Substance Use Disorders

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Substance Use Disorders

• 6.28.2006

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Substance Abuse

• One or more of the following in a 12-month
  period
• Recurrent use resulting in not meeting major
  obligations
• Recurrent use in physically dangerous sitations
• Recurrent substance-related legal problems
• Continued use despite knowing it causes or
  exacerbates persistent or recurrent social or
  interpersonal problems

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Substance Dependence

• A. Maladaptive pattern of substance use, leading
  to clinically significant impairment or distress,
  as manifested by three (or more) of the
  following, occurring at any time in the same
  12-month period
• 1. Tolerance, as defined by either of the
  following
• a. Need more to get the same effect
• b. Diminished effect when the same amount is
  used
• 2. Withdrawal as manifested by either of the
  following
• a. Characteristic withdrawal syndrome for the
  substance
• b. The same substance is taken to relieve or
  avoid withdrawal symptoms

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Substance Dependence

• 3. Substance is often taken in larger amounts or
  over a longer period of time intended
• 4. There is a persistent desire or unsuccessful
  efforts to cut down or control substance use
• 5. Great deal of time is spent obtaining, using,
  or recovering from the substance
• 6. Important social, occupational, or
  recreational activities are given up or reduced
  because of substance use
• 7. Substance use is continued despite knowledge
  of having a persistent or recurrent physical or
  psychological problem that is likely to have been
  caused or exacerbated by the substance

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Abuse vs. Dependence

• Abuse (v.) to put to wrong or improper use
• Dependence (n.) the quality or state of being
  influenced or determined by another, also relying
  on another (physically or psychologically
  addicted/dependent)

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Administration

• Method of administration influences how quickly
  one experiences the high, the intensity of the
  high, and the likelihood of escalating substance
  use
• Most rapid and efficient absorption
• Injection, smoking, snorting

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Alcohol

• Effects
• Low levels Stimulates the brains pleasure areas
• High levels Depresses brain functioning (impairs
  learning, judgment, self-control, perceptual
  acuity, etc.)
• Decreases motor coordination, anxiety, tension
• Increases sense of warmth, well-being,
  self-esteem, adequacy
• Intoxication at blood alcohol level of .08
• Passes out at blood alcohol level of
  approximately .5
• Lethal at blood alcohol level of .55

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Alcohol

• Effects of chronic use
• Liver damage, cirrhosis
• Malnutrition alcohol reduces appetite for other
  food (highly caloric), decreases ability to use
  nutrients
• Chronic fatigue
• Ultimately lowered feelings of adequacy and worth
• Impaired reasoning and judgment
• Neglects personal, professional, and social
  responsibilities
• Mood changes
• Behavior changes

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Alcohol

• Withdrawal
• Autonomic hyperactivity (increased heart rate,
  sweating, etc.)
• Hand tremor
• Insomnia
• Nausea/vomiting
• Agitation
• Anxiety
• Grand mal seizures
• Transient visual, auditory, or tactile
  hallucinations/illusions
• Taking substance to stave off withdrawal symptoms

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Alcohol Dependence

• Prevalence 10-15 of U.S. population (lifetime)
• Gender 3-5 times more common in men
• Women often become intoxicated more
  quickly than men and metabolize alcohol more
  slowly
• Age of Onset First intoxication mid-teens
• Dependence peaks in 20s-30s
• Women tend to start drinking later

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Alcohol Dependence

• Course w/o treatment people can abstain on
  their own, but relapse is common and quickly
  leads to dependence
• w/ treatment abstinence longer lasting
  (45- 65 abstinent 1 year after treatment)
• Culture Prevalence rates vary greatly around
  the world
• Low rates in Asia 50 have enzyme
  deficiency that aids in alcohol metabolism
• Low rates in Islamic countries
• Equal rates in Whites, African Americans
• Higher rates in Latino males

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Alcohol Dependence

• Risk Factors
• Conduct disorder/ADHD in childhood (men)
• Major Depressive Disorder (women)
• Poverty
• Urban residence
• Low educational level
• Unemployment
• Family history twin adoption studies support
  genetic transmission
• Alcohol and drug dependence are the only
  completely preventable mental disorders

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Classes of Drugs

• Caffeine and Nicotine
• Sedatives (Alcohol and Barbituates)
• Stimulants (Cocaine and Amphetamines)
• Narcotics (Opium and its derivatives)
• Psychedelics/Hallucinogens
• Marijuana (Mild Hallucinogen)

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Caffeine and Nicotine

• Effects of Caffeine Intoxication
• Restlessness
• Nervousness
• Excitement
• Insomnia
• Muscle Twitching
• Gastrointestinal complatints
• Can mimic anxiety symtpoms
• Caffeine Withdrawal
• Headaches (usually mild)

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Caffeine and Nicotine

• Nicotine Withdrawal Disorder
• Craving for nicotine
• Irritability
• Frustration
• Anger
• Anxiety
• Difficulty concentrating
• Restlessness
• Decreased heart rate
• Increased appetite/weight gain
• Headaches
• Insomnia

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Sedatives (Barbituates)

• Depressants Alcohol and Barbituates
• Most are legal
• Were widely used as sleeping pills slow down
  central nervous system and induce sleep
• Barbituates and Alcohol often used in
  combination, this combination is very deadly
• Adolescents and young adults often experiment
  and abuse
• Middle-aged and elderly - most likely to become
  dependent

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Sedatives (Barbituates)

• Administration
• Injestion
• Effects
• Reduce tension
• Increases relaxation and fatigue
• Impaired decision making, motor skills, and
  problem solving
• Sluggishness, slowed speech, mood shifts
• Facilitate social interaction
• Addiction/Dependency
• Overdose extremely lethal
• Can build up tolerance, but same amount still
  causes death

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Sedatives (Barbituates)

