marital therapy, and job counseling
          2. May include Antabuse, which interferes with metabolic processing of alcohol causing unpleasant reactions; patient may stop taking drug
        4. Support Groups: Alcoholic Anonymous
          1. Social support provides reminder that help is available
          2. Most widely known is Alcoholics Anonymous (AA)
          3. AA: once an alcoholic, always an alcoholic
          4. AA: an alcoholic can never go back to normal drinking
          5. Regular meetings, sponsor system, and Twelve Steps are important to recovery
          6. AA has extremely high dropout rate; those who stay with it do get better
          7. Those who are highly motivated, most confident, and most active in coping likely to continue and benefit
        5. Outpatient and Brief Treatments
          1. Residential, outpatient, and day-hospitals expanding
          2. Appears to be no difference in relapse between inpatient and outpatient programs
          3. Brief treatments such as motivational interviewing increases motivation of person to change; follows several principles; FRAMES describes treatment process
        6. Relapse Prevention
          1. Relapse prevention important since most alcoholics who stop drinking eventually relapse
          2. Relapse prevention approach has created treatment programs for addictions often used in conjunction with other models of treatment
          3. Relapse begins with high-risk situations that generate internal reactions
          4. Effective coping skills protect person from relapse
          5. Abstinence violation effect causes slips to turn into relapse
        7. Matching
          1. Treatment may be more effective by matching where patients are directed to programs that best fit their characteristics
          2. Motivation level, demographics, intelligence, severity of abuse are used in matching patients to programs
          3. Project MATCH's results question matching
  4. Nicotine Dependence
    1. Nicotine dependence refers to those who want to stop smoking but cannot
    2. Nicotine has paradoxical effects on the nervous system
      1. Nicotine can stimulate nervous system
      2. Nicotine can have a calming effect
    3. The Antismoking Movement
      1. Surgeon General's Report in 1964 started public concern over smoking's health hazard
      2. Secondhand smoke is a health hazard as well
      3. Cigarette advertisements have been banned on radio and television; warning labels have been placed on packaging; smoking banned in many public places
      4. Tobacco companies have vigorously opposed antismoking legislation
      5. Proportion of Americans who smoked has decreased from 45% in 1954 to 25% in 1997
        1. Fewer people are starting to smoke
        2. Some are using smokeless tobacco, which is linked to cancer
    4. Legal Remedies
      1. Tobacco companies pressured by federal and state governments
      2. Agreement between federal government and tobacco companies requires payment and more federal control with disallowing lawsuits
      3. Many argue that agreement was not enough
    5. Nicotine Dependence: Theory and Therapy
      1. Learning or Addiction?
        1. Behaviorist sees tobacco addiction as learned habit maintained by reinforcers
        2. Research found that smokers smoke to avoid withdrawal, suggesting there is physiological addiction
        3. Smokers self-regulate nicotine levels to prevent withdrawal from occurring
      2. Treatment
        1. High relapse rates seen in treatment programs; even higher among those who try to quit on their own
        2. A number of new treatments have been developed, such as cognitive behavioral therapy and chewing gum
        3. A number of motivational, cognitive, social factors predict who will remain abstinent
          1. Self-efficacy predicts continued abstinence
          2. Use of coping mechanisms predicts abstinence
          3. Antidepressants are being tried as a smoking-cessation aid
          4. Bad moods weaken resistance
          5. Environmental effects such as advertisements and smoker's immediate environment affect likelihood of relapse
  5. Other Psychoactive Drugs
    1. Drugs have been available for many years legally and illegally
      1. Use of illegal drugs has been variable
      2. Use of legal drugs has remained fairly constant
    2. Depressants
      1. Depressant is a drug that reduces pain, tension, anxiety, and slows intellectual and motor reactivity
        1. Opiates, sedatives, and tranquilizers
        2. Tolerance develops; withdrawal symptoms occur; high dosages depress vital systems
      2. Opiates
        1. Opiates are drugs that induce relaxation and reverie and provide relief from anxiety and pain
        2. Opium is a chemically active substance derived from opium poppy
        3. Morphine is used as an analgesic and is dangerously addictive
        4. Heroin is much stronger than morphine
        5. Methadone is a synthetic chemical and differs from other opiates
          1. Effective when taken orally
          2. It is longer-lasting and takes effect slowly
          3. Satisfies craving without an equivalent euphoria
        6. Heroin is most widely abused opiate in United States
          1. Normally taken by injection
          2. There is a rush and euphoria
          3. iii. Addiction and tolerance develop
          4. iv. Withdrawal can be very unpleasant
        7. Drug use represents means of adapting to stress
      3. Barbiturates
        1. Barbiturates have a sedative effect, relieving tension and bringing relaxation and sleep
        2. Used by suicide attempters and can have synergistic effect when taken with alcohol
        3. Used by the young sporadically and generally for recreational purposes
