Substance Abuse

1
Substance Abuse

• Reasons for abuse
• Defining Abuse, Dependence, Intoxication
• Treatments
• Detoxification
• Antagonist drugs, Aversives
• Self-help
• Multimodal treatment
• Relapse Prevention
• Prevention of Substance Abuse

2
Reasons for Substance Abuse

• Modeling, availability
• Reinforcement
• Expectancies
• Social and cultural issues
• Biological variables and individual differences

3
Abuse vs. Dependence

• DSM-IV makes this distinction
• How does substance abuse differ from substance
  dependence?

4
DSM-IV Criteria for Substance Abuse

• Maladaptive pattern of use leading to impairment
  and distress including one or more of the
  following within a 12-month period
• recurrent use resulting in problems at
  work, school, home
• recurrent use in situations which it is
  physically hazardous
• recurrent use causes legal problems
• continued use despite social, interpersonal
  problems being exacerbated by effects
• Symptoms do not meet the criteria for substance
  dependence

5
Concepts of Substance Dependence

• Tolerance
• body needs more and more of drug to achieve same
  level of effect
• develops eventually with most drugs
• Withdrawal
• aversive effects the body experiences when drug
  usage ceases
• can be mild to severe

6
DSM-IV Criteria for Substance Dependence-1

• Maladaptive pattern of use, leading to clinical
  impairment with three or more of the following
  within a 12-month period
• Tolerance by either
• increased amount of substance to
  achieve desired effect
• diminished effect with continued use of same
  amount

7
DSM-IV Criteria for Substance Dependence-2

• Withdrawal with either of following
• characteristic withdrawal symptoms for
  substance
• same or related substance taken to
  avoid withdrawal symptoms
• Substance taken in larger amounts over longer
  period than intended
• Persistent desire and unsuccessful efforts to cut
  down or control usage
• Great deal of time spent obtaining drug,
  using drug, recovering from drug

8
DSM-IV Criteria for Substance Dependence-3

• Important social, occupational,
  recreational activities given up to use
  drug
• Continued use despite
  physical or psychological problems

9
Substance Intoxication

• Syndrome that includes one or more of the
  following symptoms
• mood swings
• unreliability
• belligerence
• cognitive impairment
• impaired social or occupational functioning

10
DSM-IV Diagnostic Criteria for Substance
Intoxication

• Development of reversible substance-specific
  syndrome due to ingestion of substance
• Clinically significant maladaptive
  behavioral or psychological changes due to
  the substance
• Symptoms not due to general medical
  condition or other mental disorder

11
Treatment of Substance Abuse
12
Stages in Overcoming Substance Abuse

• Detoxification
• Antagonist, aversive drugs
• Substance replacement, maintenance
• Self-help groups
• Multimodal treatment
• Relapse prevention

13
Detoxification

• Removal of drug from body
• Gradual process
• Conducted under medical supervision in hospital,
  residential facility, treatment center

14
Antagonist, Aversive Drugs

• Antagonist drugs block the effects of the
  substance
• Aversive drugs cause a negative reaction when the
  substance is used

15
Self-Help Groups

• Provide support and help for people with abuse
  problems
• Conducted by other substance abusers
• Readily available
• Usually low cost or free

16
Multimodal Treatment

• Combines several methods for substance dependence
• detoxification
• coping skills
• social support
• stress management

17
Relapse Prevention

• Focuses on deterring future use by education
  about relapse and prevention techniques

18
Prevention of Substance Abuse

• Legal restrictions
• Global education programs
• Specific educational programs
• Minimum-cost interventions