The Narcissist & Substance Dependence
Substance Dependence
In order to justify the diagnosis of a psychoactive substance
use disorder, the impairment in functioning that
results from the substance use must be severe and long lasting.
Some of the symptoms must continue for at
least a month or they must occur frequently for a period
of at least 6 months. Getting drunk at the company
New Year's Eve party would not qualify; neither would
a single drunken binge after a family quarrel. Instead,
ere must be significant, ongoing maladaptive behavior
that interferes with social functioning or effectiveness on
the job and continues even though the person knows
that use of the substance is having important negative
consequences.
The characteristic of substance dependence is
that when not actually using the substance, the person
spends a lot of time looking forward to using it and
devotes a great deal of effort to making it available for
example, an office worker might have a three-martini
lunch and keep the glow going by nipping at a bottle
he keeps hidden in his desk. He would be unable to
restrict his use of alcohol to certain times of the day,
such as after working hours, even though his accuracy
in preparing reports had slipped and he had received
several warnings from the boss. A factory worker might
know that her safety depended on being alert around a
drill press, yet she might still drink on the job . A retired
engineer might continue to drink even though he knew
that the resultant damage to his liver was creating a life
threatening situation. All of these examples involve alcohol
however we could have substituted marijuana, 'heroin
or Valium. The critical factor is not the part of the substance
used but its effects on the person's life.
Physiological dependence on a substance can be
shown in one of two ways: tolerance or withdrawal.
Withdrawal refers to a particular set of physical symptoms
that occur when a person stops or cuts down on
the use of a psychoactive substance. The physical reaction
that occurs when the use of heroin is stopped is
probably the best-known form of withdrawal. Tolerance
means that the person has to use more and more
of a substance to get the same effect, or that the same sized
dose has progressively less effect as time goes by.
For example, the pain-reducing power of morphine
decreases if the drug is given over a long period. alcoholics
consume increasing amounts of alcohol, their cell
membranes are altered so that less and less of the alcohol
permeates the membrane, less alcohol is actually
penetrating cell membranes, an alcoholic may have less
alcohol in his or her brain than a normal person with
the same blood level of alcohol would. This is interesting
in view of the fact that some alcoholics can perform
well after consuming an amount of1alcohol that would
put a nonalcoholic into a coma.
I’ve listed the criteria of dependence on psychoactive
substances. The substances that can produce
physiological dependence include alcohol, amphetamines,
barbiturates, opioids, and tobacco . Four types
of substances are related to psychological dependence
only (i.e., have never been shown to produce psychological
dependence). They are cannabis, cocaine, psychedelics, and PCP.
Psychologists are interested in substance dependence
because a person's response to drugs seems to be
due to a combination of physiological and psychological
factors. Some people can control their use of many of
these substances; others seem unable to do so. Some
individuals who are addicted have severe withdrawal
symptoms others do not. The effects that drugs produce
also differ from one user to another.
In order to justify the diagnosis of a psychoactive substance
use disorder, the impairment in functioning that
results from the substance use must be severe and long lasting.
Some of the symptoms must continue for at
least a month or they must occur frequently for a period
of at least 6 months. Getting drunk at the company
New Year's Eve party would not qualify; neither would
a single drunken binge after a family quarrel. Instead,
ere must be significant, ongoing maladaptive behavior
that interferes with social functioning or effectiveness on
the job and continues even though the person knows
that use of the substance is having important negative
consequences.
The characteristic of substance dependence is
that when not actually using the substance, the person
spends a lot of time looking forward to using it and
devotes a great deal of effort to making it available for
example, an office worker might have a three-martini
lunch and keep the glow going by nipping at a bottle
he keeps hidden in his desk. He would be unable to
restrict his use of alcohol to certain times of the day,
such as after working hours, even though his accuracy
in preparing reports had slipped and he had received
several warnings from the boss. A factory worker might
know that her safety depended on being alert around a
drill press, yet she might still drink on the job . A retired
engineer might continue to drink even though he knew
that the resultant damage to his liver was creating a life
threatening situation. All of these examples involve alcohol
however we could have substituted marijuana, 'heroin
or Valium. The critical factor is not the part of the substance
used but its effects on the person's life.
Physiological dependence on a substance can be
shown in one of two ways: tolerance or withdrawal.
Withdrawal refers to a particular set of physical symptoms
that occur when a person stops or cuts down on
the use of a psychoactive substance. The physical reaction
that occurs when the use of heroin is stopped is
probably the best-known form of withdrawal. Tolerance
means that the person has to use more and more
of a substance to get the same effect, or that the same sized
dose has progressively less effect as time goes by.
For example, the pain-reducing power of morphine
decreases if the drug is given over a long period. alcoholics
consume increasing amounts of alcohol, their cell
membranes are altered so that less and less of the alcohol
permeates the membrane, less alcohol is actually
penetrating cell membranes, an alcoholic may have less
alcohol in his or her brain than a normal person with
the same blood level of alcohol would. This is interesting
in view of the fact that some alcoholics can perform
well after consuming an amount of1alcohol that would
put a nonalcoholic into a coma.
I’ve listed the criteria of dependence on psychoactive
substances. The substances that can produce
physiological dependence include alcohol, amphetamines,
barbiturates, opioids, and tobacco . Four types
of substances are related to psychological dependence
only (i.e., have never been shown to produce psychological
dependence). They are cannabis, cocaine, psychedelics, and PCP.
Psychologists are interested in substance dependence
because a person's response to drugs seems to be
due to a combination of physiological and psychological
factors. Some people can control their use of many of
these substances; others seem unable to do so. Some
individuals who are addicted have severe withdrawal
symptoms others do not. The effects that drugs produce
also differ from one user to another.
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