2 Discussions – Abnormal Psychology

THE FIRST DISCUSSION (SUBSTANCE ABUSE WITH PERSONALITY DISORDER) IS DUE IN 4 HOURS AND THE 2ND ONE IS DUE IN 24 HOURS.

Substance Abuse With Personality Disorder: A Case Study [WLOs: 4, 5, 6, 7, 8] [CLOs: 1, 2, 3, 4, 5, 6]

Prior to beginning work on this discussion forum, you must successfully complete the Week 3 Terminology Quiz before you will be allowed to post in this discussion forum. The Week 3 Terminology Quiz is intended to support your ability to write critically considered postings that are accurate and aligned to the prompt appropriately.

In addition, to prepare for this discussion read Chapter 4, Chapter 7, and Chapter 9 in your required textbook and the articles Substance Use Disorders and Borderline Personality: Common Bedfellows (Links to an external site.) and Borderline Personality  (Links to an external site.)Disorder & Substance Abuse (Links to an external site.). Lastly, view the video Debunking the Myths & Misunderstandings of Borderline Personality Disorder (Links to an external site.) and play the Mouse Party (Links to an external site.) interactive game.

1. Access the Society of Clinical Psychology: Division 12 of APA web page that features case studies: Case Studies Search (Links to an external site.).
2. As you scroll down this page, note the area where you can choose the specific topic(s) you wish to access.

1. hoose one of the cases available that relates to an addictive and/or personality disorder or eating disorder. (Use the “diagnosis” selection area.)
   • Remember that you are assessing the potential substance abuse associated with a specific illness.
2. After you have chosen your criteria, differing options may be available. Choose the one you find most thought-provoking or applicable to your interests.

1. Read the case study details and refer to your textbook, and the DSM-5, as needed to support your understanding. (ALBERT: BORDERLINE PERSONALITY DISORDER WITH CO-MORBID ALCOHOL USE)

In your initial post,

• Start by identifying the symptom or diagnosis you searched and the name of the case study you chose.
  • (e.g. Albert [borderline personality disorder with comorbid alcohol use])
• Next, describe the patient’s symptoms and the available demographic and historical data.
  • If new terminology is introduced, be sure to explain to your peers what this entails.
• Analyze the differences between the diagnosis of the person identified in your case study and a similar illness/diagnosis.
  • Access the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (Links to an external site.) and do a search to support your suggestions. (Be sure to cite.)
    • For additional support citing this resource, review the video The DSM-5 (Links to an external site.).
• Discuss the available treatments for your case study.
• Evaluate the health and social risks, as well as costs, of alcohol or substance use disorder.
• What do you think about how our society handles this problem? Is there more we should be doing or is society too involved in this issue?
• Finally, develop at least three recommendations for the patient/family for ongoing functioning (social, occupational, and academic, if applicable), associated with your chosen case study.

Post your initial response of 300 words

DISCUSSION 2

Psychosis and Schizophrenia: A Case Study [WLOs: 4, 5, 6, 7, 8] [CLOs: 1, 2, 3, 4, 5, 6]

Prior to beginning work on this discussion forum, you must successfully complete the Week 4 Terminology Quiz before you will be allowed to post in this discussion forum. The Week 4 Terminology quiz is intended to support your ability to write critically considered postings, that are accurate and aligned to the prompt appropriately.

In addition, to prepare for this discussion read Chapter 8 in your text and the articles Is Adherence Therapy an Effective Adjunct Treatment for Patients With Schizophrenia Spectrum Disorders? A Systematic Review and Meta-Analysis and Current Approaches to Treatments for Schizophrenia Spectrum Disorders, Part I: An Overview and Medical Treatments. Lastly, view the following videos that will help you to better understand the personal perspectives of people suffering from schizophrenia: Schizo :60 (Bring Change 2 Mind’s Second PSA) (Links to an external site.), Cecilia’s Life With Schizophrenia (Living With Hallucinations) (Links to an external site.), and The Voices in my Head | Eleanor Longden (Links to an external site.).

To successfully complete this discussion:

1. Access the Society of Clinical Psychology: Division 12 of APA website that features case studies: Case Studies Search (Links to an external site.).
2. As you scroll down this page, note the area where you can choose the specific topic(s) you wish to access.
3. Choose one of the cases available that relates to psychosis (severe mental illnesses), schizophrenia, or dissociative or somatic symptom disorder. (Use the “diagnosis” selection area.)
4. After you have chosen your criteria, differing options may be available. Choose the one you find most thought-provoking or applicable to your interests.

