Substance-Related Disorders Flashcards
Substance Use Disorder
Using large amounts or for longer time than intended
Persistent desire or unsuccessful attempts to cut down or control use
Great deal of time obtaining, using, or recovering
Craving
Fail to fulfill major roles (work, school, home)
Persistent social or interpersonal problems caused by substance use
Important social, occupational, recreational activities given up or reduced
Use in physically hazardous situations
Use despite physical or psychological problems caused by use
Tolerance
Withdrawal
Which substances have no withdrawal even after repeated use?
PCP, inhalants, hallucinogens
Severity of disorder
Depends on # of symptom criteria endorsed
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 or more symptoms
Specifiers of substance use disorder?
In early remission: no criteria for > 3 months but < 12 months (except craving)
In sustained remission: no criteria for > 12 months (except craving)
In a controlled environment: access to substance restricted (e.g. jail)
Intoxication
REVERSIBLE substance-specific syndrome due to recent ingestion
Behavioral/psychological changes due to effects on CNS after ingestion (e.g. disturbances of perception, wakefulness, attention, thinking, judgement, psychomotor behavior and interpersonal behavior)
Not due to another medical condition or mental disorder
* Does not apply to tobacco
Withdrawal
Substance-specific syndrome due to stopping or reducing prolonged use
Physiological & cognitive components
Significant distress in social, occupational or other important areas of functioning
Not due to another medical condition or mental disorder
Substance-Induced Mental Disorder
Can be due to any of the 10 classes of substances
During or within 1 month of use
Not an independent mental disorder (can’t have preceded onset of use or persist for substantial time after use)
10 classes of substances?
Alcohol Caffeine Cannabis Hallucinogens (e.g. PCP) Inhalants Opioids Sedatives, hypnotics, anxiolytics Stimulants Tobacco Other (gambling??)
Neuroadaptation
Underlying CNS changes that occurs after repeated use such that person develops tolerance and/or withdrawal
Pharmacokinetic neuroadaptation
Adaptation of metabolizing system
Pharmacodynamic neuroadaptation
Ability of CNS to function despite high blood levels
Tolerance
Need to use an increased amount of substance in order to achieve desired effect
OR
Markedly diminished effect with continued use of same amount of substance
Rates of substance abuse by age
1% of 12 y/o
25 % of 21 y/o
1% of 65 y/o
Does starting substance use at earlier age matter?
Starting at earlier age (<15 y/o), more likely to become addicted
e.g. alcohol addiction is 18% if started use before 15 y/o vs. 4% if started at 18 y/o or older
Demographics associated with substance abuse?
Men American Indians and whites Unemployed Large metro areas Parolees
Alcohol epidemiology
$300 billion/year spent on alcohol
13 million require tx for alcohol
(vs. 5.5 million require tx for drug use)
What percent of population reported using Rx meds non-medically within past month?
2.5%
What percent of hospital admissions have alcohol or drugs associated?
40%
What percent of hospital deaths have alcohol or drugs associated?
25% = 100,000 deaths per year
Intoxication is associated with what % of MVAs, DV cases, murders?
50% of all MVAs
50% of all DV cases
50% of all murders
ER visits due to substances?
1.2 million = non-medical use of pharmaceuticals!! 660 K = alcohol 425 K = cocaine 380 K = marijuana 210 K = heroin 93 K = stimulants
Is substance abuse a “brain disease”?
Changes in structure and neurochemistry transform voluntary drug-using to compulsive using
Changes are not necessary/sufficient (drug-dependent person changes behavior in response to positive reinforcers)
Psychodynamic etiology?
Disturbed ego function (inability to deal with reality)
Self-medication etiology?
Alcohol - panic
Opioids - anger
Amphetamines - depression
