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Define and give examples of gender identity and gender roles.This Topic can be found on coursedocument chapter 10.
Layout 1 C H A P T E R :10 Substance Use and Addictive Disorders TO P I C OV E RV I E W Depressant Substances Alcohol Sedative-Hypnotic Drugs Opioids Stimulant Substances Cocaine Amphetamines Stimulant Use Disorder Hallucinogens, Cannabis, and Combinations of Substances Hallucinogens Cannabis Combinations of Substances What Causes Substance Use Disorders? Sociocultural Views Psychodynamic Views Cognitive-Behavioral Views Biological Views How Are Substance Use Disorders Treated? Psychodynamic Therapies Behavioral Therapies Cognitive-Behavioral Therapies Biological Treatments Sociocultural Therapies Other Addictive Disorders Gambling Disorder Internet Use Disorder: Awaiting Official Status Putting It Together: New Wrinkles to a Familiar Story 141 COMER_Fund7E_IR_CH10.QXP_Layout 1 5/1/13 4:10 PM Page 141 142 CHAPTER 10 L E C T U R E O U T L I N E I. SUBSTANCE USE DISORDERS A. What is a drug? 1. Any substance other than food that affects our bodies or minds a. Need not be a medicine or be illegal B. Current language uses the term substance rather than drug to overtly include alcohol, to- bacco, and caffeine C. Substances may cause temporary changes in behavior, emotion, or thought 1. May result in substance intoxication (literally, “poisoning”), a temporary state of poor judgment, mood changes, irritability, slurred speech, and poor coordination 2. Some substances such as LSD may produce a particular form of intoxication, some- times call hallucinosis, which consists of perceptual distortion and hallucinations D. Some substances also can lead to long-term problems [See Table 10-1, text p. 294] 1. Substance use disorder: a pattern of maladaptive behaviors and reactions brought about by repeated use of substances 2. In many cases, people become physically dependent on the substances, developing a tolerance for them (needing increasing doses to get an effect) and experiencing withdrawal reactions (unpleasant and dangerous symptoms when substance use is stopped or cut down) E. About 9 percent of all teens and adults in the United States display substance abuse or dependence 1. The highest rates of substance abuse or dependence in the United States is found among Native Americans (15.5 percent), while the lowest is among Asian Americans (3.5 percent) 2. White Americans, Hispanic Americans, and African Americans display rates be- tween 9 and 10 percent 3. Only 11 percent receive treatment from a mental health professional F. Many drugs are available in our society 1. Some are harvested from nature, others derived from natural substances, and still others are produced in a laboratory 2. Some require a physician’s prescription for legal use; others, like alcohol and nico- tine, are legally available to adults 3. Still others, like heroin, are illegal under all circumstances G. Recent statistics suggest that drug use is a significant social problem 1. Twenty two million people in the United States have used an illegal substance within the past month 2. Almost 24 percent of all high school seniors have used an illegal drug within the past month H. There are several categories of substances under use and study: 1. Depressants 2. Stimulants 3. Hallucinogens 4. Cannabis II. DEPRESSANT SUBSTANCES A. Depressants slow the activity of the central nervous system (CNS) 1. Reduce tension and inhibitions 2. May interfere with judgment, motor activity, and concentration B. Three most widely used: 1. Alcohol 2. Sedative-hypnotic drugs 3. Opioids C. Alcohol COMER_Fund7E_IR_CH10.QXP_Layout 1 5/1/13 4:10 PM Page 142 Substance Use and Addictive Disorders 143 1. The World Health Organization estimates that 2 billion people worldwide consume alcohol 2. In the United States, more than half of all residents drink alcoholic beverages from time to time 3. When people consume five or more drinks in a single occasion, it is called a binge- drinking episode a. 24 percent of all people in the United States over age 11, most of them male, binge-drink each month 4. Nearly 7 percent of people over age 11 binge-drink at least 5 times each month a. Considered heavy drinkers, males outnumber females by more than 2:1 (ap- proximately 8 percent to 4 percent) 5. All alcoholic beverages contain ethyl alcohol a. It is absorbed into the blood through stomach lining and takes effect in the bloodstream and CNS (a) Short-term, alcohol blocks messages between neurons—alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker (b) First brain area affected is that which controls judgment and inhibition (c) Next affected are additional areas in the cenral nervous system, leaving the drinker even less able to make sound judgments, speak clearly, and re- member well (d) Motor difficulties increase as drinking continues, and reaction times slow 6. The extent of the effect of ethyl alcohol is determined by its concentration (propor- tion) in the blood a. A given amount of alcohol will have less effect on a large person than on a small one b. Gender also affects blood alcohol concentration (a) Women have less alcohol dehydrogenase, an enzyme in the stomach, which metabolizes alcohol before it enters the blood (b) Women become more intoxicated than men on equal doses of alcohol c. Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood: (a) BAC � 0.06: Relaxation and comfort (b) BAC � 0.09: Intoxication (c) BAC � 0.55: Death (i) Most people lose consciousness before they can drink this much 7. The effects of alcohol subside only after alcohol is metabolized by the liver a. The average rate of this metabolism is 25 percent of an ounce per hour (a) You can’t increase the speed of this process! 8. Alcohol use disorder a. Though legal, alcohol is one of the most dangerous recreational drugs (a) Its effects can extend across the life span (b) Alcohol use is a major problem in high school, college, and adulthood (c) 7.4 percent of all adults in the U.S. display an alcohol use disorder over a one-year period, while over 13 percent display it at some point in their lives (i) Men outnumber women 2:1 (ii) Many teenagers also experience the disorder (d) The prevalence of alcoholism in a given year is about the same (7 to 9 per- cent) for white Americans, African Americans, and Hispanic Americans (i) American Indians, particularly men, tend to display a higher rate of alcohol use disorders than any of these groups; overall, 15 percent of them have the disorder (e) Generally, Asians have lower rates of alcohol disorders (3 percent) than people from other cultures (i) As many as one-half of these individuals have a deficiency of alco- hol dehydrogenase, causing a negative reaction to even modest al- cohol intake COMER_Fund7E_IR_CH10.QXP_Layout 1 5/1/13 4:10 PM Page 143 144 CHAPTER 10 9. Clinical picture a. In general, people with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious (a) Eventually, the drinking interferes with social behavior and the ability to think and work b. Individuals, patterns of alcoholism vary 10. Tolerance and withdrawal a. For many individuals, alcohol use disorder includes the symptoms of tolerance and withdrawal reactions (a) As their bodies build up a tolerance for alcohol, they need to drink greater amounts to feel its effects (b) They may also experience withdrawal symptoms when they stop drink- ing, including nausea and vomiting (c) A small percentage of these people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”), which can be fatal 11. What is the personal and social impact of alcoholism? a. Alcoholism destroys families, social relationships, and careers (a) Losses to society total many billions of dollars annually (b) Alcohol plays a role in suicides, homicides, assaults, rapes, and accidents (c) Has serious effects on the children (some 30 million) of persons with this disorder 12. Long-term excessive drinking also can seriously damage physical health a. Especially damaged is the liver (cirrhosis) b. Long-term excessive drinking also can cause major nutritional problems (a) Example: Korsakoff’s syndrome 13. Women who drink alcohol during pregnancy place their fetuses at risk from fetal al- cohol syndrome (FAS) and increased risk of miscarriage D. Sedative-hypnotic drugs 1. Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness a. At low doses, they have a calming or sedative effect b. At high doses, they function as sleep inducers or hypnotics c. The sedative-hypnotic drugs include barbiturates and benzodiazepines 2. Barbiturates a. First discovered more than 100 years ago, barbiturates were widely prescribed in the first half of the twentieth century to fight anxiety and to help people sleep (a) Although still prescribed, they have been largely replaced by benzodiaz - epines b. Barbiturates usually are taken in pill or capsule form (a) At low doses, they reduce excitement in a manner similar to alcohol, by attaching to the GABA receptors and helping GABA operate (b) At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death c. Repeated use of barbiturates can quickly result in sedative-hypnotic use disor- der d. A great danger of barbiturate tolerance is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects e. Barbiturate withdrawal is particularly dangerous because it can cause convulsions 3. Benzodiazepines a. Benzodiazepines often are prescribed to relieve anxiety (a) They are the popular sedative-hypnotics available (b) The class includes Xanax, Ativan, and Valium b. These drugs have a depressant effect on the central nervous system by binding to GABA receptors and increasing GABA activity c. Unlike barbiturates and alcohol, however, benzodiazepines relieve anxiety without causing drowsiness COMER_Fund7E_IR_CH10.QXP_Layout 1 5/1/13 4:10 PM Page 144 Substance Use and Addictive Disorders 145 (a) They are also less likely to slow breathing and lead to death by overdose d. Once thought to be a safe alternative to other sedative-hypnotic drugs, benzo- diazepine use can cause intoxication and lead to an addictive pattern of use (a) As many as 1 percent of U.S. adults display a sedative-hypnotic use dis- order that centers on benzodiazepines at some point in their lives E. Opioids 1. This class of drug includes both natural (opium, heroin, morphine, codeine) and syn- thetic (methadone) compounds and is known collectively as “narcotics” 2. Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”) a. Injection seems to be the most common method of use, although other tech- niques have been increasing in recent years b. An injection quickly brings on a “rush”—a spasm of warmth and ecstasy that sometimes is compared with orgasm c. This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”) 3. Opioids create these effects by depressing the CNS a. These drugs attach to the receptors in the brain ordinarily receiving endorphins (neurotransmitters that naturally help relieve pain and decrease emotional