• Withdrawal
• Symptoms more severe, long-lasting, and dangerous
  than opiate withdrawal
• Anxious, apprehensive
• Tremors in hands and face
• Insomnia
• Abdominal cramps, nausea, vomiting
• Increases in heart rate, blood pressure
• Weight loss
• Delirium, psychosis
• Brain damage

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Sedatives - Barbituates
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Stimulants (Cocaine and Amphetamines)

• Cocaine
• Derived from the Coca plant, primarily grown in
  the Andes of Columbia, Bolivia, and Peru
• Coca tea is still used today to treat altitude
  sickness
• Amphetamines (Dexedrine, Meth, Benzedrine)
• Wonder pills
• Used by soldiers during WWII to stay awake
• Used by students, athletes, night workers to ward
  off fatigue
• Used as appetite suppressants by people wanting
  to lose weight
• Prescribed for overactive children, mild
  depression, weight loss, and narcolepsy

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Stimulants (Cocaine and Amphetamines)

• Administration
• Sniffing, swallowing, injecting
• Effects
• Euphoria, contentment, excitement
• Increases confidence, alertness, sex drive,
  sexual pleasure
• Decreases feelings of fatigue and need for sleep
• Headache, dizziness, and restlessness

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Stimulants (Cocaine and Amphetamines)

• Addiction/Dependency
• Dont create energy, rather they take push the
  limits of ones own resources, so your resources
  are depleted faster
• Can cause visual, auditory, and tactile
  hallucinations
• Increased blood pressure, enlarged pupils,
  sweating, tremors, loss of appetite, confusion,
  sleeplessness, excitability, death
• Withdrawal
• Peaks at 48-72 hours, lessens over the next few
  days
• Symptoms of depression
• Fatigue
• Disturbed sleep
• Increased dreaming
• Brain damage (inability to concentrate, learn,
  remember, etc.)

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Chronic Meth Use
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Meth Labs
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Meth Mouth
Accelerated tooth decay
Causes Acidic nature of the drug, cravings for
high calorie, carbonated Beverages, teeth
grinding and clenching, and poor oral hygiene
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Narcotics (Opium and its derivatives)

• Morphine (after Morpheus, Greek god of sleep)
• Used as a powerful pain reliever and sedative
• Found to be very addictive
• Heroin
• Replaced Morphine as pain-reliever
• Found to be more addictive than Morphine
• No longer used for medicinal purposes
• Codeine
• Also a derivative of opium
• Still used for pain-relief today

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Narcotics (Opium and its derivatives)

• Administration
• Smoking, snorting, eating, and injecting
• Effects
• Alleviate physical pain
• Induce relaxation, euphoria
• Alleviate tension and anxiety
• State of lethargy
• Addiction
• Effects last 4-6 hours
• Addiction sets in after about a month of use

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Narcotics (Opium and its derivatives)

• Withdrawal
• Symptoms of withdrawal occur after about 8 hours
  and last up to a week
• Perspiration
• Restlessness
• Chills/Flushes
• Vomiting/diarrhea
• Refusal of food/water
• Weight loss and dehydration
• Cramps, back pain, headaches
• Tremors
• Insomnia
• Occasionally delirium, hallucinations, and
  manic activity

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Psychodelics and Hallucinogens

• LSD researchers tested whether or not it could
  be used as a medication or to study
  hallucinations
• 1961 Harvards Dr. Timothy Leary received a
  grant to test LSD on research participants
  spiritual growth
• Mescaline/Psilocybin derived from mushrooms,
  used in ceremonial rites by people in Mexico,
  Latin America
• Ecstasy hallucinogen and a stimulant, tested as
  a diet pill, medication for psychological
  illness, used as a party drug by teens and
  young adults

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Psychodelics and Hallucinogens

• Administration
• LSD - one of the most potent drugs, 20-30
  micograms (millionths of a gram) will produce an
  effect
• Injestion sugar cubes, pills, tablets, blotter
  art
• Effects
• Fiction These drugs create hallucinations
  (sensing something that is not there)
• Fact These drugs distort sensation ordinary
  objects/experiences take on different
  appearances/meanings
• Mood swings
• Depersonalization/derealization
• Increases impulsivity and poor judgment

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Psychodelics and Hallucinogens
A typical full size sheet of LSD blotter paper
is 900 ¼ squares. The patterns often
represent different doses. The squares are
then digested. Often emphasize psychadelic
themes.
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Psychodelics and Hallucinogens

• Addiction/Dependency
• Physical dependency doesnt occur
• Risk of psychological dependency, but its rare
• Tolerance builds up quickly
• Withdrawal
• No real withdrawal
• Flashbacks
• Can trigger psychosis

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Marijuana (Mild Hallucinogen)

• Marijuana - Dried leaves and flowering tops of
  the hemp plant
• Hashish Derived from a secretion of the leaves
  of the hemp plant, stronger than marijuana
• Administration
• Smoked in cigarettes/pipes, baked into
  cookies/brownies

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Marijuana

• Effects
• Vary by quality/quantity used, personality/mood
  of user, past experiences, social setting, and
  users expectations
• Mild doses mild euphoria, increased feelings of
  well-being, perceptual acuity, enhanced pleasure,
  memory loss, distortions in sense of time,
  overtalkativeness, and pleasant relaxation
• High doses extreme euphoria, hilarity,
  overtalkativeness, anxiety, depression,
  hallucinations, etc.
• Physiological effects increased heart rate,
  slowed reaction time, enlarged pupils, dry mouth,
  increased appetite

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Marijuana

• Dependence/Addiction
• Only mild physiological dependence
• Stronger psychological dependence feel a need
  for the drug, especially when anxious or tense
• Withdrawal
• Nervousness
• Tension
• Sleep problems
• Appetite changes