Abnormal Psychology Chapter 12

Substance Use and Addictive
Disorders
Chapter 12
Slides & Handouts by Karen Clay Rhines, Ph.D.

American Public University System
Comer, Abnormal
Psychology, 8e
DSM-5 Update
Substance Use Disorders

Many drugs are available in our society
Some are harvested from nature, others derived
from natural substances, and still others are
produced in a laboratory
Some require a physicians prescription for legal
use; others, like alcohol and nicotine, are legally
available to adults
Still others, like heroin, are illegal under all
circumstances
Comer, Abnormal Psychology, 8e
DSM-5 Update

Recent statistics suggest that drug use is a
significant social problem
22 million people in the U.S. have used an illegal
substance within the past month
Almost 24% of all high school seniors have used an
illegal drug within the past month

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What is a drug?
Any substance other than food that affects our
bodies or minds
Need not be a medicine or illegal
Current language uses the term substance

rather than drug to overtly include alcohol,
tobacco, and caffeine

DSM-5 Update

Substances may cause temporary changes in
behavior, emotion, or thought
May result in substance intoxication (literally,
poisoning), a temporary state of poor judgment,
mood changes irritability, slurred speech, and
poor coordination
Some substances such as LSD may produce a
particular form of intoxication, sometimes called
hallucinosis, which consists of perceptual
distortions and hallucinations
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Substances can also lead to long-term problems:
Substance use disorder: a pattern of maladaptive
behaviors and reactions brought about by repeated
use of substances
In many cases, people become physically dependent
on the substances, developing a tolerance for it
(needing increasing doses to get an effect) and
experiencing withdrawal reactions (unpleasant and
dangerous symptoms when substance use is stopped
or cut down)
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About 9% of all teens and adults in the U.S.
display substance use disorders
The highest rate in the U.S. is found among
American Indians (15.5%), while the lowest is
among Asian Americans (3.5%)
White Americans, Hispanic Americans, and African
Americans display rates between 9
and 10%
Only 11% receive treatment from a mental health
professional
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The substances people misuse fall into several
categories:
Depressants
Stimulants
Hallucinogens
Cannabis

DSM-5 Update
Depressants
Depressants slow the activity of the central
nervous system (CNS)
Reduce tension and inhibitions
May interfere with judgment, motor activity, and
concentration
Three most widely used depressants:

Alcohol
Sedative-hypnotic drugs
Opioids

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Depressants: Alcohol
The World Health Organization estimates that
2 billion people worldwide consume alcohol
In the U.S., more than half of all residents
drink alcoholic beverages from time to time

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When people consume 5 or more drinks in a
single occasion, it is called a binge-drinking
episode
24% of all people in the U.S. over the age of 11,
most of them male, binge-drink each month
Nearly 7% of people over age the age of 11

binge-drink at least 5 times each month
Considered heavy drinkers, males outnumber
females by more than 2:1 (around 8% to 4%)
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All alcoholic beverages contain ethyl alcohol
It is absorbed into the blood through the
stomach lining and takes effect in the
bloodstream and CNS
Short-term: alcohol binds to certain neurons
Alcohol helps GABA (an inhibitory messenger)
shut down neurons and relax the drinker

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The first brain area affected is that which
controls judgment and inhibition
Next affected are additional areas in the CNS,
leaving the drinker even less able to make
sound judgments, speak clearly, and
remember well
Motor difficulties increase as drinking
continues, and reaction times slow

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The extent of the effect of ethyl alcohol is determined
by its concentration (proportion) in the blood
A given amount of alcohol has a lesser effect on a large
person than on a small one
Gender also affects blood alcohol concentration

Women have less alcohol dehydrogenase, an enzyme in
the stomach that metabolizes alcohol before it enters the
blood
Women become more intoxicated than men on equal
doses of alcohol

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Levels of impairment are closely tied to the
concentration of ethyl alcohol in the blood:
BAC = 0.06: Relaxation and comfort
BAC = 0.09: Intoxication
BAC > 0.55: Death
Most people lose consciousness before they can drink
this much

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The effects of alcohol subside only after
alcohol is metabolized by the liver
The average rate of this metabolism is 25% of an
ounce per hour
You cant increase the speed of this process!

