Substance Related and Addictive Disorders

Question 1

Substance Related and Addictive Disorders

DSM 5

Answer 1

DSM 5:

1. Abuse and dependence criteria have been combined into a single list
2. DELETED: recurrent legal problems
3. ADDED: craving or a strong desire or urge to use a substance
4. ADDED: Gambling Disorder
5. Threshold for disorder has increased to 2 or more criteria (not one or more for disorder and 3 or more for dependence).
6. Cannabis and caffeine withdrawal added
7. Tobacco use disorder are the same as those for other substances!
8. inclusion of Tobacco is new!
9. Severity based on number of criteria endorsed: 2-3=mild; 4-5=moderate; 6+=severe.
10. Deleted: physiological subtype and polysubstance dependence.
11. Early remission: 3-12 months w/o substance and full remission is over 12 months.
12. new specifiers include: ‘in a controlled environment’ and ‘on maintenance therapy’

Question 2

Substance Related Disorders

definitions

Answer 2

1. tolerance, withdrawal, taken in larger amounts and more frequently, persisttent desire or unsuccessful attempts to control/cut down use, time alloted to get, use and recover from, important social, occupational, or recreational activities reduced, continued use of the substance despite psychological or physical problems.

ETIOLOGY (alcohol):

• Conger’s Tension-Reduction Hypothesis: negative reinforcement, “alcohol takes away tension/anxiety, so i feel better”
• Marlatt and Gordon: addictive behaviors are acquired as overlearned, maladaptive habit patterns.
• Biopsychosocial models: initiation, maintenance and progression of addiction is an interaction between physical, psychological, and sociocultural factors.

TREATMENT/PROGNOSIS

1. covert sensitization an other forms of aversion therapy
2. multicomponent interventions that combine social skill training, stress management, moderation training, contingency managment, coping skill training, and other self-control techniques
3. self-help programs (AA) increase abstinence when combined with other interventions.

RELAPSE:

• precipitated by anxiety, frustration, depression or other negative emotional states, and many interventions target the situations that elicit negative emotions.
• Marlatt and Gordon: typical reaction to relapse as an ‘abstinence violation effect’ that involves self-blame, guilt, anxiety, and depression, which leads to increased susceptibility to relapse (alcohol).
  
  • Propose that the potential for future relapse is reduced wht the person views the episode of drinking as a mistake resulting from a specific, external, and controllable factors.
• Relapse Prevention Therapy (RTP): identifying circumstances that increase the risk for relapse, situations that elicit negative emotional states, expose to alcohol, or cultivate social pressure to drink.
  
  • implement a variety of bx and cognitive strategies that help prevent future lapses and deal more effectively with them when they occur (coping skills, cognitive restructuring, self-efficacy enhancement, and lapse management)

​Smoking/Nicotine:

1. smokers are 3-4x’s more likely to have myocardial infarction, cardiac arrest or stroke.
2. within 1-5 years of stopping, risk of these disorders is same as non smokers!
3. nicotine is addictive; fear of weight gain for women (5-6 pounds), craving is intense, and high rate of relapse.
4. Successful Smoking Cessation: men, over 35, educated, non-smoking home/work, married, started smoking later, low level of nicotine dependence and have stopped for over 5 days before.
5. Smoking Cessation Interventions:
   
   1. nicotine replacement therapy,
   2. multicomponent behavior therapy which includes skills training, relapse prevention, stimulus control, and/or rapid smoking (aversion),
   3. and support and assistance from a clinician.

Question 3

Alcohol Related Disorders

Answer 3

1. Alcohol Intoxication: maladaptive behaviors and psychological changes, slurred speech, incoordination, unsteady gait, nystagmus (dancing eyes), impaired attention or memory (anterograde amnesia/blackouts), and stupor/coma.
2. Alcohol Withdrawal: autonomic hyperactivity (sweating, tachycardia), hand tremor, insomnia, nausea, vomit, transient hallucinations, anxiety, psychomotor agitation, grand mal seizures following cessation of alcohol consumption after a period of prolonged or heavy use.
3. Alcohol Withdrawal Delirium: distrubances in consciousness and other cognitive functions, autonomic hyperactivity, vivid hallucinations, delusions, and agitation following heavy use.
4. Alcohol Induced Persisting Amnestic Disorder/Korsakoff Syndrom: retrograde amnesia, anterograde amnesia, and confabulation (fabricating memories to compensate for memory loss), and due to Thiamine deficiency.
   
   1. Anterograde amnesia is most severe for declarative memories; retrograde amnesia affects recent, long-term memories more than remote memories.
   2. Often preceded by Wernicke Syndrome which involves ataxia, abnormal eye movements, confusion.
   3. Co-occurrence of the two disorders is referred to as Wernicke-Korsakoff Syndrom.
   4. physical before memory symptoms
5. Alcohol-induced Sleep Disorder: usually the Insomnia Type and can result of either Intoxication or Withdrawal.
   
   1. Intoxication: period of increased sleepiness followed by increased wakefulness, restlessness, and vivid anxiety-arousing dreams.
   2. Withdrawal: severe disruption in sleep continuity with vivid dreams.

Question 4

Other Substance-Induced Disorders

Answer 4

1. Coke/Amphetamine Intoxication: maladaptive bx and psychological changes, tachycardia, elevated or lowered blood pressure, dilated pupils, sweet/chills, nausea/vomit, weight loss, agitation, muscular weakness, confusion and seizures.
2. Coke/Speed Withdrawal: dysphoric mood, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation after heavy use. Withdrawal after an intense, high-dose use can cause a ‘crash’ that involves intense lassitude and depression.
3. Caffeine Intoxication: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, stomach issues. High doses: muscle twitching, rambling thoughts/speech, cardiac arrhythmias, psychomotor agitation.
4. Sedative, Hypnotic or Anxiolytic Intoxication: maladaptive behavioral and psychological changes and slurred speech, incoordination, poor gait, nystagmus, impaired memory/attention, stupor or coma.
5. Opioid Intoxication: heroin, morphine, codeine, methadone, oxycodone, fentanyl. initial state of euphoria that is followed by apathy or dysphoria, psychomotor agitation or retardation, and imparied judgement. Pupillary constriction, drowsiness, impaired attention or memory, slurred speech. Severe intoxication: pupillary dilation, respiratory distress, coma and death.
6. Opioid Withdrawal: symptoms resemble a moderate to sever case of the flu and includes sweating, goose bumps, fever, pupillary dilation, nausea and vomit, cramps, diarrhea, agitation, restlessness, insomnia and dysphoric mood.
7. Nicotine Withdrawal: depressed mood, insomnia, irritability, anxiety, restlessness, impaired concentration, decreased heart rate and increased appetite.
8. Hallucinogen Persisting Perception Disorder (flashbacks): re-experiencing of one or more perceptual symptoms (trailing images, after-images, halos) that were experienced during the trip. The person is currently not intoxicated and is aware that the perception is a drug effect.