1. Read the case study details and refer to your textbook, and the DSM-5, as needed to support your understanding. (CHRIS PSYCHOTIC DISORDER)

In your initial post,

• Start by identifying the symptom or diagnosis you searched and the name of the case study you chose.
• Next describe the patient’s symptoms and the available demographic and historical data.
  • If new terminology is introduced, be sure to explain to your peers what this entails.
• Evaluate the plausibility of prescribing medication to a person who is vulnerable to schizophrenia, considering medication is often effective for most people who have psychotic symptoms. What are the possible advantages and disadvantages of this proactive approach to treatment?
  • See you required text for potential vulnerability factors. Be sure to cite in your writing.
• Given the broad range of symptoms and social deficits that are often associated with psychotic disorders, these patients often need a broad array of services and support systems. Evaluate the most important forms of mental health services that would be helpful, both to these patients and their families, in addition to medication.
• Analyze the political variables surrounding the cost of treatment. Who should pay for mental health services to patients with serious mental disorders such as schizophrenia or bipolar disorder? Should they be included in standard health insurance programs? Should they be prioritized like other medical disorders, such as cancer and heart disease?

Post your initial response of 300 words

Required Resources

Text

Getzfeld, A. R. (2018). Abnormal psychology (2nd ed.). Retrieved from https://content.ashford.edu

• Chapter 4: Substance-Related and Addictive Disorders
• Chapter 7: Sleep-Wake and Eating Disorders
• Chapter 9: Personality Disorders

• Chapter 5: Dissociative Disorders and Somatic Symptom and Related Disorders
• Chapter 8: Schizophrenia Spectrum and Other Psychotic Disorders
• Chapter 12: Paraphilic Disorders, Sexual Dysfunctions, and Gender Dysphoria

Book

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (Links to an external site.). https://doi.org/10.1176/appi.books.9780890425596

• This manual will support your understanding of diagnosis and treatment for mental illness and support you in your Substance Abuse With Personality Disorder: A Case Study discussion forum this week. Note that you will only be reviewing one to three pages, and it will be based on what specific disorders you choose to evaluate this week.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Articles

Maryland Recovery. (n.d.). Borderline personality disorder & substance abuse (Links to an external site.). Retrieved from https://www.marylandrecovery.com/blog/borderline-personality-disorder-and-substance-abuse/

• This article provides information about addiction and borderline personality disorder and will assist you in your Substance Abuse With Personality Disorder: A Case Study discussion forum this week.
  Accessibility Statement does not exist.
  Privacy Policy (Links to an external site.)

Sansone, R. A., & Sansone, L. A. (2011). Substance use disorders and borderline personality: Common bedfellows (Links to an external site.). Innovations in Clinical Neuroscience, 8(9), 10–13. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196330/

• This article discusses the prevalence of substance abuse, predominantly associated with borderline personality disorder, and will support you with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Chien, W., & Yip, A. L. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part I: An overview and medical treatments. Neuropsychiatric Disease and Treatment, 2013(9), 1311–1332. https://doi.org/10.2147/NDT.S37485

• The full-text version of this article is available through the ProQuest Central database in the Ashford University Library. This article provides an overview of different treatment approaches used in schizophrenia spectrum disorders to focus on health issues and a wide range of abnormalities resulting from the illness. Students will use this article to respond to their Psychosis and Schizophrenia: A Case Study discussion forum this week.

Gray, R., Bressington, D., Ivanecka, A., Hardy, S., Jones, M., Schulz, M., . . . Chien, W. (2016). Is adherence therapy an effective adjunct treatment for patients with schizophrenia spectrum disorders? A systematic review and meta-analysis. BMC Psychiatry, 16(90), 1–12. https://doi.org/10.1186/s12888-016-0801-1

• The full-text version of this article is available through the EBSCOhost database in the Ashford University Library. This article researches the poor adherence to medications in patients with schizophrenia spectrum disorders. This can lead to inadequate control of symptoms. Researchers assess adherence therapy (AT), an intervention that seeks to reduce patients’ psychiatric symptoms by enhancing treatment adherence. Students will review and assess this article to support their Psychosis and Schizophrenia: A Case Study discussion forum response this week.

Multimedia

Fox, D. [Dr. Daniel Fox]. (2018, November 3). Debunking the myths & misunderstandings of borderline personality disorder (Links to an external site.) [Video file]. Retrieved from https://youtu.be/YdQpvYuB7g0

• This video shares the misconceptions associated with borderline personality disorder and will support you with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week. This video has closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Genetic Science Learning Center. (2006). Mouse party (Links to an external site.) [Interactive learning game]. Retrieved from https://learngendev.azurewebsites.net/content/addiction/mouse/

• This interactive game helps us to better understand the effects of how drugs interact with dopamine neurotransmitters and will support you with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week. This interactive game has closed captioning and transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Bring Change to Mind. (2013, May 14). Schizo :60 (bring change 2 mind’s second PSA) (Links to an external site.) [Video file]. Retrieved from https://youtu.be/Zn6yw2KUIwc

