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014 - Chapter 12 - Addiction Disorders 0001

014 - Chapter 12 - Addiction Disorders 0001



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Published by Joseph Eulo

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Published by: Joseph Eulo on Feb 08, 2009
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Addiction Disorders
The Prevalence, Comorbidity, and Demographicsof Alcohol Abuse and DependenceThe Clinical Picture of Alcohol Abuse andDependenceBiological Factors in the Abuse of andDependence on Alcohol and Other SubstancesPsychosocial Causal Factors in Alcohol Abuseand DependenceSociocultural FactorsTreatment of Alcohol Abuse Disorders
Opium and Its Derivatives(Narcotics)Cocaine and Amphetamines (Stimulants)Barbiturates (Sedatives)LSD and Related Drugs (Hallucinogens)EcstasyMarijuana
Exchanging Addictions:Is This an Effective Approach?
he increasing problem of substance abuse and dependence in our society has drawn both publicand scientific attention. Although our present knowledge is far from complete, investigating theseproblems as maladaptive patterns of adjustment to life's demands, with no social stigmainvolved, has led to clear progress in understanding and treatment.Such an approach, of course, does not mean that an individual bears no personal responsibility in the development of a prob-lem. Individual lifestyles and personality features are thought by many to play important roles inthe development of addictive disorders and are central themes in some types of treatment.
Addictive behavior-behavior
based on the pathological need for a substance or activity-may involve the abuse of substances such as nicotine, alcohol, or cocaine. Addictive behavior isone of the most pervasive and intransigent mental health problems facing our society today.Addictive disorders can be seen all around us: in extremely high rates of alcohol abuse anddependence, in tragic exposes of cocaine abuse among star athletes and entertainers, and inreports of pathological gambling, which has increased with the widening opportunity for legal-ized gambling today.The most commonly used problem substances are those drugs that affect mental function-ing,or
psychoactive drugs:
alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin,ecstasy, and marijuana. Some of these drugs, such as alcohol and nicotine, can be purchasedlegally by adults; others, such as the barbiturates or pain killers,can be used legally under med-ical supervision; still others, such as heroin, ecstasy, and methamphetamine, are illegal.For diagnostic purposes, addictive or substance-related disorders are divided into two majorcategories. The first category includes those conditions that involve organic impairment result-ing from the prolonged and excessive ingestion of psychoactive substances-for example, analcohol-abuse dementia disorder involving amnesia, formerly known as "Korsakoff's syndrome." The other category comprises substance-induced organic mental disorders and syndromes (thelatter of which are included within the organic mental disorders). These conditions stem from
the poisonous nature of the substance (leading to, for example, amphetamine delu-sional disorder, alcoholic intoxication, or cannabis delirium), or physiological changes in thebrain due to vitamin deficiency.The majority of addictive disorders fall into the second category, which focuses on the mal-adaptive behaviors resulting from regular and consistent use of a substance and includes sub-stance-abuse disorders and substance-dependence disorders. The system of classification forsubstance-abuse disorders that is followed by both DSM-IV-TR and ICD-10 (International Classi-fication of Disease System, published by the World Health Organization) provides two majorcategories: substance-dependence disorders and substance-abuse disorders. Although someresearchers and clinicians disagree with the dichotomous grouping, others consider this classi-fication approach to have both research and clinical utility (Epstein, 2001).
Substance abuse
generally involves a pathological use of a substance resulting in (1) poten-tially hazardous behavior such as driving while intoxicated, or (2) continued use despite a per-sistent social, psychological, occupational, or health problem.
Substance dependence
includesmore severe forms of substance-use disorders and usually involves a marked physiological needfor increasing amounts of a substance to achieve the desired effects. Dependence in these disor-ders means that an individual will show a tolerance for a drug and/or experience withdrawalsymptoms when the drug is unavailable.
need for increased amounts of a sub-stance to achieve the desired effects-results from biochemical changes in the body that affectthe rate of metabolism and elimination of the substance from the body.
Withdrawal symptoms
are physical symptoms such as sweating, tremors, and tension that accompany abstinence fromthe drug.
The termsalcoholic and
have been subject to some controversyand have been used differentlyby vari- ous groupsin thepast. The World HealthOrganization no longer recommendstheterm
