Chapter 12 Substance-Related Disorders (alcohol only)
Addictive behavior - involves a pathological need for a substance or activity.
The DSM approach - Psychoactive substance related disorders are divided into two
major categories: [1] reflects conditions brought about by long term chronic use
(e.g., alcohol amnestic amnesia) and [2] more acute conditions brought about by
the "toxic" effects of substances (e.g., amphetamine delusional disorder). The majority
of disorders (e.g., alcohol intoxication) fall into the second category.
Substance abuse - involves a pattern of abuse that results in potentially hazardous
behavior and continued use despite obvious problems.
Substance dependence - is more severe and usually will involve "tolerance"
and/or "withdrawal."
Tolerance - increasing amounts of the substance are needed to achieve the desired effect.
Withdrawal - unpleasant physical symptoms that accompany abstinence from the drug.
Lifetime prevalence - for alcohol dependence is high at about 13.4%.
Comorbidity - substance abuse and dependence co-occur with many other disorders
but especially depression.
Gender differences - men outnumber women about 5 to 1.
Desired effects - warmth, expansiveness, well-being, increased self esteem and adequacy.
Chemical action of alcohol - is to activate the brain's "pleasure centers," releasing
endogenous opium-like chemicals. Also CNS activity is depressed via inhibition of
"glutamate," one of the brain's excitatory neurotransmitters.
Fetal alcohol syndrome (FAS) - results from consuming alcohol during pregnancy. No
safe level of consumption has been established.
Liver damage - cirrhosis is common as the liver processes alcohol.
Malnutrition - alcohol is high calorie so it lessens the desire for food. Also, it reduces the
body's ability to utilize what nutrients are taken in.
Alcohol withdrawal delirium - formerly known as delirium tremens (DTs). Occurs with
abrupt abstinence in a chronic drinker. Symptoms include: disorientation, vivid
hallucinations esp. small fast moving animals, suggestibility, tremors, perspiring, fever,
and rapid heartbeat. Symptoms can be eased with benzodiazepine drugs such as
valium.
Alcohol amnestic disorder - formerly known as Korsakoffs syndrome. Primarily a memory
deficit that accompanies many years of heavy drinking. Symptoms include delirium,
delusions, and disorientation for time and place. Other cognitive impairments will also
be present. A deficiency in thiamin (vitamin B) is strongly implicated.
Confabulation - is a term that applies to filling in missing "gaps" with made-up or false
information.
Neurobiology of Addiction:
The MCLP - mesocorticolimbic dopamine pathway is the primary pleasure center in the
brain and. as its name implies, involves the neurotransmitter, dopamine. It consists of
[1] the ventral tegmental area, [2] the nucleus accumbens, and [3] the
(pre)frontal cortex.
Heritability - alcoholism tends to run in families. Goodwin et al. (1973) found that adopted
children (with alcoholic biological parents) were much more likely to develop alcohol
problems than were adopted children whose biological parents were NOT alcoholics.
Ethnic differences - Certain groups such as Asians, Native Americans, and Eskimos have
unusual or hypersensitive reactions such as "flushing" of the skin and a drop in blood
pressure.
Learning - Despite the strong genetic influence, the person still must be exposed to
alcohol at some point.
Psychological Vulnerability:
Personality factors - Although usually associated with a more antisocial pattern, I believe
there are two types of "alcoholic personalities." 1. a sensation seeking (antisocial)
type and 2. a more depressed/anxious self-medicating type. These personality traits
are at least partly inherited.
Other factors - Potential alcohol abusers tend to be emotionally immature, expect a great
deal from the world, require excessive praise, are easily hurt, are easily frustrated,
and may be impulsive and aggressive.
Comorbid disorders - that may contribute to abuse potential are depression, anxiety,
borderline personality, and bipolar disorders.
Marital conflict - along with poor parenting, inconsistent discipline and lack of "attachment"
may also increase risk.
Sociocultural factors - Some groups such as Muslims prohibit alcohol use so
alcoholism is uncommon. Orthodox Jews restrict use to religious ceremonies so
alcoholism is also uncommon for this group. Europeans have high rates of alcoholism.
Treatment:
Disulfiram - (antabuse) causes nausea when mixed with alcohol. The problem is that
most alcoholics will stop taking the drug when not in a controlled setting.
Naltrexone - is a drug that negates the pleasant effects of alcohol by blocking dopamine
receptors. It is an "opiate antagonist."
Valium - and other benzodiazepines help reduce alcohol withdrawal symptoms.
Aversive conditioning - based on the principle of classical conditioning. An aversive
stimulus such as an emetic or shock is paired with alcohol so the alcohol becomes
a "conditioned stimulus." Somewhat effective, at least short term but not popular.
Controlled drinking - some advocate this more moderate approach. Alcoholics with less
severe addiction and fewer co-existing diagnoses are more likely do be able to gain
and sustain partial control over their drinking.
Alcoholics Anonymous (AA) - is a large "self-help" organization. According to Brandsma et
al., success rates are NOT very high. There is a high dropout rate as many don't like
the "quasi-religious" nature of the meetings. Some more recent studies differ.
Brandsma et al. - also concluded that some form of treatment, professional or self-help,
was better than no treatment.
Relapse - Many treatment programs report high "cure" rates. However, relapse rates
are also high.
Abstinence violation effect - A problem with total abstinence is that if one slips and has
one drink, there is a tendency to feel guilty. This is usually followed by heavy drinking.