• This video provides an interesting perspective on a common misperception regarding schizophrenia and will support your completion of your Psychosis and Schizophrenia: A Case Study discussion forum this week. This video contains closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Grande, T. [Dr. Todd Grande]. (2018, June 6). What is illness anxiety disorder? (Links to an external site.) [Video file]. Retrieved from https://youtu.be/6l9XwJGh2xg

• This video provides information about anxiety illness disorder based on the expertise of Dr. Todd Grande, a licensed professional counselor of mental health, a licensed chemical dependency professional, and has a PhD in counselor education and supervision. This video will support our knowledge application associated with the Somatic Symptom and Related Disorders assignment this week. This video has closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Mayo Clinic. (2014, September 11). Somatic symptom disorders part II: Core features and treatment  (Links to an external site.)[Video file]. Retrieved https://youtu.be/-F2ETlmyvXM

• This video provides additional information about somatic symptom disorder and will support you in your Somatic Symptom and Related Disorders assignment this week. This video has closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

Special Books by Special Kids. (2017, November 16). Cecilia’s life with Schizophrenia (living with hallucinations) (Links to an external site.) [Video file]. Retrieved from https://youtu.be/7csXfSRXmZ0

• This video provides a personal perspective on living with schizophrenia and will help to support your Psychosis and Schizophrenia: A Case Study discussion forum this week. This video has closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy (Links to an external site.)

TED. (2013, August 8). The voices in my head | Eleanor Longden (Links to an external site.) [Video file]. Retrieved from https://youtu.be/syjEN3peCJw

• This video provides a personal perspective on living with schizophrenia and will help to support your Psychosis and Schizophrenia: A Case Study discussion forum this week. This video has closed captioning and a transcript.
  Accessibility Statement (Links to an external site.)
  Privacy Policy

Web Page

Society of Clinical Psychology: Division 12. (n.d.). Case studies search (Links to an external site.). Retrieved from https://www.div12.org/case-studies/

• This site will be utilized to identify a case study to analyze associated with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week.
  Accessibility Statement does not exist.
  Privacy Policy (Links to an external site.)

Supplemental Materials

Rosser-Majors, M. (2019). Week 1 Study Guide. Retrieved from https://www.ashford.instructure.com

• This study guide will help you prepare for your Midcourse Comprehensive Review this week.

Rosser-Majors, M. (2019). Week 2 Study Guide. Retrieved from https://www.ashford.instructure.com

• This study guide will help you prepare for your Midcourse Comprehensive Review this week.

Rosser-Majors, M. (2019). Week 3 Study Guide. Retrieved from https://www.ashford.instructure.com

• This study guide will help you prepare for your Midcourse Comprehensive Review and Week 3 Terminology Quiz this week.

Recommended Resources

Books

Beatty, L. A., & Willis, T. D. (2014). Substance abuse treatments. In F. T. L. Leong (Ed.), APA handbook of multicultural psychology: Vol. 2: Applications and training (pp. 455–477). https://doi.org/10.1037/14187-026

• The full-text version of this chapter is available through the EBSCOhost database in the Ashford University Library. The focus of this chapter assesses the drug treatment needs of racial and minority populations. Focus of treatment includes treatment approaches, therapeutic interventions, and ongoing research needs. This information may support you with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week.

Ogden, J. T. (2015). Personality disorders. In P. Moglia (Ed.), Salem health: Psychology & behavioral health: Vol. 4 (4th ed.). Retrieved from https://www.salempress.com/health

• The full-text version of this encyclopedia entry is available through the EBSCOhost database in the Ashford University Library. This entry in a comprehensive five-volume set reviews personality disorders, and it may support you with your Substance Abuse With Personality Disorder: A Case Study discussion forum this week.

Supplemental Material

Maryland Recovery. (n.d.). Holistic remedies to help with mental disorders and substance abuse cravings (Links to an external site.) [Educational brochure]. Retrieved from https://www.marylandrecovery.com/wp-content/uploads/2017/05/marylandRecovery_HolisticRemedies.pdf

• This brochure offers insight into holistic methods for addressing addiction and may support you in your Substance Abuse With Personality Disorder: A Case Study discussion forum this week, as well as future writing assignments.
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  4 Substance-Related and Addictive Disorders

  Lee O’dell/Hemera/Thinkstock

  Learning Objectives

  After reading this chapter, you should be able to:

  • Explain what psychoactive substances are.

  • Explain why psychoactive substances are so popular.

  • Analyze the potential dangers of using psychoactive substances.

  • Explain how substance-related disorders are treated.

  • Discuss ways that substance-related disorders can be prevented.

