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What is tolerance?
- a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
- diminished effect with continued use of the same amount of alcohol
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What is withdrawal?
alcohol or closely related substance is taken to relieve or avoid withdrawal symptoms
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evolution of diagnosis of SUDs
- DMS1 = suds grouped under sociopathic personality disturbances + paraphilias + antisocial personality disorder
- DMS2 = small changes, removed sociopathic categorization
- DSM3 = included tobacco/nicotine dependence for the first time
- DSM3-R = distinction between abuse and dependence
- DSM4 = social consequences moved from dependence criteria to abuse criteria
- DSM5 = only included non-substance related addictions, previously included as an impulse control disorder
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Cloninger’s neurobiological model for SUDs
- type 1 - later onset of alcohol problems
- type 2 - earlier onset of alcohol problems, more severe
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Five clusters for clinical sub typing of SUDs
- young adult subtype
- functional subtype
- intermediate familial subtype
- young antisocial subtype
- chronic severe subtype
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risk factors for addictive disorders?
- family history — potentially stronger heritability for illicit drug use than for alcohol
- level of response to alcohol — heritable mechanism influencing ones propensity to develop an alcohol disorder, lower response associated with family history, development of tolerance
- expectancies — beliefs about anticipated effects of alcohol or other substance use, can predict initiation, progression, problem use, etc
- cognitive distortions — gambler’s fallacy, chasing losses
- peer influences
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cognitive distortions in gambling
- overconfidence about one’s ability
- illusory correlations — superstitions, pathological gamblers often believe that their personal luck will impact the outcome of gambling
- interpretive control — heavy gamblers are more likely remember their wins than their losses
- illusion of control — pathological gamblers are less able to distinguish between situations in which they do and do not have control
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Gender differences in addictive disorders
- men consume greater quantities and abuse substances at higher rates
- however the gap is narrowing slowly
- women are more vulnerable to many physiological consequences of alcohol use and abuse — have higher BAC after consuming same amount of alcohol, develop liver disease more quickly, increased risk of breast cancer
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teratogenic effects of alcohol
- fetal alcohol syndrome (FAS) — physical and neuropsychological effects/deformities, a result of consuming significant amounts of alcohol during pregnancy
- fetal alcohol effects (FAE) — less severe alcohol effects occur with lower levels of alcohol consumption
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Gender differences in gambling behaviors
- men and women equally likely to have gambled in the past year
- men gamble more frequently, have greater wins and losses
- female pathological gamblers at greater risk for mood and anxiety disorders
- males at greater risk for SUDs
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