Substance-related and addictive disorder

Question 1

Definition

Answer 1

A substance-related and addictive disorder is the continued use of a substance despite harmful consequences, including significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home due to substance use.

Question 2

Epidemiology

Answer 2

Prevelence:?

2.Clinical assessment of substance use:
°Unhealthy use of 1 substance ↑ likelihood of unhealthy use of other substances.

°Start with “socially accepted” substances:

¶ Caffeine

¶ Tobacco/nicotine

¶ Alcohol

° Prescription medication misuse:

¶ Opioids

¶ Sedative/hypnotics

¶ Stimulants

¶ Marijuana

° Illicit drugs:

¶ Stimulants (e.g., methamphetamine, cocaine)

¶ Opioids (e.g., heroin)

¶ Hallucinogens

¶ Inhalants

Question 3

Etiology

Answer 3

°It is a combination of multiple factors.

1. Biologic factors:
   ° Feedback cycle of drug use or dangerous behavior
   ° Dependence/escalation
   ° Withdrawal/relapse
   ° Enhanced effect of dopamine at the nucleus accumbens
   ° Drugs of abuse replace reinforcement
2. Genetic factors:
   ° Alcohol use disorder: correlated with biologic parents
   ° No specific genes have been identified with substance use disorders.
3. Environmental factors:
   ° Low socioeconomic status
   ° Pressure from substance-using peers

4. Personality disorders (especially cluster B):
° Borderline 
° Histrionic 
° Narcissistic
° Antisocial