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  Section 4.1 Psychoactive Substances: Some Basic Information

  4.1 Psychoactive Substances: Some Basic Information Chemicals that alter moods or behavior have been used for thousands of years by people from just about every culture and society. This chapter is concerned with why so many people use these psychoactive substances, the problems such substances can cause, how to help people who want to stop using substances, and how to prevent people from taking them up in the first place. Psychoactive substances—chemicals that alter our moods or behavior—touch every aspect of modern life; they affect the way we live, work, relax, and die. In the United States, the total cost of substance abuse in 2016 (the most recent year for which estimates are available) was more than $400 billion in lost workplace productivity (in part due to prema- ture mortality), health care expenses, law enforcement and other criminal justice costs (for example, drug-related crimes), and losses from motor vehicle crashes (U.S. Department of Health and Human Services [USDHHS], 2016). Furthermore, about three quarters of the costs associated with alcohol use were due to binge drinking, and about 40% of those costs were paid by the government, emphasizing the huge cost of alcohol misuse to taxpayers (USDHSS, 2016). This value represents both the use of resources to address health and crime conse- quences as well as the loss of potential productivity from disability, death, and withdrawal from the workforce.

  There is no precise boundary between social drinking and alcohol abuse. Like many psy- chological problems, substance-related disorders are often just extreme cases of common behaviors. How common? Recent data reported by the Center for Behavioral Health Statistics and Quality (CBHSQ, 2015) reveal that slightly more than half of Americans aged 12 or older (139.7 million, or 52.7%) reported some amount of alcohol use. This refers to general use of alcohol—a beer with pizza or a glass of wine at dinner, for example. A bit more than two out of every five people aged 12 or older (60.9 million, or 40%) participated in binge drinking at least once in the past 30 days (CBHSQ, 2015). For males, binge drinking is defined as the consumption of five or more alcoholic drinks in a row on at least one occasion during the pre- ceding two-week period; for females, it refers to the consumption of four or more drinks dur- ing that time period (Bartel et al., 2017). The rates in 2009 and 2010 were similar (23.7%). Finally, heavy drinking was reported by 6.2% of the population aged 12 or older, or 16.3 mil- lion people (CBHSQ, 2015).

  More disturbingly, data provided by the National Survey on Drug Use and Health (NSDUH) showed that in 2014, “17 million persons aged 12 or older were classified with an alcohol use disorder. This represented 6.4 percent of the population” (CBHSQ, 2015).

  Psychoactive substances form a spectrum. At one end are everyday substances, such as the caffeine found in coffee, soft drinks, and tea. At the other end of the spectrum are illicit and potentially dangerous substances, such as opiates (for example, heroin). A variety of other substances lie between these two extremes.

  Robert Jones presents an interesting example of an individual who may—or may not—have a drinking problem. Let’s meet him before we continue.

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  Section 4.1 Psychoactive Substances: Some Basic Information

  The Case of Robert Jones: Part 1

  Robert (or Bob as he prefers to be called) is a 48-year-old African American male who has been married for 30 years to Paula. He has two children, aged 16 and 5. When Bob came to us, he was well dressed, presented pleasantly and appropriately, and had a friendly demeanor. He was not entirely sure why he was sent to the clinic, but he was sure that it was a mistake.

  “I’ve got no idea what’s going on here. The cops stopped me one night after work. Both were African Americans, and they knew me. They’ve seen me in town, at church. They told me I was weaving all over the road, and they wanted to make sure I was okay. Of course I was okay! I’ve been driving for over 30 years and never had an accident, never had a ticket! They asked me twice if I’d been drinking. I don’t drink, well, not that much anyway. They thought I was drunk! Would I drive drunk? I’ve got two kids, one a teenager who’ll be driving soon herself. I told them no, and then they asked me to step out of the car as they wanted me to do some things for them . . . .”

  Bob continued his story for us during his initial intake interview. “This was so insane! I’ve got a graduate degree. I’m an upstanding citizen. The cops asked me to walk a straight line, to touch the tip of my nose with the index finger of each of my hands. That wasn’t good enough! Then they asked me if I’d been drinking—again—and then they asked me to blow into a tube in this little machine. I wasn’t sure I needed to do this, but I’d heard if you refuse to do this you’re immediately arrested. Where’s the ‘innocent until guilty’ here?” Bob decided that he’d better go along with the officers’ request and he did, but he complained the whole time. The end result was shocking to him, to say the least: “They said I was drunk! My . . . BAR . . . or something like that [we corrected him and explained that this was his blood alcohol concentration (BAC)] was .20.”

  BAC refers to the percentage of alcohol that is in the body as compared to the total blood supply. A BAC of 0.08 is equivalent to about four drinks consumed per hour for an average- sized individual.

  “That meant zip to me, so they told me it seemed like I’d had about 10 drinks. 10 drinks! That’d make me a rummy, a lush! I only drink beer anyway. 10 beers in one hour! That’d kill me much less anyone else!”