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Alcohol Use Disorder

Though legal, alcohol is one of the most
dangerous recreational drugs
Its effects can extend across the life span
Alcohol use is a major problem on college
campuses

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Surveys indicate that 7.4% of all adults in the
U.S. display alcohol use disorder over a oneyear period while over 13% display it at some
point in their lives
Men outnumber women 2:1
Many teenagers also experience the disorder

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The prevalence of alcoholism in a given year is
about the same (7% to 9%) for White Americans,
African Americans and Hispanic Americans
The men in these groups show strikingly different age
patterns
American Indians, particularly men, tend to

display a higher rate of alcohol use disorders than
any of these groups
Overall 15% of them have the disorder

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Generally, Asians have lower rates of alcohol
disorders than do people from other cultures
As many as one-half of these individuals have a
deficiency of alcohol dehydrogenase; thus, they
have a negative reaction to even modest alcohol
intake

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Clinical Picture
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
Eventually the drinking interferes with social behavior
and the ability to think and work
Individual patterns of alcoholism abuse vary

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Tolerance and Withdrawal
For many individuals, alcohol use disorder includes
the symptoms of tolerance and withdrawal reactions
As their bodies build up a tolerance for alcohol, they need
to drink greater amounts to feel its effects
They may experience withdrawal symptoms, including
nausea and vomiting, when they stop drinking
A small percentage of these people experience a dramatic
and dangerous withdrawal syndrome known as delirium
tremens (the DTs)
Alcohol withdrawal can be fatal

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What is the personal and social impact of
alcoholism?
Alcoholism destroys families, social relationships,
and careers
Losses to society total many billions of dollars annually
Plays a role in suicides, homicides, assaults, rapes, and
accidents
Has serious effects on the children (some 30 million) of
persons with this disorder

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What is the personal and social impact of
alcoholism?
Long-term excessive drinking can seriously damage
physical health
Especially damaged is the liver (cirrhosis)
Long-term excessive drinking can cause major

nutritional problems
Example: Korsakoffs syndrome
Women who drink alcohol during pregnancy place

their fetuses at risk from fetal alcohol syndrome (FAS)
and increased risk of miscarriage

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Depressants:
Sedative-Hypnotic Drugs
Sedative-hypnotic (anxiolytic) drugs produce
feelings of relaxation and drowsiness
At low doses, they have a calming or sedative
effect
At high doses, they function as sleep inducers or
hypnotics
Sedative-hypnotic drugs include barbiturates

and benzodiazepines

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Depressants: Barbiturates
First discovered more than 100 years ago,
barbiturates were widely prescribed in the
first half of the 20th century to fight anxiety
and to help people sleep
Although still prescribed, they have been largely
replaced by benzodiazepines
They can cause many problems, not the least of
which is misuse

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Barbiturates are usually taken in pill or capsule
form
At low doses, they reduce excitement in a
manner similar to alcohol by attaching to the
GABA receptors and helping GABA operate
Also similar to alcohol, barbiturates are
metabolized by the liver

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At too high a level, they can halt breathing,
lower blood pressure, and can lead to coma
and death

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Repeated use of barbiturates can quickly
result in sedative-hypnotic use disorder
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
Barbiturate withdrawal is particularly dangerous
because it can cause convulsions

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Depressants: Benzodiazepines
Benzodiazepines are often prescribed to
relieve anxiety
Most popular sedative-hypnotics available
Class includes Xanax, Ativan, and Valium

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Benzodiazepines have a depressant effect on
the CNS by binding to GABA receptors and
increasing GABA activity
Unlike barbiturates and alcohol, however,
benzodiazepines relieve anxiety without causing
drowsiness
They are also less likely to slow breathing and lead to
death by overdose

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Once thought to be a safe alternative to other
sedative-hypnotic drugs, benzodiazepines can
cause intoxication and lead to an addictive
pattern of use
As many as 1% of U.S. adults display a sedativehypnotic use disorder that centers on
benzodiazepines at some point in their lives

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Depressants: Opioids
This class of drug includes both natural
(opium, heroin, morphine, codeine) and
synthetic (methadone) compounds and is
known collectively as narcotics
Each drug has a different strength, speed of
action, and tolerance level

