2. Substance Use Disorders: Overview Chapter 10

3. Perspectives on Substance-Related Disorders: An Overview The Nature of Substance-Related Disorders Problems related to the use and abuse of psychoactive substances Psychoactive substance – any chemical entity or mixture, not required for the maintenance of health, that alters mood, thinking, or behavior when administered Some Important Terms and Distinctions Substance use vs. substance intoxication Substance abuse vs. substance dependence Tolerance vs. withdrawal Route of administration

4. Substance Use vs. Intoxication Substance Use Ingestion of psychoactive substance in moderate amounts that does not significantly interfere with functioning Substance Intoxication Ingestion of psychoactive substances that produces significant acute changes in mood, thinking, or behavior

5. Substance Abuse vs. Dependence Substance Abuse Maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by failure to fulfill major role obligations use in hazardous situations recurrent substance-related legal problems use despite knowledge of recurrent drug related problems Does not meet criteria for substance dependence

6. Substance Abuse v. Dependence Substance Dependence Maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by Tolerance Withdrawal Loss of control over use Persistent desire or unsuccessful efforts to cut down or quit Great deal of time devoted to obtaining or using substance Important activities are sacrificed due to use Continued use despite knowledge of persistent problems Specify with or without physiological dependence Course specifiers reflect current status of disorder

7. Tolerance vs. Withdrawal Tolerance need for markedly increased amounts of the substance to achieve intoxication or desired effect markedly diminished effect with continued use Withdrawal the characteristic withdrawal syndrome for the substance the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

8. Route of Administration Route of drug administration affects immediacy of psychological effects Oral  intranasal  inhalant  injection Route of administration adds health risks Overdose much easier with faster routes of administration Inhalant – lung cancer Injection – HIV, hepatitis, infection

9. Categories of Psychoactive Substances Four Main Categories of Substances Depressants – Result in behavioral sedation (e.g., alcohol, sedative, anxiolytic, and hypnotic drugs) Stimulants – Increase alertness and elevate mood (e.g., cocaine, amphetamines, nicotine, caffeine) Opiates – Primarily produce analgesia and euphoria (e.g., heroin, morphine, codeine) Hallucinogens – Alter sensory perception (e.g., marijuana, LSD)

10. The Depressants: Alcohol Use Disorders Psychological and Physiological Effects of Alcohol Central Nervous system depressant Influences several neurotransmitter systems, but mainly GABA Intoxication effects include slurred speech, loss of coordination, impaired gait, nystagmus, and memory problems Effects of Chronic Alcohol Use Alcohol withdrawal (DT’s) Physical damage (liver cirrhosis) Family and relationship distress Associated brain conditions – Dementia and Wernicke’s disease Fetal alcohol syndrome

11. In the United States Most adults consider themselves light drinkers or abstainers Most alcohol is consumed by 11% of the U.S. population Alcohol use is highest among Caucasian Americans Males use and abuse alcohol more so than females Violence is associated with alcohol, but alcohol alone does not cause aggression Facts and Statistics on Problem Drinking 10% of Americans experience significant problems with alcohol Most persons with alcoholism can moderate or cease drinking on occasion 20% of those with alcohol problems experience spontaneous recovery Alcohol: Some Facts and Statistics

12. Stimulants: An Overview Nature of Stimulants Most widely consumed drug in the United States Such drugs increase alertness and increase energy Examples include amphetamines, cocaine, nicotine, and caffeine Neurobiological effects vary, but all act as “sympathomimetic” agents and seem to ultimately activate the “pleasure center” of the brain

13. Stimulants: Amphetamine Use Disorders Effects of Amphetamines Produce elation, expansive mood, vigor, reduce fatigue Enhance the release of dopamine and norepinephrine, while blocking reuptake Such effects are followed by a “crash” (e.g., feeling depressed and tired)

14. Sedative, Hypnotic, or Anxiolytic Substances The Nature of Drugs in This Class Sedatives – Calming Hypnotic – Sleep inducing (e.g., barbiturates) Anxiolytic – Anxiety reducing (e.g., benzodiazepines) Intoxication effects of such drugs are similar to large doses of alcohol Combining such drugs with alcohol is synergistic All Exert Their Influence Via the GABA Neurotransmitter System

15. Stimulants: Cocaine Use Disorders Effects of Cocaine Produce short lived sensations of elation, vigor, reduced fatigue, self-confidence Effects result from blocking the reuptake of dopamine Cocaine is highly addictive, but dependence develops slowly Cocaine use in the United States has declined over the last decade, although experimental use is on the rise again among adolescents

16. Stimulants: Nicotine Use Disorders Effects of Nicotine Stimulates the central nervous system, specifically nicotinic acetylcholine receptors Results in sensations of relaxation, wellness, pleasure although intoxication effects are not described Nicotine is highly addictive Nicotine users dose themselves to maintain a steady state of nicotine

17. Stimulants: Caffeine Use Disorders Effects of Caffeine – The “Gentle” Stimulant Found in tea, coffee, cola drinks, and cocoa products Caffeine blocks the reuptake of the neurotransmitter adenosine Small doses elevate mood and reduce fatigue Used by over 90% of Americans Regular use can result in tolerance and dependence

18. Opioids: An Overview The Nature of Opiates and Opioids Opiate – Natural chemical in the opium poppy with narcotic effects (i.e., pain relief) Opioids – Refers to a class of natural and synthetic substances with narcotic effects Such drugs are often referred to as analgesics Examples include heroin, opium, codeine, and morphine Effects of Opioids Activate body’s enkephalins and endorphins Low doses induce euphoria, drowsiness, and slowed breathing High doses can result in death Withdrawal symptoms can be lasting and severe

19. Hallucinogens: An Overview Nature of Hallucinogens Substances that change the way the user perceives the world May produce delusions, paranoia, hallucinations, and altered sensory perception Specific neurobiological actions are unknown Examples include marijuana, LSD Marijuana Active chemical is tetrahydrocannabinol (THC) May produce several symptoms (e.g., mood swings, paranoia, hallucinations) Impairment in motivation is not uncommon (i.e., amotivational syndrome) Major signs of withdrawal and dependence do not typically occur but can in some individuals

20. Hallucinogens: An Overview (cont.) LSD and Other Hallucinogens d-lysergic acid diethylamide Tolerance tends to be rapid, and withdrawal symptoms are uncommon Psychotic delusional and hallucinatory symptoms can be problematic