        4. Used by older people as way of relieving insomnia
        5. Effects are very similar to alcohol
      4. Tranquilizers and Nonbarbiturate Sedatives
        1. Tranquilizers used in treatment of anxiety disorders and stress-related physical disorders
        2. Nonbarbiturate sedatives replaced barbiturates as prescription sleeping medication
        3. Have same problems as the barbiturates
        4. Dependence on nonbarbiturate sedatives often begins with sleeping problem
          1. Initial use may bring relief
          2. ii. Tolerance develops after about two weeks
          3. May cause drug-induced insomnia and suppression of REM leading to REM rebound
          4. iv. Addiction develops
    3. Stimulants
      1. Stimulants provide energy, alertness, and feelings of confidence
      2. Amphetamines
        1. Amphetamines are group of synthetic stimulants
        2. Most common are benzedrine, dexedrine, and methedine
        3. Irregular use and low doses appear not to pose any behavioral or psychological problems
          1. Problems arise from regular use and high doses
          2. Tolerance develops and higher doses become necessary
        4. Effects of amphetamine abuse and paranoid schizophrenia are similar
      3. Cocaine
        1. Cocaine is a natural stimulant and is active ingredient in coca plant
        2. Became fashionable in 1970s and peaked in mid-1980s
        3. Can be injected, smoked, but usually snorted
        4. Crack cocaine is within buying power of more people
        5. Cocaine intoxication includes excitement, euphoria
        6. Tolerance develops with regular use of cocaine and heavy withdrawal symptoms
          1. First phase is the crash
          2. Withdrawal is second phase
          3. iii. Extinction is final phase
    4. Hallucinogens
      1. Hallucinogens act on CNS to cause distortions in sensory perception
      2. Achieve effect without substantial changes in arousal
      3. LSD
        1. LSD (lysergic acid diethylamide) was synthesized in 1938
        2. Interferes with processing of information
        3. Effects include perceptions of colors and images, changes in body images, and alteration of time and space perception
        4. May be negative for people whose grasp on reality is not firm
        5. LSD can produce bad trips and flashbacks
      4. PCP
        1. PCP (phencyclidine) is known as angel dust
        2. Often mixed with other substances
        3. Overdose common and extremely toxic
        4. Behavioral toxicity refers to tendency of users to harm themselves
        5. Use has declined since later 1970s
    5. Marijuana and Hashish
      1. Marijuana and hashish are classified as hallucinogens
        1. Effects are more mild than other hallucinogens
        2. Use of marijuana and hashish is more common
      2. Marijuana and hashish derived from cannabis and are usually smoked and eaten
      3. The active ingredient is THC, which is not physiologically addictive
        1. Causes accelerated heart rate
        2. Causes reddening of whites of the eye
      4. Behavioral effects studied in variety of situations
        1. Effects on simple behavior are mild or nil
        2. As task becomes more complex, required response speed increases, more accuracy required, impairment becomes more apparent
        3. Reactions include a feeling of being spaced out
        4. Reactions can also heighten unpleasant experiences
      5. Is Marijuana Dangerous?
        1. Effect of prolonged heavy marijuana use on blood levels of male sex hormone testosterone
        2. Chronic marijuana use impairs function of one part of immune system
        3. Chronic marijuana use may injure the lungs
        4. Prolonged use of marijuana may result in psychological effects
          1. Few users make transition to narcotics
          2. Amotivational syndrome does exist, but may be an accentuation of preexisting behavior patterns
      6. Marijuana as a Medical Treatment
        1. Marijuana is useful in treating certain medical disorders
        2. Decreases nausea and increases appetite in cancer patients undergoing chemotherapy
        3. May help glaucoma and AIDS patients
        4. Public appears to allow physicians to weigh risks and benefits
    6. Groups at Risk for Abuse of Illegal Drugs
      1. Illegal substance highly related to race, class, education level, gender, and socioeconomic status
      2. Those individuals who are medically ill, with mental disorders, and with chronic pain are at greater risk
  6. Substance Dependence: Theory and Therapy
    1. The Psychodynamic Perspective
      1. Perspectives focus on homeostatic function of drugs
      2. Drugs and Conflict
        1. Drugs can ease adaptation in the short run
        2. Drug abuse seen as self-medication
      3. Acquiring Self-Care
        1. Therapy aims to provide self-care skills
        2. Goal is to build up patients' intrapsychic strength and improve their relationships with others
    2. The Behavioral Perspective
      1. Psychological and Biochemical Rewards
        1. Behaviorist viewed alcohol dependence as habit maintained by antecedent and consequent reinforcers
        2. Excessive drinking creates further psychological distress, which will be alleviated by more drinking
        3. Tension-reduction hypothesis received support from animal research
        4. Contemporary approaches view drinking as creating pleasant states
        5. Chemical rewards are the prime reinforcers of excessive drinking
      2. Learning Not to Abuse Drugs
        1. Early behavioral programs used aversion conditioning
          1. Drug was paired with unpleasant stimulus
          2. Programs did nothing to alter conditions that elicit and maintain behavior
