New recipes

Binge Drinking Whets Our Appetite for Criminal Behavior, Study Finds

Binge Drinking Whets Our Appetite for Criminal Behavior, Study Finds


People who regularly engage in binge drinking are up to 30 percent more likely than other drinkers to commit crimes or engage in antisocial behavior, according to a review of a decade’s worth of drug consumption data.

Using data from the Australian National Drug Strategy Household Survey, which measures the drug use of 106,193 Australian civilians aged 12 and older, researchers at Monash University found that people who binge drink — defined as five drinks or more per sitting for women, and seven drinks or more for men — were more likely to have been responsible for “a high incidence of vehicle crashes, crime, and violence.”

According to the data, at least nine percent of the population of Australia qualified as frequent binge drinkers, defined as binge drinking at least once per week.

Binge drinking was associated with a 17 percent increase in the rate of drunk-driving, leading to both fatal and nonfatal car accidents; an 11.8 percent increase in physical abuse; and a 4.2 percent increase in crimes like theft, damaging property, or creating a public disturbance. Such behaviors also lead to higher costs of law enforcement and reduced participation in the workforce and overall economy of a country.

While teenagers and young drinkers were the most likely to engage in physical abuse, theft, or create a public disturbance as a result of binge drinking, Australians aged 20 to 49 were the most likely age group to drink and drive. Beer and premixed spirits in cans, both around five percent alcohol by volume, were found to have the strongest links to all four types of negative behavior, researchers found.

To combat the effect of binge drinking on behavior, the researchers suggest a one percent increase in the price index of alcohol.

“As expected, the marginal effect of price is negative and statistically significant,” the study noted. A single percent increase would not only reduce binge drinking itself, but also reduce drunk driving by an estimated 24 percent, public disturbances by 18 percent, and physical and verbal abuse by 34 percent.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.


Chapter 11: Substance- Related Disorders

Substance abuse disorder can be seen all around us: In extremely high rates of alcohol abuse and dependence and drug abuse of mass media. Addictive behaviour based on the pathological need for a substance - may involve the abuse of substances such a nicotine, ecstasy, or cocaine.

Addictive behaviour is one of the most prevalent and difficult to treat mental health problems today. The most commonly used problem substances are those that affect mental functioning in the central nervous system - *Psychoactive Substances: alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, ecstasy, and marijuana. Some of these can be purchased legally, some can be used legally under medical supervision, and others are illegal.

For diagnostic purposes, addictive substance - related disorders are divided into two major categories.

1. The first includes those conditions that involve organic impairment resulting from the prolonged and excessive ingestion of psychoactive substances. For example, an alcohol-abuse dementia disorder involving amnesia, formerly known as Korsakoff syndrome.

2. The other category includes substance-induced organic mental disorders and syndromes. These conditions stem from toxicity which can lead to different intoxications or deliriums, or physiological changes int eh brain due to vitamin deficiencies.

Substance dependence includes more severe forms of substance use disorders and usually involves a marked physiological need for increasing the amount of substance to achieve the desired effect. Dependence in these disorders means that an individual will show tolerance for a drug and experience withdrawal symptoms when the drug is no longer available.

Tolerance the need for increased amounts of a substance to achieve the desired effects - results from biomechanical changes in the body that affect the rate of metabolism and elimination of the substance from the body.

Many ancient cultures made wide use of alcohol. Beer was first invented in Egypt and early wine making recipes are dated back to the years of christ. The process of distilation was also invented in anchent times to increase the potency of alcohol. Problems with excessive use were observed almost form the beginning.

Alcoholism is a major problem in the USA and effects indivduals and also their families and friends. Heavy drinking as associated with vulnerability to injury, marital discord, and interpartner violence. Life span of the average alchoholic is about 12 years shorter than avergae. Is significantly lowers cognitive performance on tasks and problem solving, even more severly on complex tasks. Organic impairment, including brain shrinkage, ocurs in a high proportion of peope with dependance, espcially in binge drinkers. Significant emergency room visits are alchohol related in people under 21 years of age. Those who were heavy drinkers or alchohol depenent were significantly more likley to report multiple prior emergnvy room visits.

