all about addictive disorder.

2.  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 is one of the most
pervasive and intransigent mental health
problems, that our society is facing today.
 Addictive disorder can be seen all around
us; in extremely high rates of alcohol abuse
and dependence, in tragic exposes of
cocaine abuse among star, athletes and

3.  The most commonly used problem
substances are those drugs that affect
mental functioning or are psychoactive
drugs:
a. Alcohol
b. Nicotine
c. Barbiturates
d. Tranquilizers
e. Amphetamines
f. Heroin
g. Ecstasy
h. Marijuana

4.  Substance abuse
involves a
pathological use of a
substance resulting:
a. Potentially
hazardous behavior
such as driving while
intoxicated
b. Continued use
despite a persistent
social,
psychological,
occupational or
health problem

5.  Substance dependence includes more
severe forms of substance use disorders
and usually involves a marked
physiological need for increasing amounts
of a substance to achieve the desired
effects.
 Dependence in these disorders means
that an individual will show a tolerance for
a drug or experience withdrawal
symptoms when the drug is unavailable.

6.  Tolerance, the need for increased amounts
of a substance to achieve the desired
effects- results from biochemical changes
in the body that affect the 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 from
the drug.

8.  WHO, prefers the term alcohol dependence
syndrome – “a state, psychic and usually
also physical, resulting from taking alcohol,
characterized by behavioral and other
responses that always include a
compulsion to take alcohol on a continuous
or periodic basis in order to experience its
psychic effects and sometimes to avoid the
discomfort of its psychic effects and
sometimes to avoid the discomfort of its
absence, tolerance may or may not be
present”.

9.  The term alcoholic is
often used to refer to a
person with a serious
drinking problem, whose
drinking impairs his or her
life adjustment in terms of
health, personal term
alcoholism relationships
and occupational
functioning.
 Alcoholism refers to a
dependence on alcohol
that seriously interferes
with life adjustment.

10. The prevalence, co-morbidity and
demographic of alcohol abuse and
dependence
 The life span of the average alcoholic is about 12
years shorter than that of the average citizen.
 Alcohol now ranks as the third major cause of
death behind coronary heart disease and cancer.
 Over 37 percent of alcohol abusers suffer from at-
least one co-existing mental disorder.
 Organic impairment, including brain shrinkage,
occurs in a high proportion of alcoholics.
 About 10 percent of alcoholics commit suicide and
over 18 percent are found to have a history of
suicide attempts.

11.  Research has reaffirmed the
strong relationship found
between substance abuse and
suicide (Adam & Overholser,
1992; Murphy, 1988; Rich et al.,
1988).
 Alcohol abuse is associated with
over half the deaths and major
injuries suffered in automobile
accidents each year and with
about 50 percent of all murders,
40 percent of all assaults, 35
percent or more of all rapes and
30 percent of all suicides.
 Alcohol abuse and dependence
cuts across all ages,
educational, occupational and
socioeconomic boundaries.

13. Alcohol’s Effects on the Brain
 Alcohol has complex and
contradictory effects on the brain.
 At the lower levels, alcohol
stimulates certain brain cells and
activates the brain’s “pleasure
areas”, which release opium- like
endogenous opioids that are stored
in the body.
 At higher levels, alcohol depresses
brain functioning, inhibiting one of
the brain’s excitatory
neurotransmitters, glutamate,
which in turn slows down activity in

14.  Inhibition of glutamate in the brain impairs:
- the organism’s ability to learn
- affects the higher brain centers
- impairing judgment
- other rational processes
- lowering self-control
 Some degree of motor un-coordination soon
becomes apparent and the drinker’s
discrimination and perception of cold, pain
and other discomforts are dulled.
 The drinkers experiences a sense of warmth,
expansiveness and well-being.

