Chapter 10
Substance-Related and Other Addictive Disorders
I.    Introduction (354-356)

A behavior based on the pathological need for a substance or activity is known as an addictive behavior. The most commonly used problem substances are psychoactive drugs such as alcohol, barbiturates and marijuana. Addictive or psychoactive substance disorders are divided into two major diagnostic classifications: psychoactive substance-induced organic mental disorders and psychoactive substance-abuse and substance-dependence disorders. These disorders are among the most widespread and intransigent mental health problems facing us today.
II.    Alcohol Abuse and Dependence (356-375)

Alcoholism, or alcohol dependence syndrome, refers to a dependence on alcohol that seriously interferes with life adjustments. Alcoholism is a major problem in the U.S. Alcoholism is third among the major causes of death and alcoholics on average have a shorter life span. Alcoholics also pose serious difficulties for others. Alcohol abuse is associated with many automobile accidents, murders, and rapes. Alcoholism cuts across all age, educational, occupational, and socioeconomic boundaries.
A.    The Clinical Picture of Alcohol Abuse and Dependence

Alcohol is a depressant that affects the higher brain centers, impairing judgment and other rational processes and lowering self-control. When the alcohol blood level is 0.1, muscular coordination, speech, and vision are impaired and thought processes are confused. Effects of alcohol, however, can vary for different drinkers, depending on physical condition, gender, amount of food in the stomach, and the duration of the drinking. Individuals may experience increased sexual stimulation, blackouts, and hangovers. When large amounts of alcohol are ingested, the liver may be seriously overworked and eventually suffer irreversible damage. Two psychoses associated with alcoholism are alcohol withdrawal delirium and alcohol amnestic disorder.
B.    Causes of Alcohol Abuse and Dependence

It appears that there may be several types of alcohol dependence, each with somewhat different patterns of biological, psychological, and sociocultural factors. There is evidence of a genetic predisposition to developing alcohol abuse problems, although the exact role genetics plays is unclear. Some of the psychosocial factors that may be involved in the development of alcoholism are failures in parental guidance, an expectancy for social facilitation, discontent with one's life, and poor intimate relationships. Two psychopathological conditions that have been linked to addictive disorders are depression and antisocial personality disorder. Our culture has become dependent on alcohol as a social lubricant and as a means for reducing tension. This plays a role in the high rate of alcoholism in the U.S.
C.    Treatment and Outcomes

A multidisciplinary approach to treatment of drinking problems appears to be the most effective. Treatment program objectives usually include detoxification, physical rehabilitation, control over alcohol-abuse behavior, and development of an individual realization that he/she can cope with problems of living without alcohol. Medication, such as valium, may be used to reduce withdrawal symptoms. Group therapy, behavior therapy, and groups such as Alcoholics Anonymous are also effective treatments. The chance of relapse for alcoholics is an ongoing problem and must be considered as part of the treatment program.
III.    Drug Abuse and Dependence (375-389)

The psychoactive drugs most commonly associated with abuse and dependence are narcotics, sedatives, stimulants, and hallucinogens. Drug abuse is most common during adolescence and young adulthood. Behavior patterns vary depending on the type, amount, and duration of the drug abuse.
A.    Opium and Its Derivatives (Narcotics)

Opium is a mixture of about eighteen chemical substances known as alkaloids (including morphine) which can be further processed to produce heroin. Morphine and heroin serve as powerful sedatives and pain relievers. The immediate effect of heroin is a euphoric spasm followed by a lethargic, withdrawn state in which bodily needs are diminished. These effects are followed by withdrawal which includes a desire for more heroin. The most frequently cited reasons for beginning to use heroin are pleasure, curiosity, and peer pressure.
A high incidence of antisocial personality disorder has been found among heroin addicts. Addicts are also predominantly under-educated, under-employed, and from minority groups. Treatment involves building up an addict both physically and psychologically, providing help through the withdrawal period, and abstaining from further use of narcotics. Methadone is a drug that is sometimes used to relieve the craving for heroin.
B.    Cocaine and Amphetamines (Stimulants)

