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Home , Psychological dependence

B E Chapter 9 H A V I O R and Dependence

D I S Sheila K. Grant, Ph.D. O R Professor D E R S

B E Substance-induced disorders H A Substance-induced disorders - Disorders, such as V intoxication, that can be induced by using psychoactive I substances. O R Intoxication - A state of drunkenness.

D Substance use disorders - Disorders characterized I by maladaptive use of psychoactive substances (e.g., S ). O R D E R S

B E Substance Abuse and H Dependence A V Substance abuse - The continued use of a I despite the knowledge that it is O causing a social, occupational, psychological, or R physical problem.

D Substance dependence - Impaired control over the I use of a psychoactive substance; often characterized by S physiological dependence. O R Tolerance - Physical habituation to a drug such that D with frequent use, higher doses are needed to achieve E the same effects. R S

1 B E Substance Abuse and H Dependence A V Withdrawal syndrome - A characteristic cluster of I symptoms following the sudden reduction or cessation O of use of a psychoactive substance after physiological R dependence has developed.

D In some cases of chronic , withdrawal I produces a state of , or DTs. S O DTs are usually limited to chronic, heavy users of R who dramatically lower their intake of alcohol D after many years of heavy drinking. E R S

B Lifetime prevalence of drug dependence E H disorder by type of illicit drug. A V I O R

D I S O R D E R S

B E and Other Forms of H A Compulsive Behavior V Addiction - Impaired control over the use of a I chemical substance, accompanied by physiological O dependence. R Physiological dependence - A condition in which D the drug user’s body comes to depend on a steady I supply of the substance. S O Psychological dependence - Compulsive use of a R substance to meet a psychological need. D E R S

2 B Racial and Ethnic Differences E H in Substance Use Disorders A V Despite the popular stereotype that drug dependence is I more frequent among ethnic minorities, this belief is O not supported by evidence. R To the contrary, African Americans and Latinos have D comparable or even lower rates of substance use I disorders than do European Americans (non-Hispanic S Whites). O R Moreover, African American adolescents are much less D likely than European American adolescents to develop E substance abuse or dependence problems. R S

B E Pathways to Drug Dependence H A V Although the progression to substance dependence I varies from person to person, one common pathway O involves a progression through the following stages: R 1. Experimentation. D 2. Routine use. I 3. Addiction or dependence. S O R D E R S

B E Drugs of Abuse H A Drugs of abuse are generally classified within three V major groupings: I O (a) Depressants, such as alcohol and R (b) , such as and cocaine. D I (c) . S O R D E R S

3 B E Depressants H A V A depressant is a drug that slows down or curbs the I activity of the central nervous system. O R It reduces feelings of tension and , slows movement, and impairs cognitive processes. D I In high doses, depressants can arrest vital functions S and cause death. O R D E R S

B E Alcohol H A Alcohol is the most widely abused substance in the V United States and worldwide. I O Alcoholism - An disorder or R addiction that results in serious personal, social, occupational, or health problems. D I The most widely held view of alcoholism is the S disease model, the belief that alcoholism is a O medical illness or disease. R D E R S

B E Risk Factors for Alcoholism H A A number of factors place people at increased risk for V developing alcoholism and alcohol-related problems. I These include the following: O R 1. Gender. 2. Age. D 3. Antisocial personality disorder. I 4. Family history. S 5. Sociodemographic factors. O R D E R S

4 B E Ethnicity and Alcohol H A Use and Abuse V I Rates of alcohol use and alcoholism vary among O American ethnic and racial groups. R Some groups—Jews, Italians, Greeks, and Asian— D have relatively low rates of alcoholism, largely as I the result of tight social controls placed on excessive S and underage drinking. O R Asian Americans, in general, drink less heavily than D other population groups E R S

B E H A V I O R

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B E Psychological Effects of H Alcohol A V The effects of alcohol or other drugs vary from person I to person. O R By and large they reflect the interaction of:

D (a) The physiological effects of the substances. I (b) Our interpretations of those effects. S O R D E R S

5 B E Physical Health and Alcohol H A V Chronic, heavy alcohol use affects virtually every organ I and body system, either directly or indirectly. O R Heavy alcohol use is linked to increased risk of many serious health concerns, including:

D I 1. Liver disease. S 2. Increased risk of some forms of cancer. O 3. Coronary heart disease. R 4. Neurological disorders. D E R S

B E Physical Health and Alcohol H A Two of the major forms of alcohol-related liver disease V are alcoholic hepatitis, a serious and potentially life- I threatening inflammation of the liver, and cirrhosis of O the liver, a potentially fatal disease in which healthy R liver cells are replaced with scar tissue.

