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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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

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

17. 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.

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

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

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

27. 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

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

29. 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 hours. ATI final say)

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

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

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

33. 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

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

35. 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

36. 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

37. 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

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

39. 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

40. 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

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

42. 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

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

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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

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

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

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

54. 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