15.  In such a mood, unpleasant realities are
screened out and the drinker’s feelings of self-
esteem and adequacy rise.
 Drinkers enter a world of unreality in which
worries are temporarily left behind.
 The effects of alcohol vary from different
drinkers, depending on their physical
condition, the amount of food in their stomach
and the duration of their drinking.
 Alcohol users may gradually build up a
tolerance for the drug so that ever increasing
amounts may be needed to produce the

16. Development of Alcohol
Dependence
 Excessive drinking can
be viewed as
progressing from early-
to-middle-to-late-stage
alcohol abuse disorder.
 Many investigators
have maintained that
alcohol is a dangerous
systemic poison even in
small amount, but
others believe that in
moderate amounts it is
not harmful to most

17. The Physical Effects of Chronic
Alcohol Use
 Alcohol ingested in the body may affect the liver, as
liver has to work hard and eventually suffer
irreversible damage.
 Alcohol is a high calorie drug.
 A pint of whiskey enough to make about eight to
ten ordinary cocktails, provides about 1200
calories, which is half the ordinary caloric
requirement for a day.
 Consumption of alcohol reduces a drinker’s
appetite for other food.
 Alcohol has no nutritional value, the excessive
drinker can suffer from malnutrition.

18.  Heavy drinking impairs the body’s ability to
utilize nutrients, so the nutritional
deficiency cannot be made up by popping
vitamins.
 Many alcohol abusers also experience
increased gastrointestinal symptoms such
as stomach pains.

20. Psychological Effects of Alcohol
Abuse and Dependence
 Excessive drinker suffers from chronic fatigue,
oversensitivity and depression.
 The excessive use of alcohol eventually becomes
counterproductive and can result in impaired
reasoning, poor judgment and gradual personality
deterioration.
 Behavior typically becomes coarse and
inappropriate and the drinker assumes increasingly
less responsibility, loses pride in personal
appearance, neglects spouse and family and
becomes generally touchy irritable and unwilling to
discuss the problem.
 As judgment becomes impaired, an excessive

21. Psychosis associated with
Severe Alcohol Abuse
 People who drink excessively over a long period of
time or who have a reduced tolerance for alcohol
for other reasons, shows acute reactions such as
confusion, excitement and delirium.
 These disorders are often called “alcoholic
psychosis” because they are marked by a
temporary loss of contact with reality.
 Who drink excessively for a long time, a reaction
called “alcohol withdrawal delirium”, formerly
known as “delirium tremens” may occur.
 Slight noises or suddenly moving objects may
cause considerable excitement and agitation.

22. The full-blown symptoms include:
i. Disorientation of time and place
For Example: a person may mistake the hospital for a
church or jail, no longer recognize friends etc.
ii. Vivid hallucinations, particularly of small, fast-moving
animals like snakes, rats and cockroaches.
iii. Acute fear, in which these animals may change in
form, size or color in terrifying ways.
iv. Extreme suggestibility, in which a person can be made
to see almost any animal if its presence is merely
suggested.
v. Marked tremors of the hands, tongue and lips.
vi. Other symptoms including perspiration, fever a rapid
and weak heartbeat, a coated tongue and foul
breathe.

23.  A second alcohol-related psychosis is “alcohol
amnesic disorder” formerly known as “korsakoff’s
syndrome”.
 The symptoms is a memory defect which is
sometimes accompanied by falsification of events.
 Persons with this disorder may not recognize
pictures, faces, rooms and other objects that they
have just seen, although they may feel that these
people or objects are familiar.
 These individuals may appear to be distorted,
delirious, delusional and disoriented for time and
place.
 They also show other cognitive impairments such
as planning deficits, intellectual deficits and

24. Biological Factors in the Abuse of and
Dependence on Alcohol and Other
Substances
Genes and biochemical factors is also the leading
cause of drinking problem.
Two important factors are apparently involved in
alcohol dependence:
i. The ability of most addictive drugs to activate
areas of the brain that produces intrinsic pleasure
and sometimes immediate powerful reward.
ii. The person’s biological makeup including his/her
inheritance and the environmental influences that
enters into the need to seek mind-altering
substances to an increasing degree as use
continues.

25. Psychosocial Causal Factors in
Alcohol Abuse and Dependence
a) Failures in parental guidance.
b) Psychological vulnerability.
c) Stress, tension reduction and
reinforcement.
d) Expectations of social success.
e) Marital and other intimate relationships

26. Socio-cultural Factors
 Alcohol use is a pervasive component in
the social life in western civilization and in
eastern countries.
 Social events often revolve around alcohol
use and alcohol use before and during
meals is common.
 Alcohol is seen as “social lubricant” or
tension reducer that enhances social
events.