Over 40% of deaths by automobile are related to alchohol abuse each year and about 40-50% of all murders. Arrests and violent encournters are also related with a majority of violent crimes being assoicated opposed to with drugs.

Alcohol has a complex and contradictory impact on the brain. In lower levels, it can stimulate the brain to have opium-like effect operating pleasurably. At higher levels it has a depressive function in the brain, inhibiting one of the brain's excitatory neurotransmitters which slow down the activity sensors of the brain. Inhibition of this glutamate neurotransmitter impairs the organisms ability to learn and affects higher brain functioning, impairing judgement and lowering self-control. This can cause an individual to react on impulses usually held in check. Some degree of motor coordination and perception of cold, pain and other discomforts may also be dulled. Typically the drinker experiences a sense of warmth, expansiveness, and well-being. In such a mood, unpleasant realities are screened out, and the drinkers self-esteem rises. Worries are temporarily left behind.

Intoxication in the USA is defined when the blood alcohol level goes over 0.08 and should not be operating a vehicle. Muscle coordination, speech, and vision are impaired and thought processes are confused. Before this level is reached, judgement is so impaired they are unaware of their condition. When the blood alcohol level surpasses 0.5, the individual will pass out. Blood alcohol level over 0.55 is considered lethal. It is usually the amount of alcohol concentrated in the bodily fluids, not the amount consumed, that determined intoxication. The effect of alcohol on an individual can vary depending on their physical condition, the amount of food they have consumed, and the duration of their drinking. Also, a tolerance we usually built up with those who drink regularly, so more alcohol is required to gain the same desired effects. Women metabolize alcohol less effectively than men and therefore become intoxicated on less.

Development of dependence

Excessive drinking can be viewed as progressing insidiously from early to middle to late stage alcohol related disorder, although some do not follow this pattern. No safe amount has been recognised for pregnant women.

Physical Effects of chronic alcohol use

Alcohol taken in must be assimilated by the body through the liver. In excess, the liver works overtime and can develop significant damage. Cirrhosis of the liver - the stiffening of the blood vessels - is common. Alcohol is also high in calories. Thus consumption of alcohol reduces appetite for food. Also, alcohol has no vitamins so that an excessive drinker can suffer from malnutrition. Additionally, alcohol impairs the bodies ability to utilize nutrients, so the nutritional deficiency cannot be made up by popping vitamins. Increased gastrointestinal symptoms are also common.

Psychosocial Effects of Alcohol Abuse

1) These distortions are called Alcoholic psychoses because they are marked by temporary loss of contact with reality. Among those who drink excessively for a long period a reaction called alcohol withdrawal delirium formerly known as delirium tremens may occur. This usually happens after a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or sudden moving objects may cause considerable excitement and agitation. Full-blown symptoms may include 1) distortion for time and place - where a persona may mistake a hospital for a church, no longer recognise a friend, or identify strangers as acquaintances. 2) Vivid hallucinations particularly of small, fast moving animals, 3) acute fear, I which these animals change forms, 4) extreme suggestibility where the person will view the animals as anything by mere suggestion, 5) marked tremors of the hands, tongue, and lips and 6) perspiration fever, and rapid and weakening heartbeat, a coated tongue and foul breath.

This delirium typically lasts about 3-6 days and is usually followed by a deep sleep. When they awake few symptoms remain. Typically it scared the victim into never wanting to drink again or not for a long period. However, drinking usually resumes after a period, renewing the cycle. The death rate from withdrawal delirium as a result of convulsions, heart failure, and another complication is about 10%. Certain drugs, however, can help reduce this rate.

2) the second alcohol-related psychosis is resisting alcohol disorder or alcohol amnestic disorder This condition was first described by Russian Psychiatrist Korsakoff and is one of the most severe alcohol-related disorders. The outstanding symptom is memory defect to recent events which sometimes accompanies falsification of events. People with this disorder may not recognise pictures, faces, rooms or other objects they have just seen, although they may see them as fimilar. Often these individual fills in the gaps with fantasies that lead to unconnected and distorted associations. Tey may appear to be religious or delusional, but these behaviours are usually an attempt to fill memory gaps. These memory disturbances seem related to an inability to form new associations in a manner that renders then readily retrievable. These reactions usually occur in long-term alcohol abusers after many years of excessive drinking. These patients also have cognitive impairments such as planning defects, judgement deficits, and cortical lesions.

