substance disorders and addictive (related) Flashcards
What is addiction
DSM-5 does not use “addiction” but acknowledges that many will use it as it describes compulsives and habitual use of substances
Morrison: addiction isn’t clear but can still be useful when describing a clustering of issues: loss of control and harm to self/society/others
Volkow: addiction is a loss of control
Frances: addiction is used too loosely
“disease of the brain or personal responsibility”
Volkow: addiction is disease of the brain. Adaptations that change behavior and lose control. Brain has been modified. Brain has changed to a state of deprivation…intense need for getting dopamine or “high” back
Genetics Role
Volkow: some people are more susceptible, some environments are high risk, some age related risks, length of exposure
Defintion considerations
Prior to DSM-5 substance abuse and substance dependence were kept separate.
Abuse was meant to be more acute whereas dependence more chronic.
Morrison believe the compression of abuse and dependence into one “substance use disorder” was needed.
Others don’t agree (Frances, 2014). Even Morrison noted he will likely continue to use substance dependence as a term interchangeably with substance use.
Substance related disorders
Encompasses 10 separate classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, tobacco, and other
These are not fully distinct, meaning we can only diagnosed based on what is presented by client
All drugs taken in excess have in common direct activation of brain reward system.
This system is triggered directly instead of through normal ways of behaviors
Drugs have different ways of direct triggering
List of related disorders:
Alcohol-Related Disorders
Cannabis-Related Disorders
Hallucinogen-Related Disorders
Inhalant-Related Disorders
Opioid-Related Disorders
Sedative, Hypnotic, Anxiolytic Related Disorders
Stimulant-Related Disorders
Tobacco-Related Disorders
Non-substance related (gambling)
Dopamine and addiction
The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine
When released it gives one the feeling of pleasure. This pleasure becomes desire…desire for the pleasure.
Repeat behaviors to get your “little pellet”.
How does addiction occur? Example: Cocaine binds to dopamine, prohibiting it’s recycle (absorption). There is a “stock piling” of dopamine for a short time until the bind is released and dopamine floods the system. The flooding ends after about 30 minutes creating an intense yearning for a repeat performance. Now addiction has started. Tolerance to experience increases the need for more. Yet, the exact first experience won’t happen
Dependence and abuse combined
APA (2013) provides combining the two diagnoses creates more consistency and clarity. Rationale - Dependence was often confused for addiction, but because tolerance and withdrawal occur does not mean that there is an addiction.
The criteria of Substance Abuse is covered in the Use Disorder section of “Functional consequences of (Substance) Use Disorder.” There are specific criteria for each substance in the DSM-5 rather than referencing Substance Dependence/Substance Abuse.
How previous diagnosis of Substance Abuse is represented:
*The DSM-IV-TR recurrent legal problems criterion for substance abuse has been deleted and a new criterion, craving or a strong desire or urge to use a substance.
*Recurrent (substance) use resulting in a failure to fulfill major role obligations at work, school, or home.
*Recurrent (substance) use in situations in which it is physically hazardous., has been adde
Some cautions
Addiction might be too easy to assign now. However, Frances’ example may miss what the new criteria is trying to categorize
Combining abuse and dependence loses valuable info
Assigning use disorder appears to be only option now. This sends wrong message to society about the variations with one’s use.
Too many being diagnoses a possibility (low “hits” on criteria
Dependence and abuse combined-use disorder
Now only two remission specifiers:
*In Early Remission (previous criteria met, but now not in approximately 3/6 to 12 months)
*In Sustained Remission (12+ months)
Additional specifiers have been removed:
*On Agonist Therapy
*With Physiolocial Dependence
*Without Physiolocial Dependence
Now a severity scale:
*Mild (2-3 criteria met)
*Moderate (4-5 criteria met) or *Severe (6 or more criteria met)
COMMON PRINCIPLES OF SUBSTANCE USE DISORDERS
The person will usually be affected physiologically. Heavy and prolonged use = tolerance, which then increases to satisfy withdrawal (cravings), which then results in symptoms due to decreases
Loss of control. Using more than intended, repeated failure to control use, preferring use over other activities (i.e. relationships), and persistent use despite knowledge of harm or danger
Several social issues result in misuse. Include, failure to fulfill life roles, interpersonal disputes, and excessive time spent obtaining substance
Different criteria for each disorder; however, 2-3 symptoms puts person in range for mild use disorder
Common principles of substance use disorders
The person will usually be affected physiologically. Heavy and prolonged use = tolerance, which then increases to satisfy withdrawal (cravings), which then results in symptoms due to decreases
Loss of control. Using more than intended, repeated failure to control use, preferring use over other activities (i.e. relationships), and persistent use despite knowledge of harm or danger
Several social issues result in misuse. Include, failure to fulfill life roles, interpersonal disputes, and excessive time spent obtaining substance
Different criteria for each disorder; however, 2-3 symptoms puts person in range for mild use disorder
