Class notes

Chapter 12 Substance Abuse Disorders

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Course
PSYC 300A

Institution
University Of British Columbia (UBC )

Explore lecture notes on Substance Abuse Disorders. Gain insights into the complexities of addiction and substance abuse. Examine diagnostic criteria, symptoms, and contributing factors. Discover evidence-based treatments for managing substance abuse disorders.

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Uploaded on May 11, 2023
Number of pages 28
Written in 2021/2022
Type Class notes
Professor(s) Sheila woody
Contains Substance abuse disorders

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PSYC 300
Chapter 12 – Substance Related Disorders
12.1 Alcohol Abuse and Dependence
- Alcohol dependence may include tolerance or withdrawal reactions.
 People physically dependent on alcohol have more severe symptoms of the disorder
- Those who begin drinking early in life develop their first withdrawal symptoms in 30s or 40s.
 Effects of abrupt withdrawal of alcohol in a chronic, heavy user may be dramatic  body has
become accustomed to the drug.
 Subjectively  person is often anxious, depressed, weak, restless, and unable to sleep.
 Tremors of the muscles (especially of small musculatures of the fingers, face, eyelids, lips, and
tongue may be marked)
 Pulse, blood pressure, and temperature are elevated.
- In rare cases, a person who has heavily drunk for years may also experience delirium tremens (the DTs)
 level of alcohol in the blood drops suddenly.
 Delirium tremens: acute form of delirium caused by withdrawal of addictive substances.
o Also called “the shakes.”
 Person becomes delirious, tremulous, hallucinates (primarily visual may be tactile).
 Unpleasant active creatures (snakes, cockroaches, spiders, etc.) may appear crawling up the wall,
felt on person's body, or may fill the room.
 Feverish, disoriented, and terrified  person may claw frantically at their skin to get rid of the
feeling of animals.
 Delirium and physiological paroxysms caused by withdrawal of alcohol indicate the drug is
addictive.
- Increased tolerance follows heavy, prolonged drinking.
 Some alcohol abusers can drink litres of alcohol a day without showing drunkenness
 Levels of alcohol in the blood are unexpectedly low after excessive drinking  body adapts to
the drug and can process it more efficiently.
- Changes in the liver enzymes that metabolize alcohol can account to a small extent for tolerance
 Most researchers now believe the CNS is implicated.
 Research suggests tolerance results from changes in the number/sensitivity of GABA/glutamate
receptors
 Withdrawal may be the result of increased activation in neural pathways to compensate for
alcohol's inhibitory effects in the brain.
 When drinking stops, inhibitory effects of alcohol disappear  resulting in state of
overexcitation.
- Tolerance is mostly due to physiological factors
- Response expectations (psychological) and the consequences of behaviour can have a direct influence on
tolerance and the effects of alcohol
 Similarly, the development of addictions often reflects the interplay of biological and
psychological factors.
- Drinking patterns of people alcohol dependent indicate their drinking is out of control.
 There is a need to drink daily and inability to stop or cut down despite repeated efforts to abstain
completely or to restrict drinking to certain periods of the day.
 Alcoholics may go on binges, remaining intoxicated for two, three, or more days.
 Alcoholics may consume a litre of alcohol at a time, suffer blackouts, have no memory of events
that took place during intoxication
 The craving may be so overpowering that they are forced to ingest alcohol in a non-beverage
form (e.g., hair tonic)
- Drinking can cause social & occupational difficulties, trouble with family or friends, violent behaviour,
absences from work, loss of jobs, and arrests for intoxication or traffic accidents.

, - A person who abuses alcohol (vs. a person physically dependent on it) experiences negative social and
occupational effects from the drug but does not show tolerance, withdrawal, or compulsive drinking
patterns seen in alcohol dependent people.

Prevalence & Comorbidity Alcohol Abuse
- Study found about 3 in 4 people with alcohol dependence never received treatment.
- Prevalence rates were higher in men, younger cohorts, and whites.
 Course was often chronic, with an average of four years for alcohol dependence
- U.S. survey  over 10,000 adolescents (ages of 13 – 18) found 15% of adolescents (1 in 7) met criteria
for lifetime substance abuse.
 Additional analyses indicated median age of onset for drug or alcohol abuse with dependence
was about 14 years old
 Based on 2004 Canadian Addiction Survey:
o 22.6% of current alcohol drinkers exceeded low risk drinking guidelines  stipulate no
more than two drinks per day
o 17.0% of current alcohol drinkers engaged in hazardous drinking.
o Strong gender differences exist  hazardous drinking among 25.1% men and 8.9%
women.
- Prototypical heavy drinker in Canada is a young, not married, relatively well off financially male
- Problem drinking is comorbid with several personality disorders
 Canadian researchers sought to identify genetic factors common to personality disorders and
alcohol misuse
 Comorbid with mood & anxiety disorders, drug use, and schizophrenia.
 Comorbidity is important to assess  comorbid psychiatric disorders predict higher relapse rates
and less initial treatment improvement among dually diagnosed individuals with substance abuse
- Drinking is on the rise  binge drinking among students remains a problem
 9% increase in Canada overall in alcohol consumption  increase was almost 2x as high (16%)
in British Columbia
 Alcohol-related deaths increased to a similar degree, underscoring the dangers of excessive
drinking.
 Other analyses found the heaviest drinking 10% of respondents accounted for 50% of overall
consumption

