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Substance-Use Disorders

A substance is any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors.

(1) central nervous system depressants, including alcohol, barbiturates, benzodiazepines, and inhalants

(2) central nervous system stimulants, including cocaine, amphetamines, nicotine, and caffeine

(3) opioids, including heroin and morphine (4) hallucinogens and phencyclidine (PCP) (5) cannabis

Five categories of abused substances

Substance intoxication: Substance withdrawal:

Substance abuse:Substance dependence:

Substance-Related Conditions Recognized by the DSM-IV-TR

Substance intoxication: Experience of significant maladaptive behavioral and psychological symptoms due to the effect of a substance on the central nervous system.

Substance withdrawal: Experience of clinical significant distress in social, occupational, or other areas of functioning due to the cessation or reduction of substance use.

Substance abuse: Diagnosis given when recurrent substance use leads to significant harmful consequences.

Substance dependence: Diagnosis given when substance use leads to physiological dependence or significant impairment or distress.

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Impaired centre control1. The substance is taken in increasingly

large amount or over period of time than originally intended.

2. The substance user craves the use of the substance.

3. The substance user feels an ongoing desire to cut down or control substance abuse.

4. Much time is spent in obtaining, using or recovering from the substance.

Criteria for Substance Use Disorder

Social impairment5. The ongoing use of the substance

often results in an inability to meet responsibilities at home, work or school

6. Important social, work-related or recreational activities are abandoned or cut back because of substance use.

7. Ongoing substance use despite recurring social or relationship difficulties caused or made worse by the effects or the substance.


Risky use8. Ongoing substance use in physically

dangerous situations such as driving car or operating machinery.

9. Substance use continues despite the awareness of ongoing physical or psychological problems that have likely arisen or been made worse by the substance.


Pharmacological Criteria10. Changes in the substance user’s tolerance of the substance is indicated by the need for increased amounts of the substance to achieve the desired effect or by a diminished experience of intoxication over time with the same amount of the substance.11. Withdrawal is demonstrated by the characteristic withdrawal syndrome of the substance and or taking the same or similar substance to relieve withdrawal symptoms.


DSM-5

Substance abuse and dependence may be combined in one diagnosis to be called substance-use disorder.

Diagnostic criteria for substance-use disorder will include: continued use of substances despite negative

social, occupational, and health consequences evidence of tolerance or withdrawal.

“Craving the substance” will be added because it is a common symptom of abuse/dependence

“Legal problems” will be removed from the criteria

DSM V

Depressants

Depressants slow the central nervous system.

In moderate doses, they make people relaxed and somewhat sleepy, reduce concentration, and impair thinking and motor skills.

Includes alcohol, benzodiazepines, barbiturates, and inhalants.

1. DEPRESSANTS

Alcohol

Alcohol abuse Alcohol dependence Binge drinking Withdrawal

Depressants: Alcohol

Alcohol abuse Alcohol dependence Binge drinking Withdrawal

Alcohol

Gender Differences

Ethnic Differences in Alcohol Use in the United States

Long-term Effects of Alcohol Abuse

Low-grade hypertension Alcohol-induced persisting amnesic disorder

Wernicke’s encephalopathy Alcohol-induced dementia

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cause decrease in blood pressure, respiratory rate and heart rate.

(overdose) can cause respiratory arrest or cardiovascular collapse

Benzodiazepines and Barbiturates

Benzodiazepines and Barbiturates

Benzodiazepines (such as Xanax, Valium, Halcion, and Librium) and barbiturates (such as Quaalude) are legally manufactured and sold by prescription, usually for the treatment of anxiety and insomnia.

Two common patterns of abuse can develop with these substances: 1. adolescents using them for recreational

purposes 2. people (particularly women) using initially

under physician’s care but then increasing doses as tolerance develops

2. STIMULANTS Activate the central nervous system, causing feelings of energy, happiness, and power, a decreased desire for sleep, and a diminished appetite

Include cocaine and the amphetamines (including the related drugs methamphetamines) Impart a psychological lift or rush Cause dangerous increases in blood pressure and

heart rate, alter the rhythm and electrical activity of the heart, and constrict the blood vessels, which can lead to heart attacks, respiratory arrest, and seizures

Caffeine and nicotine Prescription stimulants, including Dexedrine

and Ritalin

white powder extracted from coca plant; one of the most addictive substances known.

people snort or inject it intravenously.