  We confirmed the BAC results on Bob’s paperwork, sent to us by his probation officer. She sent him to us as part of his plea bargain in order to avoid jail time. Bob believed that he had no reason to be in our office. “Why don’t you concentrate on the real problems out there— the murderers, lying politicians, and the drunks that kill people while driving—huh? I’m a hardworking family man; I don’t belong in here with the winos and the loony tunes.” We pointed out the conditions of his probation and gave him the option to leave. Bob thought about this for a while and then finally stood up to leave.

  See appendix for full case study.

  Because the DSM–5 includes many substance-related disorders, it is not possible to review each one here. Instead, this chapter emphasizes the common features of psychoactive sub- stance use by focusing on the four substances most frequently used by American college stu- dents: caffeine, nicotine, alcohol, and cannabis (marijuana). Let’s start by surveying the physi- cal and psychological effects of each of these substances.

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  Section 4.1 Psychoactive Substances: Some Basic Information

  Caffeine If you need proof that practically everyone uses psychoactive substances at one time or another, just consider caffeine. It is practically everywhere. The only way you can avoid it is to shun coffee, tea, Red Bull, many popular soft drinks, cocoa, and chocolate. Even then, you may not succeed because caffeine is also found in headache, diet, and cold medications. Today, coffee remains the world’s most popular source of caffeine (see Figure 4.1 for other common sources).

  Figure 4.1: Common sources of caffeine

  Source: Data from Consumer Reports, “What Caffeine Can Do for You and to You,” Consumer Reports on Health, 9(1997), pp. 97, 99–101, as appearing in S. Schwartz, Abnormal Psychology: A Discovery Approach. Mountain View, CA: Mayfield Publishing Company, 2000, Figure 6.1, p. 238.

  Caffeine (mg)

  0 25 50 75 100 125 150 175 200

  Espresso, 2 oz Regular coffee, brewed, 6 oz Instant coffee, 6 oz

  Coffee

  Jolt Cola, 12 oz Mountain Dew, 12 oz Surge, 12 oz Coca-Cola Classic, 12 oz Pepsi, 12 oz Java Water, 12 oz Water Joe, 12 oz Java Juice, 12 oz XTC Juice, 12 oz

  Soft drinks

  Black tea, 6 oz Green tea, 6 oz

  Tea

  Aspirin-free Excedrin Anacin NoDoz maximum strength NoDoz

  Medications

  S o

  u rc

  e o

  f c a ff

  e in

  e

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  Section 4.1 Psychoactive Substances: Some Basic Information

  Action Caffeine belongs to a class of chemicals called stimulants, whose main psychoactive effect is to make us more alert. Within 45 to 60 minutes after you drink a cup of coffee or munch on a chocolate bar, caffeine is absorbed from the stomach and the intestines. Once in the blood- stream, it causes blood pressure, pulse rate, and stomach acid production to increase. In the nervous system, caffeine acts as an antagonist to the neuroinhibitor adenosine (Kaster et al., 2015). Antagonists are chemicals that reduce the potency of other chemicals. In contrast, agonists are chemicals that increase the potency of other chemicals (for example, fluoxetine [Prozac] is a serotonin agonist). Caffeine is also a powerful diuretic because it increases the excretion of liquid from the body.

  Health Effects Although it is widely used and generally regarded as safe, caffeine may still have adverse effects on health (de Mejia & Ramirez-Mares, 2014). For example, it increases the production of stomach acid, which may worsen digestive disorders and can cause acid reflux (“heartburn”). Insomnia, poor sleep, and anxiety are other potential results of overuse of caffeine. Excessive continual coffee consumption can also lead to bone loss, increased blood pressure, and lower bone density, meaning that fractures are more likely (Chaudhary, Grandner, Jackson, & Chakra- vorty, 2016; de Mejia & Ramirez-Mares, 2014). Some researchers, however, found that coffee consumption does not lead to ulcers or acid reflux (Papakonstantinou et al., 2016).

  Psychological Effects Because caffeine is a stimulant, many people consume drinks containing it to combat drowsi- ness, increase alertness, and boost energy. Paradoxically, many people also consume caffeine to relax. It is possible that the relaxing effect of caffeine is not the result of its chemical action but of expectancies (what people expect when they use a drug or substance) and social rein- forcements. If we expect caffeine to be relaxing, it probably will be.

  Nicotine Nicotine is the primary psychoactive ingredient in tobacco, a plant that has grown in the Americas for centuries. Let’s look at a few statistics to put tobacco use into perspective. Although tobacco usage has decreased over the past few years, in 2015 nearly 25.3% of high school students used some type of tobacco product, including 13% who reported cur- rently using at least two or more tobacco products (Singh, 2016). Among current high school users, smokeless tobacco was the product used most often during the past month (42%), followed by cigarettes

  kolosigor/iStock/Thinkstock As with substances administered through a needle, our bodies react physiologically to nicotine within a matter of seconds.