D Habitual drinkers tend to be malnourished, which I can put them at risk of complications arising from S nutritional deficiencies. O R This condition, also known as Korsakoff ’s D syndrome, is characterized by glaring confusion, E disorientation, and memory loss for recent events. R S

B E Moderate Drinking: H Is There a Health Benefit? A Despite this list of adverse effects associated with V heavy drinking, evidence shows that moderate use of I alcohol (1 to 2 drinks per day for women, 2 to 4 drinks O for men) is linked to lower risks of heart attacks and R strokes, as well as lower death rates overall.

D Higher doses of alcohol are associated with higher I mortality (death) rates. S Health promotion efforts might be better directed O toward finding safer ways of achieving the health R benefits associated with moderate drinking than by D encouraging alcohol consumption, such as by quitting E smoking, lowering dietary intake of fat and cholesterol, R and exercising more regularly. S

6 B E H A Barbiturates - Sedative drugs which are depressants V with high addictive potential. I O About 1% of adult Americans develop a substance abuse R or dependence disorder involving the use of barbiturates, sleep medication (), or D antianxiety agents at some point in their lives. I S Barbiturates such as amobarbital, pentobarbital, O phenobarbital, and secobarbital are depressants, R or sedatives. D E R S

B E Opioids H A Narcotics - Drugs that are used medically for pain V relief but that have strong addictive potential. I O Opioids include both naturally occurring opiates R (morphine, , codeine) derived from the juice of the poppy plant and synthetic drugs (e.g., Demerol, D Darvon) that have opiate like effects. I S The ancient Sumerians named the poppy plant opium, O meaning “plant of joy.” R D E R S

B E Opioids H Two discoveries made in the 1970s show that the brain A produces chemicals of its own that have opiate-like V effects. I O One was that neurons in the brain have receptor sites R that opiates fit like a key in a lock.

D The second was that the human body produces its own I opiate-like substances that dock at the same receptor S sites as opiates do. O R Endorphins - Natural substances that function as D neurotransmitters in the brain and are similar in their E effects to morphine. R S

7 B E Morphine H Morphine - A strongly addictive narcotic derived from A the opium poppy that relieves pain and induces feelings V of well-being. I O Morphine—which receives its name from Morpheus, R the Greek god of dreams—was introduced at about the time of the U.S. Civil War. D Morphine, a powerful opium derivative, was used I liberally to deaden pain from wounds. S O Physiological dependence on morphine became known R as the “soldier’s disease.” D There was little stigma attached to dependence until E morphine became a restricted substance. R S

B E Heroin H A Heroin - A narcotic derived from morphine that has V strong addictive properties. I O Heroin, the most widely used opiate, is a powerful R depressant that can create a euphoric rush.

D Users of heroin claim that it is so pleasurable it can I eradicate any thought of food or sex. S O Heroin was developed in 1875 during a search for a R drug that would relieve pain as effectively as morphine, D but without causing addiction. E R S

B E Heroin H A Heroin - A narcotic derived from morphine that has V strong addictive properties. I O Heroin, the most widely used opiate, is a powerful R depressant that can create a euphoric rush.

D Users of heroin claim that it is so pleasurable it can I eradicate any thought of food or sex. S O Heroin was developed in 1875 during a search for a R drug that would relieve pain as effectively as morphine, D but without causing addiction. E R S

8 B E Heroin H A V I O R

D I S O R D E R S

B E Stimulants H A Stimulants are psychoactive substances that V increase the activity of the central nervous system, I which enhances states of alertness and can produce O feelings of pleasure or even euphoric highs. R The effects vary with the particular drug.

D I S O R D E R S

B E Amphetamines H A Amphetamines - A class of stimulants that activate V the central nervous system, producing heightened I states of arousal and feelings of pleasure. O R psychosis - A psychotic state induced by ingestion of amphetamines.

