😵Abnormal Psychology Unit 12 – Substance Use & Addictive Disorders

Key Concepts and Definitions

• Substance use disorder (SUD) characterized by compulsive drug seeking and use despite negative consequences
• Addiction a chronic, relapsing disorder of the brain's reward, motivation, and memory systems
• Tolerance occurs when higher doses are needed to achieve the same effect
• Withdrawal symptoms that arise when substance use is abruptly ceased or reduced
• Craving an intense desire or urge to use a substance
• Dependence a state of physiological adaptation to a substance
  • Physical dependence marked by withdrawal symptoms upon cessation
  • Psychological dependence marked by emotional and motivational changes
• Substance abuse a maladaptive pattern of substance use leading to impairment or distress

Types of Substance Use Disorders

• Alcohol use disorder (AUD) characterized by problematic drinking patterns and impaired control over alcohol use
• Opioid use disorder (OUD) involves misuse of prescription pain relievers (oxycodone) or illicit opioids (heroin)
• Stimulant use disorder includes abuse of cocaine, methamphetamine, and prescription stimulants (Adderall)
• Cannabis use disorder marked by problematic marijuana use and dependence
• Sedative, hypnotic, or anxiolytic use disorder involves misuse of prescription medications (benzodiazepines)
• Hallucinogen use disorder includes abuse of LSD, psilocybin, and other psychedelic drugs
• Inhalant use disorder involves inhaling vapors from solvents or aerosols to achieve a high
• Tobacco use disorder characterized by nicotine dependence and difficulty quitting smoking

Neurobiology of Addiction

• Drugs of abuse activate the brain's reward system, primarily the mesolimbic dopamine pathway
• Repeated drug use leads to long-term changes in brain structure and function
  • Sensitization an increased response to a drug following repeated exposure
  • Desensitization a decreased response to a drug following repeated exposure
• Drugs hijack the brain's natural reward circuitry, leading to compulsive use and addiction
• Genetic factors influence an individual's vulnerability to addiction
• Environmental cues associated with drug use can trigger cravings and relapse
• Chronic drug use alters prefrontal cortex function, impairing decision-making and impulse control
• Stress and negative emotional states can increase the risk of substance abuse and relapse

Risk Factors and Causes

• Genetic predisposition accounts for 40-60% of the risk for addiction
• Family history of substance abuse increases an individual's vulnerability
• Adverse childhood experiences (ACEs) such as abuse or neglect elevate the risk of addiction
• Mental health disorders (depression, anxiety) often co-occur with substance use disorders
• Peer influence and social norms can contribute to substance use initiation and escalation
• Accessibility and availability of drugs in the environment increase the likelihood of use
• Lack of parental supervision and poor family relationships are risk factors for substance abuse
• Personality traits such as impulsivity and sensation-seeking may predispose individuals to addiction

Diagnostic Criteria and Assessment

• DSM-5 provides diagnostic criteria for substance use disorders based on 11 categories
  • Criteria include tolerance, withdrawal, loss of control, and social impairment
  • Severity is determined by the number of criteria met (mild, moderate, severe)
• Structured clinical interviews (SCID) used to assess substance use and related disorders
• Screening tools (CAGE, AUDIT) help identify problematic substance use patterns
• Urine drug screens and blood tests provide objective measures of recent substance use
• Assessment of co-occurring mental health disorders is crucial for comprehensive treatment planning
• Motivational interviewing a client-centered approach to elicit behavior change
• Addiction severity index (ASI) evaluates the extent and impact of substance use across multiple domains

Common Substances and Their Effects

• Alcohol a central nervous system depressant that impairs judgment, coordination, and memory
• Opioids (heroin, prescription painkillers) produce euphoria and respiratory depression
  • Overdose can lead to life-threatening respiratory arrest
• Stimulants (cocaine, methamphetamine) increase alertness, energy, and feelings of euphoria
  • Chronic use can result in psychosis, cardiovascular problems, and cognitive impairment
• Cannabis (marijuana) induces relaxation and altered perception
  • Regular use may impact brain development in adolescents and young adults
• Benzodiazepines (Xanax, Valium) are sedatives prescribed for anxiety and insomnia
  • Abuse can lead to dependence, withdrawal, and cognitive impairment
• Hallucinogens (LSD, psilocybin) produce altered states of consciousness and perceptual distortions
• Inhalants (solvents, aerosols) can cause dizziness, impaired judgment, and organ damage

Treatment Approaches and Interventions

• Detoxification the process of safely managing withdrawal symptoms under medical supervision
• Pharmacotherapy involves the use of medications to treat substance use disorders
  • Methadone and buprenorphine are opioid agonists used to treat opioid addiction
  • Naltrexone an opioid antagonist that blocks the effects of opioids and reduces cravings
  • Acamprosate and disulfiram are medications used to treat alcohol use disorder
• Cognitive-behavioral therapy (CBT) helps individuals identify and change maladaptive thoughts and behaviors
• Motivational enhancement therapy (MET) aims to increase intrinsic motivation for change
• Contingency management uses rewards to reinforce abstinence and treatment adherence
• 12-step programs (Alcoholics Anonymous) provide peer support and a structured path to recovery
• Family therapy addresses the impact of addiction on family dynamics and relationships
• Relapse prevention strategies help individuals identify triggers and develop coping skills

Social and Cultural Aspects

• Stigma surrounding substance use disorders can hinder help-seeking and recovery
• Socioeconomic factors (poverty, lack of education) are associated with higher rates of substance abuse
• Cultural norms and attitudes towards substance use vary across different populations
• Racial and ethnic disparities exist in access to addiction treatment and quality of care
• Social support from family, friends, and community is crucial for long-term recovery
• Substance use disorders can have profound impacts on employment, relationships, and overall functioning
• Public health approaches aim to prevent substance abuse through education and policy interventions
• Harm reduction strategies (needle exchange programs) prioritize reducing the negative consequences of drug use

Current Research and Controversies

• The opioid epidemic has led to increased focus on developing new treatments and prevention strategies
• Legalization and decriminalization of cannabis have sparked debates about its potential risks and benefits
• Research on the therapeutic potential of psychedelics (psilocybin) for addiction treatment is ongoing
• The role of genetics in addiction vulnerability and treatment response is an active area of investigation
• Controversies surrounding medication-assisted treatment (MAT) for opioid addiction persist
• Balancing pain management and the risk of opioid addiction is a challenge for healthcare providers
• Addressing the social determinants of health is crucial for preventing and treating substance use disorders
• Integrating addiction treatment with primary care and mental health services is an important goal