Substance-Related Disorders Part I Chapter 13 Substance-Related Disorders Part I

Substance-Use Disorders Substance abuse DSM-IV-TR criteria Recurrent substance use results in A failure to fulfill major role obligations at work, school, or home Use in situations in which it is physically hazardous

Substance-Use Disorders (cont.) Substance abuse DSM-IV-TR criteria (cont.) Recurrent substance-related legal problems Continued substance use despite having persistent or recurrent social or interpersonal problems

Substance-Use Disorders (cont.) Substance dependence Physical dependence The need for increasing amounts to produce the desired effects A syndrome of withdrawal on cessation

Substance-Use Disorders (cont.) Substance dependence (cont.) Psychological dependence An overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort Extremely powerful; producing intense craving for a substance as well as compulsive use of it

Substance-Use Disorders (cont.) Substance dependence DSM-IV-TR criteria Evidence of tolerance Need for markedly increased amounts Markedly diminished effects Evidence of withdrawal Symptoms associated with the cessation of the substance Substance taken to relieve withdrawal symptoms

Substance-Use Disorders (cont.) Substance dependence DSM-IV-TR criteria (cont.) Substance often taken in larger amounts or over a longer period Persistent desire or unsuccessful efforts to cut down or control use

Substance-Use Disorders (cont.) Substance dependence DSM-IV-TR criteria (cont.) A great deal of time is spent Obtaining the substance Using the substance Recovering from the effects Social, occupational, recreational activities given up or reduced because of substance use

Substance-Use Disorders (cont.) Substance dependence DSM-IV-TR criteria (cont.) Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem associated with use of the substance

Substance-Use Disorders (cont.) Substance intoxication DSM-IV-TR criteria Development of reversible substance syndrome caused by recurrent ingestion of a substance Clinically significant maladaptive behavior or psychological changes Resulting from the effect of the substance on the CNS Developed during or shortly after use of substance

Substance-Use Disorders (cont.) Substance intoxication DSM-IV-TR criteria (cont.) Symptoms not due to a general medical condition and not better accounted for by another mental disorder

Substance-Use Disorders (cont.) Substance withdrawal DSM-IV-TR criteria Development of a substance-specific syndrome caused by cessation of or reduction in heavy and prolonged substance use

Substance-Use Disorders (cont.) Substance withdrawal DSM-IV-TR criteria (cont.) Clinically significant distress or impairment in Social relationships Occupation Other important areas of functioning

Substance-Use Disorders (cont.) Substance withdrawal DSM-IV-TR criteria (cont.) Symptoms not due to a general medical condition and not better accounted for by another mental disorder

Classes of Psychoactive Substances Alcohol Amphetamines and related substances Caffeine Cannabis Cocaine Hallucinogens

Classes of Psychoactive Substances (cont.) Inhalants Nicotine Opioids Phencyclidine and related substances Sedatives, hypnotics, and anxiolytics

Etiological Implications Biological factors Genetics: apparent hereditary factor, particularly with alcoholism Biochemical: alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction.

Etiological Implications (cont.) Psychological factors Developmental influences May be related to severe ego impairment and disturbances in the sense of self Fixation in the oral stage of psychosexual development

Etiological Implications (cont.) Psychological factors (cont.) Personality factors: certain personality traits are thought to increase a tendency toward addictive behavior, including Low self-esteem Frequent depression Passivity Inability to relax or defer gratification Inability to communicate effectively

Etiological Implications (cont.) Sociocultural factors Social learning: children and adolescents are more likely to use substances if they have parents who provide a model for substance use Use of substances may also be promoted within the peer group

Etiological Implications (cont.) Sociocultural factors (cont.) Conditioning: pleasurable effects from substance use act as a positive reinforcement for continued use of substance Cultural and ethnic influences: some cultures are more prone to the abuse of substances than others

Dynamics of Substance-Related Disorders Alcohol abuse and dependence Patterns of use or abuse Phase I. Prealcoholic phase: characterized by use of alcohol to relieve everyday stress and tensions of life

Dynamics of Substance-Related Disorders (cont.) Alcohol abuse and dependence (cont.) Patterns of use or abuse (cont.) Phase II. Early alcoholic phase: begins with blackouts: brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person

Dynamics of Substance-Related Disorders (cont.) Alcohol abuse and dependence (cont.) Patterns of use or abuse (cont.) Phase III. The crucial phase: person has lost control; physiological dependence clearly evident Phase IV. The chronic phase: characterized by emotional and physical disintegration; person is usually intoxicated more often than sober

Effects on the Body Peripheral neuropathy Alcoholic myopathy Wernicke’s encephalopathy Korsakoff’s psychosis Alcoholic cardiomyopathy Esophagitis Gastritis Pancreatitis

Effects on the Body Alcoholic Hepatitis Cirrhosis Leukopenia Portal hypertension Ascites Esophageal varices Hepatic encephalopathy Leukopenia Thrombocytopenia

Effects on the Body (cont.) Sexual dysfunction For women Changes in the menstrual cycle Decreased or loss of ability to become pregnant For men Diminished libido Decreased sexual performance Impaired fertility

Use During Pregnancy Fetal Alcohol Spectrum Disorders (FASDs) Fetal alcohol syndrome (FAS) Alcohol-related neurodevelopmental disorder Alcohol-related birth defects

