1. Substance-Related and Addictive Disorders
Dr. Mohammed Alblowi
SB-Psych
Consultation Liaison Psychiatry – Queen’s University
Neuropsychiatry – University of Western Ontario

2. Disorders Associated with Specific Substances

3. Classifying psychoactive drugs
Depressants
Stimulants
Hallucinogens
Alcohol
Amphetamines
LSD, DMT
Benzodiazepines
Methamphetamine
Mescaline
Opioids
Cocaine
PCP
Solvents
Nicotine
Ketamine
Barbiturates
Khat
Cannabis (high doses)
Cannabis (low doses)
Caffeine
Magic mushrooms
MDMA

4. Alcohol Effects Alcohol is a depressant Immediate effects
A psychoactive substance that causes the depression of central nervous system activity.
Immediate effects
Sedating
Central nervous system depressant
Potentially fatal in excess
Potentiation compounds these effects
In small amounts, alcohol has sedating effects leading users to feel relaxed.
In larger amounts, alcohol may lead drinkers to feel more outgoing, self-confident, and uninhibited.
As drinking continues, alcohol’s effects as a central nervous system depressant become more apparent, as sleepiness, uncoordination, dysphoria, and irritability set in.
Depressant: A psychoactive substance that causes the depression of central nervous system activity.
Excessive drinking affects vital functions and can be fatal.
Potentiation: Combination of the effects of two or more psychoactive substances such that the total effect is greater than the effect of either substance alone.
Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

5. Alcohol Effects Long-term effects Permanent brain damage
NeuroCognitive disorder
Wernicke’s disease: Form of aphasia in which the individual is able to produce language but has lost the ability to comprehend, so that these verbal productions have no meaning.
Korsakoff’s syndrome: Permanent form of amnestic disorder associated with long-term alcohol use in which the individual develops retrograde and anterograde amnesia, leading to an inability to remember recent events or learn new information.
Retrograde amnesia: Amnesia involving loss of memory for past events.
Anterograde amnesia: Amnesia involving the inability to remember new information.
Harmful changes in the liver, gastrointestinal system, bone density, muscles, and immune system, sexual dysfunction.
Wernicke’s disease: Form of aphasia in which the individual is able to produce language but has lost the ability to comprehend, so that these verbal productions have no meaning.
Korsakoff’s syndrome: Permanent form of dementia associated with long-term alcohol use in which the individual develops retrograde and anterograde amnesia, leading to an inability to remember recent events or learn new information.
Retrograde amnesia: Amnesia involving loss of memory for past events.
Anterograde amnesia: Amnesia involving the inability to remember new information.

6. Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2010

7. Theories and Treatment of Alcohol Dependence
Biological
Genetic factors
Medications
Naltrexone - Blocks the effects of the body’s production of alcohol-induced opioids, through involving dopamine.
Disulfiram: Known popularly as Antabuse, a medication used in the treatment of alcoholism that inhibits aldehyde dehydrogenase (ALDH) and causes severe physical reactions when combined with alcohol.
Acamprosate - Reduces the risk of relapse by reducing the individual’s urge to drink and thereby reducing the drive to use alcohol as a way of reducing anxiety and other negative psychological states.
Biological
Twin, family, and adoption studies consistently point to the importance of genetic factors as contributors to alcohol-related disorder.
Genetics of alcohol-related disorders comes from studies examining associations with genes involved in alcohol metabolism and neural transmission.
Medications
Naltrexone - Blocks the effects of the body’s production of alcohol-induced opioids, through involving dopamine.
Disulfiram: Known popularly as Antabuse, a medication used in the treatment of alcoholism that inhibits aldehyde dehydrogenase (ALDH) and causes severe physical reactions when combined with alcohol.
Acamprosate - Reduces the risk of relapse by reducing the individual’s urge to drink and thereby reducing the drive to use alcohol as a way of reducing anxiety and other negative psychological states.

8. Theories and Treatment of Alcohol Dependence
Psychological Treatment
Cognitive-behavioral interventions
Motivational approaches
Expectancy manipulation
Relapse prevention
Combined behavioral intervention
Dual-process theory: Proposes there are automatic processes that generate an impulse to drink alcohol and controlled, effortful processing that regulates these automatic impulses.
Alcohol myopia theory: Proposes that as individuals consume greater amounts of alcohol, they are more likely to make risky choices because the immediate temptation of the moment overcomes the long-term consequences of the behavior.
Relapse prevention: Based on the expectancy model, in which individuals are encouraged not to view lapses from abstinence as signs of certain failure.
The primary emphasis of CBI is on enhancing reinforcement and social support for abstinence.

