Substance Use Disorders Overview

Substance Use Disorders

• Substance intoxication is a state of behavioral and psychological changes resulting from the body's physiological response to a substance.

• Intoxication subsides as the substance level decreases, but symptoms may linger for hours or days.

• Specific symptoms depend on the substance, amount, timing, user tolerance, and context. Acute and chronic intoxication symptoms differ.

• Diagnosis requires maladaptive behavior disrupting daily functioning, such as relationship problems, job issues or risk of accidents.

• Substance intoxication can occur in those with or without a substance use disorder.

• Substance withdrawal is a collection of behavioral and physiological symptoms arising from ceasing heavy substance use.

• Symptoms counter the effects of intoxication, demanding distress and impairment of daily life.

• Substance use disorder is characterized by repeated difficulty resisting substance use.

• DSM-5 criteria group difficulties into impaired control, use despite negative consequences, risky use, and tolerance/withdrawals.

• Diagnosis requires at least two symptoms over a year.

• Severity is rated as mild (2-3 criteria), moderate (4-5 criteria), or severe (6+ criteria).

• "Addiction" is synonymous with severe substance use disorder in DSM-5.

• Ten substance categories exist in DSM-5: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and other/unknown substances.

Criteria for Substance Use Disorder

• Impaired Control: Increasing use amounts or duration, craving, attempts to reduce or control use, significant time spent on substance use/recovery.

• Social Impairment: Inability to meet responsibilities at home, work, or school. Key activities are reduced or abandoned due to substance use. Substance use despite existing social or relationship issues.

• Risky Use: Using substances in hazardous settings (driving, operating machinery) despite awareness of harm. Continued use despite obvious physical or psychological problems worsened by substance use.

• Pharmacological: Tolerance (increased amounts/diminished effect) or withdrawal (characteristic syndrome/use to relieve symptoms).

Comorbidity

• Substance use disorders frequently co-occur with other psychological disorders.

• 53-76% of those with substance dependence have other concurrent psychiatric disorders.

• Bipolar disorder, major depression, anxiety, schizophrenia, bulimia, and personality disorders frequently co-occur with substance use disorders at higher rates than in the general population.

• Psychiatric disorders generally predate substance abuse/dependence, possibly due to self-medication.

Classes of Drugs

• Depressants: Lower doses produce relaxation, impaired motor/cognitive skills, and reduced concentration; higher doses lead to stupor or death.

• Stimulants: Increase central nervous system activity, leading to feelings of increased energy, euphoria, reduced sleep/appetite, and heightened awareness. Cocaine and amphetamines are associated with more severe disorders. Nicotine and caffeine also fall under this category.

• Hallucinogens: In small doses, they result in perceptual changes; larger doses can cause anxiety, fear, paranoia, and emotional dysregulation. Examples include LSD, and PCP.

• Opioids: Naturally derived or synthetic compounds with pain-relieving properties. They are also known to result in Euphoria or intense feeling of warmth and tingling in the abdomem. Examples include morphine, heroin, and codeine.

• Cannabis: Mild stimulant and psychoactive effects influence cannabinoid receptors affecting memory and motor functions.