Lecture 8 - Addictive Disorders

Question 1

When was gambling disorder first included in the DSM?

Answer 1

DSM-5.

Question 2

What two sections are included in the DSM-5 chapter ‘Substance-Related and Addictive Disorders’?

Answer 2

A section on addictive disorders that involve substances as the addictive agents.
A section on gambling disorder.

There are also two sections for substance-related disorders:
1. Substance-use disorders
2. Substance-induced disorders

Question 3

What are the 10 separate classes of drugs listed in the DSM-5?

Answer 3

1. Alcohol.
2. Caffeine.
3. Cannabis.
4. Hallucinogens.
5. Inhalants.
6. Opioids.
7. Sedatives, hypnotics, or anxiolytics.
8. Stimulants.
9. Tobacco.
10. Other (unknown) substances.

Question 4

What is a substance use disorder?

Answer 4

A treatable mental health disorder that affects a person’s brain and behaviour leading to their inability to control their use of using a given substance.

Question 5

Individuals who have a substance use disorder often have other co-occuring mental health disorders. This leads to higher levels of stigma directed toward them. They are also likely to have a poorer prognosis for their mental health disorder and the consequences of this experience.

True or false?

Answer 5

True.

Question 6

Do individuals with mental health disorders have a higher chance of having a co-morbid substance use disorder compared to the general population?

Answer 6

Yes.

Question 7

What is the mental health disorder that is associated with the highest co-morbid substance use disorder?

Answer 7

Personality disorders.

I would have thought PTSD, but that wasn’t included on the slide, so maybe it wasn’t part of the study.

Question 8

What are some of the attitudes toward people with substance use disorders?

Answer 8

There is an attitude of blame toward the individual for having an addiction.

There is a separation between how people view other mental health disorders and substance use disorder. There is a historically driven perceived divide between SUDs and other mental health difficulties.

Question 9

Is the term ‘addict’ a pejorative term?

Answer 9

Yes.

Question 10

What are some of the theories that attempt to explain how individuals develop substance use disorders?

Answer 10

There is a school of thought that thinks there is an underlying biological mechanism that makes it very difficult or impossible for the individual to moderate or cease the use of a substance.

There may be something to this line of thinking. According to Gabor Mate, however, we need to take a much broader and nuanced look at why someone would turn to substances in the first place, and what other factors prevent them from stopping despite the harmful effects to self and others.

Question 11

What are some general diagnostic criteria in the DSM-5 for SUDs?

Answer 11

Impaired control over substance use:
1. The individual may take substance in larger doses and over a longer period of time than originally intended.
2. Individual has tried repeatedly to cut down or stop using the substance unsuccessfully.
3. Individual spends a great deal of time engaging in and recovering from substance use.
4. Cravings for the substance, especially when not taken at the regular time or in certain settings.

Social impairment:
1. Recurrent substance use may result in inability to meet social expectations and roles, including friendships, work, family, and spouse.
2. Individual continues to use the substance despite the negative impacts it has on relationships and work.
3. Social, occupational, or recreational activities are given up due to substance use.

Risky use of the substance:
1. Individual continues to use the substance even when physically dangerous.
2. Individual continues to use the substance despite having knowledge of the negative side effects.

Pharmacological criteria:
1. Individual begins to develop tolerance to the substance, where they need to take more substance to get the desired effect.
2. Withdrawal - when individual tries to come off substance they get physiological and psychological disturbances that the individual feels are only relieved by using the substance again.

Question 12

Is substance abuse disorder a pejorative term?

Answer 12

Yes. ‘Use’ is a less pejorative.

Question 13

What are the course and descriptive feature specifiers for substance use disorders in the DSM-5?

Answer 13

“in early remission”
“in sustained remission”
“on maintenance therapy”
“in a controlled environment”

Question 14

In the DSM-5 there are several specific substance use disorders with a list of criteria. What is considered a MILD, MODERATE, and SEVERE substance use disorder?

Answer 14

MILD - two to three of the criteria.
MODERATE - four to five of the criteria.
SEVERE. - six or more of the criteria.

Question 15

Is Alcohol Use Disorder a SUD in the DSM-5?