9. Theories and Treatment of Alcohol Dependence
Sociocultural
Family, community, & cultural stressors
Children of alcoholics at greater risk
Alcohol dependent individuals showed a variety of behaviors :
Early neural dysfunction.
Nervousness and fretfulness as infants.
Hyperactivity as children.
Poor physical coordination.

10. Sedatives, Hypnotics, & Anxiolytics
Sedatives have calming effects on the central nervous system
Hypnotics induces sleep
Anxiolytics are anti-anxiety medications
Medications include:
Benzodiazepines
Barbiturates
Nonbenzodiazepine sleep medications such as:
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)
Medications include:
Benzodiazepines
Barbiturates
Nonbenzodiazepine sleep medications such as:
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zalepon (Sonata)

11. Substances Other Than Alcohol

12. Stimulants
This category of drugs includes substances that have an activating effect on the nervous system.
Amphetamine
Methamphetamine
Cocaine
Stimulants: Substances that have an activating effect on the nervous system.
Amphetamine: Affects the central nervous and the autonomic nervous systems.
Methamphetamine: Related to amphetamine but provokes more intense central nervous system effect.
Cocaine: Highly addictive central nervous system stimulant that an individual snorts, injects, or smokes.
Effects include feelings of euphoria, heightened mental alertness, reduced fatigue, and heightened energy.

13. Long-term Effects of Methamphetamine on the Brain

14. Cocaine in the Brain

15. Cannabis Marijuana Hashish
Marijuana: Psychoactive substance derived from the hemp plant whose primary active ingredient is delta-9-tetrahydrocannabinol (THC).
Hashish, containing a more potent form of THC, comes from the resins of the plant’s flowers.
Individuals use synthetic forms of THC for medicinal purposes:
Treating asthma and glaucoma and reducing nausea in cancer patients undergoing chemotherapy.
Heavy and continued use of marijuana:
Produce effects on bodily functioning.
Lead to higher risk of heart attack.
Lead to impaired respiratory functioning.

16. Cannabis
Marijuana: Psychoactive substance derived from the hemp plant whose primary active ingredient is delta-9-tetrahydrocannabinol (THC).
Hashish, containing a more potent form of THC, comes from the resins of the plant’s flowers.
Individuals use synthetic forms of THC for medicinal purposes:
Treating asthma and glaucoma and reducing nausea in cancer patients undergoing chemotherapy.
Heavy and continued use of marijuana:
Produce effects on bodily functioning.
Lead to higher risk of heart attack.
Lead to impaired respiratory functioning.

17. Summary of Effects of Cannabis on Executive Functions

18. Hallucinogens
Hallucinogens are drugs that cause people to experience profound distortions in their perception of reality.
LSD
Peyote
Psilocybin
PCP
MDMA
Included in hallucinogen-related disorders are use and intoxication, but not withdrawal.
Hallucinogens: Psychoactive substances that cause abnormal perceptual experiences in the form of illusions or hallucinations, usually visual in nature.
LSD (lysergic acid diethylamide): Users ingest in tablets, capsules, and liquid form.
Produces tolerance.
Peyote: Primary ingredient is mescaline.
Psilocybin: Found in certain mushrooms.
PCP (phencyclidine, a.k.a. “angel dust”): Originally developed as an intravenous anesthetic.
Symptoms that mimic schizophrenia, mood disturbance, memory loss, difficulties with speech and thinking, weight loss, and depression.
MDMA- known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine and mescaline. Users experience feelings of increased energy, euphoria, emotional warmth, distorted perceptions and sense of time, and unusual tactile experiences.
Users experience unpleasant psychological effects
Confusion, depression, sleep problems, cravings for the drug, and severe anxiety.
Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

19. Hallucinogens
Psychoactive substances that cause abnormal perceptual experiences in the form of illusions or hallucinations, usually visual in nature.
LSD (lysergic acid diethylamide): Users ingest in tablets, capsules, and liquid form.
Produces tolerance.
Peyote: Primary ingredient is mescaline.
Psilocybin: Found in certain mushrooms.
PCP (phencyclidine, a.k.a. “angel dust”): Originally developed as an intravenous anesthetic.
Symptoms that mimic schizophrenia, mood disturbance, memory loss, difficulties with speech and thinking, weight loss, and depression.
MDMA- known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine and mescaline.
Users experience feelings of increased energy, euphoria, emotional warmth, distorted perceptions and sense of time, and unusual tactile experiences.
Users experience unpleasant psychological effects: Confusion, depression, sleep problems, cravings for the drug, and severe anxiety.