27. Treatment objectives usually include:
 Detoxification
 Physical rehabilitation
 Control over alcohol-abuse behavior
 The individual’s realizing that he or she can
cope with the problems of living and lead a
much more rewarding life without alcohol

28. a) Use of medications in
treating alcohol
abusers.
b) Medications to block
the desire to drink,
Disulfiram (Antabuse).
c) Medications to reduce
the side effects of
acute withdrawal.
d) Psychological
treatment approaches.

30. The DSM-IV TR includes addiction of two legally
available and widely used drugs: caffeine and
nicotine.
These substances create important physical
mental health problems in our society for several
reasons:
i. These drugs are easy to abuse. It is easy to
become addicted to them because they are
widely used and most people are exposed to
them early in life.
ii. These drugs are readily available to anyone who

31. iii. It is difficult to quit these drugs because of
their addictive properties and they are so
embedded in the social context.
iv. The extreme difficulty most people have in
dealing with the withdrawal symptoms
when trying to “break the habit” often
produces considerable frustration.
v. The health problems and side effects of
these drugs, particularly nicotine, have
been widely noted. One in seven deaths in
the country is associated with cigarette
consumption.

32.  The poisonous alkaloid nicotine is the chief
active ingredient in tobacco, it is found in such
items as cigarettes, chewing tobacco and
cigars and it is even used as an insecticide.

33.  Nicotine dependence syndrome always
begins during the adolescent years and
may continue into adult life as a difficult to
break and health endangering habit.
 The “nicotine withdrawal disorder” results
from ceasing or reducing the intake of
nicotine containing substances after an
individual has developed physical
dependence on them.

34.  The diagnostic criteria for nicotine withdrawal
include:
i. The daily use of nicotine for at least several
weeks.
ii. The following symptoms after nicotine
ingestion is stopped or reduced:
 Craving for nicotine
 Irritability, frustration or anger
 Anxiety
 Difficulty in concentration
 Restlessness
 Decreased heart rate
 Increased appetite or weight gain

35.  Several other physical concomitants are
associated with withdrawal from nicotine
including decreased metabolic rate,
headaches, insomnia, tremors, increased
coughing and impairment of performance
on tasks requiring attention.
 These withdrawal symptoms continues for
several days to several weeks, depending
on the extent of the nicotine habit.

37.  Numerous treatment programs have been
developed to help smokers quit, including:
- social support groups
- various pharmacologic agents that replace
cigarette consumption with safer forms of nicotine
such as candy or gum
- self-directed change which involves giving
individuals guidance in changing their own
behaviors
- professional treatment using psychological
procedures such as behavioral or cognitive-
behavioral interventions

38.  Psychoactive drugs commonly involved in drug abuse are
as follows:
Classification Drug Effect
•Sedatives Alcohol (ethanol)
Barbiturates
Nembutal
Seconal
 Veronal
Tuinal
•Reduce tension
•Facilitate social interaction
“Blot Out” feelings or events.
•Stimulants Amphetamines
Benzedrine
Dexedrine
Methedrine
Cocaine
•Increase feelings of fatigue
and confidence
•Stay awake for long periods
•Increase endurance,
stimulate sex drive

39. •Narcotics Opium and its
derivatives
Opium morphine
Codeine
Heroin
Methadone
•Alleviate physical pain
•Induce relaxation and
pleasure
•Alleviate anxiety and
tension
•Treatment of heroin
dependence
•Psychedelics and
Hallucinogens
Cannabis
Marijuana
Hashish Mescaline
Psilocybin
LSD (Lysergic acid
Diethylamide-25)
PCP (Phencyclidine)
•Induce changes in
mood, thought and
behavior
•Expand one’s mind
•Induce stupor (state of
unconsciousness)
•Antianxiety drugs Librium
Milltown
Valium
Xanax
•Alleviate tension and
anxiety
•Induce relaxation and
sleep