D I Cocaine - A derived from the leaves of the S coca plant. O R D E R S

9 B E Ecstasy H A The drug ecstasy, or MDMA (3,4- V methylenedioxymeth-amphetamine) is a designer drug, I a chemical knockoff similar in chemical structure to O amphetamine. R It produces mild euphoria and hallucinations and has

D become especially popular on college campuses and in I clubs and “raves” in many cities. S O Ecstasy can produce adverse psychological effects, R including , anxiety, insomnia, and even D paranoia and psychosis. E R S

B E Cocaine H A Coca-Cola was originally described as a “brain tonic V and intellectual beverage,” in part because of its I cocaine content. O R Cocaine is a natural stimulant extracted from the leaves of the coca plant—the plant from which the soft

D drink obtained its name. I S Crack - The hardened, smokable form of cocaine. O R D E R S

B E Effects of Cocaine H A Like heroin, cocaine directly stimulates the brain’s V reward or pleasure circuits. I O It also produces a sudden rise in blood pressure and R an accelerated heart rate that can cause potentially dangerous, even fatal, irregular heart rhythms.

D I Overdoses can produce restlessness, insomnia, S headaches, nausea, convulsions, tremors, O hallucinations, delusions, and even sudden death due R to respiratory or cardiovascular collapse. D E Regular snorting of cocaine can lead to serious nasal R problems, including ulcers in the nostrils. S

10 B E H A Habitual smoking is not merely a bad habit: It is also a V physical addiction to a stimulant drug, nicotine, found I in products including cigarettes, cigars, and O smokeless tobacco (American Cancer Society, 2004). R Smoking is also deadly, claiming more than 400,000

D lives in the United States alone, most from lung cancer I and other lung diseases, as well as cardiovascular S (heart and artery) disease. O R The World Health Organization estimates that 1 billion D people worldwide smoke and more than 3 million die E each year from smoking-related causes. R S

B E Smoking-related causes of H death, by type of disease. A V I O R

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B E Ethnic and gender differences in rates H of cigarette smoking among U.S. adults. A V I O R

D I S O R D E R S

11 B E Hallucinogens H A Hallucinogens - Substances that cause V hallucinations. I O Hallucinogens, also known as psychedelics, are a R class of drugs that produce sensory distortions or hallucinations, including major alterations in color D perception and hearing. I S Hallucinogens may also have additional effects, such O as relaxation and euphoria or, in some cases, panic. R D E R S

B E LSD H A LSD is the acronym for lysergic acid diethylamide, a V synthetic hallucinogenic drug. I O In addition to the vivid parade of colors and visual R distortions produced by LSD, users have claimed it “expands consciousness” and opens new worlds—as if

D they were looking into some reality beyond the usual I reality. S O Sometimes they believe they have achieved great R insights during the LSD “trip,” but when it wears off D they usually cannot follow through or even summon up E these discoveries. R S

B E Phencyclidine (PCP) H A Phencyclidine, or PCP—which is referred to as “angel V dust” on the streets—was developed as an anesthetic in I the 1950s but was discontinued as such when its O hallucinatory side effects were discovered. R A smokable form of PCP became popular as a street

D drug in the 1970s. I S However, its popularity has since waned, O largelybecause of its unpredictable effects. R D E R S

12 B E Marijuana H A Marijuana - A hallucinogenic drug derived from the V leaves and stems of the plant sativa. I O Marijuana is derived from the plant. R Marijuana is generally classified as a D because it can produce perceptual distortions or mild I hallucinations, especially in high doses or when used S by susceptible individuals. O R D E R S

B E Neurotransmitters H Many psychoactive drugs, including nicotine, alcohol, A heroin, marijuana, and especially cocaine and V amphetamines, increase levels of the neurotransmitter I in the brain’s pleasure or reward circuits— O the networks of neurons responsible for producing R feelings of pleasure or states of euphoria. Over time, regular use of these drugs reduces the D I brain’s own production of dopamine. S Consequently, the brain’s natural —the O “feel good” circuitry that produces states of pleasure R associated with the ordinarily rewarding activities of D life, such as consuming a satisfying meal and engaging E in pleasant activities—becomes blunted. R S

B E Cocaine’s effects in the brain. H Neurotransmitters are released A into the synapse (synaptic cleft V or gap) from terminal buttons at I the end of axons. Normally, O excess molecules of neurotransmitters are R reabsorbed by the terminal buttons of the transmitting D neuron in a process called reuptake. Cocaine, as I represented here by the orange S circles, blocks this process of O reuptake, allowing more R neurotransmitter molecules to remain in the synapse, which D creates a euphoric high by E overstimulating receiving R neurons in brain networks S regulating feelings of pleasure.

