substance use

• Criteria (need 2 or more within last year)

  1. Taking more of the substance than intended 
  2. Desire to cut down use but unable to do so 
  3. Excessive time spent using/acquiring/recovering 
  4. Craving 
  5. Role disruption (e.g. at work) 
  6. Interpersonal problems (e.g., arguments about use) 
  7. Reduction of important activities (social, hobbies, work) 
  8. Use in physically hazardous situations (e.g. driving) 
  9. Keep using despite causing problems/negative consequences 
  10. Tolerance
  11. Withdrawal
• Withdrawal 

  • Negative psychological and physical symptoms when reducing or stopping use
  • Substance taken to relieve/avoid withdrawal symptoms
• • Depressants 
  • Behavioural sedation (e.g., alcohol, sedative, anxiolytic drugs)
• • Opiates 
  • Produce analgesia and euphoria (e.g., heroin, morphine, codeine)
• • Stimulants 
  • Increase alertness and elevate mood (e.g., cocaine, nicotine) 
• • Hallucinogens 
  • Alter sensory perception (e.g., marijuana, LSD)
• • Other drugs of abuse 
  • Include inhalants, anabolic steroids, “club”/designer drugs
• • Alcohol stimulates gamma-aminobutyric acid (GABA) receptors
• • Decreases glutamate - impairs memory, judgement/thinking
• Acute withdrawal symptoms

  • Physical: Headache, nausea, tremor 
  • Psychological: anxiety/depression symptoms
• • “hard core” withdrawal symptoms for alcohol
  • Organ failure, malnutrition, foetal alcohol syndrome, delirium Tremens (DTs):
• 8.5% of US population met criteria for alcohol abuse or dependence in DSM-IV
• • Sedative – calming (e.g., barbiturates)
• • Hypnotic – sleep inducing (e.g. GHB: GammaHydroxybutyrate)
• • Anxiolytic – anxiety reducing (e.g., benzodiazepines)
• Amphetamines stimulate CNS by increasing dopamine, norepinephrine (and serotonin)
• Norepinephrine (noradrenaline)

  • Prepares the body for ‘fight or flight’
  • Increases heart rate, releases glucose from energy stores
  • Moves blood away from digestive system to skeletal muscles
• Identical twins: 41-61% concordance rate, fraternal twins: 24-42% concordance rate.
• Agonist substitution = “safe” drug with similar chemical makeup to addictive drug
• • Antagonist treatment = drug blocks effects of addictive drug 
• Aversive treatment = drug makes taking the drug unpleasant
• • Interventions 
  • Confront sufferer and ask them to go to rehabilitation
• • Community Support programs (AA)
  • Learn to live with addiction
• • Contingency Management
  • Vouchers for good behaviour