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Narcotics are smoked, inhaled, injected by needle just
under the skin (skin popped), or injected directly into
the bloodstream (mainlined)
Injection seems to be the most common method of use,
although other techniques have been increasing in recent
years
An injection quickly brings on a rush a spasm of
warmth and ecstasy that is sometimes compared with
orgasm
This spasm is followed by several hours of pleasurable
feelings (called a high or nod)

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Opioids create these effects by depressing the
CNS
Opioids bind to the receptors in the brain that
ordinarily receive endorphins (NTs that naturally help
relieve pain and decrease emotional tension)
When these sites receive opioids, they produce
pleasurable and calming feelings, just as endorphins
do
In addition to reducing pain and tension, opioids can
cause nausea, narrowing of the pupils, and
constipation

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Heroin use exemplifies the problems posed by
opioids:
After just a few weeks, users may become caught in a
pattern of abuse (and often dependence)
Users quickly build a tolerance for the drug and
experience withdrawal when they stop taking it
Early withdrawal symptoms include anxiety and
restlessness; later symptoms include twitching, aches,
fever, vomiting, diarrhea, and weight loss from
dehydration

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Such individuals soon need the drug just to
avoid experiencing withdrawal, and they must
continually increase their doses in order to
achieve even that relief
Many users must turn to criminal activity to
support their habit and avoid withdrawal
symptoms

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Surveys suggest that close to 1% of adults in
the U.S. display opioid use disorder at some
time in their lives

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What are the dangers of opioid use ?
Once again, heroin provides a good example:
The most immediate danger is overdose
The drug closes down the respiratory center in the brain,
paralyzing breathing and causing death
Death is particularly likely during sleep
Ignorance of tolerance is also a problem

People who resume use after having avoided it for some time
often make the fatal mistake of taking the same dose they had
built up to before

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What are the dangers of opioid use?
Each year approximately 2% of persons addicted
to heroin and other opioids die under the drugs
influence
In addition, users run the risk of getting impure
drugs
Opioids are often cut with noxious chemicals
Dirty needles and other equipment can spread

infection

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Stimulants
Stimulants are substances that increase the activity of
the central nervous system (CNS)
Cause increases in blood pressure, heart rate, and
alertness
Cause rapid behavior and thinking
The four most common stimulants are:
Cocaine
Amphetamines
Caffeine
Nicotine

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Stimulants: Cocaine
Derived from the leaves of the coca plant,
cocaine is the most powerful natural stimulant
known
28 million people in the U.S. have tried cocaine
1.6 million people are currently using it

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Stimulants: Cocaine
Cocaine produces a euphoric rush of wellbeing
It seems to work by increasing dopamine at
key receptors in the brain and overstimulating
them
Also appears to increase norepinephrine and
serotonin

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Stimulants: Cocaine
High doses of cocaine can produce cocaine
intoxication, whose symptoms include mania,
paranoia, and impaired judgment
Some people also experience hallucinations
and/or delusions, a condition known as cocaineinduced psychosis
As the stimulant effects of the drug subside,

the user experiences a depression-like
letdown, popularly called crashing
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Stimulants: Cocaine
Cocaine use in the past was limited by the drugs
high cost
Since 1984, newer, more powerful, and
sometimes cheaper versions of the drug have
become available, including:
A freebase form where the drug is heated and
inhaled with a pipe
Crack, a powerful form of freebase that has been
boiled down for smoking in a pipe

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Stimulants: Cocaine
What are the dangers of cocaine?
Aside from its behavioral effects, cocaine poses
significant physical danger
The greatest danger of use is the risk of overdose
Excessive doses depress the brains respiratory function, and
stop breathing
Cocaine use can also cause heart failure
Pregnant women who use cocaine have an increased
likelihood of miscarriage and of having children with
abnormalities

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Stimulants: Amphetamines
Amphetamines are stimulant drugs that are
manufactured in the laboratory
Most often taken in pill or capsule form
Some people inject the drugs intravenously or smoke
them for a quicker, more powerful effect

