Substance Use Disorders 433opioid use quickly leads to tolerance and
withdrawal, as well as compulsive drug-re-
lated behaviors. Heroin is an opioid. Opioids
activate the dopamine reward system. They
also depress the central nervous system and
decrease endorphin production, thereby re-
ducing the body’s inherent ability to relieve
pain. Using an opioid and a depressant at the
same time is potentially lethal.
Hallucinogens include LSD, mescaline,
psilocybin, and marijuana. Hallucinogens
have unpredictable effects, which depend in
part on the user’s expectations and the con-
text in which the drug is taken. People can
have a “bad trip” when using LSD and can ex-
perience fl ashbacks long after the drug wears
off. Although the effects of marijuana are
more subtle, abuse of or dependence on this
hallucinogen affects motivation, learning, and
memory. The active ingredient in marijuana,
THC, appears to have an effect on the brain
similar to that of cannabinoids, activating the
dopamine reward system.
Dissociative anesthetics are so named be-
cause they induce a sense of dissociation and
cause anesthesia. They depress the central
nervous system and affect glutamate activ-
ity. Dissociative anesthetics include PCP and
ketamine. Use and abuse of this type of drug
impairs cognitive functioning, and can lead to
violent behavior. Genes may predispose some
people to develop abuse of or dependence on
these substances.
Psychological factors related to substance
use disorders include observational learning,
and operant conditioning (reinforcement of
the effects of the drug) and classical condi-
tioning of stimuli related to drug use. Social
factors related to substance use disorders in-
clude the individual’s relationship with family
members, peers’ use of substances, cultural
norms and perceived norms, and socioeco-
nomic factors.
Thinking like a clinician
Nat didn’t care much for drinking; his drugs
of choice were ketamine and LSD. His friends
worried about him, though, because every
weekend he’d either be clubbing (and taking
ketamine) or tripping on LSD.
What might be some of the sensations
and perceptions that each drug induced in
Nat, and why might his friends be concerned
about him? Suppose he stopped using LSD,
but started smoking marijuana daily. What
symptoms might he experience, and why
might his friends become concerned? If he
switched from taking ketamine to snorting
heroin before clubbing, what difference might
it make in the long term?
How would you determine whether Nat
was abusing or was dependent on these sub-
stances? What other information might you
want to know before making such a judgment?
Do you think he might develop withdrawal
symptoms—why or why not? If so, which ones?
According to the neuropsychosocial approach,
what factors might underlie Nat’s use of drugs?Summary of Treating
Substance Abuse
Treatments that focus on neurological factors
include detox to help reduce symptoms of
withdrawal that come from dependence. Med-
ications may reduce unpleasant withdrawal
symptoms or block the pleasant effects of us-
ing the substance, which can help maintain
abstinence.
Treatments that target psychological
factors, such as motivational enhancement
therapy, are designed to motivate users to
decrease substance abuse. CBT addresses
antecedents, consequences, and specifi c be-
haviors related to substance use. Twelve-step
facilitation provides structure and support
to help patients abstain. Social factors are
targeted by residential treatment and other
types of community-based treatment, as well
as family therapy to address issues of com-
munication, power, and control.Thinking like a clinician
Karl has been binge drinking and smoking
marijuana every weekend for the past couple
of years. He’s been able to maintain his job,but Monday mornings he’s in rough shape
and sometimes he’s had blackouts when he
drinks. He’s decided that he wants to quit
drinking and smoking marijuana, but feels
that he needs some help to do so. Based on
what you’ve read in this chapter, what would
you advise for Karl and why? What wouldn’t
you suggest to him as an appropriate treat-
ment and why not?Key Terms
Psychoactive substance (p. 382)
Substance use disorders (p. 382)
Substance intoxication (p. 382)
Substance abuse (p. 383)
Substance dependence (p. 383)
Tolerance (p. 385)
Withdrawal (p. 385)
Common liabilities model (p. 385)
Gateway hypothesis (p. 386)
Polysubstance abuse (p. 388)
Dopamine reward system (p. 396)
Reward craving (p. 400)
Relief craving (p. 400)
Drug cues (p. 401)
Delirium tremens (DTs) (p. 408)
Detoxifi cation (p. 421)
Antabuse (p. 422)
Stages of change (p. 424)
Motivational enhancement
therapy (p. 425)More Study Aids
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