20. Opioids An opioid is a substance that relieves pain.
Within opioid-related disorders are opioid use, intoxication, and withdrawal.
Hydrocodone
Oxycodone
Morphine
Codeine
Heroin
Opioids: Psychoactive substances that relieve pain.
Clinicians prescribe hydrocodone products for a variety of painful conditions, including dental and injury-related pain.
Physicians use morphine before and after surgical procedures to alleviate severe pain.
Clinicians prescribe codeine for mild pain.
Heroin: Form of opioid, synthesized from morphineis.
Serious health consequences of heroin use:
Fatal overdoses
Infectious diseases
Damage to the cardiovascular system, abscesses, and liver or kidney disease.

21. Opioids
Clinicians prescribe hydrocodone products for a variety of painful conditions, including dental and injury-related pain.
Physicians use morphine before and after surgical procedures to alleviate severe pain.
Clinicians prescribe codeine for mild pain.
Heroin: Form of opioid, synthesized from morphineis.
Serious health consequences of heroin use:
Fatal overdoses
Infectious diseases
Damage to the cardiovascular system, abscesses, and liver or kidney disease.
Opioids: Psychoactive substances that relieve pain.
Clinicians prescribe hydrocodone products for a variety of painful conditions, including dental and injury-related pain.
Physicians use morphine before and after surgical procedures to alleviate severe pain.
Clinicians prescribe codeine for mild pain.
Heroin: Form of opioid, synthesized from morphineis.
Serious health consequences of heroin use:
Fatal overdoses
Infectious diseases
Damage to the cardiovascular system, abscesses, and liver or kidney disease.

22. Caffeine
Found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies.
Increases:
An individual’s perceived level of energy alertness
Blood pressure and may lead to increases in the body’s production of cortisol
Intoxication: > 300 mg
Withdrawal Sx
Caffeine withdrawal symptoms:
Headache
Tiredness and fatigue
Sleepiness and drowsiness
Dysphoric mood
Difficulty concentrating
Depression
Irritability
Nausea
Vomiting
Muscle aches
Stiffness

23. Caffeine Caffeine withdrawal symptoms: Headache Tiredness and fatigue
Sleepiness and drowsiness
Dysphoric mood
Difficulty concentrating
Depression
Irritability
Nausea
Vomiting
Muscle aches
Stiffness

24. Tobacco Nicotine: Psychoactive substance found in cigarettes
Stimulates the release of adrenaline (norepinephrine)
Increases blood pressure, heart rate, and respiration
Withdrawal symptoms
Irritability, difficulties with concentration, and strong cravings for nicotine.
Withdrawal symptoms
Irritability, difficulties with concentration, and strong cravings for nicotine.

25. Inhalants
Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors.
Inhalants have similar effects as alcohol.
Slurring of speech, loss of coordination, euphoria, dizziness, and, over time, loss of inhibition and control.

26. Inhalants
Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors.
Examples: Volatile solvents, Aerosols, Gases, Nitrites
Inhalants have similar effects as alcohol.
Slurring of speech, loss of coordination, euphoria, dizziness, and, over time, loss of inhibition and control.
Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors.
Inhalants have similar effects as alcohol.
Slurring of speech, loss of coordination, euphoria, dizziness, and, over time, loss of inhibition and control.

27. Treatment

28. Substance Disorders: The Bio-psychosocial Perspective
Various treatment programs for people with substance-related have emerged.
Biological treatment may involve the prescription of substances that block or reduce cravings.
Behavioral treatment involves techniques such as contingency management, cognitive behavioral therapy, and relapse prevention.

29. Treatment To prevent heroin relapse
Methadone: Synthetic opioid that produces a safer and more controlled reaction than heroin and is used in treating heroin addiction.
Buprenorphine: Used in the treatment of heroin addiction.
Naltrexone: Used in the treatment of heroin addiction.

30. Non-Substance-Related Disorders

31. Gambling Disorder
A non-substance-related disorder involving the persistent urge to gamble.
This disorder is included with substance use disorders as it is now conceptualized as showing many of the same behaviors, such as:
Cravings
Increasing needs to engage in the behavior
Negative social consequences.

32. gambling disorder
People with gambling disorder also have high rates comorbidity:
Nicotine dependence (60 percent)
Dependence on other substances (58 percent)
Mood disorder (38 percent)
Anxiety disorder (37 percent)
Mood and anxiety disorders are more likely to precede, rather than follow, the onset of gambling disorder

33. Another non-substance addiction

34. Thank you
Summary
Questions