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Like cocaine, amphetamines:
Increase energy and alertness and reduce appetite
when taken in small doses
Produce a rush, intoxication, and psychosis in high
doses
Cause an emotional letdown as they leave the
body
stimulate the CNS by increasing dopamine,
norepinephrine, and serotonin

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One kind of amphetamine, methamphetamine,
has had a major surge in popularity in recent
years
Almost 6% of all persons over the age of 11 in the US
have used this stimulant at least once
Most of the nonmedical meth is made in

stovetop laboratories
Meth is about as likely to be used by women as
men and has gained popularity as a club drug

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Stimulant Use Disorder

Regular use of either cocaine or amphetamine
may lead to stimulant use disorder
The stimulant comes to dominate the individuals life
Tolerance and withdrawal reactions may also develop
In a given year, 0.5% of all people over the age of

11 display stimulant use disorder centered on
cocaine and 0.25 display it centered on
amphetamines

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Stimulants: Caffeine
Caffeine is the worlds most widely used
stimulant
Around 80% of the worlds population consumes it
daily
Most consumption is in the form of coffee; the rest is in
the form of tea, cola, energy drinks, chocolate, and
over-the-counter medications
Around 99% of ingested caffeine is absorbed by the
body and reaches its peak concentration within an hour

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Caffeine acts as a stimulant in the CNS,
producing a release of dopamine, serotonin,
and norepinephrine in the brain
More than 2 to 3 cups of brewed coffee can lead
to caffeine intoxication
Seizures and respiratory failure can occur at doses
greater than 10 grams of caffeine (about 100 cups
of coffee)

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Many people who suddenly stop or cut back their
usual intake experience withdrawal symptoms,
including headaches, depression, anxiety, and
fatigue
Studies suggest correlations between high doses of
caffeine and heart rhythm irregularities, high
cholesterol levels, and risk of heart attacks
High doses during pregnancy also increase the risk of
miscarriage

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Hallucinogens, Cannabis, and

Combinations of Substances
Other kinds of substances may also cause
problems for users and for society
Hallucinogens
Produce delusions, hallucinations, and other sensory
changes
Cannabis
Produces sensory changes, but have both depressant and
stimulant effects
Many individuals take combinations of substances

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Hallucinogens
Hallucinogens, also known as psychedelic drugs,
cause powerful changes in sensory perceptions
(sometimes called trips)
Include natural hallucinogens
Mescaline
Psilocybin
And laboratory-produced hallucinogens

Lysergic acid diethylamide (LSD)
MDMA (Ecstasy)

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Hallucinogens
LSD is one of the most famous and powerful
hallucinogens
Within two hours of being swallowed, it brings on a
state of hallucinogen intoxication (hallucinosis)
Increased and altered sensory perception
Hallucinations may occur
The drug may cause different senses to cross, an effect called
synesthesia
May induce extremely strong emotions

May have some physical effects
Effects wear off in about six hours

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Hallucinogens
LSD produces these symptoms by binding to
serotonin receptors
These neurons help control visual information and
emotions, thereby causing the various effects of
the drug on the user

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Hallucinogens
More than 14% of Americans have used
hallucinogens at some point in their lives
Tolerance and withdrawal are rare
But the drugs do pose dangers
Users may experience a bad trip the experience of
enormous unpleasant perceptual, emotional, and
behavioral reactions
Another danger is the risk of flashbacks

Can occur days or months after last drug use

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Cannabis
The drugs produced from varieties of the hemp
plant are, as a group, called cannabis
They include:
Hashish, the solidified resin of the cannabis plant
Marijuana, a mixture of buds, crushed leaves, and flowering
tops
The major active ingredient in cannabis is

tetrahydrocannabinol (THC)
The greater the THC content, the more powerful the
drug

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Cannabis
When smoked, cannabis produces a mixture of
hallucinogenic, depressant, and stimulant effects
At low doses, the user feels joy and relaxation
May become anxious, suspicious, or irritated
This overall high is technically called cannabis intoxication
At high doses, cannabis produces odd visual experiences,

changes in body image, and hallucinations
Most of the effects of cannabis last 2 to 6 hours