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  Section 4.1 Psychoactive Substances: Some Basic Information

  (31.6%). Not surprisingly, e-cigarettes were used by about 15.5% of those surveyed (Neff et al., 2016). Cigar smoking was also common among high school students, at about 13.1% (Neff, Spiker, & Truant, 2015; Singh, 2016).

  Action Nicotine is a powerful stimulant, so toxic that it has been used as a natural insecticide. A small amount instantly kills a variety of insects. In humans, nicotine is one of the fastest acting psy- choactive substances. Within seconds of a smoker’s puffing on a cigarette, nicotine reaches the smoker’s brain (Benowitz, 1996). It activates specific receptors in the midbrain that pro- duce increased arousal. The end result is similar to the one produced by caffeine—smoking makes people more alert and less drowsy.

  Health Effects Carbon monoxide, the poisonous gas found in automobile exhaust emissions, is also present in cigarette smoke. It reduces the smoker’s oxygen supply, thereby affecting the heart and other circulatory organs. The organic chemicals suspended in smoke droplets, known as tar, contain several known carcinogens, or substances that can cause cancer. Many other danger- ous substances, such as formaldehyde (a well-known carcinogen) and nitric oxide (a poison- ous gas), are also found in tobacco smoke.

  The effects of smoking on health have been known for decades. In 1948, researchers began a prospective study of more than 5,000 people living in Framingham, Massachusetts. Their aim was to identify the factors that contribute to heart disease. The now-famous Framingham Heart Study revealed a number of risk factors (characteristics, genetic or otherwise, that seem to be associated with an increased risk of disease onset or recurrence). Somewhat unex- pectedly, at least at the time, high among those risk factors was smoking (Dawber, 1980). The Framingham study was the first evidence that tobacco smoking was related to heart disease. It was followed by a study of 8,000 men of Japanese descent, which found that smoking is also a risk factor for stroke (Abbott, Yin, Reed, & Yano, 1986). Smokers have three times as many strokes as people who have never smoked. A 34-year follow-up of the Framingham study shows a continuing association between smoking and a range of diseases years after smoking ceases (Freund, Belanger, D’Agostino, & Kannel, 1993).

  In addition to heart disease and stroke, smoking is a risk factor in respiratory diseases such as bronchitis and emphysema (Rigotti, 2013), in stomach ulcers, and in diseases of the mouth (Sood et al., 2014). Exposure to the smoke of other people’s cigarettes, pipes, and cigars (known as passive smoking) is also a health risk, especially for young children (Czogala et al., 2014). These researchers estimated that passive smoking kills more than 600,000 people worldwide every year, an astonishingly high figure (Czogala et al., 2014).

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  Section 4.1 Psychoactive Substances: Some Basic Information

  According to the World Health Organization (WHO), tobacco is the second leading cause of death around the globe. WHO estimates that 12% of all deaths among adults aged 30 or older are smoking related, which comes out to about 5 million people each year. This number is expected to grow to 8 million by 2030. Half of all smokers will die from their tobacco use (WHO, 2012). In 2015, WHO estimated that over 1.1 billion people smoked tobacco (WHO, 2012).

  Although smoking is directly related to stroke, heart disease, diabetes, chronic obstructive pulmonary disease (COPD), and 12 types of cancer (Carter et al., 2015; Farsalinos et al., 2016), the best known link is the relationship between smoking and lung cancer (Carter et al., 2015).

  Psychological Effects Despite nicotine’s arousing effects, most smokers, like most coffee drinkers, claim that they smoke to relax. Some research suggests that smoking may actually increase stress levels (Par- rott, 2000). Other studies reveal that smoking is relaxing and that smoking increases under stressful circumstances (Hughes, 2005). As with coffee drinking, the relaxing effects of ciga- rette smoking may be, at least in part, the result of expectancies and social reinforcement.

  Personality may play a role in nicotine use. Despite the well-known health risks, millions of people continue to smoke. Hans Eysenck (1991) suggested that this phenomenon may be partly explained as a behavioral expression of the personality trait of extroversion. Accord- ing to Eysenck, extroverts are born with low levels of arousal. The experience of low arousal is perceived as unpleasant, so extroverts continuously seek stimulation—and smoking is a source of stimulation. Not all extroverts smoke, of course. There are other ways to raise arousal; some may drink lots of coffee. However, once extroverts start smoking (because of peer pressure, rebelliousness, or for some other reason), they are likely to continue because smoking provides the stimulation they crave (Hakulinen et al., 2015). In 2015, e-cigarettes were the most commonly used tobacco product among middle (5.3%) and high (16.0%) school students (Singh, 2016). During 2011–2015, significant increases in current use of e-cigarettes and hookahs occurred among middle and high school students. This finding is bothersome, but what is interesting is that the current use of conventional tobacco products such as cigarettes and cigars decreased during that timeframe. Many people falsely believe that e-cigarettes are healthier for you, and although ads may imply that this is the case, it is not true (Callahan-Lyon, 2014).