13 B E Genetic Factors H A Evidence links genetic factors to various forms of V substance use and abuse, including and I dependence, heroin dependence, and even cigarette O smoking (). R Alcoholism tends to run in families (APA, 2000).

D I Familial patterns provide only suggestive evidence of S genetic factors, because families share a common O environment as well as common genes. R D E R S

B E Learning Perspectives H A Learning theorists propose that substance-related V behaviors are largely learned and can, in principle, be I unlearned. O R They focus on the roles of operant and classical conditioning and observational learning. D I Substance abuse problems are not regarded as S symptoms of disease but rather as problem habits. O R D E R S

B E H People may initially use a drug because of social A influence, trial and error, or social observation. V I In the case of alcohol, they learn that the drug can O produce reinforcing effects, such as feelings of R euphoria, and reductions in anxiety and tension.

D Alcohol may also reduce behavioral inhibitions. I S Alcohol can thus be reinforcing when it is used to O combat depression (by producing euphoric feelings, R even if short lived), to combat tension (by functioning D as a tranquilizer), or to help people sidestep moral E conflicts (for example, by dulling awareness of moral R prohibitions). S

14 B E Alcohol and Tension Reduction H A Learning theorists have long maintained that one of V the primary reinforcers for using alcohol is relief from I states of tension or unpleasant states of arousal. O R According to the tension-reduction theory, the more often one drinks to reduce tension or anxiety, the

D stronger or more habitual the habit becomes. I S We can think of some uses of alcohol and other drugs O as forms of self-medication—as a means of using the R pill or the bottle to ease psychological pain, at least D temporarily E R S

B E Negative and H Withdrawal A V Once people become physiologically dependent, I negative reinforcement comes into play in maintaining O the drug habit. R In other words, people may resume using drugs to gain D relief from unpleasant withdrawal symptoms. I S In operant conditioning terms, relief from unpleasant O withdrawal symptoms is a negative reinforcer for R resuming drug use D E R S

B E The Conditioning Model of H Cravings A V Classical conditioning may help explain drug cravings. I O In this view, cravings reflect the body’s need to restore R high blood levels of the addictive substance and thus have a biological basis. D I But they also come to be associated with S environmental cues associated with prior use of the O substance. R D E R S

15 B E Observational Learning H A Modeling or observational learning plays an important V role in determining risk of substance abuse problems. I O Parents who model inappropriate or excessive R drinking or use of illicit drugs may set the stage for maladaptive drug use in their children.

D I Evidence shows that adolescents who have a parent S who smokes face a substantially higher risk of O smoking than do their peers in families where neither R parent smokes D E R S

B E Cognitive Perspectives H A Evidence supports the role of cognitive factors in V substance abuse and dependence, especially the role of I expectancies. O R Alcohol or other drug use may also boost self-efficacy expectations—personal expectancies we hold about our

D ability to successfully perform tasks. I S Expectancies may account for the “one-drink effect”— O the tendency of chronic alcohol abusers to binge once R they have a drink. D E R S

B E Psychodynamic Perspectives H A According to traditional psychodynamic theory, V alcoholism reflects an oral-dependent personality. I O Psychodynamic theory also associates excessive alcohol R use with other oral traits, such as dependence and depression, and traces the origins of these traits to D fixation in the oral stage of psychosexual development. I S Excessive drinking or smoking in adulthood symbolizes O an individual’s efforts to attain oral gratification. R D E R S

16 B E Sociocultural Perspectives H A Drinking is determined, in part, by where we live, V whom we worship with, and the social or cultural I norms that regulate our behavior. O R Cultural attitudes can encourage or discourage problem drinking.

D I Peer pressure and exposure to a drug subculture are S important influences in determining substance use O among adolescents and young adults R D E R S

B E Detoxification H A Detoxification - The process of ridding the system of V alcohol or other drugs under supervised conditions. I O Detoxification is often more safely carried out in a R hospital setting.

