Substance-Related and Addictive Disorders

Question 1

Substance Use Disorders

Answer 1

characterized by a “cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems as manifested by at least two characteristic symptoms can be categorized in terms of four groups:

• Impaired control- substance used in larger amounts or for a longer period of time than intended; persistent desire or unsuccessful efforts to cut down or control use; great deal of time spent in activities related to obtaining the substance or recovering from its effects; craving for the substance
• Social impairment- recurrent substance use that results in a failure to fulfill major role obligations at home, school, or work; recurrent substance use despite persistent social problems caused or worsened by substance use; important activities given up or reduced due to substance use
• Risky use- recurrent substance use in situations in which it is physically dangerous to do so; continued substance use despite knowing that doing so creates or worsens a physical or psychological problem
• Pharmacological criteria- tolerance & withdrawal symptoms

Substance Use Disorder can be applied to all classes of drugs except caffeine

Addiction is not a DSM term, but used to describe a compulsion to use a drug, development of tolerance for the drug, and experience of withdrawal symptoms when the drug is not taken

Question 2

Etiology of Substance Use

Answer 2

Conger’s Tension Reduction Hypothesis- contends that alcohol reduces anxiety, fear, and other states of tension and that people drink to reduce tension, which eventually leads to addiction

Addiction is the result of negative reinforcement

Marlatt and Gordon (1985) hypothesis- contend that addictive behaviors, like other behaviors, are acquired and describe addiction as an overlearned, maladaptive habit pattern

Several biopsychosocial models have been proposed that view the initiation, maintenance, and progression of addiction as involving an interaction between physical, psychological, and sociocultural factors

Question 3

Treatment for Substance Use Disorders

Answer 3

treatment ordinarily involves a combination of psychotherapeutic interventions and medication

Psychotherapeutic interventions- include CBT, family and couple therapy, and a 12-step or other self-help program

Options for medication include naltrexone or disulfiram for Alcohol Use Disorder and nicotine replacement with gum, patches, or electronic cigarettes and the antidepressant bupropion for Tobbaco Use Disorder

Question 4

Relapse for Substance Use Disorders

Answer 4

most common precipitant of relapse among people with Alcohol and other Substance Use Disorders is the experience of anxiety, frustration, depression, or other negative emotional state

Marlatt and Gordon (1985)- refer to the typical reaction to relapse as an “abstinence violation effect” that involves self-blame, guilt, anxiety, and depression, which leads to an increased susceptibility to further alcohol consumption; propose that the potential for future relapse is reduced when the person views the episode of drinking as a mistake resulting from specific, external, and controllable factors

Question 5

Relapse Prevention Therapy

Answer 5

involves identifying circumstances that increase the individual’s risk for relapse and then implementing behavioral and cognitive strategies that help the individual prevent future lapses and deal more effectively with them if they occur

Question 6

Tobacco Use Disorder

Answer 6

interventions for Tobacco Use Disorder are most likely to lead to long-term abstinence when they include three elements:

1. nicotine replacement therapy
2. multicomponent behavioral therapy that includes, for example, skills training, relapse prevention, stimulus control, and or rapid smoking
3. support and assistance from a clinician

Smokers that quit are more likely to be male, age 35 or older, have a college education, live in a smoke-free home and have a non-smoking policy at work, be married or living with a partner, have started smoking at a later age, have a low level of nicotine dependence and have abstained for longer than 5 days during previous attempts to quit

Question 7

Substance-Induced Disorders

Answer 7

include substance intoxication, substance withdrawal, and substance/medication-induced mental disorders; latter are potentially severe, usually temporary, but sometimes persisting central nervous system syndromes that develop in the context of the effects of substances of abuse, medications, or toxins

share following features:

a. clinically significant symptomatic presentation of a mental disorder
b. evidence from a history, physical exam, laboratory results that the disorder developed during or within one month of substance intoxication or withdrawal or of taking a medication and the substance or medication is capable of producing the mental disorder
c. disorder cannot be better explained by another mental disorder or medical condition
d. does not occur only during the course of delirium
e. symptoms cause clinically significant distress or impaired functioning

Question 8

Alcohol-Induced Disorders

Answer 8

Alcohol intoxication- maladaptive behavioral and psychological changes with at least one of the following symptoms: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory, stupor or coma

Alcohol Withdrawal- diagnosed in the presence of at least two of the following symptoms within several hours to a few days following cessation or reduction of alcohol consumption: autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient illusions or hallucinations; anxiety; psychomotor agitation; generalized tonic-clonic seizures

Alcohol Withdrawal Delirium- involves prominent disturbances in attention, awareness, and cognition following cessation or reduction of alcohol consumption that are sufficiently severe to warrant clinical attention; common associated features include autonomic hyperactivity, vivid hallucinations, delusions, and agitation

Alcohol-Induced Major Neurocognitive Disorder- characterized by the evidence of a significant decline in one or more cognitive domains that interferes with independence in everyday activities

Question 9

Korsakoff Syndrome

Answer 9

characterized by anterograde and retrograde amnesia and confabulation (attempts to compensate for memory loss by fabricating memories) and has been linked to a thiamine deficiency

Question 10

Alcohol-Induced Sleep Disorder

Answer 10

usually of the insomnia type and can be the result of either intoxication or withdrawal;

when produced by intoxication, it involves immediate sedation accompanied by increased Stages 3 and 4 sleep and reduced REM sleep followed by increased wakefulness, increased REM sleep (with vivid anxiety-arousing dreams) and reduced Stages 3 and 4 sleep

when produced by withdrawal, the disorder involves a severe disruption in sleep continuity with vivid dreams

Question 11

Opioid Withdrawal

Answer 11

occurs following cessation or reduction in the use of an opioid following prolonged or heavy use or administration of an opioid antagonist following a period of opioid use

diagnosis requires the presence of at least three of the following symptoms:

• dysphoric mood
• muscle aches
• nausea or vomiting
• lacrimation or rhinorrhea
• pupillary dilation
• piloerection, or sweating
• diarrehea
• yawning
• fever
• insomnia

Question 12

Tobacco Withdrawal

Answer 12

characterized by the development of at least four characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco (irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia