Substance Abuse Disorders Overview

Substance Related Disorders

• Substance Abuse Disorder (SUD) is a condition where use of one or more substances leads to significant impairment or distress.

Key Features of Drug Abuse

• Problematic use
• Lack of control
• Craving
• Neglecting responsibilities
• Tolerance
• Withdrawal
• Risky behavior
• Ignoring consequences

Time Criterion for Substance Use Disorders

• To diagnose a substance use disorder, problematic patterns of use must occur within a 12-month period and meet at least two of the diagnostic criteria outlined in the DSM-5-TR.

Common Types of Drug Abuse

• Alcohol use disorder
• Caffeine use disorders
• Opioid use disorder
• Stimulant disorder
• Cannabis disorder
• Sedative, hypnotic, Anxiolytic use disorder
• Hallucinogen use disorder
• Tobacco use disorder

Alcohol-Related Disorders

• Alcohol-related disorders result from excessive or problematic alcohol consumption.
• Alcohol use disorder
• Alcohol intoxication
• Alcohol withdrawal
• Alcohol-induced mental disorder
• Unspecified alcohol-related disorder

Alcohol Content and Fermentation

• All three alcoholic drinks (beer, whisky, and wine) contain 18 ml of pure ethanol.
• Fermentation of sugar and yeast with oxygen produces alcohol and carbon dioxide.

Alcohol Use Disorder Symptoms

• Symptoms vary depending on frequency, quantity consumed, and individual factors.
• Short-term effects: slurred speech, impaired motor coordination, flushed skin nausea or vomiting, headache, or dizziness
• Long-term consequences: liver damage (e.g., fatty liver, cirrhosis), high blood pressure, heart disease, weakened immune system
• Signs of dependence: poor judgment and decision-making, mood swings (e.g., euphoria, irritability or aggression), impaired memory and concentration, engaging in risky behaviors (driving under the influence, unsafe sexual activities)

Alcohol Use Disorder (AUD) in DSM-5-TR

• Alcohol Use Disorder (AUD) is a condition in which someone's alcohol use causes problems in their life, health, or relationships (difficulty controlling drinking, needing more alcohol to feel the same effects, or continuing to drink even when it causes harm)
• To be diagnosed with AUD, a person must meet at least 2 out of 11 criteria within a 12-month period. These criteria include: drinking more or longer than intended, wanting to cut down or stop drinking but being unable to, spending a lot of time drinking or recovering from its effects, craving alcohol, problems with responsibilities at work, school, or home, continuing to drink even when it causes relationship problems, giving up important activities because of drinking, drinking in dangerous situations, continuing to drink despite physical or mental health problems caused or worsened by alcohol, needing more alcohol to feel the same effect (tolerance), Feeling sick or uncomfortable when not drinking (withdrawal).

Specifiers

• Severity Specifiers: Mild (2-3 symptoms), Moderate (4-5 symptoms), Severe (6 or more symptoms)
• Remission Specifiers: Early (3-12 months, except cravings), Sustained (12+ months, except cravings)

Etiology (Causes)

• Biological factors: Genetics, brain chemistry, tolerance
• Psychological Factors: coping mechanisms
• Social and environmental: Family and peer influence, Cultural acceptance, stressful life events

Prevalence and Differential Diagnosis

• AUD is common worldwide; higher in men vs. women
• In the U.S., about 5-10% of adults, and 2-5% of teenagers have AUD in a given year
• Rates vary by country/region
• Nonpathological Alcohol Use: some people drink occasionally without causing harm
• Other Mental Health Disorders; conditions like depression or anxiety might cause similar symptoms but alcohol isn't the root cause

Comorbidity (Co-occurring conditions)

• People with AUD often have other physical or mental health issues—specifically mental health disorders (depression, anxiety, PTSD), and Physical conditions (liver disease, fatty liver, cardiovascular issues, and digestive disorders)

Alcohol Intoxication

• Alcohol intoxication disorder occurs when someone drinks excessively, causing noticeable mental, physical, and behavioral changes.
• Diagnostic Criteria include: recent alcohol use and significant problems: behavioral or mental state changes, and physical symptoms: slurred speech, poor coordination, unsteady walking, involuntary eye movements (nystagmus), and impaired attention or memory

Cannabidiol (CBD) vs. Tetrahydrocannabinol (THC)

• CBD: non-psychoactive component (non-mind altering) with relaxant, anti-inflammatory, and other properties.
• THC: psychoactive component causing potential effects like appetite stimulation, euphoria, paranoia, and analgesics.

