A.P. Chapter 9
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What are the Jellinek's stages of alcoholism?
- 1. Prealcohlic symptomatic
- 2. prodromal (early) alcoholism
- 3. crucial alcoholism
- 4. Chronic alcoholism
- 5. Death
person is exposed to alcohol and learns the tension-reducing effects of social drinking. continued drinking leads to tolerance. Person often discovers "hidden" alcohol in household products (e.g. nighttime cold medications) for additional consumption.
describe prodromal (early) alcoholism
blackouts begin. frequent but mostly inconspicuous drinking, growing preoccupation with drinking as well as more time needed to recover from use, and verbalized rationalizations and/or denial of alcohol consumption. Person is likely irritable and depressed, has sleep disturbances, experiences some guilt, and breaks numerous promises to self to cut down or stop behavior. psychologically dependent. (likely meets criteria for subtance abuse)
describe crucial alcoholism
person frequently and openly consumes alcohol to total intoxication. pronounced dterioration in family, social, and occupational functioning (if these roles still exist for the person). psychological symptoms include severe depression with suicidal ideation and Korsakoff's Syndrome (deterioration in memory and confabulation); physical dterioration includes advanced liver disease, hypertension, muscle/bone diseases, oral/esphageal cancers, and brain damage.
describe death of alcoholism
depending on overall health status, functioning levesl prior to alcoholism, and pattern of alcohol addiction, life expectancy is shortened by approximately 8-12 years.
what are the two ways DSM-IV differentiates substance disorders
- 1. pattern of use (abuse or dependence)
- 2. type of substance(s) used
what are the diagnostic criteria for substance abuse?
- - recurrent, maladaptive pattern of use leading to significant distress or impairment
- - at least 1 of the following occuring within 12 months.
- * recurrent use leads to impaired functioning
- * recurrent use in physically hazardous circumstances
- *recurrent substance-related legal problems
- * despite difficulties, inability to refrain from use
what are the diagnostic criteria for substance dependence?
- maladaptive use leading to significant distress or impairment
- at least 3 of the following
- - marked tolerance
- - marked withdrawal
- - take larger amounts over longer periods than intended
- - persitent desire or unsuccessful efforts to control use
- - considerable time spent obtaining, using or recovering
what are some short-term subtance use disorders?
- - Intoxication- poisoning
- - Halluncinosis
what are some effects of Stimulants
- - speed up activities of ANS, CNS
- - decrease appetite, speed up metabolism
- - increase feelings of elation, grandosity
- - in higher dosages = nervous, jittery, restless
- - feel exhausted afterwards
- - highly addictive, overuse = tolerance and possibly psychosis
whast are some examples of stimulants?
what are some effects of hallucinogens
- - induce mind alterations, changes in perception and emotion
- - magnify mood
- - dependency not documented, abuse does occur
- - can produce paranoia, panic, amotivational syndrome (lazy)
what are some examples of hallucinogens?
- phencyclidine (PCP)
- lysergic acid diethylamide (LSD)
- inhalants - 'huffing'
highly addictive opiates and analgesics; used to relieve pain, induce sleep or paralyze internal muscles
what are some effects of narcotics?
- mimic endorphin effects: initial rush of pleasure followed by drowsiness, lathargy, and inactivity
what are some examples of narcotics?
- perscriptions containing narcotics ( vicodin, oxycontin, percocet)
what are some effects of sedatives?
- - slow activities of CNS, ANS
- - exert depressive effects by mimicking GABA
- - overuse leads to decrease REM sleep, seizures, hallucinations, depression
- - combining sedatives produces synergistic effects
what are synergistic effects?
since drugs are both depressants, they drop the heart rate dangerously low, where it can stop, as well as blood pressure, respirations etc.
what are some examples of sedatives?
- - benzodiazepines - calm, non-drowsy
- - barbiturates- calm, drowsiness
- - alcohol
what are the biological theories/etiologies or maintainence for subtance abuse
- genetics (eg. familial alcoholism)
- deficits of DA, GABA, and/or gutamate (reward deficiency)
- A1+ allele of D2 receptor gene
- opponent-process theory
what is the opponent process theory
- (Solomon & Corbit)
- people dont use the drug to get high anymore. but to feel normal because they dont get high or happy when using it
what is the psychodynamic theory/etiology for subtance abuse
- oral fixation
- unresolved dependency/aggressive conflicts
- personality profile: impulsive, antisocial (rules that appy to others dont apply to me), depressive, hostile
descirbe what Shedler & block founded in 1990 called longitudinal study
found substance "experimenters" exhibited best personal adjustment (had great outcomes, marriage, college, etc. were experimenters when younger)
what is the behavior theory/etiology for substance abuse?
- classical condtioning (learned association)
- operant conditioning (reward, tension reduction)
- social learning (modeling)
describe Tiffany's automatic process theory
substance use atuomatically linked to environmental cues/triggers; its not strong cravings but cues that maintain use
what is the social/sociocultural theory/etiology for substance abuse
- gender role expectations
- cultural norms
- media influences
- numerous lifestyle stressors(leading cause of relapse)
what is the Mascot
- well liked "pet"
- positive attention
- smiles, laughs,
describe the protector
- "chief enabler"
- keeps secrets
- takes care of family (member)
what is the hero
- "little adult"
- takes on household responsibilities (mini parent)
what is the lost child
- quiet, stays in room
what is scapegoat
- "problem child"
- everyone blames this kid
- they act up to be bad kid in order to take the attention off of drunk parents
what is the cognitive theory/etiology for substance abuse?
- low perceived control in life
- irrational beliefs and illogical problem -solving
describe Marllatt's abstinence violation effect
in high-risk situations will likely use again, causing persons to feel weak, powerless, and guilty; increases likelihood of full relapse
what is the more effective treatments for substance abuse?
- the two-phase approach:
- detoxification (usually in-patient)
- longterm sobriety programs (AA,NA)
what are the pharmocological treatments for substance abuse?
- * naltrexone or antabuse (disulfiram) - alcoholics
- * methadone or clonidine- heroin addicts
- * nicotine replacements (NRT)- smokers
what are some behavior therapies for treatment of subtance abuse?
- 1. aversion therapy- eg emetics with alcohol
- 2. covert desensitization-eg. imagine feces in drink
- 3. rapid use- eg 1 puff every 6 sec til sick
- 4. behavioral self-control - eg identify triggers (driving, eating)
- 5. relaxation trainiing/systematic desensitization
what are cognitive therapies/ treatments for substance abuse?
- 1. increase perceptions of self-control
- 2. challenge irrational beliefs that prompt use
- 3. teach healthy self-talk for high-risk situations (Glantz's calm)
what is Glantz's calm
- C= connect to consciousness (aware of feelings and thoughts)
- A= alleviate anxiety response ( control frantic urge to use)
- L= logically examine liabilities (think about consequences)
- M= mobilize and move one (leave triggering environment)
studies of the A1 allele of the D2 dopamine receptor gene have shown what?
that the A1= gene may be a causal mechanism for substance dependence
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