Substance & Addictive Disorders

• Substance use disorder


  Excessive or harmful use of drugs and alcohol
• Substance use disorder (DSM-5 criteria)


  • At least two of the following within a 12-month period and causing significant distress:
  • Increasing amounts use or time spent using over time
  • Efforts to control use are unsuccessful
  • Considerable time spent using, recovery, obtaining substance
  • Strong cravings, urges
  • Substance use interferes with life obligations
  • Continues used despite harmful social / interpersonal effects
  • Avoiding or reducing participation in work, social activities
  • Use of substances in inappropriate situations
  • Continued use when having physical or psychological problems
  • Tolerance develops
  • Withdrawal is present
• Substance use disorder severity


  • Mild if two or three of designated symptoms present
  • Moderate if four of five are present
  • Six or more symptoms indicates severe disorder
• Substance use may cause depression, anxiety, sleep difficulties, or psychotic disorders
• Addiction


  • Compulsive drug-seeking behavior and loss of control over drug use
  • Withdrawal symptoms occur when the use is discontinued due to physiological dependence
  • Increased tolerance to the drug's effects
• Substances associated with abuse


  • Prescription medications (used to treat anxiety, insomnia, or pain)
  • Legal substances (alcohol, caffeine, tobacco, and household chemicals)
  • Illegal substances (cocaine, and heroin)
• Alcohol (ethanol)


  Alcohol is considered a depressant and slows the nervous system
• Alcohol drinking patterns


  • Moderate drinking (no more than one drink for women or two drinks for men per day)
  • Heavy drinking (levels exceeding moderate)
  • Binge drinking (four to five drinks or more on a single occasion for men, four or more drinks for women)
• Effects of alcohol abuse


  • Alcohol poisoning (can result in impaired breathing, coma, and death, may require hospitalization)
  • Alcohol-use disorder (18% of US adult population, twice as likely to develop in men, alcoholism progresses more quickly in women)
  • Delirium tremens (life-threatening condition produced by alcohol withdrawal symptoms)
• Men and boys are more likely to consume alcohol and participate in binge and heavy drinking
• Asian Americans have the lowest levels of excessive drinking
• Native Americans of both genders begin drinking at the earliest age
• Latin American men have the highest rates of daily alcohol consumption
• Binge drinking and heavy drinking are especially problematic among young adults
• Opioids


  Pain-killing agents that depress the central nervous system, highly addictive, produce both euphoria and drowsiness, liberal prescribing resulted in their widespread misuse and deaths, Fentanyl is 50 to 100 times more powerful than morphine
• Sedatives, Hypnotics, and Anxiolytics


  Used to treat agitation, muscle tension, insomnia, and anxiety, high potential for tolerance building and withdrawal symptoms
• Sedatives, Hypnotics, and Anxiolytics


  • Sedatives (Ambien) (drowsiness, impaired judgment, diminished motor skills, accidental overdose or death, particularly if combined with alcohol)
  • Hypnotics (induce sleep)
  • Anxiolytics (reduce anxiety, benzodiazepines like Valium, Ativan, Xanax have rapid anxiolytic effects in moderate doses and hypnotic effects in higher doses)
• Stimulants


  Speed up central nervous system activity, produce feelings of euphoria and well-being, improve mental and physical performance, reduce appetite and prevent sleep, but can also cause anxiety, restlessness, agitation, paranoia, and tolerance develops rapidly
• Caffeine


  Stimulant found in coffee, chocolate, tea, and soft drinks, most widely consumed psychoactive substance in the world, withdrawal symptoms include headache, fatigue, irritability, difficulty concentrating, intake has increased due to widespread marketing and consumption of energy drinks, can produce caffeine intoxication or withdrawal
• Amphetamines


  Also known as "uppers" for speeding up central nervous system, can produce euphoria, confidence, agitation, psychosis, violence, suicidality, prescribed for attention and sleep disorders like Ritalin and Adderall, increasingly used illicitly, can cause psychosis and brain damage, methamphetamine can cause permanent damage to the heart and has high potential for abuse and addiction
• Cocaine


  Immediate, short-lived effects, high potential for addiction, crack is a potent form of cocaine produced by heating cocaine with other substances, typically smoked, cocaine withdrawal can cause lethargy and depression, cocaine users sometimes experience acute psychiatric symptoms like delusions, paranoia, hallucinations, sleep difficulties
• Hallucinogens