Mood changes may continue longer

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Cannabis
Cannabis Use Disorder
In the 1970s, use of marijuana rarely led to cannabis
use disorder
Today many users are developing this disorder
Some users develop tolerance and withdrawal, experiencing
flulike symptoms, restlessness, and irritability when drug use
is stopped
About 1.7% of people in the U.S. displayed marijuana abuse
or dependence in the past year
Between 4 and 5% will fall into these patterns at some point in
their lives

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Cannabis
Cannabis Use Disorder
One theory about the increase in cannabis use
disorder is the change in the drug itself
The marijuana available today is significantly more
potent than the drug used in the early 1970s

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Cannabis
Is marijuana dangerous?
As the strength and use of the drug has increased,
so have the risks of using it
May cause panic reactions similar to those caused by
hallucinogens
Because of its sensorimotor effects, marijuana has
been implicated in accidents
Marijuana use has been linked to poor concentration
and impaired memory

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Cannabis
Is marijuana dangerous?
Long-term use poses additional dangers
May cause respiratory problems and lung cancer
May affect reproduction
In males, it may lower sperm count
In women, abnormal ovulation has been found

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Cannabis
Cannabis and Society: A Rocky Relationship
For centuries, cannabis played a respected role in
medicine, but its use fell out of favor and was
criminalized
In the late 1980s, several interest groups
campaigned for the medical legalization of
marijuana

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Cannabis
In 2009, the US Attorney General directed federal
prosecutors to not pursue cases against medical
marijuana users complying with state laws
In 2011 and 2012, several state and city-level
officials petitioned the government to reclassify
marijuana as a drug with acceptable medical
usage

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Cannabis
In 2012, residents of Colorado and Washington
voted to legalize marijuana for use of any kind,
although such state measures can be blocked by
the federal government
In the meantime, both the Netherlands and

Canada permit its use for medical purposes

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People often take more than one drug at a
time, a pattern called polysubstance use
Researchers have studied the ways in which drugs
interact with one another, focusing on crosstolerance and synergistic effects

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Cross-tolerance
Sometimes two or more drugs are so similar in their
actions on the brain and body that as people build a
tolerance for one drug, they are simultaneously
developing a tolerance for the other (even if they have
never taken it)
Users who display this cross-tolerance can reduce the
symptoms of withdrawal from one drug by taking the
other
Example: alcohol and benzodiazepines

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Synergistic effects
When different drugs are in the body at the same
time, they may multiply, or potentiate, each
others effects
This combined impact is called a synergistic effect,
and is often greater than the sum of the effects of
each drug taken alone

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Synergistic effects
One kind of synergistic effect occurs when two or
more drugs have similar actions
Example: alcohol, barbiturates, benzodiazepines, and
opioids
All depressants, these drugs may severely depress the
CNS when mixed, leading to death

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Synergistic effects
A different kind of synergistic effect results when
drugs have opposite (antagonistic) effects
Example: stimulants or cocaine with barbiturates or
alcohol
May build up lethal levels of the drugs because of metabolic
issues (stimulants impede the livers processing of
barbiturates and alcohol)

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Each year tens of thousands of people are
admitted to hospitals because of
polysubstance use
May be accidental or intentional
As many as 90% of people who use one illegal drug are
also using another to some extent

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What Causes
Substance Use Disorders?
Clinical theorists have developed
sociocultural, psychological, and biological
explanations for substance abuse and
dependence
No single explanation has gained broad support
Best explanation: a COMBINATION of factors

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Causes of Substance Use Disorders:

Sociocultural Views
A number of theorists propose that people are
more likely to develop substance use disorders
when living in stressful socioeconomic
conditions
Example: higher levels of unemployment correlate
with higher rates of alcohol use
Example: people of lower SES have higher rates of
substance use in general

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Sociocultural Views
Other theorists propose that substance use
disorders are more likely to appear in families
and social environments where substance use
is valued or accepted
Example: rates of alcohol use vary among cultures

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Psychodynamic Views
Psychodynamic theorists believe that people with
substance use disorders have powerful dependency
needs that can be traced to their early years
Caused by a lack of parental nurturing
Some people may develop a substance abuse personality as a
result
Limited research does link early impulsivity to later

substance use, but the findings are correlational and
researchers cannot presently conclude that any one
personality trait or group of traits stands out in substancerelated disorders

