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Endogenous cannabinoids assist in regulation of hunger, pain perception, inflammation, and stress responses. Tetrahydrocannabinol (THC), a component of cannabis, activates cannabinoid receptors, producing effects that are often emotionally pleasing and cognitively interesting. THC effects impair complex tasks, such as driving. Addiction develops in 8--10 percent of all cannabis users, and in about 25 percent of daily users. Regular adolescent users are especially vulnerable. Adverse outcomes of cannabis addiction include too much time spent intoxicated, important activities given up, worsening of psychological problems, and failed attempts to stop use. The withdrawal syndrome includes irritability, anxiety, depression, and sleep difficulties. Long-term heavy use of cannabis is associated with academic failure and subtle cognitive impairment. Medical uses of cannabis include relief of nausea, appetite improvement, and lessened neuropathic pain. Medical use may increase cannabis addiction, a risk somewhat similar to that of other, more traditional medications for pain, anxiety, and attention disorders. Because cannabis is now a commercial product, its potency has increased in recent years.
This textbook surveys the current knowledge on substance use disorders (SUD), summarizing scientific evidence from numerous fields. It uses a biopsychosocial framework to integrate the many factors that contribute to addictions, from genetic predispositions, neurological responses caused by drugs, co-occurring psychiatric disorders, personality traits, and developmental conditions to cultural influences. Real-life vignettes and first-person accounts build understanding of the lived experience of addiction. The currently accepted practices for diagnosis and treatment are presented, including the role of 12-step programmes and other mutual-assistance groups. The text also investigates the research methods that form the foundation of evidence-based knowledge. The main body text is augmented by study guideposts such as learning objectives, review exercises, highlighted key terms, and chapter summaries, which enable more efficient comprehension and retention of the book's material.
According to behavioral theory, positive and negative reinforcement, along with stimuli associated with positive or negative incentives, control SUD as well as benign drug use. Cognitive theory adds the influence of the social context and human cognition. Positive reinforcement, often experienced as pleasure, is most effective immediately after a given behavior – such as addictive drug use. Negative reinforcement (relief of an aversive state) also has powerful behavioral control. Addictive drugs temporarily relieve many unpleasant conditions, including the shame and guilt of addiction. Any aversive (punishing) consequences usually appear much later, decreasing their power to suppress behavior. When drugs are easily available and intoxication is tolerated in a society, heavy use is more prevalent, abuse is enabled, and addiction develops in those with fewer risk factors. Eventually, after losses resulting from heavy drug use, further use may be the only available coping tactic and source of reward. Continued drug use brings additional harm, but now has even greater control over behavior because it is the sole source of even temporary relief.
Smoking is socially accepted or tolerated and produces neither intoxication nor immediate adverse consequences. Nicotine binds to acetylcholine receptors, indirectly resulting in dopamine release and positive reinforcement. Nicotine effects become conditioned to smoking-related stimuli, including taste and tactile sensations, adding to the reward value of smoking. Two-thirds of daily smokers are addicted to nicotine. Situations associated with smoking trigger tobacco craving, especially during nicotine withdrawal. The nicotine withdrawal syndrome includes irritability, anxiety, anger, and depression. Relief of these symptoms promotes continued smoking. Emotional states similar to withdrawal symptoms also elicit craving. Stopping tobacco use is very difficult for addicted smokers with psychiatric conditions, as well as for those who began tobacco use during adolescence. Tobacco use shortens lifespan by an average of 13--14 years. Half of all heavy smokers die from a tobacco-related disease. Nicotine vapor is less toxic than tobacco smoke, but electronic cigarette users often become smokers. Some addicted individuals maintain that nicotine dependence is the hardest SUD to overcome.
Psychoactive drug effects can be useful and pleasurable, but can also be dangerous, with the potential for development of substance use disorders (SUD). Although for most addictive drugs a minority of users develops an SUD, drug misuse is a significant public health hazard. In addition to biological toxicity, dangerous behavior, and other problems, an addictive lifestyle often accompanies compulsive drug use and brings isolation, dishonesty, and interpersonal difficulties. The causes of SUD are multiple and often difficult to identify, coming from genetic, neurological, psychiatric, developmental, and environmental factors. Adverse consequences may be delayed and of uncertain origin, rather than definite results of drug use. Causes and consequences of SUD are investigated by clinical observations, epidemiological surveys, studies of brain function and genetics, and controlled experiments, including research with animal subjects. SUD is identified by aberrant behaviors related to drug use, and, because of the numerous causes, is best viewed as biopsychosocial in nature.