Substance use disorders Flashcards
Disease - noun
A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or
symptoms or that affects a specific
location and is not simply a direct
result of physical injury
10 classes of substance use disorders
○ Alcohol
○ Caffeine
○ Cannabis
○ Hallucinogens
○ Inhalants
○ Opioids
○ Sedatives, hypnotics, anxiolytics
○ Stimulants
○ Tobacco
○ Other
Reward center process
- ↑ dopamine into nucleus accumbens
promotes pleasure and reinforcing
behavior - Nucleus accumbens (post-dopamine
infusion), signals cerebral cortex, codes the experience, create memories, and guides future behavior
Dopaminergic neurons
- Located in the midbrain structures
- Substantia Nigra (SNc)
- Ventral Tegmental Area (VTA)
Dopaminergic neurons project their axons to:
- Striatum
- Dorsal prefrontal cortex
- Ventral prefrontal cortex
Substance-Induced Disorders
Substance-Induced Disorders:
Intoxication
Withdrawal
Other Substance Induced
Mental Disorders
What is NSDUH and what do they do?
The National Survey on Drug Use and Health (NSDUH): a nationwide
survey interviewing around 70,000 random individuals aged 12 and older
* Provide national/state-level estimates on the use of tobacco, alcohol, illicit
drugs (including non-medical use of prescription drugs), and mental health
* Assess and monitor the consequences of drug and alcohol use
Most common substance use disorder
Alcohol use disorder
Substance-Use Disorder:
Defines as a pathological pattern of
symptoms (cognitive, behavioral, physiologic) indicating that the
individual continues to use the substance despite significant
consequences
DSM Criteria for Substance use disorders
11 criteria under 4 headings
* Impaired control
* Social impairment
* Risky use
* Pharmacological criteria
Subtance use disorders DSM - Impaired control:
taking a larger amount of a substance or over a longer period of time than originally intended:
1. A need for markedly ↑ amounts of the substance to achieve intoxication or desired effect
2. Having a persistent desire or unsuccessful efforts to cut down or
control substance-use
3. The individual may spend a great deal of time obtaining, using, or recovering from the effects of the substance
4. Craving – an intense desire or urge for the drug that may occur at any time, and more likely in certain circumstances
Ex: driving by the bar on the way home from work
Substance use disorders DSM - Social Impairment criteria:
- Recurrent substance-use may result in a failure to fulfill major role obligations at work, school, or home
- Substance use may continue despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
- Important social, occupational, or recreational activities may be given up or ↓ because of substance-use
Ex: Withdrawn from family activities and hobbies, to use
Substance-Use Disorders – risky use:
- Recurrent substance-use in situations in which it is physically
hazardous - May continue using despite knowledge of having a persistent or
recurrent physical or psychological problem likely caused by or
exacerbated by the substance
Substance-Use Disorders – Pharmacological criteria:
- Tolerance – needing ↑ dosing of the substance to achieve the desired effect or a markedly ↓ effect when the usual dose is consumed
* Lab tests may be helpful (ie ↑ blood levels of substance and little
intoxication) - Withdrawal* – a syndrome occurring when blood or tissue
concentrations of a substance decline after prolonged use
* Specific symptoms are dependent upon the substance
DSM-5 Criterion for Substance use disorders: Severity and Specifiers
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6+ symptoms
Substance-Induced Disorders
Potentially severe, usually temporary, but sometimes persistent,
syndromes that develop in the context of the effects of substances
of abuse, meds, or toxins. Includes:
● Intoxication
● Withdrawal
● Induced Mental Disorders
T/F Substance-Induced Disorders are not factors that contribute to the continued use of a substance
T
Substance Intoxication Criterion (DSM)
A. Development of a reversible substance-specific syndrome due to
the recent ingestion (within 1 month) of a substance (Essential)
B. Clinically significant problematic behavioral or psychological
changes, are attributable to the physiologic effects of the substance
C. Symptoms are not attributable to another medical condition
Substance Withdrawal Criterion (DSM-5)
A. Development of a substance-specific problematic behavioral
change, with physiological and cognitive problems due to cessation
or reduction in heavy and prolonged substance-use Essential
B. Clinically significant distress or impairment in social occupational or
other areas of functioning
C. Symptoms are not attributable to another medical condition
Patients often re-administer the substance to _____
reduce symptoms
Codependence
Misguided attempts by a loved one, to protect a patient with
substance-use disorder from the consequences of substance use
Enabling – The instinct to shelter a loved one from harm, allowing
the substance use to continue and progress in severity
The ____ of codependents usually focus on helping patients with substance-use disorder manage short-term crises
rather than focusing on long-term solutions
enabling behaviors
Etiology of Substance Abuse - Biological factors
susceptibility to acute
psychopharmacologic effects of a given drug
● Metabolism of the drug
● Cellular adaptation within the CNS to chronic exposure to the drug
● Predisposing personality characteristics
● Susceptibility to medical and neuropsychiatric complications of
chronic drug self-administration.
Etiology of Substance Abuse - Psychological factors
● Presence of co-occurring psychopathology
● Medical illnesses
○ Chronic pain, essential tremor
● Past or present severe stress
○ Resulting from crime, battle exposure, sexual trauma, or economic difficulties
● Potential causes of “self-medication”