butprefersthe term
alcohol dependencesyndrome-"a
state, psychic and usually also physical,resulting from taking alcohol,char- acterizedby behavioral and other responses thatalways include a compulsionto take alcoholon acontinuousor periodic basis in order to experience its psychic efects, and sometimes to avoid the discomfort of its absence;tol- erancemayormay not be present"(1992, p. 4).However, becausetheterms "alcoholic" and "alcoholism"are still widelyused in practice, inscientific journals, and ingov- ernment agencies and publications, we willsometimesuse them in this boo. People of many ancient cultures,including theEgypt- ian, Greek, andRoman, made extensive and often excessive use of alcohol.Beer was first made in Egypt around 3000
The oldestsurviving wine-making formulas were recorded by Marcus Cato in Italy almosta century anda half before the birth of Christ.About
800, theprocessof distillation was developed byan Arabian alchemist,thus making possiblean increase in boththe range and the potency of alcoholic beverages. Problems withexcessive use of alcohol were observed almost as earlyas itsuse began. Cambyses,King of Persia in thesixth century
has the dubious distinction of being one of the firstalco- holicabusers onrecord.
The Prevalence, Comorbidity, andDemographics of Alcohol Abuse andDependence
Alcohol abuse and dependence are major problems in the United States and are among the most destructive of the psychiatric disorders (Volpicelli, 2001). In 2003, 22.6 per- centof Americans 12or older reported bingedrinking,and 6.8 percent were found to beheavydrinkers(Substance Abuse and Mental Health Services Administration, 2004). Inthe recent NationalComorbidity Survey-Replication study,the lifetime prevalenceor alcoholabusein the United States is 13.4 percent(Kessler,Chiu,etal.,2005). The potentiallydetrimentaleffects of excessive alco- holuse-for an individual,his or her lovedones,and society-are legion.Heavydrink ing is associatedwithvul- nerability to injury (Shepherd
Brick ley, 1996)and becoming involved inintimatepartner violence(O'Leary
Schumacher, 2003). The life spanof the averageperson with alcohol dependenceis about12 years shorterthan that othe average person without thisdisorder.Alcohol significantlylowers performance oncognitive taskssuchas problemsolving-andthemore complex the task,the more the impairment(Pick worth,Rohrer,
Fant, 1997). Organic impairment, includingbrainshrinkage, occurs in a highproportionof people withalcoholdependence (Gazdzinski, Durazzo, & Meyerhoff,2005; Harper, Dixon, et al.,2003), especially among bingedrinkers-peoplewho abuse alcohol followingperiods of sobriety (Hunt,1993). Over 37 percent of alcoholabusers sufferfrom atleast one coexistingmental disorder (Lapham, Smith, et al., 2001). Not surprisingly, given thatalcohol is adepressant, depressionrankshigh among themental disorders oten comorbidwithalcoholism.It isnosurprise thatmany alcoholics commit suicide (Huff ord, 2001; McCloud, Barnaby, etal.,2004).In addition to the seriousproblems thatexcessivedrink ers createfor themselves,theyalso pose serious diiculties for others (Gortner etal.,1997). Alco- holabuse also co-occurs with high requency with person- alitydisorder.Grant,Stinson,etal.(2004) reportedthat amongindividuals witha currentalcohol-usedisorder, 28.6 percent hadatleast one personalitydisorder. Alcoholabuse is associated withover half the deaths andmajor injuries suffered in automobile accidents each year (Brewer, Morris, etal., 1994) andwithabout 40 to 50 percent of allmurders(Bennett& Lehman, 1996),40 per- centof allassaults, and over 50 percent of allrapes(Abbey, Zawacki, etal., 2001). About one of every three arrests in the UnitedStatesis relatedto alcoholabuse, andover 43 percentof violentencounters with the police involve alco- hol(McClelland
Teplin, 2001).In astudy of substance abuse and violent crime, Dawkins(1997) found that alco- holismore frequently associated with both violent and nonviolent crimethan other drugs suchas marijuana and that people withviolence-related injuriesare more likelyto have a positive Breathalyzer test(Cherpitel,1997).An esti- mated13.6percentof people12or olderdroveunder the inluence of alcohol inthe pastyear (Substance Abuse and Mental HealthServices Administration, 2004). Alcoholabuse anddependence inthe United States cuts across allage, educational,occupational, andsocioe- conomic boundaries.One recent study reportedthat in 2001, there were an estimated 244,331 alcohol-related visits to an emergencyroom among peopleages 13 to 25. Of these, an estimated119,503 involved people belowthe legal drinking age of 21(Elder, Shults, et al., 2004).How- ever, alcoholabuse is considered a serious problem in industry, in the professions,and in the military as well; alcoholabuse is foundamongsuchseemingly unliely candidates as priests, politicians, surgeons, law enforce- ment officers, and teenagers. Theimage of the alcohol- dependent personasan unkempt residentof skid row is clearly inaccurate.Furthermyths about alcoholism are notedin Table12.1on page 415.

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