  Nicotine, as a stimulant, belongs to the same class of substances as amphetamines, cocaine, and MDMA, which is also known as ecstasy or Molly (see Table 4.1).

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  Alcohol Alcohol (known more accurately as ethanol) is the second most commonly used psychoac- tive substance in the United States and perhaps in the world. It is estimated that 2 billion peo- ple worldwide use alcohol (WHO, 2011). Globally, 45% of the world’s population has never consumed alcohol (35% of men and 55% of women).

  Alcohol is found in wine, liquor, spirits, beer, cider, and many cold medications. Unlike smok- ing, alcohol use is positively correlated with educational attainment. College graduates drink more than those who ended their education after high school (although college students with low marks drink more than high-performing students; Ansari, Stock, & Mills, 2013; Quinn & Fromme, 2011). International comparisons suggest considerable cross-cultural variability in

  Table 4.1: Examples of stimulants (other than caffeine and nicotine)

  Name Description

  Amphetamine A synthetic (manufactured) compound that comes in legal prescription versions and ille- gal street versions, such as “speed.” Amphetamine powder can be inhaled (“snorted”) or injected. Amphetamines enhance neurotransmitter concentration, especially norepineph- rine and dopamine. This increased concentration produces alertness and arousal. Origi- nally intended as an asthma medication, amphetamines still have several medical uses. For example, drugs such as dextroamphetamine (Adderall) and methylphenidate (Ritalin) may be prescribed for people with attention-deficit/hyperactivity disorder (discussed in Chapter 11); and because they suppress appetite, they are sometimes used as diet aids. Large doses of amphetamines can also be fatal.

  Cocaine Derived from the South American coca plant, cocaine, or coke, comes in several forms and was once an ingredient in Coca-Cola (Musto, 1992). Cocaine produces stimulatory effects similar to those produced by amphetamines. Also like amphetamines, cocaine can be injected, snorted, or smoked in forms known as free-base and crack. Cocaine acts to enhance the action of dopamine and other neurotransmitters, thereby increasing arousal while producing a variety of psychological effects including (after prolonged use) paranoia, anxiety, panic attacks, and even a psychotic disorder (Yudofsky, Silver, & Hales, 1993). Withdrawal does not seem to produce symptoms unless cocaine use extends over a consid- erable period, usually defined as six months or longer (Gawin & Kleber, 1992). Similar to amphetamines, cocaine can be fatal in large doses (Harlow & Swint, 1989). In 2010, about 1 million people had cocaine dependence in the United States (NSDUH, 2011).

  MDMA MDMA (3, 4-methylenedioxymethamphetamine), also known as ecstasy, is technically a stimulant but is often considered to be a hallucinogen as it produces hallucinogenic effects. This drug is often used in clubs and at raves as it provides users with a boost in energy that allows them to go on dancing for extended time periods. MDMA has no medicinal effects and can lead to many physical problems, including increased blood pressure and heart rate, which can lead to cardiac arrest (Ksir, Hart, & Oakley, 2008). The popular nickname Molly (slang for “molecular”) often refers to the supposedly “pure” crystalline powder form of MDMA, usually sold in capsules. Sometimes the capsule is “cut” with another substance (meaning that another substance in addition to MDMA is added in, often without the user’s or buyer’s knowledge). Other stimulants include cocaine, ketamine, methamphetamine, over-the-counter cough medicine, and synthetic cathinones (“bath salts”).

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  alcohol consumption depending on availability and cultural prohibitions (Erol & Karpyak, 2015; WHO, 2014).

  In all ethnic groups, males are much more likely than females to be binge drinkers, although women appear to be closing the gap (Erol & Karpyak, 2015). This also puts women at risk for other drug use, where they also seem to be catching up to men (Clinkinbeard & Barnum, 2015). Even so, the gap between men and women still exists. Why might that be? First, blood levels of alcohol build up more quickly in women than in men of the same size because women have less of the enzyme—known as alcohol dehydrogenase (ADH)—that helps break down alcohol in the stomach before it enters the bloodstream (Erol & Karpyak, 2015). Note, how- ever, that Erol and Karpyak (2015) also found some reports that suggested this is not the case. Second, many women do not drink when they are pregnant because of the now well-known fact that alcohol can cause birth defects (Landgraf, Nothacker, Kopp, & Heinen, 2013).

