SUBSTANCE USE DISORDERS: DEPENDENCE AND ABUSE

Alcohol Abuse and Alcohol Dependence are clearly distinguished in the DSM. Early negative signs of alcohol dependence will appear in those who suffer from the condition towards the ages of 30-40. Abstinence symptoms may lead to dramatic effects in a chronic drinker as the organism has become totally addicted to the substance. On the subjective plane, the individual is often anxious, depressed, feels weak, tense and cannot sleep. Muscular tremors, especially in the small muscles of the phalanges, face, eyelids, lips and tongue can be quite marked and an accelerated heartbeat will be noted, together with raised blood pressure and body temperature. Chronic drinkers need to consume alcohol every day and are incapable of stopping and reducing intake quantity despite repeated attempts at completely abstaining or limiting alcohol consumption to certain times during the day. It may occur that they get drunk and then remain intoxicated for days. Such cases are referred to as an abuse. A frequent symptom of intoxication is a loss of memory of events that occurred during the acute phase of intoxication. Behaviour of this type obviously causes social and occupational difficulties, arguments at home or with friends, violent behaviour during the phase of intoxication, frequent absences from work with a risk of being dismissed and arrest for being drunk and disorderly.

Nicotine and cigarettes. Nicotine, the main alkaloid of tobacco, is the agent which produces dependence. It stimulates the nicotine receptors located in the cerebral ‘pleasure centres’. According to some studies carried out by the Ministry of Health of the United States, tobacco kills more Americans than AIDS, road accidents, cocaine, heroin and cases of murder and suicide put together (Shultz, 1991). The children of smokers have a greater risk of suffering from affections of the upper respiratory tracts, bronchitis and auricular infections than individuals of the same age whose parents do not smoke. The health risks however are significantly lower for pipe and cigar-smokers as they only rarely inhale smoke into their lungs but these types of smoking habits increases the risk of developing cancer of the mouth. Amongst medical problems associated with the habit of smoking cigarettes and which, almost certainly, are caused or exacerbated by it, the most significant include cancer of the lungs, emphysema, cancer of the larynx and oesophagus and various cardiovascular diseases. After quitting smoking, the risks of disease decrease drastically over the subsequent 5-10 years until levels only slightly higher than those of non-smokers are eventually reached, however the destruction of pulmonary tissue is irreversible (Jaffe, 1985). A further important aspect of the phenomenon of smoking cigarettes is passive smoking. Smoke from a lit cigarette spreads in the atmosphere and is also breathed in by non-smokers. The latter may suffer from pulmonary damage, which may also be permanent, following prolonged exposure to cigarette smoke. Many non-smokers cannot stand the smell of burning tobacco, which in certain cases may cause allergic reactions.

Marijuana. This substance is obtained from the processing of Cannabis Sativa and can be smoked, chewed, drunk as an infusion or consumed through eating oven-baked products. Hashish, which is much stronger than marijuana, is also produced from Cannabis Sativa by means of a different type of process. The intoxicating effects of these two substances partly depend on their concentration and dosage. Marijuana smokers find that the substance makes them feel relaxed and sociable and it has been referred that high doses produce rapid alterations at the emotional level, reduce the level of attention, cause difficulty in complex mental processing and compromise the memory. Hallucinations and panic attacks are also possible. Laboratory studies conducted during the 1960s in particular have highlighted the fact that marijuana interferes with a wide range of cognitive functions including the memory. Intoxication also undermines the complex psychomotor skills required to drive a vehicle. In a more recent study, it emerged that the use of marijuana and hashish during adolescence contributes towards the insurgence of psychological problems in adulthood (Kandel and other, 1986). Such substances also generate numerous short-term somatic effects, including bloodshot and irritated eyes, dryness of the mouth and throat and an increase in appetite. The heartbeat may also be considerably accelerated, which may represent a source of risk in subjects that present an already altered cardiac functionality.