Answer 15

yeS.

Question 16

In Alcohol Use Disorder what is the criteria that can still be met even when an individual is in early or sustained remission?

Answer 16

“Craving, or strong desire or urge to use alcohol.”

Question 17

Does the DSM-5 split substance related disorders into two categories?
What are they?

Answer 17

Yes.
They are:
1. Substance-induced disorders.
2. Substance-use disorders.

Question 18

What are the three categories the DSM-5 splits substance-induced disorders into?

Answer 18

1. Intoxication -
2. Withdrawal -
3. Other substance/medication induced mental disorders, e.g substance-induced mood disorder.

Question 19

What are the general criteria in the DSM-5 for substance-induced disorders?

Answer 19

For Substance-induced disorders of intoxication, the criteria are:
1. Development of a reversible, substance-induced syndrome that arises from ingestion of a substance.
2. The clinically significant problematic behaviour is due the symptoms of intoxication.

For substance-induced disorders of withdrawal, the criteria are:
1. Essential feature is the development of problematic, distressing and impairing cognitive, behavioural, and affective symptoms due to the cessation of a substance of dependence or prolonged use.

Question 20

What are the drugs/substances with their own SUD or SID in the DSM-5?

Answer 20

1. Alcohol.
2. Caffeine
3. Cannabis.
4. Phencyclidine - e.g. “angel dust” /PCP.
5. Other hallucinogen.
6. Inhalant - e.g. hydrocarbons from glues, fumes
7. Opioid.
8. Hypnotic, sedative, or anxiolytic - e.g. sleeping pills, benzodiazapines such as valium.
9. Stimulants.
10. Tobacco.
11. Other substance intoxication.

Question 21

What are Substance induced disorders?

Answer 21

They are mental health disorders that arise as a result of the use of a substance.
These mental disorders are characterised as the following:
1. Substance-induced (S-I) dementia
2. S-I amnestic disorder.
3. S-I psychotic disorder.
4. S-I mood disorder.
5. S-I anxiety disorder.
6. S-I sexual dysfunction.
7. S-I sleep disorder.
8. S-I intoxication delirium.
9. S-I withdrawal delirium.

Question 22

What are the common characteristics of Substance-Induced disorders in the DSM-5?

Answer 22

Substance-induced disorders share common characteristics:

1. The disorder represents a clinically significant symptomatic presentation of a relevant mental health disorder.
2. There is evidence/knowledge of the disorder arising within one month of intoxication or cessation of substance use AND the substance is capable of inducing the symptoms of the disorder.
3. The disorder is not better explained by a non-substance-induced disorder. This would be evidenced by symptoms of the disorder preceding the use of the substance or the symptoms of the disorder persist beyond one month of the intoxication or beyond period of acute withdrawal.
4. The disorder causes clinically significant distress or impairment in social or occupational functioning.

Question 23

Is substance-dependence the single largest contributor to disease burden in Australia?

Answer 23

Yes.

Question 24

If drug/substance use is so ubiquitous, why do only some people develop a substance-use disorder?

Answer 24

Class.
Socio-cultural factors.
Race.
Gender.

Question 25

What are some demographic correlates of substance-use disorders?

Answer 25

Age - young adults are more likely to use substances.

Gender - males more likely to use substances in a point of dependence.

Urban dwellers more likely to use.

Black people in America and indigenous people in Australia are more likely to use substances.

Individuals with mental health disorders are also more likely to use substances to a point of dependence.

Question 26

Is weed the most used illicit drug used in Aus?

Answer 26

Yes.

Question 27

What proportion of those who use tobacco are dependent?

What proportion of those who use heroin are dependent?

What proportion of those who use cannabis are dependent?

Answer 27

Around 35%.

Around 25%.

Around 12%.

Question 28

What aspects of a substance increase its risk of being a substance of dependence?

Answer 28

1. How quickly the positive effects of the substance are felt.
2. The half-life of the drug, or how quickly the substance leaves the system - a high up, high down nature of a drug increases its risk of being a substance of dependence.

Question 29

Do people who inject drugs, such as heroin, more likely to become addicted? Why?