Nature of the Disorder
- Addictive disorders like alcohol abuse are considered & conceptualized according to models.
- Disease model  view that problems like excessive drinking are due to vulnerabilities within a person
(e.g., a genetic predisposition, brain chemistry).
 Disease (Medical) model: a conceptual model that maintains dysfunction stems from internal
biological processes and factors within the individual  more likely to reflect psychiatry than
psychology.
 Disease model reflects the medical model and announcement by the American Medical
Association that alcoholism is a disease (1954)
 Disease model is endorsed  belief in no cure possible and abstinence is indicated.
o Also promotes research for brain mechanisms implicated in addiction
- Moral model  view that excessive drinking reflects personal failings and choices of individual.
 Moral model: conceptual view that excessive drinking or other forms of addiction reflect personal
failings and personal choices of the afflicted individual because they have a deficit or moral
failing in their character.
- Models have clear implications for a host of other issues
 Recovery

,  Perceived likelihood of relapse
 Role of personal responsibility
 Self-directed change.

Course of the Disorder
- Initial beliefs about nature and course of alcoholism were strongly influenced by views and work of E.
Morton Jellinek.
 Jellinek's emphasis on stages of alcoholism (emerge over time) is responsible for promoting the
disease model.
- Life histories of alcohol abusers were thought to have a common, downhill progression.
- Survey of 2,000 members in AA  male alcohol abusers pass through four stages, beginning with social
drinking and progressing to a stage at which they live to drink.
- Available evidence does not always corroborate stage model.
 Past of alcohol-dependent people show progression from alcohol abuse to dependence
o Data reveals fluctuations in drinking patterns, from heavy drinking to abstinence or
lighter drinking at others
o Patterns of maladaptive use of alcohol are variable  heavy use of alcohol may be
restricted to weekends, or long periods of abstinence
o May be interspersed with binges of continual drinking for several weeks
o There is no single pattern of alcohol abuse.
- Evidence indicates Jellinek's account does not apply to women.
 Difficulties with alcohol usually begin at a later age in women and after a stressful experience
(e.g., family crisis)
 Time interval between onset of heavy drinking and alcohol abuse is briefer in women.
 Women with drinking problems tend to be steady drinkers who drink alone and are less likely
than men to binge

Costs of Alcohol Abuse
- Clear regional differences in costs of alcohol abuse.
 Example  rates of hazardous alcohol drinking are high in Russia and has been established
indirectly that relatively low life expectancy of Russian men is attributable to hazardous alcohol
drinking.
 Leon et al. (2007)  found almost half of all deaths in working-aged men in a typical Russian
city is attributed to hazardous drinking.
- Most people who have a drinking problem do not seek professional help, but people who abuse alcohol
constitute a large proportion of new admissions to mental and general hospitals.
 Problem drinkers use health services 4x more often than non-abusers, and their medical expenses
are 2x higher.
 Suicide rate for alcohol abusers is much higher than the general population.
- Alcohol-related traffic fatalities has declined in Canada, but analyses of national data between 2000 and
2010 showed 56.7% of fatally injured drivers tested positive for alcohol, drugs, or both
 In Canada drunk drivers kill an average of 3 - 4 people per day and injure 187 people
 Alcohol increases the likelihood and severity of traffic accidents
- Prototypical drinking driver in Canada  male between ages 25-34, drinks large amounts of alcohol on a
regular basis or is a social drinker who occasionally drinks heavily
 Despite profile, social significance of drunk driving in teenagers is important.
 6-to 19-year-olds made up 5.4% of Canadian population in 2003 but accounted for 23% of
pedestrian fatalities where driver had been drunk.
 Authors called for nationwide requirement of zero blood alcohol for drivers 21 and under, greater
police powers, and more rigorous enforcement of existing legislation.

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