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Cognitive-Behavioral Views
According to behaviorists, operant conditioning
may play a key role in substance abuse
They argue that the temporary reduction of tension
produced by a drug has a rewarding effect, thus
increasing the likelihood that the user will seek this
reaction again
Similarly, the rewarding effects may also lead users to
try higher doses or more powerful methods of
ingestion

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Cognitive theorists further argue that such
rewards eventually produce an expectancy
that substances will be rewarding, and this
expectation is sufficient to motivate
individuals to increase drug use at times of
tension

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Causes of Substance-Related Disorders:

In support of these views, studies have found
that many subjects do in fact drink more
alcohol or seek heroin when they feel tense
In a manner of speaking, this model is arguing
a self-medication hypothesis

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If true, one would expect higher rates of
substance use among people with
psychological problems
More than 22% of all adults who suffer from
psychological disorders have displayed substance
use disorders within the past year

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Other behaviorists have proposed that classical
conditioning may play a role in these disorders
Objects present at the time drugs are taken may act as
classically conditioned stimuli and come to produce
some of the pleasure brought on by the drugs
themselves
Although classical conditioning may be at work, it has
not received widespread research support as the key
factor in such patterns

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Biological Views
In recent years, researchers have come to
suspect that drug misuse may have biological
causes
Studies on genetic predisposition and specific
biochemical processes have provided some
support for this model

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Biological Views
Genetic predisposition
Research with alcohol-preferring animals has
demonstrated that their offspring have similar
alcohol preferences
Similarly, research with human twins has
suggested that people may inherit a
predisposition to misuse substances
Concordance rates in identical (MZ) twins: 54%
Concordance rates in fraternal (DZ) twins: 28%

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Biological Views
Clearer support for a genetic model may come
from adoption studies
Studies compared adoptees whose biological parents
abuse alcohol with adoptees whose biological parents
do not
By adulthood, those whose biological parents were
dependent showed higher rates of alcoholism themselves

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Biological Views
Genetic linkage strategies and molecular biology
techniques provide more direct evidence in
support of this hypothesis
An abnormal form of the dopamine-2 (D2) receptor
gene was found in the majority of research participants
with substance use disorders, but in less than 20% of
participants who do not display such disorders

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Biological Views
Biochemical factors
Over the past few decades, investigators have pieced
together several biological explanations of drug
tolerance and withdrawal
Based on NT functioning in the brain
The specific NTs affected depend on which drug is used
Recent brain imaging studies have suggested that

many (perhaps all) drugs eventually activate a reward
center or pleasure pathway in the brain

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Biological Views
Biochemical factors
The reward center apparently extends from the ventral
tegmental area of the brain to the nucleus accumbens and on to
the frontal cortex
The key NT appears to be dopamine
When dopamine is activated at this reward center, a person
experiences pleasure
Certain drugs stimulate the reward center directly

Examples: cocaine, amphetamines, caffeine
Other drugs stimulate the reward center in roundabout ways

Examples: alcohol, opioids, marijuana

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Biological Views
Biochemical factors
A number of theorists believe that when
substances repeatedly stimulate the reward
center, the center develops a hypersensitivity to
the substances
This theory, called the incentive-sensitization theory,
has received considerable support in animal studies

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Biological Views
Biochemical factors
Other theorists believe that people who abuse
substances suffer from a reward-deficiency
syndrome
Their reward center is not readily activated by normal
life events so they turn to drugs to stimulate this
pleasure pathway, particularly in times of stress
Defects in D2 receptors have been cited as a possible cause

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How Are Substance Use Disorders

Treated?
Many approaches have been used to treat substance
use disorders, including psychodynamic, behavioral,
cognitive-behavioral, and biological, along with
sociocultural therapies
Although these treatments sometimes meet with great
success, more often they are only moderately helpful
Today treatments are typically used in combination on
both an outpatient and inpatient basis

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How Are Substance Use Disorders

Treated?
The value of treatment for substance use
disorders can be difficult to determine
Different substance use disorders pose different
problems
Many people with such disorders drop out of
treatment early
Some people recover without any intervention at all
Different criteria are used by different clinical
researchers

