Substance Use and Related Disorders

• This document presents a study of substance use, misuse, and related disorders, as well as their biological and psychological factors, and potential treatments

Terminology

• Substance use occurs when ingesting a substance with no negative effects
• Substance intoxication occurs when experiencing intended physiological effects of substances

Substance Abuse vs Dependence

• Substance abuse happens when substance use causes distress and/or impairment; distress and/or impairment needs to be present to diagnose
• Substance dependence is defined as a state in which cessation of drug use causes withdrawal symptoms, it does not necessarily negatively affect you
• Physiological dependence can be physiological, with experiences of withdrawal and tolerance
• Tolerance is needing to increase the amount of a substance to maintain the desired effect
• Psychological dependence can manifest as craving, beliefs, and behaviors related to substance use

Common Misconceptions

• Illegal drugs do not have only negative effects; some have medicinal effects, such as marijuana to treat nausea, cocaine or heroin, MDMA for PTSD, and psychedelics to combat depression
• Using an illegal drug once does not necessarily lead to addiction
• Cannabis is not necessarily a "gateway" drug
• Prohibition does not necessarily decrease drug availability
• Portugal has decreased drug availability through decriminilisation
• Former drug users are no better at being drug therapists than trained social workers

Substance Use Disorder Criteria

• 11 criteria in the DSM-5-TR can be grouped based on physical dependence, risky use, social problems, and impaired control
• A minimum of 2 criteria must be met within a two-month period to be diagnosed
• A pattern of substance use leads to significant impairment and distress, indicated by several factors over 12 months

DSM-5-TR Criteria

• Using more of a substance or for longer than intended
• Ongoing desire or repeated failed attempts to control use
• Devoting substantial time to obtaining, using, and recovering from substance effects
• Experiencing cravings or a strong urge to use
• Neglecting responsibilities at work, school, or home
• Continuing use despite social or interpersonal problems caused or worsened by it
• Giving up important social, recreational, or work activities
• Using substances in physically dangerous situations
• Continuing use despite knowledge of a physical or psychological problem caused or worsened by the substance
• Developing tolerance, needing more of the substance for desired effect, or experiencing a diminished effect
• Experiencing withdrawal symptoms, which can be relieved by taking more of the substance

General Biological Factors of Substance Use

• Genetics play a role in alcohol, tobacco, and opiate dependencies
• Reward areas in the brain are affected by released dopamine
• Released dopamine relates to addictions
• Opioid system hijacking can occur as substances make us enjoy food, sex, & socializing

Treatments

• Antagonists counteract overdoses for some substances like Naloxone for fentanyl overdose or Valium for stimulant/cocaine overdose

Medically Supervised Withdrawal

• Replacement medications like methadone offer safer alternatives

General Psychological Etiological Factors

• The Disease Model states that addiction is the same as a disease: if someone has access to the substance then they cannot control their actions.
• Parental influence can affect drug use as using drugs is used as coping mechanisms.
• Expectancy effects are present as how beneficial we believe the drug will be may increase our likelihood of use.

General Psychological Etiological Factor- Reinforcement

• Positive reinforcement can be encouraged by the the high from substance
• Positive reinforcement often leads to polysubstance use in an attempt to enhance positive effects
• Negative reinforcement is used when we need to remove the unpleasant feelings (physiological or psychological distress), which leads to reinforcing substance use
• Self medication motivation is often less linked to abuse but more linked to dependence

Opponent-Process Theory

• Drug addiction results from emotionally pairing pleasure and pain, otherwise known as withdrawal symptoms
• There are emotions paired as opposites
• Paired emotions are like happy and sad, fear and relief, as well as pleasure and pain
• One emotion is temporarily inhibited when you experience another
• Initial stimulus will become weaker with repeated stimulus
• The initial emotion will weaken and the opposing emotion will intensify
• The second emotion will suppress the first emotion

Conditioned Place preference

• Craving may be a response to conditioned place preference
• Conditioned place preference explains how a specific place can facilitate addiction and overdose

General Psychological Treatments

• 12-step programs can have a religious component with strong social support but they do not like researchers checking on their efficacy
• Support Groups/Community resources are generally ineffective
• Inpatient programs are effective for detox.
• CBT focuses on controlled use
• Motivational interviewing is used to find one's own reason for addressing their substance use
• Harm-reduction focuses on the goals and safety of the individual and can be combined with CBT
• Multiple relapses during treatment are common

Substance-Related and Addictive Disorders

• Alcohol
• Tobacco
• Cannabis
• Amphetamines/Cocaine
• Opioids
• Hallucinogens
• Gambling Disorder

Alcohol Intoxication and Withdrawal

• Initial intoxication shows an increase in well-being/decreased inhibitions
• As intoxication progresses, there are decreased motor control/coordination/reaction times, poor judgement, and blackouts
• Withdrawal symptoms include hand tremors, nausea, anxiety, insomnia, hallucinations, and delirium tremens
• 12% of men and 5% of women have alcohol addiction

Factors for Addiction

• Teenagers and Young Adults are at a higher risk for alcohol dependence than other adults
• Young males are also particularly at risk for alcohol addiction
• Long term chronic use of alcohol can cause dementia, brain damage, and FASD(Fetal Alcohol Spectrum disorder)
• 5 drinks in 2 hours for men correlates to binge drinking while 4 drinks in 2 hours correlates to binge drinking for women

