CH6- Substance Use Disorders

Question 1

Substance Use def’n

Question 2

Substance Abuse vs. Dependence

Answer 2

Dependence (Tolerance & Withdrawal)

Abuse- No dependence but causing problems such as inability to meet work/family
obligations, physical danger, legal difficulties, etc.

• DSM 5 eliminated the distinction between abuse and dependence

Question 3

Substance-Related and Addictive Disorders

Answer 3

Alcohol OR Caffeine Related Disorders
* Alcohol Use Disorder
* Alcohol (Caffeine) Intoxication
* Alcohol (Cafeine) Wihdrawal
* Other (Cafeine) Alcohol-Induced Disorders
* Unspecified (Cafeine) Alcohol-Related Disorder

Similar Categories Exist for Hallucinogen, Inhalant (no withdrawal
category), Opioid, Sedative/Hypnotic/Anxiolytic, Stimulant, Tobacco (no
intoxication category), Cannabis, Other Substance and Unspecified
Substance-Related Disorders

Non-Substance-Related Disorders
* Gambling Disorder

Question 4

Substance Use Disorder

Answer 4

a problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Taken in larger amounts or over a longer period than was intended.
2. Persistent desire or unsuccessful efforts to cut down or control the substance use.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from it’s effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance use resulting in a failure to fulfill major role obligations
   at work, school, or home
6. Continued substance use despite having persistent or recurrent social or
   interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or
   reduced because of substance use.
8. Recurrent substance use in situations in which it is physically hazardous.
9. Substance use is continued despite knowledge of having a persistent or
   recurrent physical or psychological problem that is likely to have been
   caused or exacerbated by the substance.
10. Tolerance
11. Withdrawal

Question 5

What Are the Pros and Cons of Cannabis
Legalization in Canada?

Answer 5

Pros
* Improved safety control
* Reducing the black market
* Increased tax revenue
* Availability for medical purposes
* Decrease in gang-related violence
* Police can focus on more serious crimes

Cons
* Addictive (not everyone develops addiction)
* Second-hand smoke
* Increased risk of mental disorders
* Lung problems from smoking
* A gateway drug

Question 6

Risk Factors For Substance-Related Problems

Answer 6

• Biological
  Genetic predispositions
• Psychological
  Stress (self-medicate)
  Past trauma and victimization
  Expectations
  Personality (impulsiveness and antisocial)
• Social
  Media messaging
  Peer pressure
  Socioeconomic conditions (e.g., poverty)

Question 7

Steps Leading to Substance Use Disorders

Answer 7

• Positive Attitude Toward Using Substances
• Experimentation
• Regular Use
• Heavy Use
• Physical Dependence and Abuse

Question 8

Alcohol Use Disorder

Answer 8

• Lifetime prevalence approximately 12.5%
• Increased suicide attempts and completions
• Conduct problems are associated with alcohol use
• Fetal Alcohol Syndrome
• Physical Problems (Vitamin B deficiency, liver problems)
• 31% of fatally injured drivers were over the legal limit
• Comorbid with other mental disorders
• Predicts relapse of other mental disorders

Question 9

Effects of Alcohol

Answer 9

• Has a biphasic effect
• Higher rates in men (25.1%) compared to women (8.9%)
• Prototypical heavy drinker in Canada:
• Male
• Not married
• Relatively well-off financially
• Long Term Abuse Causes Physiological and Psychological Damage
  (e.g., cardiac problems, stroke, etc that can also lead to brain damage)

Question 10

Fetal Alcohol Spectrum Disorder (FASD)

Answer 10

• Caused by heavy alcohol consumption during
  pregnancy
• Can result in cognitive deficits
• Physical anomalies (e.g., cranial, facial, and
  limb anomalies) known as fetal alcohol
  syndrome
• see also partial fetal alcohol syndrome and
  alcohol-related neurodevelopmental disorder
  (ARND)

Question 11

Treatment

Answer 11

• Pharmacological
  Antabuse for alcohol (disulfiram)
  Nicotine replacement and Buproprion (tobacco)
  Heroine substitutes (methadone)
  Heroine antagonists (butorfanol)
• Psychological
  Motivational interviewing
  CBT, mindfulness
  Emphasis on control
  Combining CBT and pharmacological increases benefit
  Contingency management
  Involvement of significant other
  Safe injection sites
  Alcoholics Anonymous
  Controlled Drinking
• Psychological Treatment (continued)
  Aversion Therapy- Covert sensitization
• Contingent-Management Therapy
  Emphasizes patient control and includes:
• Stimulus control
• Modification of the topography of drinking
• Reinforcing abstinence
• Moderation in Drinking
  Controlled drinking
  Harm reduction therapy
  `