Substance Use Disorder

• Substance Use Disorder


  Problematic pattern of use that impairs functioning. Two or more symptoms within a 1-year period
• DSM-5 Criteria for Substance Use Disorder

  • Failure to meet obligations
  • Repeated relationship problems
  • Repeated use in situations where it is physically dangerous
  • Continued use despite problems caused by the substance
  • Much time is spent trying to obtain the substance
  • Social, hobbies, or work activities given up or reduced
  • Craving to use the substance is strong
• Tolerance


  • Larger doses of drug needed to produce desired effect
  • Effects of drug decrease if usual amount is taken
• Withdrawal


  • Negative physical and psychological effects from stopping substance use
  • E.g., muscle pain, twitching, sweats, vomiting, diarrhea, insomnia
• Alcohol Use Disorder


  People who develop tolerance or withdrawal
• Alcohol withdrawal


  Muscle tremors, elevated pulse, blood pressure, and temperature
• Delirium tremens


  • Rare withdrawal symptom when alcohol in blood drops suddenly
  • Delirium, tremulous, hallucinations
  • Associated with other drug use
• 80-85% of people with alcohol use disorder smoke tobacco
• Binge drinking


  5 drinks in a short period of time
• Heavy-use drinking


  5 drinks on the same occasion 5 or more times in a 30-day period
• Alcohol use is especially frequent among college-age adults
• Prevalence of alcohol use disorder varies by gender, race, and education level
• Alcohol use disorder is more common in men than women, but this gender difference continues to shrink
• Alcohol use disorder is often comorbid with borderline and antisocial personality disorders, mood disorders, and anxiety disorders
• Alcohol metabolism


  • Enters the bloodstream quickly through small intestine
  • Metabolized by the liver slowly at 1 ounce of 100 proof per hour
• Alcohol concentration


  Varies by gender, height, weight, liver efficiency, food in stomach
• Standard drink size


  12 oz. glass of beer, 5 oz. glass of wine, and 1.5 oz. of hard liquor are equal in alcohol content
• Alcohol's effects on neurotransmitters

  • Stimulates GABA receptors: reduces tension
  • Increases dopamine & serotonin: Produces pleasure
  • Inhibits glutamate receptors: Produces cognitive difficulties (e.g., slowed thinking, memory loss)
• High dose alcohol effects

  • Significant motor impairment
  • Difficulty monitoring errors and making decisions
  • May make poor decisions about driving and not realize they are making mistakes
• Prolonged alcohol use can impair digestion of food and absorption of vitamins, leading to severe memory loss
• Cirrhosis


  Damage to the liver from prolonged alcohol use
• Fetal Alcohol Syndrome


  • Heavy alcohol intake during pregnancy
  • A leading cause of intellectual disability among children
  • Fetal growth slowed
  • Cranial, facial, and limb anomalies occur
• Nicotine


  • Addicting agent of tobacco
  • Stimulates dopamine neurons in mesolimbic area
  • Involved in reinforcing effect of most drugs
• Smoking remains the single most preventable cause of premature death in the U.S.
• Smoking is more prevalent among people in lower socioeconomic status
• Secondhand smoke


  • Environmental tobacco smoke contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than does the smoke actually inhaled by the smoker
  • Nonsmokers can suffer lung damage
  • Babies of women exposed in pregnancy are more likely to be born prematurely, have lower birth weights, have birth defects
  • Children of smokers are more likely to experience upper respiratory infections, asthma, bronchitis, and inner-ear infections
• 1. cigarettes


  • Look like cigarettes except are made of plastic or metal and are filled with liquid nicotine that is mixed with other chemicals and often with flavors
  • People inhale and exhale vapors ("vaping")
  • Among young people, those who vape are more likely to take up smoking cigarettes
• Marijuana


  • Drug derived from dried and crushed leaves and flowering tops of the hemp plant (Cannabis sativa)
  • Most often smoked, but it can be chewed, prepared as a tea, or eaten in baked goods
• Hashish


  • Stronger than marijuana
  • Produced by drying the resin exudate of the tops of the plant
• Synthetic marijuana


  Spice or K2
• Marijuana is considered an illicit drug, but is legal for all uses in 8 states and legal for medical uses in 29 states
• Rates of daily marijuana use are on the rise, which may be related to varying degrees of legal status by state
• Psychological effects of marijuana

  • Feelings of relaxation and sociability
  • Large doses can lead to rapid shifts of emotion, interferes with attention, memory, and thinking
  • Heavy doses can lead to hallucinations and panic
• Short-term physiological effects of marijuana

  • Difficult to regulate dosage
  • Effects take 30 minutes to appear
  • Bloodshot and itchy eyes
  • Dry mouth and throat
  • Increased appetite
  • Reduced pressure within the eye
  • Increased blood pressure
• Long-term physiological effects of marijuana

  • Damage to lung structure and function in long-term users
  • Cognitive problems linked to the effects of marijuana on CB1 and CB2 receptors in the brain (e.g., hippocampus)
  • Different patterns of connectivity between amygdala and frontal cortex among users compared to non-users
  • Use can develop tolerance and withdrawal
• Therapeutic effects of marijuana

  • Reduces nausea and loss of appetite caused by chemotherapy
  • Can relieve discomfort associated with cancer, glaucoma, chronic pain, muscle spasms, seizures, and discomfort from AIDS
• Federal law prohibits dispensing marijuana for medicinal purposes
• Medical marijuana legalization is not associated with an increase in use among adolescents
• Opioids


  • Includes: Opium, morphine, heroin, codeine
  • Moderate doses relieve pain
  • Prescription pain medications among the most abused of all drugs
• 7% of the US population has misused opioids at least once