Nicotine, which was introduced in the French court t in the 16th century is what gives smoking its pleasurable qualities. About 30% of all Americans smoke, which is down from 4 2.4 % who were smokers in 1965. Nicotine in small doses stimulates the central nervous system, but may also relieve stress and improve mood. It can also cause high blood pressure, heart disease and cancer. High doses blur vision, cause confusion, lead to convulsions and sometimes death.
Caffeine Use Disorders
Caffeine is called the “gentle stimulant” and is used regularly by 90% of Americans. This drug is found in tea, coffee, cola drinks, and cocoa products. In small doses, caffeine can elevate mood and reduce fatigue, but larger doses can produce jitteriness and insomnia.
Regular caffeine use can result in tolerance and dependence. Withdrawal symptoms include headaches, drowsiness, and a generally unpleasant mood. Caffeine’s effect on the brain appears to involve the neurotransmitters adenosine and to a lesser extent serotonin Caffeine block adenosine reuptake.
Biological Causes of Substance-related Disorders
Evidence suggests that substance abuse has a genetic component. Twin, family, and adoption studies indicate that certain people may be genetically vulnerable to drug abuse. Most genetic data on substance abuse comes from research on alcoholism.
Both twin and adoption studies suggest genetic factors play a role in alcoholism, particularly in males. Two studies have located genes that may influence alcoholism on chromosomes 1, 2, 7, and 11, plus a finding that a gene on chromosomes 4 may serve to protect people from becoming alcohol dependent. The field of functional genomics focuses on how genes work to influence addiction.
The pleasurable experience reported by people who use psychoactive substances partly explains why people continue to use them. In effect, people are positively reinforced for using drugs. All drugs seem to affect the reward or pleasure centers of the brain. The pleasure center is believed to include the dopaminergic system and its opioid-releasing neurons that begin in the midbrain ventral tegmental area and then work their way through the nucleus accumbens a region in the basal forebrain rostral to the preoptic area of the hypothalamus) and on to the frontal cortex.
Amphetamines and cocaine (including nicotine and alcohol) act directly on the dopamine system, whereas other drugs increase the availability of dopamine indirectly. GABA, as a major inhibitory neurotransmitter system, helps to turn off the continued activity of the reward system. Opiates inhibit GABA from doing its job, which in turn stops the GABA neurons from inhibiting dopamine, thus making more dopamine available from inhibiting dopamine, thus making more dopamine available in the reward center.
With several drugs, negative reinforcement is related to the drug’s anxiolytic effect, particularly alcohol. Such drugs reduce anxiety via the septal/hippocampal system, which includes a large number of GABA sensitive neurons. Such drugs may enhance the activity of GABA in this region, thereby inhibiting the brain’s normal reaction (anxiety/fear) to anxiety-producing situations.
The personality disorders represent long-standing and ingrained ways of thinking, feeling, and behaving that can cause significant distress. Because people may display two or more of these maladaptive ways of interacting with the world, considerable disagreement remains over how to categorize personality disorders.
DSM-5 includes 10 personality disorders that are divided into three clusters: Cluster A (odd or eccentric) includes paranoid, schizoid, and schizotypal personality disorders; Cluster B (dramatic, emotional, or erratic) includes antisocial, borderline, histrionic, and narcissistic personality disorders; and Cluster C (anxious or fearful) includes avoidant, dependent, and obsessive-compulsive personality disorders.
Cluster A Personality Disorders
People with paranoid personality disorder are excessively mistrustful and suspicious of other people, without any justification. They tend not to confide in others and expect other people to do them harm.
People with schizoid personality disorder show a pattern of detachment from social relationships and a limited range of emotions in interpersonal situations. They seem aloof, cold, and indifferent to other people. People with schizotypal personality disorder are typically socially isolated and behave in ways that would seem unusual to most of us. In addition, they tend to be suspicious and have odd beliefs about the world.
