Professional Documents
Culture Documents
I. General
A. Background
1. Diagnosis
Pre-DSM-III substance abuse was classified as a personality disorder part of ones character; antisocial tendency
B. Substance Abuse
DSM-IV criteria for abuse (p. 381) A. Substance use leading to significant impairment or distress as manifested by one or more of the following in a 12-month period: 1) failure to fulfill major role obligations 2) recurrent use when hazardous 3) recurrent substance-related legal problems 4) recurrent social or interpersonal problems B. Never met for dependence for the substance
C. Substance Dependence
Case of Tim DSM-IV criteria for dependence (p. 382)
Substance-Related Disorders
II. Alcohol Use Disorders
A. Background
Early research Jellineks alcoholic stages
Stage 1 = prealcoholic social drinker who begins drinking to reduce stress Stage 2 = prodromal becomes obsessed with alcohol; drinks in secret; blackouts Stage 3 = crucial cant stop once they start; denial; nutritional problems; social problems; life falls apart Stage 4 = chronic like the wino on the street; sobriety followed by binges, benders
A. Background (cont.)
Jellineks two alcoholic types
1. Gamma alcoholic = person who loses control of use
Typical in U.S.
Alcohol use is most common between ages 18 and 24 Disorder onset peaks in the 20s and mid30s
Women tend to onset later than men
C. Related Problems
High comorbidity
Among most frequent of comorbid conditions Comorbidity cuts across classes of disorders (depression, anxiety, ASPD, psychotic, bulimia) Contribution to crime
D. Causal Influences
1. Biological factors
Alcoholism runs in families Twins data: MZ > DZ (genetic influence) Strains of inbred mice differ in level of preference for alcohol Strains of inbred mice differ in level of sensitivity to alcohol Children of alcoholics show low sensitivity to alcohol, which predicts later alcoholism
GABA system alcohol may serve its anxiolytic (anti-anxiety) function Serotonin system alcohol appears to dampen effects Dopamine system alcohol has its rewarding/pleasurable effects
One version of the D2 receptor gene more common among alcoholics than controls
Positive reinforcement (social acceptance, social competence) Self-medication Expectancies (beliefs about alcohols effect) Personality (impulsivity, negative emotionality)
E. Treatments
1. Aversion treatments
Disulfiram (Antabuse) causes build up of acetaldehyde (byproduct in metabolism of alcohol) high levels cause sickness (nausea, vomiting) Problem: only works when taken; doesnt cure dependence, just prevents use
E. Treatments (cont.)
2. Inpatient hospital
E. Treatments (cont.)
4. Motivational interviewing (MI)
5. Relapse prevention
Summary
General criteria for abuse and dependence (same across substances) Substance-specific criteria for intoxication and withdrawal Multidimensional influences on alcohol use disorders Treatment of alcohol use disorders ranges from aversion therapy to relapse prevention