Cannabis-Related Disorders

• Cannabis use disorder—harmful pattern of cannabis abuse (see more detail below)
• Cannabis intoxication—experiencing a variety of physical and mental symptoms due to cannabis use
• Cannabis withdrawal—experiences when cannabis use is stopped
• Cannabis-induced mental disorders—mental health symptoms (mood, anxiety, psychoses) directly linked to cannabis use
• Unspecified Cannabis-Related Disorders—when symptoms don't fit other diagnosis

Hallucinogens

• Psychoactive substances altering perception, mood, and cognition; causing intense sensory distortions & vivid visual hallucinations.
• Alter body sensations (e.g., feeling unusually large or small);
• Changing perception of time.

Phencyclidine (PCP)

• Dissociative hallucinogen; initially an anesthetic but now no longer used medically due to its dangerous side effects.
• Known as "angel dust" or "wet" on the street.
• Causes hallucinations, detachment from reality, intense psychological effects (paranoia and aggression).
• Affects brain receptors, leads to distorted sensory experiences and altered perceptions of body movement.
• Ingested by smoking, snorting, or swallowing.

Hallucinogen-Related Disorders

• Phencyclidine Use Disorder
• Other Hallucinogen Use Disorder
• Phencyclidine Intoxication
• Other Hallucinogen Intoxication
• Hallucinogen Persisting Perception Disorder
• Phencyclidine-Induced Mental Disorders
• Hallucinogen-Induced Mental Disorders
• Unspecified Phencyclidine-Related Disorder
• Unspecified Hallucinogen-Related Disorder

Sedative, Hypnotic, or Anxiolytic Disorders

• Prescription medications used for anxiety disorders, sleep disorders, seizures, or anesthesia
• Drugs include benzodiazepines (e.g., Ativan, Halcion, Librium, Valium, Xanax, Rohypnol), barbiturates (e.g., Amytal, Nembutal, Seconal, Phenobarbital), Ambien, Lunesta, and Sonata
• Symptoms of use disorder: acute intoxication symptoms (mood changes, slowed breathing, tiredness, slurred speech, unsteady walk, trouble with coordination, irregular/uncontrolled eye movements, inability to focus, lack of attention, stupor, coma); dependence symptoms (tolerance—needing more to feel the effect; unsuccessful attempts to stop use; drug-seeking behaviors to get medication— doctor shopping, misrepresentation of illnesses; intense cravings);
• Withdrawal symptoms: anxiety; tremors; sleep disturbances; appetite changes; nausea/vomiting; rapid pulse or breathing; changes in blood pressure, fever; sweating; delirium; seizures
• Specific disorders include Intoxication and Withdrawal
• Prevalence and risk factors related to use, abuse, and dependence.
• Treatment and potential therapies.
• Associated symptoms of induced mental and other substance disorders.

Stimulant Disorders

• Continued use of stimulants despite harm, including cocaine, amphetamine, methamphetamine, MDMA
• Signs may include elevated heart rate, dilated pupils, increased blood pressure, sweating or chills, nausea or vomiting, and chest pain.
• Withdrawal symptoms may include depression, anxiety, irritability, drug cravings, and increased appetite, sleep problems, paranoia, fatigue, problems concentrating, suicidal thoughts.
• Effects of stimulant use (unhealthy use) can include heart attack, stroke, significant weight loss, violent behavior, psychosis, paranoia, anxiety, increased confusion, reduced productivity, overdose, and/or premature death
• Criteria and symptoms for related disorders

Tobacco-Induced Substance Related Disorders

• No specific details are provided in this set of notes.

Other/Unknown Substance-Related Disorders

• No specific details are provided in this set of notes.

Explore the key features and diagnostic criteria of Substance Use Disorders (SUD) in this quiz. Understand the various types of drug abuse and their implications, including alcohol-related disorders. Test your knowledge on recognizing problematic patterns of substance use and their impact on individuals.