Answer 29

Yes. This is because the effects of the drug are felt quicker when taken this way.

Question 30

Why do people use mood and function-altering drugs/substances?

Answer 30

There can be cultural reasons, such as social aspect of drinking in Australia.

There can be a need brought on by work, such as needing to be very functioning, caffeine or cocaine.

There can be medical or therapeutic reasons we use substances, such as for pain relief - physical or psychological.

Question 31

What are some of the theories of the aetiology of substance use disorders?

Answer 31

1. Moral models that see individuals with substance use disorders as having a moral defect that leads to them to use or inability to control use. e.g. weak, misfits, sinful.
   Suggest that there is not much that can be done for the individual, as there is an inherent defect within the person = “once a junky, always a junkie”.
2. Disease models - individuals have a disease that causes them to become addicted to the substance. The individual is not to blame, because they have a physical sickness. Suggests that the disease state is lifelong. Individual needs to become enlightened by relinquishing control to a higher power - e.g. AA or NA. There is a belief that the condition is not curable, so all they can do abstain from use. Some find this approach very useful. Some do not.
   However, they can be quite punitive.
3. Education models suggest that substance-use disorders arise from the lack of knowledge around the dangerous effects of substances.
4. Social learning model - social environment conditions individual in either a protective or precipitating/perpetuating way for substance use.
5. Biological model - there are biological predispositions, genetic factors, and other biological factors that lead to and perpetuate problematic drug use.
6. Biopsychosocial model - looks at biological, psychological, and social predisposing, precipitating, perpetuating, and protective factors that make up the relationship individuals and communities have with susbtances.
7. Public health model - considers the type of drug, the individual, and the environment. Similar to the biopsychosocial model. This model strives to help individuals to use drugs in a safe way, if they are to use them. Not trying to eliminate drug use.

Question 32

What are some of the reasons people continue to use substances despite negative impacts on theirs and others’ lives?

Answer 32

The positive effects of the substance may be their only perceived way of coping with their suffering.

Question 33

Does prohibition aid in reducing drug use?

Answer 33

No.

Question 34

What are some examples of harm-minimisation programs for substance-use disorders?

Answer 34

Safe-injecting sites.

Medication-aided treatment for opiod addiction, such as methodone.

Providing clean drugs to avoid harm caused by mixed ingredients.

Sobering up services - allows individuals who are intoxicated to sober up in a safe place - prevents the incarceration of individuals for intoxication/”public drunkeness”.

Question 35

According to the DSM-5, what is Gambling Disorder?

Answer 35

At least four of the following:
1. Need to gamble more or with more money to achieve desired effect, such as excitement.
2. Restlessness or irritability when trying to stop or reduce gambling.
3. Repeated unsuccessful attempts at stopping or reducing gambling frequency or money spent.
4. Frequent thoughts about gambling.
5. Often gamble when feeling distressed.
6. Often returning to gambling to “make up” what they have previously lost.
7. Lying to conceal gambling activity.
8. Jeopardising significant relationships or work due to gambling.
9. Relying on others for money due to loss of money to gambling and need for more money to continue gambling.

Question 36

Have 70% of Australians engaged in gambling over the last year?

Answer 36

Yes.

Question 37

What percentage of Australian’s meet criteria for gambling disorder?

Answer 37

1%.

Question 38

Are rates of gambling higher in countries that do not regulate gambling heavily?

Answer 38

Yes.

Question 39

What demographic factors increase risk of individual’s developing gambling disorder?

Answer 39

Gender - males more likely to engage in problematic gambling.

Indigenous Australians.

People not in a secure relationship.

Those in lower socioeconomic groups.

Young adults - 19-35

Likelihood is further increased if the individual started gambling early in life.
If they had large wins when they first started gambling.
If there is a history of gamblig in the family.

Question 40

What type of conditioning do gambling machines tend to employ?

Answer 40

Intermittent reinforcement - one of the strongest types of behavioural learning.

Question 41

Is there a disorder in the DSM-5 included in the section of the DSM called “Further study required” called ‘Internet gaming disorder’?

Answer 41

Yes.