Genetic and biochemical factors have been stressed. Psychosocial factors and sociocultural factors have also been implicated. Some combination of all these seems to influence the risk of alcohol dependency.

All addictive substances have powerful effects because 1) most, if not al,l have the ability to activate the areas of the brain that produce intrinsic pleasure and sometimes powerful immediate reward. AND 2) personas biological makeup, or constitution, including his or her genetic inheritance and the environmental influences that enter into their need to seek mind altering substances to increasing degree as use continues. The development of alcohol addiction is a complex process involving constitutional vulnerability and environmental encouragement, as well as the unique biochemical properties of certain psychoactive substances.

Neurobiology of Addiction - When addictive substances enter the brain central neurochemical processes underlying addiction activate the pleasure pathways. Drug ingestion or behaviours that lead to activation of the brain reward system re reinforced by the brain's normal functioning to activate the pleasure pathway. As a result, further use is promoted. The exposure of the brain to an addictive drug alters its neurochemical structure nd results in some behavioural effects. With continued use, neuroadaptation and tolerance, as well as dependence on the substance, can develop.

Genetic vulnerability - The possibility of genetic predisposition to developing alcohol abuse problems has been widely researched. Heredity probably plays an important role in sensitivity to addiction. Alcohol abuse problems tend to run in families due to inherent sensitivity to the drug or inherent motivation.

The heritability of personality characteristics inclined to alcoholism has also been studied. An alcohol risk personality is usually described as impulsive, risk taker and emotionally unstable. Additionally, pre-alcoholic men ( those genetically predisposed but who have not yet developed the problem) show different psychological patterns. They experience the greater lessening of stress when consuming alcohol, they also show different alpha wave patterns in their EEGs and have a larger conditioned physiological response to alcohol cues. This may further suggest that pre-alcoholic men may be more prone to developing a tolerance for alcohol than low-risk men.

Some research suggests that different ethnic groups, particularly Asians and Native Americans have abnormal physiological reactions to alcohol. "Alchohol flush reaction". Asian and Eskimo subjects showed hyper sensitivity including the flush of their skin, a drop in blood pressure, and heat palpitations and nausea doing the ingestion of alcohol. This results from a mutant enzyme that has difficulty breaking down alcohol in most Asian genetic systems. The relatively lower rate of alcoholism in Asian populations may be linked to this.

Although genetic inclination os one-factor contributing to heredity. It is not his whole story as it does not follow the same pattern of strickly hereditary disorders of other kinds. Some argue that genetic play a larger role in men than women.Negative results have been found in twin and adoptive studies as well as positive. Additionally, a great majority of children who have parents with alcohol-related problems do not themselves develop these same problems.The children of those who make successful life adjustments have not been sufficient studies. Although much genetic research implicated heresy in alcoholism, we do not know the precise role they play. At present, genetics are an attractive hypothesis. However, additonal research is needed. Social circumstances are still considered powerful forces in providing both the availability and the option of drug abuse and use. Genetic influence should be viewed as compatible, rather than competitive, with psychological and social determinants.

Psychological vulnerability

Research suggests that personality factors related to having a family history of alcoholism are associated with the developments of alcohol use disorders. Many potential alcohol abusers tend to be emotionally immature, expect a great deal from the world, and require a great deal fo praise and appreciation, react to failure with marked feelings of hurt and inferiority, have low frustration tolerance, and feel inadequate and unsure of their abilities to fulfill expected male-female roles. They have also been found to more impulsive and aggressive. About half of the persons with schizophrenia have either drug abuse or alcohol abuse dependence. Antisocial personality shows the highest comorbidity rates with alcoholism as well as with aggression. Additionally there are relationships between depressive disorder and alcohol use, and there may be stronger gender differences in females in an association between these disorders.