Alchohol Biological Factors- Etiology

• There are heritability linked genetic factors, especially for men
• Individuals with family history can have more pleasure when drinking
• Heritability has been shown to have a 70% correlation with alcohol dependence
• Decreasing glutamate may cause blackout but increasing GABA slows the firing of neurons

Serotonin, Dopamine, and Opioids

• Serotonin and opioids increase initially but deplete over time
• Dopamine experiences initial decrease but long term causes dependence
• Alcohol dehydrogenase is an enzyme in the liver that breaks down alcohol
• 30-50% of Asians lack the enzyme dehydrogenase, resulting in skin flushing

Treatments- Biological

• Antabuse causes nausea for the user when consuming alcohol
• Naltrexone stops the euphoria of drinking by blocking receptors

Psychological Factors of Alchohol Use

• Cultural differences can be tied to religion, perception, and alcohol type consumed
• Alcohol Myopia is the increased concentration upon immediate events as well as reduced awareness of distant events

Motivators for Use and Alcohol Treatment

• Motivators for use include self medicating and trying to get high
• Alcoholics Anonymous focuses on abstinence
• High drop rate due to lack of social support
• CBT focuses on control
• High Relapse rate is 70-80%
• Harm reduction helps patients make their goals with control of drugs and alcohol

Amphetamines/Cocaine and their Effects

• Intoxication experiences include euphoria, alertness, insomnia
• Hallucinations, anxiety, vomiting, weight loss, seizures, and coma are also present
• Chronic use ages the brain quickly
• Withdrawal includes apathy, boredom, depression, increased sleep, and irritability
• 0.2% of people have reported using Cocaine
• Less than 10% of the population have ever used cocaine

Biological Factors for Amphetamines/Cocaine

• Drug sensitization is the opposite of developing tolerance

Treatments

• Propranolol
• Modafinil
• ADHD medications
• Cocaine Anonymous
• CBT with contingency management- positive rewards in response to goals
• Harm reduction as promoting non-sharing of needles

Nicotine/Tobacco Effects

• Intoxication releases stress and improves mood
• During intoxication there may be blurred vision, confusion, and convulsion
• Withdrawal includes depressed mood, insomnia, anxiety, difficulty concentrating, restlessness, increased appetite/weight gain, and irritability
• 15% of people smoke (12mo)

Nicotine and Biological Factors

• Nicotine can improves cognition function from it's usefulness for dementia and alzheimer's
• Men start smoking younger and rates for women increase during their first year of university
• Most smokers (40%) have been smokers at some point
• Nicotinic Acetylcholine receptors are located in the limbic system (pleasure system) and Genetics can predispose to individual with depression and addiction to nicotine
• Smoking enhances alcohol and dopamine

Nicotine Treatment

• Replace with nicotine use that is most effective when pared with therapy
• Wellbutrin/Zyban are halluncinogen/delusion side effects
• Silver acetate is a form of chewing gum that makes the substance taste awful

Tobacco/Nicotine Psychological Factors

• Depression/anxiety can prompt relapse
• Use to reduce negative stimuli
• Change environment stimuli and psycho education using CBT

Overall Opioid Effects

• During Intoxication, experiences are euphoria, drowsiness, and slowed breathing that can even death
• Withdrawal includes Nausea, chills, diarrhea, and insomnia
• 0.1-1% use opioids

Opioids- Biological and Psychological

• Enkephalin and endorphin systems are often hijacked
• Used to relieve pain
• Opioid can be treated with methadone for improved quality of life and reduce criminal acts
• Buprenorphine is when the high isn't being met, individuals seek other substances and Naltrexone

Opioids Psychological Treatment

• Withdrawal symptoms can prompt reuse
• Sensations are positive reinfocement while emotional Copers are negative
• Narcotics Anonymous
• CBT
• Harm reduction

Cannabis use Factors

• During intoxication their may be Euphoria, loss of time, heightened sensory experiences, mood swings, anxiety
• One may experience Paranoia, hallucinations, and dizziness
• Tolerance and Sensitization
• Withdrawal include Irritability, appetite loss, and difficulties sleeping

Cannabis Info and Treatment

• 1-4% use cannabis
• Sensitization
• Treat comorbid conditions such as anxiety or depression as may slow or effect the pleasure system
• CBT is relapse prevention, and harm reduction
• Motivator for use

Hallucinogen Effects

• Hallucinations, depersonalization, distorted sensory perceptions as heart and breathing rate increases
• Rapid tolerance and does not have a withdrawal
• 0.1% use it and Can improve personality with one dose.

Causes and Treatments

• They affect seratonin and norepinephine
• CBT, Harm-reduction are used for Psychological Treatment
• Treatment is linked
• Motivation used

Gambling Disorder

• To be diagnosed with gambling disorder, at least 4 of 9 the criteria in a 12-month period must be met
• Gambling is prompted by a need to gain excitement ,restlessness, or irritability after an unsuccessful attempt to quit
• Gambling when distressed
• Losers often return to win attempts.
• Jeopardizing relationships and or work at 0.2% of total population

Biological Factors

• All result in lowered Dopamine levels, the pleasure source
• Drugs blocking Opioid receptos such as lithium are an affective countermeasure

Gambling Psychological Factors and Treatment

• In the Casino, Positive Reinforcements and unpredictability occur
• Also there is a reliance on Emotions rather than a clear plan
• Conditions of operant conditioning involve the high and stimuli
• Treatment can be done by CBT, and Gamblers anonymous and Harm reduction
• Treatment can involve barring oneself and adaptive methods such as video games