Cocaine

Crack- freebase cocaine usually smoked in a water pipe or mixed in tobacco or marijuana cigarette.

produces instant rush intense euphoria; heightened self-esteem; alertness; energy; feelings of competence and creativity.

Cocaine

When taken repeatedly: grandiosity, impulsiveness, hyper sexuality, compulsive behavior, agitation and anxiety reaching to the point of panic and paranoia.

Stimulants: Amphetamines

Used to combat depression or fatigue or boost energy and self-confidence; also in diet drugs

Cause the release of dopamine and norepinephrine and block reuptake

Symptoms of intoxication are similar to cocaine intoxication

Stimulants: Cocaine

Symptoms include:

– behavioral changes (e.g., euphoria or affective blunting; impaired judgment)

– rapid heartbeat, dilation of pupils, elevated or lowered blood pressure

– weight loss, nausea or vomiting– muscular weakness– slowed breathing, chest pain, confusion

– seizures, coma27

Stimulants: Nicotine

• No DSM-V diagnosis for the symptoms, but nicotine operates on both the central and peripheral nervous system

• Results in the release of several biochemicals that may have direct reinforcing effects on the brain, including dopamine, norepinephrine, serotonin, and the endogenous opioids

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Stimulants: Nicotine (continued)

• Withdrawal Symptoms •dysphoria or depressed mood• insomnia• irritability•frustration or anger•anxiety •difficulty concentrating•restlessness •decreased heart rate • increased appetite or weight gain

Stimulants: Caffeine•The most heavily used stimulant drug

•75% of caffeine ingested through coffee

•The average American drinks about two cups of coffee per day; a cup of brewed coffee has about 100 milligrams of caffeine

•Caffeine stimulates the central nervous system increasing levels of dopamine, norepinephrine, and serotonin

Stimulants: Caffeine (continued)

• Symptoms: Restlessness, nervousness, excitement, insomnia, flushed face, frequent urination, stomach upset, muscle twitching, rambling flow of thought or speech, rapid heartbeat, periods of inexhaustibility, psychomotor agitation

• Withdrawal Symptoms: Marked fatigue or drowsiness, increased appetite or weight gain, marked anxiety or depression, nausea or vomiting

3. Opioids- derived from the opium poppy

•Morphine•Heroin•Codeine•Methadone34

4. Hallucinogens and PCP

Hallucinogens are a mixed group of substances including LSD, MDMA (also called ecstasy), and peyote.

PCP, also known as angel dust, is a manufactured as a powder to be snorted or smoked. Although not classified as a hallucinogen, it has many of the same effects.

5. Cannabis The leaves of the cannabis (or hemp) plant

can be cut, dried, and rolled into cigarettes or inserted into food and beverages. In North America, the result is known as marijuana, weed, pot, grass, reefer, and Mary Jane

Cannabis is the most commonly used illegal drug in the United States, with about 40% of the population reporting use of it at some time in their lives, and 6% in the last month

About 7% of the population would qualify for a diagnosis of cannabis abuse, and 2 to 3% for a diagnosis of cannabis dependence

Occasional use is widespread: 30% of college students say they have used cannabis in the last year

Cannabis

Inhalants Inhalants: solvents such as gasoline, glue,

paint thinners, and spray paints. Greatest users of inhalants are young boys

between 10 and 15 years of age. Chronic users may have a variety of

respiratory irritations and rashes. Can also cause permanent damage to the

central nervous system, and can lead to organ failure and death.

Inhalants have a variety of effects depending on the specific drug:

Intoxications Symptoms

Behavioral changes: impaired judgment, belligerence, assaultiveness, apathy.

Dizziness, Incoordination, Slurred speech, Unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, blurred vision, stupor, coma, euphoria.

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