Stress, Tension reduction and reinforcement

Research shows that individuals with substance abuse problems how high levels of trauma in their prior histories. High rates of those with PTSD also show correlation with substance abuse. Trauma would result from a threat of personal injury, witnessing an injury, sexual abuse, witnessing a major catastrophic disaster, and exposure to threatening situations and atrocities such as war. Typical alcohol abusers are discontent with their lives and are unable to tolerate tension or stress. High degrees are reported between alcohol consumption and negative affectivity such as anxiety and somatic complaints. Alcoholics thus tend to drink to relax.As a result, anyone who finds alcohol to be a tension reducing substance is at risk to abuse alcohol, even without especially threatening or stressful situations. However, this causal model is not a sole explanatory hypotheses. If it were the case, we would expect substance abuse disorder to be way more common as alcohol tends to reduce tension fo most people who use it. This also does not explain why some excessive drinkers are still able to maintain control over their drinking and continue to function in society when others cannot.

Expectations of social success Some have studied the idea that cognitive expectation may play a role in the initiation of drinking and the maintenance of drinking behaviour once the person has begun the use of alcohol. Many people, especially young adolescence, expect that alcohol will lower tension and anxiety and increase sexual desire and pleasure in life. Many begin the use with the expectation that it will increase their popularity and acceptance among their peers. This gives professionals a powerful motivation to want to catch adolescence at an earlier time, to help provide them better skills to alleviate social tensions so that they do not resort to alcohol. Prevention efforts should target children before they are even at an age that they can drink so that positive feedback and a reciprocal cycle of reinforcement between expectancy and drinking will never be established. Tim and experience do have moderating influences on these alcohol expectancies. There is a significant decrease in outcome expectancy over time, meaning that older students show less expectation of the benefits of alcohol than beginning students.

marital and other intimate relationships
Adults with less intimate and supportive relationship tend to show greater drinking following sadness or hostility than those with close peers and with more positive relationships. Excessive drinking usually begins during a crisis period in marital or other intimate relationship, a particularly crisis that leads to hurt and devastating. The marital relationship may serve to maintain a pattern of excessive drinking as the partners may behave in a way together that promotes the excessive drinking. For example, a husband who lives with a wife who abuses alcohol may be unaware fo the fac that, gradually, many of the decision she makes every day are based on the expectation that his wife will be drinking. These expectations, in turn, may make the drinking behaviour more likely. Eventually, an entire marriage may centre on the drinking of substance abusing spouse. In some instances, the husband and wife may also begin drinking together excessively. This one important concern fo many treatments today identify the personality or lifestyle factors in a relationship that tends to foster the drinking in the alcohol abusing person.These relationships can also occur in those in love in love affairs and friendships.

Disulfiram, a drug that causes violent vomiting when followed by ingestion of alcohol may be administered to prevent an immediate return to drinking., However, such deterrent therapy is seldom advocated as the sole approach because the pharmacological methods alone have not proved effective in treating the many severe alcohol abuse problems. For example, because ethe drug is self-administers the patient may just choose not to take it after they have been released from the hospital or treatment facility and then the cycle starts again. The primary value of drugs such as this is to temporarily stop the cycle of abuse long enough for therapy to begin. The cost of this treatment is quite high comparatively, and other side effects can occur.

Another medication prominently used Naltrexone an opiate antagonist that helps rescue cravings for alcohol by blocking the pleasure producing effects of alcohol. This is particularly effective for individuals with a high level of craving. However, some studies have also found this drug to not reduce cravings, so confidence in its use must await more research.

Medications to reduce the side effects of acute withdrawal

The initial focus in cases of acute intoxication is detoxification, treatment of the withdrawal symptoms described earlier, and on a medical regime for physical rehabilitation. One of the primary goals in the treatment of withdrawal symptoms is to reduce the physical symptoms characteristic of withdrawal such as insomnia, headache, gastrointestinal distress, and tremulousness. Central to the medical treatment approaches is the prevention of heart arrhythmias, seizures, delirium, and death. These are usually best handled in a hospital or clinic, where drugs such as Valium have largely revolutionized the treatment of withdrawal symptoms. Such drugs overcome the motor excitement, nausea, and vomiting prevent withdrawal delirium and convulsions nd help alleviates the tension and anxiety associated with withdrawal. Treatments with long lasting benzodiazepines have also shown to reduce the severity of withdrawal symptoms.

