Substance Use

Question 1

What are the two indicators in addiction?

Answer 1

These two indicators are tolerance and withdrawal. Tolerance is where an individual has become physiologically dependent on a substance, whereby they require a higher dose of the substance to get a desired effect. Withdrawal is where an individual decreases or ceases a substance after a period of heavy or prolonged use, and experiences physical and psychological effects from this.

Question 2

What are the 10 classes of drugs and their effects?

Answer 2

• 10 classes of drugs:
  
  • Alcohol
    
    • Intoxication: Slurred speech, in-coordination, unsteady gait, impaired attention/memory, stupor/coma, nystagmus (involuntary eye movement)
    • Withdrawal: Autonomic hyperactivity (sweating and pulse above 100), increased hand tremor, insomnia, nausea/vomiting, transient hallucinations/illusions, psychomotor agitation, anxiety, seizures
  • Caffeine
    
    • Intoxication: Restlessness, nervousness, excitement, insomnia, flushed face, dieresis, gastrointestinal disturbance, muscle twitching, rambling flow of thought/speech, tachycardia, psychomotor agitation
    • Withdrawal: Headache, fatigue, dysphoric mood/irritability, difficulty concentrating, flu-like symptoms
  • Cannabis
    
    • Intoxication: Increased appetite, dry mouth, tachycardia, impaired judgment/motor coordination, slow reaction time, conjunctival infection.
    • Withdrawal: Irritability, anger, aggression, nervousness/anxiety, sleep difficulty, restlessness, decreased appetite, depressed mood, tremors, sweating, fever/chills, headache, abdominal pain
  • Hallucinogens
    
    • Intoxication: Perceptual changes, dilated pupils, tachycardia, sweating, palpitations, blurred vision, tremors, in-coordination, paranoid ideation etc
  • Inhalants
    
    • Intoxication: Dizziness, in-coordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremors, muscle weakness, blurred vision, coma, euphoria
  • Opioids
    
    • Intoxication: Initial euphoria followed by apathy, dysphoria, agitation/retardation, impaired judgment, drowsiness/coma, slurred speech, impaired attention/memory
    • Withdrawal: Dysphoric mood, nausea/vomiting, muscle aches, diarrhoea, yawning, fever, insomnia
  • Sedatives, hypnotics, anxiolytics
    
    • Intoxication: Slurred speech, in-coordination, unsteady gait, impaired cognition, stupor/coma
    • Withdrawal: Sweating/pulse greater than 100, hand tremor, insomnia, nausea/vomiting, transient hallucinations/illusions, agitation, anxiety, seizures.
  • Stimulants (amphetamine-type substances, cocaine, and other stimulants)
    
    • Intoxication: Tachycardia or bradycardia, dilated pupils, elevated/lowered blood pressure, perspiration/child, nausea/vomiting, evidence of weight loss, agitation/retardation, muscle weakness, respiratory depression, chest pain, confusion, seizures, coma
    • Withdrawal: Fatigue, vivid/unpleasant dreams, insomnia/hypersomnia, increased appetite, retardation/agitation
  • Tobacco
    
    • Withdrawal: Irritability, frustration or anger, anxiety, difficulty concentrating, increased appetite, restlessness, depressed moon, insomnia
  • Other (unknown)

Question 3

What are the key features of substance use disorder (11 criteria)?

Answer 3

• Criterion A: overall groupings of impaired control, social impairment, risky use, and pharmacological criteria
  
  • Impaired control over substance use:
    
    • Criterion 1: Take substance in larger amount or over longer period than was originally intended
    • Criterion 2: Persistent desire to cut down/regulate – multiple unsuccessful attempts to decrease/discontinue
    • Criterion 3: Great deal of time obtaining and using substance and recovering from effects
    • Criterion 4: Cravings – intense desire/urge for drug particularly with environmental cues– classical conditioning & activation of reward circuits in brain.
  • Social impairment:
    
    • Criterion 5: Failure to fulfil major role obligations at work, school, home
    • Criterion 6: Continue use despite social/interpersonal problems
    • Criterion 7: Important social, occupational or recreational activities given up/reduced, e.g., withdraw from family.
  • Risky use:
    
    • Criterion 8: Physically hazardous use
    • Criterion 9: Continue use despite having physical or psychological problem caused/exacerbated by it
  • Pharmacological:
    
    • Criterion 10: Tolerance – requiring a markedly increased dose to achieve desired effect or reduced effect when usual dose is consumed
    • Criterion 11: Withdrawal – concentrations of substance decline after period of heavy use – causes unpleasant symptoms – likely to use substance again to get relief.

Question 4

Describe the moral, spiritual, temperance, educational and conditioning models of substance use.

Answer 4

Question 5

Describe the biological, psychodynamic, family dynamics, social learning, and sociocultural models of substance use.

Answer 5