Substance-Related and Addictive Disorders

Two Groups of Substance Disorders

Substance Use Disorder: A pattern of problematic substance use that causes significant problems or distress in a person’s life (DSM-5 combines DSM-IV substance abuse and dependence into one disorder on a severity continuum: Mild: 2-3 symptoms, Moderate 4-5 symptoms, Severe: 6+)

Substance-Induced Disorders: Mental and behavioral problems caused by a substance, including intoxication and withdrawal

Substance Intoxication

A reversible substance specific syndrome of maladaptive behavioral or psychological changes due to recent ingestion of or exposure to a substance that acts upon the CNS

• Includes belligerence, cognitive impairment, impaired judgment

• Symptoms develop shortly during or shortly after the use

Substance Use Disorder

A maladaptive pattern of use leading to impairment or distress, in at least two of criteria, occurring within a 12-month period

Tolerance

Needing to use an increased amount of a substance in order to achieve desired effects OR a markedly diminished effect being associated with continued use of same amount

• Result of CNS changes that occur following repeated use of drug

Withdrawal

Maladaptive behavioral change with physiological and cognitive effects that occurs when concentration of a substance declines in the body after heavy/prolonged use

Delirium Tremens (DTs)

A severe form of alcohol withdrawal that can cause confusion, hallucinations, severe anxiety, paranoia, insomnia, and seizures

Relapse and Treatment

• Relapse is common and treatment that is longer, more frequent, and more intensive is generally associated with better outcomes

• Relapse and remission are the rule - 2/3

• 70% of of patients are eventually able to abstain or decrease use to not meet criteria

Comorbidity and Stats

Comorbidity: other psychiatric disorders including depression, bipolar disorder, anxiety, PTSD, schizophrenia, conduct disorder, and antisocial personality disorder

Stats: About 50% of people with a substance-related disorder have another mental disorder; Intoxication is associated with 50% of all MVAs, 50% of all DV cases; 50% of all murders

Dual Diagnosis

Having both a substance use disorder and another mental disorder

• 50% of ppl with a SRD have another mental disorder

Level of Treatment — Hospitalization

Overdoes, severe withdrawal risk, medical comorbidity, or suicidal psychiatric illness

Level of Treatment — Residential Treatment

Restricted environment needed but intensive medical/psychiatric monitoring is NOT required

New Addition to DSM-5

Gambling disorder → brain pathways same as those other classes of substances