Group therapy has shown to be very effective for many clinical probes, especially substance-related disorders. In the confrontational give and take of group therapy, alcohol abusers are often forces, to face their problems and their tendencies to deny or minimize them. These group situations can be tough for those who have been in denial, but such treatment helps them see new possibilities of coping with the circumstances that thave led to their difficulty. This allows them to learn more effective ways of coping and dealing with their stress. In some instances, the spouses of alcohol abusers and event their children may be invited to join the group therapy meetings. In other situations, family treatment is itself the central focus of therapeutic effects. In this case, the alcohol abuser is seen as a member of a disturbed family in which all members have a responsibility for cooperating in treat Because family members are frequently the people that are most victimized by the alcohol abusers addiction, they often tend to be judgmental and punuative, and the individual in treatment may take this further devaluation poorly. In other instances, the family may be unwilling to enforce an alcohol abuser to remain addicted - for example, a man with a need to dominate his wife may find that a continualy drunken and reorsful spouse may best meet his needs.

Environmental Intervention

Treatment that requires the measure to alleviate a patient's aversive life situation. Environmental support plays a significant role in alcoholics recovery. People often become estranged from family n friends because of their drinking and jeopardize their jobs. As a result, they are typically lonely and in impoverished neighbourhoods. Simply helping an abuser with better coping skill may not be enough if their environment remains hostile and threatening. For those who have been hospitalized, halfway houses are often important adjuncts to the total treatment program.

Behavioral cognitive therapy

Adverse conditioning therapy - involves the presentation of a wide range of noxious stimuli with alcohol consumption to suppress addictive behaiour. For example, alcohol consumption may be paired with an electric shock or a drug that promotes nausea.

Intramuscular injections are another similar deterrent measure where emetine hydrochloride, an emetic, is injected into the patient after they are given alchhol, so the sight, smell, and taste of the beverage become associated with severe vomiting. A conditioned aversion results. With repetition, the classical condition procedure acts as a strong deterrent for drinking.

One of the greatest problems with treatment for addictive substances includes maintaining self-control after treatment and over various periods of follow-up. Many treatments do not pay enough attention to maintain effective behaviour and preventing relapse. In cognitive behavioural treatment, relapse behaviour is a key factor in treatment. Relapse prevention treatment worked most effectively when a family was involved in the treatment.Behaviours behind relapses are seen as indulgent behaviours based on the patients learning history. Over time, when an individual contained, they gain more and more power over their indulgent behaviour and affirm a sense of personal control over their history. The longer they can maintain this control, the greater the sense of achievement they have - self-confidence - and the greater the chance he or she will cope with the addiction and maintain control over time.

However, though the behaviour abstains from, the cognitive behavioural view would state that the individual may still make a series of mini-decisions, through a gradual unconscious unraveling process, that establishes a chain of behaviours that render relapse inevitable for some abusers.

Additionally, the abstinence violation effect is another type of relapse behaviour where even minor transgression is seen by the abstainer as having drastic significance. For example, if that individual take a small drink at a friends wedding, they see this as a major offense, and then rationalizes that they have "blown it, and become a drunk again, so why not go all the way."

(1) narcotics such as opiates including heroin or opium

(2) Sedatives such as Barbiturates

(3) Stimulants such as cocaine and amphetamines

(4) Antianxiety drugs such as benzodiazepines

(5) Pain medications such as OxyContin

(6) Hallucinogenics such as LSD

At the turn of the century, it was discovered that morphine was mixed with acetic anhydride ( cheap and available chemical) is was converted into a powerful analgesic called Heroin. Originally this was widely administered and renowned for its pain relief a medical purpose in place of morphine. However, heroin was a cruel disappointment, as is functioned more rapidly, intensely, and addictive than morphine. Eventually, I was removed from medical practice.