  Action Chemically, alcohol is a depressant. It lowers arousal and makes people drowsy (Yi, 1991). Some of the other depressants included in the DSM–5 are described in Table 4.2.

  Alcohol exerts a variety of effects on the central nervous system, but one of its most impor- tant is to reduce inhibition, which is controlled by the GABA neurotransmitter system (GABA stands for gamma-amino butyric acid; the “gamma” is typically abbreviated with the Greek letter for gamma). The result is that drinkers lose some degree of self-control. Alcohol dilates blood vessels, decreases blood pressure, lowers heart rate, and slows respiration. Although small amounts of alcohol are exhaled as vapor by the lungs, which can be measured by road- side Breathalyzers, most of the ingested alcohol goes to the liver, where it is gradually broken down (metabolized) and excreted. The average person can metabolize about one “standard drink”—the equivalent of one 12-ounce glass of beer, one 5-ounce glass of wine, or 1 ounce of 90-proof liquor—per hour. (We will discuss the BAC a bit later in this chapter.) Neither drinking black coffee nor splashing cold water on one’s face makes any difference in the rate at which alcohol is metabolized; there is no quick way to sober up.

  Health Effects Drinking moderate amounts of alcohol, especially red wine, may reduce the likelihood of cor- onary heart disease (Chiva-Blanch, Arranz, Lamuela-Raventos, & Estruch, 2013). However, chronic use of alcohol can damage the heart and just about every other organ in the body (Shield, Parry, & Rehm, 2014; WHO, 2014). Alcohol irritates the digestive system, causing

  ZzzVuk/iStock/Thinkstock Males are more likely to be binge drinkers than females, partly because women have less of the enzyme ADH (alcohol dehydrogenase) that helps break down alcohol in the stomach.

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  inflammation and bleeding. Prolonged and intensive use of alcohol can turn the liver into nonfunctioning, fibrous tissue. This syndrome is known as cirrhosis. A very high blood alco- hol level can be fatal, although most people become unconscious before drinking enough to cause death.

  Heavy drinking during pregnancy can put a fetus at risk of developing fetal alcohol syn- drome (FAS), which is marked by intellectual disabilities, hyperactivity, facial deformities, and growth deficiencies of internal organs and the body’s systems (Caputo, Wood, & Jabbour, 2016; Landgraf et al., 2013). A classification known as fetal alcohol spectrum disorders (FASD) includes FAS, partial FAS, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects (Landgraf et al., 2013). Even when they consume the same amount of alcohol, African American women and female members of certain Native American tribes are more likely to have children with FAS than are members of other groups (Caetano, Vaeth, Chartier, & Mills, 2014). Their increased vulnerability appears to be the result of genetic differences in alcohol metabolism (Caetano et al., 2014; Gordis, 1991).

  Psychological Effects Moderate amounts of alcohol make most people feel talkative and relaxed. Even though drinkers may relax, even modest amounts of alcohol can affect cognition (Starkey & Charlton, 2014). After a few drinks, we concentrate on only the immediate and the most obvious cues in our environment, ignoring complexities and long-term consequences. For example, you may feel like talking back to a professor or to your supervisor at work, but a sober consideration of the consequences will probably inhibit you from actually saying anything. Under the influ- ence of alcohol, however, you may not consider the long-term consequences and just lash out. This narrowing of focus to the immediate is called alcoholic myopia (Fairbairn & Sayette, 2013). This can lead to having unprotected sex and inappropriate, even dangerous, acts of aggression (Giancola, 2015; Kiene, Simbayi, Abrams, & Cloete, 2016), for example.

  As the amount of alcohol in the bloodstream builds, vision becomes blurred, hearing grows less acute, and motor control begins to break down. It is these effects that make drinking and driving so dangerous. Indeed, alcohol was associated with around 29% of all automobile accident fatalities in 2015 (National Highway Traffic Safety Administration [NHTSA], 2016).

  The level of cognitive and motor impairment produced by alcohol depends on its concentra- tion in the blood. Concentrations below 0.05% of blood by volume usually produce feelings of relaxation, with minimal cognitive or motor effects. Higher concentrations affect judgment and motor coordination. Figure 4.2 shows the relationship between blood alcohol concentra- tion (BAC) and body weight.

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  Figure 4.2: Approximate blood alcohol concentration (BAC) and body weight

  Source: P. M. Insel & W. T. Roth, Core Concepts in Health, 10th ed. Mountain View, CA: Mayfield Publishing Company, 2000, p. 254. Reprinted by permission.

  1 hour

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  90–109 lb

  (0.00%) Not impaired

  (0.01–0.04%) Sometimes impaired

  (0.05–0.07%) Usually impaired

  (0.06 and up) Always impaired

  110–129 lb

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