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Psychodynamic Therapies
Psychodynamic therapists first guide clients to
uncover and work through the underlying needs
and conflicts that they believe led to the disorder
then try to help them change their styles of living
Research has not found this model to be very
effective
Tends to be of greater help when combined with
other approaches in a multidimensional treatment
program

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Behavioral Therapies
A widely used behavioral treatment is aversion
therapy, an approach based on classical
conditioning principles
Individuals are repeatedly presented with an
unpleasant stimulus at the very moment they are
taking a drug
After repeated pairings, they are expected to react
negatively to the substance itself and to lose their
craving for it

DSM-5 Update
94
Aversion therapy is most commonly applied to
alcoholism
In one version, drinking behavior is paired with druginduced nausea and vomiting
Another version of this approach requires people with
alcoholism to imagine extremely upsetting, repulsive,
or frightening scenes while they are drinking
The pairing is expected to produce negative responses to
liquor itself

DSM-5 Update
95
A behavioral approach that has been
successful in the short-term is contingency
management
This procedure makes incentives contingent on
the submission of drug-free urine specimens

DSM-5 Update
96
Behavioral interventions have usually had
onlhy limited success when used alone
They work best when used in combination with
either biological or cognitive approaches

DSM-5 Update
97
Cognitive-Behavioral Therapies
Cognitive-behavioral treatments for substance
use disorders help clients identify and change
the patterns and cognitions contributing to
their patterns of substance misuse

DSM-5 Update
98
Cognitive-Behavioral Therapies
The most prominent of these approaches is
relapse-prevention training
The overall goal is for clients to gain control over their
substance-related behaviors
Clients are taught to identify and plan ahead for high-risk
situations and to learn from mistakes and lapses
This approach is used particularly to treat alcohol use;

also used to treat cocaine and marijuana abuse

DSM-5 Update
99
Biological Treatments
Biological approaches may be used to help
people withdraw from substances, abstain
from them, or simply maintain their level of
use without further increases
These approaches have limited long-term success
when used alone, but can be helpful when
combined with other approaches

DSM-5 Update
100
Detoxification
Systematic and medically supervised withdrawal
from a drug
Can be outpatient or inpatient
Two strategies:
Gradual withdrawal by tapering doses of the substance
Induce withdrawal but give additional medication to
block symptoms

DSM-5 Update
101
Detoxification
Detoxification programs seem to help motivated
people withdraw from drugs
For people who fail to receive psychotherapy after
withdrawal, however, relapse rates tend to be high

DSM-5 Update
102
Antagonist drugs
As an aid to resist falling back into a pattern of
substance abuse or dependence, antagonist drugs
block or change the effects of the addictive
substance
Example: disulfiram (Antabuse) for alcohol
Example: naloxone for opioids, naltrexone for alcohol

DSM-5 Update
103
Drug maintenance therapy
A drug-related lifestyle may be a greater problem than
the drugs direct effects
Example: heroin addiction
Methadone maintenance programs are designed to

provide a safe substitute for heroin
Methadone is a laboratory opioid with a long half-life, taken
orally once a day
Programs were roundly criticized as substituting addictions
but are regaining popularity, partly because of the spread of
HIV/AIDS

DSM-5 Update
104
Sociocultural Therapies
Three sociocultural approaches have been
applied to substance use disorders:
Self-help programs
Culture- and gender-sensitive programs
Community prevention programs

DSM-5 Update
105
Self-help and residential treatment programs
Most common: Alcoholics Anonymous (AA)
Offers peer support along with moral and spiritual
guidelines to help people overcome alcoholism
It is worth noting that the abstinence goal of AA directly
opposes the controlled-drinking goal of relapse
prevention training and several other interventions for
substance misuse this issue has been debated for
years

DSM-5 Update
106
Self-help and residential treatment programs
Many self-help programs have expanded into
residential treatment centers or therapeutic
communities
People formerly addicted to drugs live, work, and
socialize in a drug-free environment while undergoing
individual, group, and family therapies