Is soon became apparent that opium and all its derivatives including codeine were seriously addictive. It was soon designated as a federal offense to administer certain drugs, and physicians and pharmacists were held highly accountable for each dose they dispensed. It soon turned from tolerated vice to criminal offense. Many turned to criminal acts to obtain these drugs.

Biological Effects: Introduced to the body through smoking, snorting, eating, skin popping or mainlining through injection. Immediate effects include euphoric spasm lasting 60 seconds or so, which is compared to an organism. This is followed by a lethargic withdrawn in which bodily needs are diminished ( a high). Pleasant feelings of relaxation and euphoria are dominant. Effects last 4-6 hours followed by a negative effect that produces a desire for more of the drug.

The use of opiates over time usually results in a physiological craving for the drug. With Heroin, dependence usually comes after 30 days of use. They feel ill when not using. Additionally, tolerance is built up, so an increasingly larger amount of the drug are needed. After 8 hours between, addicts experience withdrawal symptoms and severity depend on one the degree of narcotics usually used., the intervals between doses, and duration of the addiction.
Withdraw is not always dangerous or painful, and many can do so without assistance. For others, it can be agonising with symptoms such as a runny nose, tearing eyes, perspiration, restlessness, increased desperation and desire for the drug. After more time passes symptoms become more severe typically exhibiting cold sweats, vomiting, diarrhea, abdominal cramps, pain in the back, headaches, tremors, and insomnia. Food is unappealing nd dehydration occurs, causing the individual to lose weight. Occasional symptoms of delirium, hallucinations nd manic activity can result. Cardiovascular collapse can also occur resulting in death. If morphine is administered, the subjective distress experienced by the addict temporarily end, and physiological balance is quickly restored. Withdrawal symptoms usually decline by the 3rd or 4th day and have disappeared by the 7th or 8th. As symptoms subside the patients behind to eat and drink again regain g their weiht and former tolerance for the drug is reduced. As a result, taking the former large dosage may result in overdose.

Causal Factors in Opiate abuse
No single causal factor fits all addictions to opiate drugs. The three most frequently cited reasons were a pleasure, curiosity, and peer pressure - with pleasure being the widest spread reason. Other reasons include a desire to escape from life, personal maladjustment, and sociocultural conditions. Some substance abuse can be related to a sensation seeking personality charactersitc that could be mediated through genetic and biological mechanisms as well as peer influences.

Neural basis for physiological addiction
Certain isolated receptor sites int he brains act sites where certain drugs work as a skeleton key for the release of certain neurotransmitters. This interaction results in sin the drugs interaction in the brain and can result in addiction. The repeated use of the opiates results in changes in the neurotransmitter systems that regulate the incentive and motivation and stress management centers of the brain. Central nervous system dysfunction such as slower response times, impaired lraning, and impaired cognitive processing and impulse control problems can result. Th human body produces its opium like substances called endorphines int he brain. These ar believed to play a role in the human's reaction to pain. Some researchers believed that endorphins play a significant role in drug addiciton, speculating that chronic underproduction of endorphins can lead to drug addiction - but this is inconclusive.

Addiction associated with Psychopathology
High incidence of antisocial personality has been found in heroin addicts. Additionally, opiate addicts are found to be highly impulsive and unable to delay gratification. A high rate of heroin addicts is also diagnosed with personality disorders. These may result from, rather than precede, the long-term effects of addiction.

Sociocultural factors of drug use
Drug use can become a way of life when individuals join the narcotics subculture. This is a culture that protects addicts and perpetuates their addiction. The majority of illicit drug users were undereducated, and unemployed individuals from minority groups. With time, most young individuals who join drug culture become withdrawn from friends and social groups and indifferent and apathetic about sexual activity. They are likely to abandon scholarly and athletic endeavours and show a marked reduction in competitive and achievement striving. Most of these appear to lack clear sex role identification and experience feelings of inadequacy when confronted with the demands of adulthood. The feel progressively isolated but their feelings of belonging are bolstered by their continued association with their drug culture. They see drugs as a means to revolt against society and authority as a device to relieve anxiety and tensions.

