Substance Use and Gambling Disorders

Substance Use and Gambling Disorders

• Substance use disorders and gambling disorders involve chronic difficulties with substance use or gambling, causing significant distress or impairment.
• Substances are natural or synthetic products with psychoactive effects, changing perceptions, thoughts, emotions, and behaviors.
• Diagnosis does not require physical dependence.

Substance Use Disorders

• Substance intoxication is a cluster of behavioral and psychological changes resulting from a substance's physiological effects on the central nervous system.
  • Effects depend on the type and amount of substance, user's biochemistry (including tolerance), setting, and method of ingestion.
• Substance withdrawal is a set of physiological and behavioral symptoms resulting from stopping a substance after prolonged heavy use.
• Substance abuse (no longer a DSM diagnosis): Use resulting in significant harmful consequences (e.g., failing to meet obligations, using in hazardous situations, legal/social problems).
• Substance dependence (no longer a DSM diagnosis): Meeting criteria for addiction (e.g., tolerance, withdrawal).
  • Tolerance is a diminished effect from the same dose or needing more to achieve intoxication.
  • DSM-5 combined abuse and dependence into Substance Use Disorder.

Classes of Substances

• DSM-5 identifies 10 substances for diagnosing substance use disorders.
  • Categorized into 5 groups: depressants, stimulants, opioids, hallucinogens/PCP, and cannabis.

DSM-5-TR Substance Use and Addictive Disorders

• Includes alcohol-related, caffeine-related, cannabis-related, hallucinogen-related, inhalant-related, opioid-related, sedative-hypnotic-anxiolytic-related, stimulant-related, tobacco-related, and other disorders.

Alcohol Use Disorder (DSM-5-TR)

• Problematic alcohol use causing significant distress or impairment, characterized by at least two of these within a 12-month period:
  • Taking larger amounts or longer than intended.
  • Persistent desire or unsuccessful efforts to cut down or control use.
  • Spending considerable time obtaining, using, or recovering from alcohol.
  • Craving or strong desire to use alcohol.
  • Recurrent use resulting in role obligations failure.
  • Continued use despite persistent social/interpersonal problems related to alcohol.
  • Important social or recreational activities given up or reduced.
  • Recurrent use in hazardous situations.
  • Continued use despite knowledge of a persistent physical or psychological problem made worse by alcohol.
  • Tolerance (needing more or diminished effect with continued use)
  • Withdrawal (symptoms developing hours to days after cessation)

Alcohol Use Disorder: Epidemiology

• 7.4% of U.S. adults display alcohol abuse disorder. Over 13% experience it at some point.
• Males are diagnosed at a 2:1 ratio compared to females.
• Prevalence is similar for White, African American, and Hispanic Americans.
• Native Americans (male) have a higher prevalence than others.
• Asian Americans generally have lower rates than other groups, linked to differences in alcohol metabolism (ADH).

Alcohol Intoxication (DSM-5-TR)

• Clinically significant behavioral or psychological changes shortly after alcohol ingestion.
• Signs/symptoms include slurred speech, incoordination, unsteady gait, nystagmus, attention/memory impairment, stupor, or coma
  • BAC levels are relevant; 0.06=relaxation, 0.09=intoxication, >0.55=possible death.

Alcohol Withdrawal (DSM-5-TR)

• Cessation of heavy/prolonged alcohol use leads to two or more symptoms within hours to days: hyperactivity, tremors, insomnia, nausea/vomiting, hallucinations, agitation, anxiety, and seizures.

Alcohol Use Disorder Etiology

• Biological Factors:*

• Genetics (MZ twins: 54%/ DZ twins: 28%)

• Alcohol sensitivity/reactivity.

• Abnormal dopamine-2 receptor gene.

• Biochemical factors.

• Dopamine pathways (ventral tegmental area -> nucleus accumbens -> frontal cortex) play an important role in reward.

• Incentive sensitization theory and reward deficiency syndromes.

• Psychodynamic Factors:*

• Strong dependency needs due to a lack of nurturing.

• Potential development of a substance abuse personality.

Explore the complexities of substance use and gambling disorders in this quiz. Understand the diagnoses, effects of substances, and the implications of withdrawal and abuse. Test your knowledge on the psychological and behavioral changes that accompany these disorders.