  Produce vivid sensory awareness and hallucinations, traditional hallucinogens are derived from natural sources like LSD and psilocybin mushrooms, effects can vary significantly between "good trips" and "bad trips", hallucinogen persisting perception disorder can cause distressing recurrence of hallucinations or other sensations weeks or even years after drug intake
• Dissociative Anesthetics


  Produce dream-like detachment, phencyclidine (PCP) and ketamine (Special K) are highly dangerous and addictive, have dissociative, stimulant, depressant, amnesic, and hallucinogenic properties, dextromethorphan (DXM) in over-the-counter cold medicines can result in hyperthermia and heart arrhythmia when consumed in large quantities
• Substances with mixed chemical properties


  Nicotine releases both adrenaline and dopamine, vaping has gained popularity among nonsmokers and those trying to quit smoking, marijuana (cannabis) can produce euphoria, tranquility, and mild perceptual/sensory distortions but can also increase anxiety and depression or trigger psychosis, inhalants use by children and adolescents was once considered a silent epidemic and can result in stroke or sudden sniffing death
• Designer drugs


  MDMA (Ecstasy, Molly) has both stimulant and hallucinogenic properties, producing euphoria, sensory/cognitive distortions, and intimacy but followed by depression and involuntary jaw spasms/teeth clenching, club drugs like PCP, Special K, Molly, Rohypnol aim to induce energy, excitement, and reduce inhibitions but are followed by a significant crash of lethargy, low motivation, depression, dehydration, and blood pressure changes
• Synergistic effect of combining multiple substances can intensify effects and create unique side effects
• Dangerous combinations of substances


  • Tranquilizers and alcohol
  • Stimulants and sleeping pills
  • Uppers and downers
  • Speedball: opioid and cocaine use
  • Alcohol and energy drinks (caffeine)
  • Four Loko
• Biological dimension of substance use disorders


  Substance use alters brain functioning related to neurotransmitters, hormones, judgment, and self-control, genetic factors show strong correlation in families, addiction genes but also consider personality traits like impulsivity, risk taking, and self-control, women who use drugs or alcohol show a more rapid progression to addiction compared to men, are more reactive to drug-related cues, and are more susceptible to relapse
• Psychological dimension of substance use disorders


  Coping with psychological stress and emotional symptoms, almost half of abusers have a concurrent psychiatric disorder, stress plays a role in development of alcoholism and relapse, four categories of life stressors influence substance use (general life stress, stress from trauma/catastrophic events, childhood stressors/maltreatment, and everyday discrimination), behavioral undercontrol is a personality characteristic associated with rebelliousness, impulsivity, and risk-taking
• Social dimension of substance use disorders


  Childhood victimization and stressful events (neglect), adolescence is a particularly vulnerable period with parental attitudes/behaviors, lack of parental monitoring, peer pressure and wish to fit in socially, desire to assert independence and rebel, desire to "have fun" or take risks, the first year of college is a vulnerable transitional period with abrupt changes in parental supervision, increased competition and pressure to achieve, easy access to alcohol, exposure to peers who drink heavily, students frequently overestimate the extent of alcohol and marijuana use by peers, social media increases the acceptability and frequency of alcohol use in college
• African Americans have lower rates of substance use than European Americans and Latinx Americans
• Latinx Americans have the highest prevalence of illicit drug use
• European American adolescents have the highest rate of prescription drug misuse
• Discrimination encountered by LGBTQ+ youth and adults is associated with risk for substance use and abuse issues
• Treatment options for substance use disorders


  • Self-help groups (AA, NA)
  • Outpatient services
  • Inpatient / 24 hr. levels of care
• Treatment is most effective when it incorporates best practices based on high-quality addiction research
• The inclusion of integrated care that addresses underlying emotional difficulties enhances treatment outcome
• Section 35 in Massachusetts


  Allows for involuntary commitment of someone for substance use disorder
• Goals of substance use disorder treatment


  Achieving sustained abstinence, maintaining a drug-free lifestyle, functioning productively
• Phases of substance use disorder treatment


  • Detoxification: the user ceases or reduces use of the substance
  • Preventing relapse: a return to use of the substance