Dynamics of Substance-Related Disorders Alcohol intoxication: occurs at blood alcohol levels from 100 to 200 mg/dL Alcohol withdrawal: occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use (physio texbooks state 24-48 hours. ATI final say)

Dynamics of Substance-Related Disorders (cont.) Sedative, hypnotic, or anxiolytic abuse and dependence A profile of the substance Barbiturates Nonbarbiturate hypnotics Antianxiety agents

Sedative, Hypnotic, or Anxiolytic Abuse and Dependence Pattern of use/abuse Effects on the body Sleep and dreaming Respiratory depression Cardiac effects Renal function

Sedative, Hypnotic, or Anxiolytic Abuse and Dependence (cont.) Effects on the body (cont.) Hepatic effects Body temperature Sexual functioning

Sedative, Hypnotic, or Anxiolytic Abuse and Dependence (cont.) Intoxication: with these CNS depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug) Withdrawal: onset of symptoms depends on the half-life of the drug from which the person is withdrawing

Dynamics of Substance-Related Disorders CNS stimulant abuse and dependence A profile of the substance Amphetamines Nonamphetamine stimulants Cocaine Caffeine Nicotine

CNS Stimulant Abuse and Dependence Patterns of use and abuse Effects on the body CNS effects Cardiovascular effects Pulmonary effects GI and renal effects Sexual functioning

CNS Stimulant Abuse and Dependence (cont.) Intoxication Amphetamine and cocaine intoxication produces euphoria or affective blunting, hypervigilance, anxiety, tension, anger, and impaired judgment Physical effects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, confusion, seizures, coma

CNS Stimulant Abuse and Dependence (cont.) Intoxication (cont.) Intoxication from caffeine usually occurs following consumption in excess of 250 mg Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thoughts and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation

CNS Stimulant Abuse and Dependence (cont.) Withdrawal From amphetamines and cocaine: may include dysphoria, fatigue, sleep disturbances, increased appetite, and psychomotor retardation or agitation

CNS Stimulant Abuse and Dependence (cont.) Withdrawal (cont.) From caffeine: may include headache, fatigue, anxiety, irritability, depression, impaired psychomotor performance, nausea, vomiting, craving for caffeine, and muscle pain and stiffness From nicotine: may include dysphoria, anxiety, difficulty concentrating, restlessness, insomnia, irritability, frustration, decreased heart rate, and increased appetite

Dynamics of Substance-Related Disorders Inhalant abuse and dependence A profile of the substance Aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners

Inhalant Abuse and Dependence Patterns of use and abuse Effects on the body CNS effects Respiratory effects GI effects Renal system effects

Inhalant Abuse and Dependence (cont.) Inhalant intoxication Develops during or shortly after use of or exposure to volatile inhalants Symptoms include Dizziness, incoordination, unsteady gait Nystagmus, slurred speech, tremor Lethargy, psychomotor retardation Blurred vision, euphoria Stupor or coma

Dynamics of Substance-Related Disorders Opioid abuse and dependence A profile of the substance Opioids of natural origin Opioid derivatives Synthetic opiate-like drugs

Opioid Abuse and Dependence Patterns of use and abuse Effects on the body CNS Gastrointestinal effects Cardiovascular effects Sexual functioning

Opioid Abuse and Dependence (cont.) Intoxication Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment Severe opioid intoxication can lead to respiratory depression, coma, and death

Opioid Abuse and Dependence (cont.) Withdrawal From short-acting drugs (e.g., heroin): symptoms occur within 6 to 12 hours and subside in 5 to 7 days From long-acting drugs (e.g., methadone): symptoms occur within 1 to 3 days and subside in 10 to 14 days From ultra-short-acting drugs (e.g., meperidine): symptoms begin quickly, peak in 8 to 12 hours, and subside in 4 to 5 days

Opioid Abuse and Dependence (cont.) Withdrawal (cont.) Symptoms of opioid withdrawal include Dysphoric mood, nausea/vomiting, sweating Muscle aches, lacrimation or rhinorrhea Pupillary dilation, piloerection, diarrhea Abdominal cramping, yawning, fever Insomnia

Dynamics of Substance-Related Disorders Hallucinogen Abuse and Dependence A profile of the substance Naturally occurring hallucinogens Synthetic compounds Patterns of use and abuse Use is usually episodic

Dynamics of Substance-Related Disorders (cont.) Hallucinogen intoxication Occurs within minutes to a few hours after using drug Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, palpitations

Hallucinogens: Effects on the Body Physiological Nausea/vomiting Chills Pupil dilation Increased BP, pulse Loss of appetite Insomnia Elevated blood sugar Decreased respirations Psychological Heightened response to color, sounds Distorted vision Sense of slowed time Magnified feelings Paranoia, panic Euphoria, peace Depersonalization Derealization Increased libido

Hallucinogen Intoxication Symptoms of PCP intoxication include belligerence and assaultiveness and may proceed to seizures or coma

Dynamics of Substance-Related Disorders (cont.) Cannabis abuse and dependence A profile of the substance Marijuana Hashish Patterns of use and abuse

Cannabis Abuse and Dependence Effects on the body Cardiovascular effects Respiratory effects Reproductive effects CNS effects Sexual functioning

Cannabis Abuse and Dependence (cont.) Intoxication Symptoms include impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment Physical symptoms include conjunctival injection, increased appetite, dry mouth, and tachycardia Impairment of motor skills lasts for 8 to 12 hours