Cocaine is a plant product that speeds up the action of the nervous system. Due to its high price, cocaine has been considered the "high" for the affluent. Cocaine first produces a euphoric state in which the cortex of the brain is stimulated, inducing sleeplessness, excitement, and accentuated sexual feelings. Effective cocaine abuse treatment includes the use of medication, such as desipramine and naltrexone to reduce cravings, in combination with psychological treatment.
Amphetamines are used medically to curb appetite, to treat narcolepsy, and to treat hyperactive children. If the prescribed dosage of amphetamine is exceeded, the results are heightened blood pressure, enlarged pupils, unclear and rapid speech, profuse sweating, tremors, excitability, loss of appetite, confusion, and sleeplessness. Withdrawal is usually physically painless but results in the psychological symptoms of wariness and depression.
C.    Barbiturates (Sedatives)

Barbiturates act as depressants, slowing down the central nervous system. Barbiturates result in feelings of relaxation and a tendency towards drowsiness and sleep. People who become dependent on barbiturates tend to be middle-aged or older people who rely on sedatives as "sleeping pills." Barbiturate withdrawal includes anxiety, apprehensiveness, tremors, insomnia, weakness, nausea, and weight loss. These symptoms can be eased if the withdrawal from barbiturates is gradual.
D.    LSD and Related Drugs (Hallucinogens)

Hallucinogens or psychedelics are drugs whose properties are thought to induce hallucinations. These drugs, however, more often distort sensory images so that an individual sees or hears things in a different way. The major drugs in this category are LSD, mescaline, and psilocybin. Users of LSD do not develop a physiological dependence. LSD intoxication treatment is primarily a medical matter.
E.    Marijuana

Marijuana and hashish are classified as mild-hallucinogens.
The specific effects of these drugs vary among individuals. In general, there is a mild euphoria with feelings of well being, heightened perceptual activity, and pleasant relaxation. Sense of time can also be effected. There is no physiological dependence associated with marijuana use. Psychological treatment methods are effective in reducing marijuana use in adults who are psychologically dependent on the drug.
F.    Caffeine and Nicotine

Caffeine and nicotine are legal drugs that have addictive properties. Both are embedded in the social context of our society, making it even more difficult for individuals to stop using these drugs. There are health problems and side effects associated with both these drugs. Nicotine is associated with one in seven deaths in the U.S. Treatment can be difficult and is connected with the individual's desire to quit.
IV.    Other Addictive Disorders: Hyperobesity (389-396) and Pathological Gambling

A.    Hyperobesity

Hyperobesity is defined as being 100 pounds or more above ideal body weight. Obesity can result in such conditions as diabetes, muscularskeletal problems, high blood pressure, and other cardiovascular diseases. Genetic inheritance contributes to the tendency of some people to become obese. Family behavior patterns can also contribute to obesity. Overeating is also thought to function as a defense mechanism to lessen feelings of distress or depression. The most effective psychological treatment procedures are usually behavior management methods.
B.    Pathological Gambling

Pathological gambling is a progressive disorder characterized by continuous or periodic loss of control over gambling, a preoccupation with gambling and obtaining money for gambling, irrational behavior, and the continuation of gambling in spite of adverse consequences. The causal factors behind compulsive gambling are not well understood. Pathological gambling appears to be a learned behavior that is effected by cultural factors. Treatments available are psychotherapy and group therapies such as Gamblers Anonymous.
V.    Unresolved Issues on the Genetics of Alcoholism (396)

Available evidence suggests that genetic factors might be important as predisposing causes in the development of alcoholism. However, a predisposition to alcoholism could be acquired as well as inherited. It has proven difficult to distinguish between inherited and acquired traits and more research is needed.
VI.    Summary