        2. Contemporary behavioral programs attempt to remedy broad adjustment problems using combination of cognitive and behavioral techniques
          1. Taught to identify cues and situations that lead to drug taking and alternative responses
          2. ii. Taught new ways to cope with stress
        3. Contingency management techniques used and involved earning points and then redeeming points
          1. Patients underwent therapy
          2. Taught how to find nondrug recreational activities
          3. iii. Taught how to avoid high-risk situations
          4. Program worked for some alcoholics with vouchers, keeping patients in program
    3. The Interpersonal Perspective
      1. Behavioral Couple Therapy
        1. Behavioral couple therapy used for treatment of alcohol dependence
        2. May be very effective in reducing problems in relationship
          1. Most wife-beaters meet criteria for alcohol dependence
          2. Behavioral couple therapy reduces violence and reductions in drinking
        3. Behavioral couple therapy tried with other kinds of drug abusers with gain that tended to diminish during follow-up period
      2. Family Therapy
        1. Most drug-dependent people live with their parents or have daily contact with parents
        2. Family therapy seems promising in teenage drug abusers
    4. The Cognitive Perspective
      1. Thinking About Drugs
        1. Expectations play a role in effects of alcohol
        2. Alcohol expectations do not explain why some people become alcohol dependent
      2. Cognitive-Behavior Therapy
        1. Abstinence violation effect is reduced through cognitive-behavior therapy
          1. Slips now seen as part of recovery
          2. Goal is to control cognitive responses to slip to prevent it from becoming a full-blown relapse
        2. Several factors are related to relapse
          1. Individual factors include negative emotional states
          2. Environmental factors include social support, interpersonal conflict
          3. Physiological factors include withdrawal cravings
        3. An effective treatment will combine these factors
    5. The Neuroscience Perspective
      1. Genetic Studies
        1. Findings suggest that some people inherit predisposition to alcohol dependence
          1. Japanese, Koreans, and Taiwanese show facial flushing and signs of intoxication, whereas Caucasians do not with same amount of alcohol
          2. Sensitivity to alcohol is related to genetic factors
        2. Sons and brothers of severely alcohol-dependent men run 25 to 50% risk of becoming alcohol-dependent themselves
        3. Concordance rate for monozygotic (MZ) twins is 55% compared to 28% for dizygotic (DZ) twins
        4. Susceptibility to alcoholism inherited in two ways
          1. Type 1 susceptibility affects both men and women and follows diathesis-stress model
          2. Type 2 susceptibility is passed from father to son and is independent on environmental influences
        5. Susceptibility types differ
          1. Type 1 susceptibility has onset in adulthood; rarely associated with criminal behavior; individuals tend to be dependent, quiet-living
          2. Type 2 susceptibility has onset in adolescence; individuals tend to be impulsive and aggressive; more prone to depression and suicide
        6. "P" rats, alcohol-preferring rats, have been bred, suggesting heritability of alcoholism
      2. Biochemical Studies
        1. Endorphins
          1. Nerve cells in brain have opiate receptors to which opiates attach themselves
          2. Enkephalins are very similar to morphine and fit the opiate receptors
          3. Stimulation of certain parts of brain can produce endorphins
          4. Pain-relieving drugs may be linked with endorphin production
          5. Endorphins may also explain dependency and withdrawal symptoms
        2. Dopamine
          1. Most of abused drugs stimulate dopamine-producing neurons in median forebrain bundle
          2. Increased dopamine production creates drug's positive effects
          3. Dopamine-suppressing chemical blocks stimulant effects of alcohol
        3. Drug Treatment for Drug Dependence
          1. Medication is prescribed to reduce craving and withdrawal symptoms
          2. Alcoholics receiving Revia reported fewer cravings and lower relapse rates
          3. Methadone, while highly addictive, does not produce extreme euphoria of heroin but does satisfy craving and prevent withdrawal
          4. Methadone maintenance switches people from dependence on heroin to dependence on methadone
          5. Methadone maintenance programs have been successful
          6. Methadone does not prevent user from becoming dependent on other drugs
    6. The Sociocultural Perspective
      1. Drugs and Poverty
        1. Drug abuse is related to racism and poverty, which create environment for illegal drugs
        2. Dramatic decline in standard of living among urban poor since 1990
        3. Spread of AIDS by injecting drugs intravenously
        4. Relationship between drugs and crime
      2. Harm Reduction
        1. Harm reduction is set of interventions that concentrate on controlling the harm that drug dependency does to society at large
        2. Needle-exchange programs developed out of harm reduction approach
        3. Attempts to legalize drugs based on harm reduction
          1. Opponents say that it will encourage addiction
          2. Proponents say that it is the only way to prevent addicts from doing harm to society and to themselves
        4. Harm reduction policies have been slow to catch on in United States
        5. Prevention of drug abuse is supported







AlloyOnline Learning Center

Home > Chapter 12 > Chapter Outline