DSM-5 Update
107
Culture- and gender-sensitive programs
A growing number of treatment programs try to
be sensitive to the special sociocultural pressures
and problems faced by drug abusers who are
poor, homeless, or members of ethnic minority
groups
Similarly, therapists have become more aware that
women often require treatment methods different
from those designed for men
DSM-5 Update
108
Community prevention programs
Perhaps the most effective approach to substance use
disorders is to prevent them
Some prevention programs argue for total abstinence from
drugs, while others teach responsible use
Prevention programs may focus on the individual, the
family, the peer group, the school, or the community at
large
The most effective of these prevention efforts focuses on multiple
areas to provide a consistent message about drug use in all areas
of life

DSM-5 Update
109
Gambling Disorder
It is estimated that as many as 2.3% of all adults
and 3-8% of teens and college students suffer
from gambling disorder
Clinicians are careful to distinguish between this
disorder and social gambling
Gambling disorder is defined less by the amount

of time or money spent than by the addictive
nature of the disorder
People with the disorder are preoccupied with and
cannot walk away from a bet

DSM-5 Update
110
Gambling Disorder
The explanations posed for gambling disorder
often parallel those offered for substance use
disorders
These include possible genetic predisposition,
heightened dopamine activity, impulsive
personality styles, and cognitive errors
Research, however, has been limited thus far

DSM-5 Update
111
Gambling Disorder
Similarly, the leading treatments for substance
use disorder have been adapted for use with
gambling disorder
These include cognitive-behavioral approaches
and biological approaches
In addition, the self-help group program Gamblers
Anonymous is available

DSM-5 Update
112
Internet Use Disorder

As people increasingly turn to the Internet for
activities that used to take place in the real
world, a new psychological problem has
emerged: an uncontrollable need to be online
This pattern has been called Internet use disorder,
Internet addiction, and problematic Internet use

DSM-5 Update
113

For people who display this pattern, the Internet
has become a black hole
Sufferers at least 1% of all people spend all or
most of their waking hours texting, tweeting,
networking, gaming, Internet browsing, emailing,
blogging, visiting virtual worlds, shopping online, or
viewing online pornography
Specific symptoms of this pattern parallel those found
in substance use disorders and gambling disorder

DSM-5 Update
114

Although clinicians, the media, and the public
have shown enormous interest in this
problem, DSM-5 has not listed it as a disorder
Instead, it has recommended that the pattern
receive further study for possible inclusion in
future editions

DSM-5 Update
115

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Substance Use and Addictive

Slides & Handouts by Karen Clay Rhines, Ph.D.

Substance Use Disorders

Substance Use Disorders

Comer, Abnormal Psychology, 8e

Substance Use Disorders

Current language uses the term substance

Comer, Abnormal Psychology, 8e

Substance Use Disorders

Substance Use Disorders

Substance Use Disorders

Substance Use Disorders

Comer, Abnormal Psychology, 8e

Three most widely used depressants:

Comer, Abnormal Psychology, 8e

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Nearly 7% of people over age the age of 11

Comer, Abnormal Psychology, 8e

Comer, Abnormal Psychology, 8e

Gender also affects blood alcohol concentration

Comer, Abnormal Psychology, 8e

Comer, Abnormal Psychology, 8e

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Alcohol Use Disorder

Comer, Abnormal Psychology, 8e

Alcohol Use Disorder

Comer, Abnormal Psychology, 8e

Alcohol Use Disorder

American Indians, particularly men, tend to

Comer, Abnormal Psychology, 8e

Alcohol Use Disorder

Comer, Abnormal Psychology, 8e

Alcohol Use Disorder

Individual patterns of alcoholism abuse vary

Comer, Abnormal Psychology, 8e

Alcohol Use Disorder

Comer, Abnormal Psychology, 8e

Comer, Abnormal Psychology, 8e

Long-term excessive drinking can cause major

Women who drink alcohol during pregnancy place

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Sedative-hypnotic drugs include barbiturates

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Ignorance of tolerance is also a problem

Comer, Abnormal Psychology, 8e

Dirty needles and other equipment can spread

Comer, Abnormal Psychology, 8e

The four most common stimulants are:

Comer, Abnormal Psychology, 8e

Comer, Abnormal Psychology, 8e

Comer, Abnormal Psychology, 8e