PHASE 4

• Substance


  Chemical compounds that are ingested to alter mood or behavior
• Psychoactive substances


  Alter mood, behavior, or both
• Substance Use


  Ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning
• Substance Intoxication


  Physiological reaction to ingested substances
• Substance Use Disorders


  How much of a substance is ingested is problematic
• Physiological Dependence


  The use of increasingly greater amounts of the drug to experience the same effect (tolerance) and a negative physical response when the substance is no longer ingested (withdrawal)
• Alcohol Specifiers


  • In Early Remission
  • Sustained Remission
  • Controlled Environment
  • Current Severity/Remission
• First episode of alcohol intoxication is likely to occur during mid-teens
• Onset peak in the later teens or early to mid 20s
• Remission and relapse
• Among adolescents, conduct disorder and repeat antisocial behavior often co-occur with alcohol- and with other substance-related disorders
• Alcohol Use Disorder


  Describes problematic pattern of alcohol use that involves impaired control over alcohol use, social impairment due to alcohol use, risky alcohol use, and pharmacological symptoms
• Alcohol intoxication usually occurs as an episode developing over minutes to hours and typically lasting several hours
• Frequency and intensity usually decrease with further advancing age
• The earlier onset of regular intoxication, the greater the likelihood the individual will go on to develop AUD
• Substance/medication-induced psychotic disorder


  When hallucinations occur in the absence of delirium
• Acute alcohol withdrawal occurs as an episode usually lasting 4-5 days and only after extended periods of heavy drinking
• Withdrawal is rare for individuals younger than 30 years
• The symptoms of an alcohol-induced mental disorder are likely to remain clinically relevant as long as the individual continues to experience severe intoxication or withdrawal
• Breathalyzer


  Measures levels of intoxication
• GABA seems to be particularly sensitive to alcohol
• The Glutamate system is involved in why alcohol affects our cognitive abilities
• Organic brain syndromes resulting from long-term alcohol use

  • Dementia
  • Wernicke-Korsakoff Syndrome (Confusion, loss of muscle coordination, and unintelligible speech, believed to be caused by a deficiency of thiamine)
• Fetal Alcohol Syndrome
• Alcohol Dehydrogenase


  Metabolize alcohol
• Korsakoff syndrome


  A chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1)
• Korsakoff syndrome is most caused by alcohol misuse, but certain other conditions also can cause the syndrome
• Caffeine withdrawal


  Consistent with a half-life of caffeine of approximately 4-6 hours, usually remit with the first day or so and do not have any known long-lasting consequences

  
• Symptoms must not be associated with another medical condition or another mental disorder that could better explain them

  
• Caffeine withdrawal symptoms


  Usually begin 12-24 hours after the last caffeine dose and peak after 1-2 days of abstinence, last for 2-9 days with the possibility of withdrawal headaches occurring for up to 21 days

  
• The final determination of caffeine withdrawal should rest on a determination of the pattern and amount consumed, the time interval between caffeine abstinence and onset of symptoms, and the particular clinical feature presented by the individual

  
• Cannabis Use Disorder Specifiers

  • In early remission
  • In sustained remission
  • In controlled environment
  • Current severity/remission
• Most common during adolescence or young adulthood
• Progression may be more rapid in adolescents, particularly those with conduct problems
• CUD among adults typically involves well-established patterns of daily cannabis use that continue despite clear psychosocial or medical problems
• Early onset of cannabis use is a robust predictor of the development of CUD and other types of substance use disorders and mental disorders during young adulthood
• Substance/medication-induced psychotic disorder


  When hallucinations occur in the absence of intact reality testing
• Cannabis withdrawal


  Onset typically occurs within 24-48 hours after cessation of use, peaks within 2-5 days and resolves within 1-2 weeks, although sleep disturbance can persist longer

  
• Women can experience more severe withdrawal symptoms
• Phencyclidine Use Disorder


  Describes problematic pattern of phencyclidine use that involves impaired control, social impairment, and pharmacological symptoms