1. Substance-Related and Addictive Disorders
Chapter 14
Substance-Related and
Addictive Disorders
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2. DSM-5 Diagnosis of Substance-Related Disorders
Substance-use disorders
Repeated, frequent use of substances, resulting in problematic behaviors or impairments in personal, social, and occupational functioning
10 categories of substances
Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other/unknown substances
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3. Table 14.1 The DSM-5 in Simple Language: Diagnosing Substance Use Disorders (p. 450)
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4. Alcohol Alcohol Use Disorders Experienced by over 17 million Americans
18% of U.S. college students have suffered from alcohol- related problems in the past year
Cost society billions of dollars in crime, illness, absenteeism, and serious accidents
Binge drinking is the most common pattern of excessive alcohol use in the U.S.
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5. Alcohol Effects of Alcohol Depressant effects in the brain
Dose response:
At lower levels, the drinker experiences lowered inhibitions, increased talkativeness, and increased relaxation
As BAC rises, judgment becomes impaired, self-awareness is reduced, clear thinking becomes more difficult, and slurred speech and mild motor impairments may be present
With BAC >.08%, motor coordination problems are noticeable, along with mood changes, poor attention and memory, and a lack of inhibition
With BAC >.25%, loss of consciousness and severe respiratory problems can occur, leading to death
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6. Alcohol Treatment of Alcohol Use Disorders
Detoxification and inpatient programs
Alcoholics Anonymous
Marital and family therapy
Behavioral treatments
Community reinforcement
Controlled drinking treatments
Motivational interviewing
Relapse prevention
Harm reduction approaches
Medication
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7. Other Sedatives
Reduce neural activity, leading to sedating, hypnotic, or anxiolytic effects
Barbiturates (i.e. “downers”)
Produce relaxation and mild euphoria at low levels and have an effect similar to alcohol intoxication at higher levels
Often prescribed for insomnia
Benzodiazepines (E.g., Valium, Librium, Xanax)
Produce relaxation and mild euphoria
Widely prescribed
Barbiturates and benzodiazepines can produce strong withdrawal symptoms and dependence
Prolonged use can lead to sedative use disorder
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8. Stimulants
E.g., amphetamines, cocaine, Ritalin, caffeine, nicotine, over-the-counter diet pills
Excitatory effects on the central nervous system
Are often abused in conjunction with other drugs
Can cause dangerous physical changes in the brain and cardiovascular system
Can produce psychological and physiological dependence
Stimulant Use Disorder
Tobacco Use Disorder
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9. Stimulants Treatment and Prevention of Tobacco Use Disorder
Public education
Smoking restrictions
CBT and behavior modification programs
Motivational interviewing
Nicotine replacement strategies, bupropion, and varenicline
Most smokers attempt to quit several times before doing so successfully.
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10. Opioids E.g., morphine, heroin, codeine, oxycodone, methadone
Usually produce a pleasurable rush, followed by a dreamy euphoria
Create strong physical dependence and intense withdrawal symptoms
Heroin is the most commonly abused opioid
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11. Opioids Treatment of Opioid Use Disorder
Methadone or buprenorphine maintenance
Adrenergic agonists (ameliorate withdrawal)
Opioid antagonists (prevent relapse)
Adjunctive psychotherapy
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12. Cannabis E.g., marijuana, hashish
Usually produces mild euphoria, sedation/relaxation, and some perceptual distortions
The most commonly used illegal drug in the U.S.
Produces withdrawal and psychological dependence
Associated with a variety of harmful long-term effects
Diseases of lungs, liver, heart, and vasculature
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13. Hallucinogens E.g., LSD, mescaline, psilocybin, MDMA, PCP
Produce perceptual distortions and other unusual sensory experiences
Are not physically addictive but can lead to psychological dependence
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14. Gambling Disorder New disorder in DSM-5
A pattern of ongoing and problematic gambling behavior, leading to clinically significant impairment or distress
Symptoms include
Preoccupation with gambling
Tendency to gamble when feeling upset
Lying or hurting people due to gambling
Unsuccessful attempts to reduce personal gambling
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