D In the case of addiction to alcohol or barbiturates, I hospitalization allows medical personnel to monitor S and treat potentially dangerous withdrawal symptoms O such as convulsions. R D E R S

B E Disulfiram H A The drug disulfiram (brand name Antabuse) V discourages alcohol consumption because the I combination of the two produces a violent response O consisting of nausea, headache, heart palpitations, and R vomiting.

D In some extreme cases, combining disulfiram and I alcohol can produce such a dramatic drop in blood S pressure that the individual goes into shock or even O dies. R D Although disulfiram has been used widely in E alcoholism treatment, its effectiveness is limited R because many patients who want to continue drinking S simply stop using the drug.

17 B E Antidepressants H A Antidepressants may help reduce cravings for cocaine V following withdrawal. I O These drugs stimulate neural processes that promote R feelings of pleasure derived from everyday experiences. D I However, antidepressants have yet to produce S consistent results in reducing relapse rates for cocaine O dependence, so it is best to withhold judgment R concerning their efficacy. D E R S

B E Nicotine Replacement Therapy H Most regular smokers, perhaps the great majority, are A nicotine dependent. V I The use of nicotine replacements in the form of O prescription gum (brand name Nicorette), transdermal R (skin) patches, and nasal sprays can help smokers avoid unpleasant withdrawal symptoms and cravings for D cigarettes. I S After quitting smoking, ex-smokers can gradually wean O themselves from the nicotine replacement. R D E R S

B E Methadone Maintenance H Programs A V Methadone - An artificial narcotic that is used to help I people who are addicted to heroin to abstain from it O without a withdrawal syndrome. R Because methadone in normal doses does not produce D a high or leave the user feeling drugged, it can help I heroin addicts hold jobs and get their lives back on S track (Schwartz et al., 2006). O R However, like other opioids, methadone is highly D addictive. E R S

18 B E Naltrexone H A Naltrexone - A drug that blocks the high from alcohol V as well as from opiates. I O The drug doesn’t prevent the person from taking a R drink or using heroin, but seems to blunt cravings for these drugs. D I Evidence shows that naltrexone and similar drugs are S useful in treating alcohol and opiate dependence O R D E R S

B E Culturally Sensitive Treatment H of Alcoholism A V Members of ethnic minority groups may resist I traditional treatment approaches because they feel O excluded from full participation in society. R Native American women, for example, tend to respond less favorably to traditional alcoholism D counseling than White women (Rogan, 1986). I S Hurlburt and Gade (1984) attribute this difference to O the resistance of Native American women to “White R man’s” authority. D They suggest that Native American counselors might E be more successful in overcoming this resistance. R S

B E Therapist Louise Roberts H A V I O R

D I S O R D “You try to make sense out of an addiction that E doesn’t make sense.” R S

19 B E Nonprofessional Support H Groups A Despite the complexity of the factors contributing to V substance abuse and dependence, these problems are I frequently handled by laypeople or nonprofessionals. O R The most widely used nonprofessional program, Alcoholics Anonymous (AA), is based on the belief that D alcoholism is a disease, not a sin. I S The AA philosophy holds that that people suffering O from alcoholism will never be cured, regardless of how R long they abstain from alcohol, rather, people with D alcoholism who remain “clean and sober” are seen as E “recovering alcoholics.” R S

B E Residential Approaches H A A residential approach to treatment requires a stay in a V hospital or therapeutic residence. I O Most inpatient programs use an extended 28-day R detoxification period.

D Most people with alcohol use disorders do not require I hospitalization. S O R D E R S

B E Psychodynamic Approaches H Psychoanalysts view substance abuse and dependence A as symptoms of conflicts rooted in childhood V experiences. I O The therapist attempts to resolve the underlying R conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of D gratification. I Although there are many successful psychodynamic S case studies of people with substance abuse problems, O there is a dearth of controlled and replicable research R studies. D E The effectiveness of psychodynamic methods for R treating substance abuse and dependence thus S remains unsubstantiated.

20 B E Self-Control Strategies H A Self-control training helps abusers develop skills they V can use to change their abusive behavior. Behavior I therapists focus on three components—the “ABCs”— of O substance abuse: R 1. The antecedent cues or stimuli (As) that prompt or

D trigger abuse. I S 2. The abusive behaviors (Bs) themselves. O R 3. The reinforcing or punishing consequences (Cs) that D maintain or discourage abuse. E R S

B E H A V I O R QUESTIONS?

D I S O R D E R S

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