Cocaine is a plant product discovered in ancient times. Because of its cost, it was once seen as a "high" for the affluent. "Crack* is the street name given to the drug when mixed with hydrochloride so it can be smoked. It has gradually become less expensive and more available. It may be ingested by snorted, swallowed or injected. It precipitates a euphoric state from 4-6 hours in duration, during which user feels confident and content. However, after the state is preceded by headaches, dizziness, and restlessness. When it is chronically abused, it can result in acute toxic psychotic symptoms including frightening visual and auditory and tactile circination similar to that in acute schizophrenia. Stimulates excitement, sexual arousal, and sleeplessness. Acute tolerance has been demonstrated and some chronic tolerance as well. Cognitive impairment may also be a long-term consideration. The view that people did not develop a dependence on this drug has changed. Chronic abusers who become abstinent develop uniform, depression-like symptoms, but the symptoms are transient. Cocaine withdrawal - as identified in the DSM - involves symptoms of depression, fatigue, disturbed sleep, and increased dreaming. Employment, family, psychological, and legal problems are more likely to occur among cocaine and crack users than nonusers. A large part of this comes from the considerable amount of money it takes to support this habit. Increased sexual activity, often trading sex for drugs has also become common. However, problems with sexual functioning have also be associated with cocaine use. Althugh there is no fetal crack syndrom such as seen in alcohol users, women who use cocaine while pregnant place their babies at increased risk to lose their mothers at infancy, or be mistreated by their mothers.

Treatment and outcomes

Treatment for dependence of cocaine does not differ much compared to other drugs that involve psychological dependence. Drugs such as naltrexone are administered to help relieve symptoms during abstinence and withdrawal times. The feelings of tension and depression are dealt with immediately during the withdrawal period. Those who continued te drug use to help with their symptoms, and continued other structures treatment were at higher risk to complete, lower risk of relapse or overdose, and many do well with their treatment goals. Poor outcomes are associated with the severity of the abuse, proper psychiatric functioning, and the presence of alcoholism. People unable to sustain abstinence during treatment have a less likely chance of recovery after treatment. A few issues seen by clinicians include high dropout rate of cocaine abusers in treatment, a strong correlation between antisocial personality disorder and cocaine abusers - which results in resistance to treatment, or are psychosis-prone personalities. Additionally, men tended to have more problems transitioning to abstinence.

Benzedrine was one of the earliest amphetamines an was initially available in drug stores as an inhalant for runny nose. However, some individual started chewing the wicks of the inhalers for a kick. Later on Dexedrine and then the more potent Methedrinewere introduced. The abuse of methedrine can be lethal. Initially these were prescribed as wonder pills o help keep people awake. They were used t ward off fatigue in war and help student cram for exams. It was also used as an appetite suppressant or to counter strong sleeping pills. Today they are sometimes used to medically curb appetite when weight reduction is needed or for individuals suffering from narcolepsy. Surprisingly, amphetamines have a calming rather than stimulating effect on many young people and are sometimes prescribed to help with mild depression, and fatigue. However, by far the most common use is for recreational purpose for young people to get high. These drugs are labeled to have a high abuse potential and must be prescribed for purchase. They are more difficult to obtain legally, and their use has been reduced even medically. They are, however, one of the most model abused drugs in the illegal market.

Effects
These amphetamines push users towards greater expenditures of their resources, often tot he point of hazardous fatigue. They are psychologically and physically addictive, and the body quickly builds up a tolerance for them. In some cases users inject the drug so it will absorb faster. For someone who exceeds to prescription dose, the consumption can result in high blood pressure, enlarged pupils, unclear or rapid speech, sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Injected in large quantities, methedrine can raise blood pressure enough to cause immediate death. Chronic abuse can result in brain damage and a wide range of psychopathology including Amphetamine psychosis which is similar to paranoid schizophrenia. Suicide, homicide, and assult are also associated with this abuse.