Sedatives. Also known as tranquillizers, these substances slow down the general functioning of the organism and reaction times. Sedatives include opiates (opium and its derivatives: morphine, heroin and codeine), barbiturates and tranquillizers. Opiates are a group of sedatives that produce dependence and in moderate doses alleviate pain and induce sleep. The most important is opium, from which are derived morphine and heroin. These substances produce states of euphoria, sleepiness, reveries and daydreaming and occasionally a deficit in coordination. Opiates produce their effect by stimulating the neural receptors of the endogenous opioid system of the organism. The human organism produces opioids called endorphins and encephalins and opium and its derivatives adapt to their receptors, stimulating them. They induce dependence and tolerance or, in other words, an increase in the quantity of substance tolerated by the organism. Abstinence leads to muscular pain, repeated sneezing, sweating, lacrimation (secretion of tears) and frequent yawning. The symptoms are similar to those that would appear in a person suffering from influenza, however after about 36 hours of abstinence they get worse. Uncontrollable muscular conditions may also appear such as cramps, cold shivering alternated with hot flushes, tachycardia and an increase in blood pressure. These symptoms last for about 72 hours and then gradually subside.

Barbiturates. These are synthetic sedatives and are used to induce and facilitate sleep. They relax the muscles, lower anxiety and in small doses produce a slight degree of euphoria. If used in high doses, they generate indistinct speech and a difficulty in maintaining one’s balance. People who use these substances lose control over their emotions and may become irritable and aggressive before falling into a deep sleep. Very high doses may be lethal as this would relax the diaphragmatic muscle to an excessive degree, thereby causing suffocation. The effects of abstinence last for many days and can also cause sudden death.

Amphetamines. These drugs produce their effect stimulating the  release of noradrenaline and dopamine (see glossary). They may induce dependence and reduce the need for sleep, inhibit intestinal functions and reduce the sensation of hunger. They increase the heart rate, cause vigilance, euphoria and extraversion, and increase the individual’s level of energy and resistance. Individuals who consistently use these substances often become suspicious and hostile, and to such an extent they may become dangerous for others. Massive doses absorbed over long periods generate a state comparable with that presented in schizophrenia of the paranoid type. The state of great energy which they produce is moreover replaced by complete psycho-physical exhaustion when the effect wears off.

Cocaine. This substance, which is extracted from the leaves of the coca plant, the centres of origin of which are the elevated plateaux and slopes of the Andes mountains, has an analgesic action and, acting on dopamine (see glossary), intensifies sensorial perception and induces a state of euphoria. Sexual desire is increased and the individual is filled with a sensation of self-confidence, wellbeing and tirelessness. Intoxication caused by a dose that is too high produces shivering, nausea, insomnia, crises of the paranoid type and hallucinations. Habitual use will result in the personality being changed and the appearance of irritability, dysfunctional social relations, paranoid ideation, alterations in eating patterns and sleep behaviour (cf. Scientific Perspective on Cocaine Abuse, 1987). The cessation of prolonged use of cocaine seems to cause a severe abstinence syndrome. If consumed during pregnancy, the substance will provoke evident dependence in the newborn child.

LSD and other hallucinogens: LSD is a chemical, laboratory-produced substance defined as a hallucinogenic on account of the effects it produces. It induces hallucinations of various kinds and other sensations such as synaesthesia (see glossary) but to a large extent its effects depend on individual psychological variables. It is believed that the overall psychological situation of the individual - that is, the subject’s attitudes, expectations and motivations concerning the use of drugs - is a determining factor as regards his or her reaction to the substance. The main dangers deriving from use of this substance include the possibility of suffering an extremely negative mental experience (a so-called ‘bad trip’), which may assume the characteristics of a panic attack. A minority of individuals will enter into a psychotic state requiring hospitalization and prolonged treatment. Other hallucinogenic drugs include mescaline, psilocybin, MDA and MDMA (the so-called ‘designer drugs’).

>>> (Schizophrenia and other Psychotic Disorders)




Bibliographical references:

Jaffe, J.H. (1985). Drug addiction and drug abuse. In Goodman and Gilman's the pharmacological basis of theurapeutic behavior. New York: Macmillan.

Kandell, D.B., Davies, M., Karus, D., Yamaguchi, K. (1986). The consequences in young adulthood og adolescent drug involvement. Archives of General Psychiatry, 43, 746-754.

Schultz, J. (1991). Smoking-attributable mortality and years of potential life lost: U.S. Morbidity and Mortality Weekly Report, 40, 63-71.
Psychology and psychotherapy
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