Cluster B Personality Disorders
People with antisocial personality disorder have a history of failing to comply with social norms. They perform actions most of us would find unacceptable, such as stealing from friends and family. They also tend to be irresponsible, impulsive, and deceitful. In contrast to the DSM-5 criteria for antisocial personality, which focuses almost entirely on observable behaviors (for example, impulsively and repeatedly changing employment, residence, or sexual partners), the related concept of psychopathy primarily reflects underlying personality traits (for example, self-centeredness or manipulativeness). People with borderline personality disorder lack stability in their moods and in their relationships with other people, and they usually have poor self-esteem. These individuals often feel empty and are at great risk of suicide. Individuals with histrionic personality disorder tend to be overly dramatic and often appear almost to be acting.
Cluster C Personality Disorders
People with avoidant personality disorder are extremely sensitive to the opinions of others and therefore avoid social relationships. Their extremely low self-esteem, coupled with a fear of rejection, causes them to reject the attention of others. Individuals with dependent personality disorder rely on others to the extent of letting them make everyday decisions, as well as major ones; this results in an unreasonable fear of being abandoned.
People who have obsessive-compulsive personality disorder are characterized by a fixation on things being done “the right way.” This preoccupation with details prevents them from completing much of anything.
Treating people with personality disorders is often difficult because they usually do not see that their difficulties are a result of the way they relate to others.
Personality disorders are important for the clinician to consider because they may interfere with efforts to treat more specific problems such as anxiety, depression, or substance abuse. Unfortunately, the presence of one or more personality disorders is associated with a poor treatment outcome and a generally negative prognosis.
In a 2010 article , Personality disorder: a new global perspective, in the journal, World Psychology, there is growing acceptance that personality disorder is an equal partner with other disorders, and is now accepted worldwide , affecting roughly 6% of the world’s population.
Information found in the 2015 article, Personality Disorders and Their Impact — A Summary from the Personality Disorders Foundation, explains that,
People with severe personality disorders are high-cost, persistent, and intensive users of mental health services. One in every 20 individuals suffers with a personality disorder. Up to 10% of those in outpatient mental health treatment clinics have a personality disorder, and almost 15% of individuals in inpatient psychiatric care have a severe personality disorder. Individuals with personality disorders usually present for therapy with presenting issues other than personality problems, most often with complaints of depression and anxiety. For example, among patients with Borderline Personality Disorder, major depression has been observed in up to 74% of these individuals, and Panic Disorder has been found to occur in 10% to 25% of these individuals. Individuals with personality disorders are also more likely to have an eating disorder, or a history of significant trauma. About one-third of people who frequently use general health services (and for whom no clear medical diagnosis is found) have severe personality disorders. Individuals with personality disorders are more likely to be stigmatized and blamed for their illness, relative to other psychiatric and medical disorders. Relative to other psychiatric disorders, personality disorders have been less understood and recognized, and treatment options and appropriate supportive housing have been less available. Concerns about “stigmatizing” the client sometimes leads clinicians who recognize a personality disorder in a particular patient to not assign this diagnosis because the label “personality disorder” often suggests more frustrating challenges for the clinician. Significant problems with clinical management and treatment compliance often emerge. The length of treatment, frequency of treatment sessions, treatment strategies used, and goals and expectations for both therapist and patient need to be changed when a patient has a personality disorder. There has been an increase in research that clearly supports the underlying neurobiology of these disorders, and increased demonstrations of the effectiveness of different types of medications and psychotherapies. The linkages for treatment of substance abuse and personality disorders are growing, and programs for effective community diversion in the criminal justice system for non-violent personality disordered offenders are being established (2015, paragraphs 6 – 12).
Researchers A. Tom Horvath , Kaushik Misra , Amy K. Epner , and Galen Morgan Cooper , have written in the online AMHC article, Addiction and Personality Disorders, that, “contrary to popular belief, research has been unable to identify an ‘ addictive personality. ‘ However, some personality traits are more commonly observed in people with substance use disorders. Most of the research regarding addiction and personality traits has been conducted with people who have alcohol use disorders. Nonetheless, we observe many of these traits in people with other substance use disorders as well. The most common of these personality traits include nonconformity; impulsivity; sensation- or thrill-seeking; emotional dysregulation, negative affect (e.g., depression, anxiety); low self-esteem; and an external locus of control ” ( no date, AMHC, paragraph 4).