Understanding Substance Use Disorders and Treatments

Substance

Mood, behavior modifying chemical

Intoxication

Reversible symptoms due to the direct effects of a substance ingested or exposed

Tolerance

Using the same amount of a substance no longer has the desired effect

Withdrawal

Specific symptoms (depends on substance used) as a result of ceasing to use or drastically decreasing use of a substance

Substance Use Disorder

A problematic pattern of use (within last 12 mo) causing significant impairment/distress as manifested by 2 or more of the following: Tolerance, Withdrawal, Craving, Use longer and more than you intend, Want to cut down but cannot, Spend a great deal of time getting, using or recovering from use, Use results in failure to fulfill major role obligations

Mild Substance Use Disorder

2-3 symptoms

Moderate Substance Use Disorder

4-5 symptoms

Severe Substance Use Disorder

6 or more symptoms

Depressants

Alcohol, sedative hypnotics, opioids

Stimulants

Amphetamines, cocaine, methamphetamines, nicotine, caffeine

Hallucinogens

LSD, mescaline

Cannabinoids

Marijuana, hashish

Inhalants

Solvents, gas

Inhaling

Time to reach brain: 7-60 seconds

Snorting

Time to reach brain: 4 minutes

Injecting (IV)

Time to reach brain: 20 seconds

Injecting (IM)

Time to reach brain: 4 minutes

Oral consumption

Time to reach brain: 20 minutes

Heavy Alcohol Use (Men)

4 or more standard drinks on any given day constitutes heavy alcohol use

Heavy Alcohol Use (Women)

3 or more standard drinks on any given day constitutes heavy alcohol use

Binge drinking (Men)

5 or more standard drinks on the same occasion (or within 2 hours)

Binge drinking (Women)

4 or more standard drinks on the same occasion (or within 2 hours)

Alcohol

Slows the activity of the CNS and binds to neurons that typically bind to GABA, helping GABA shut down neurons

Alcohol dehydrogenase

Metabolized by liver

Average alcohol metabolism rate

Average: .25 ounces/hour

BAC = 0.06

Relaxation and comfort

BAC = 0.09

Intoxication

BAC > 0.55

Death

Long-term excessive alcohol use

Damage physical health

Cirrhosis

Especially damaged is the liver

Korsakoff's syndrome

Nutritional problems due to long-term excessive alcohol use

Fetal alcohol syndrome (FAS)

Women who drink alcohol during pregnancy place their fetuses at risk

Sedative Hypnotics

Impaired judgment, mood swings, risk of aggressive/sexual behavior, relaxed, sleepy, slurred speech, incoordination, unsteady gait, impaired attention and memory, 'eye drifting,' stupor, coma

Risk of addiction for Sedative Hypnotics

Moderately high risk

Withdrawal symptoms from alcohol or sedative/hypnotics

Sweating, increased heart rate, anxiety, insomnia, vomiting, hallucinations, tremor, agitation, seizures, delirium, possibly death (rare instances)

DTs

Occurs in 5-10% of chronic alcohol abusers and carries up to 5% mortality with treatment and up to 35% mortality without treatment

Opioids

Natural or synthetic substances like Morphine, Heroin, Methadone

Biggest risk of Opioids

Overdose can close down respiratory center in the brain

Heroin withdrawal symptoms

Nausea, vomiting, diarrhea, muscle ache, fever, insomnia, pupil dilation, runny nose and/or eyes, yawning, dysphoric mood

Stimulants

Substances that increase the activity of the central nervous system (CNS)

Common stimulants

Cocaine, Amphetamines, Caffeine

Stimulant intoxication symptoms

Increased/decreased heart rate, euphoria, pupil dilation, elevate/lower blood pressure, sweating/chills, nausea/vomiting, weight loss, psychomotor agitation/retardation, cardiac arrhythmia/chest pain, confusion, seizure, coma

Stimulant withdrawal symptoms

Dysphoric mood, fatigue, unpleasant dreams, increased appetite, psychomotor, sleep disturbance

Dangers of cocaine/stimulants

Overdose can depress the brain's respiratory function, causing the person to stop breathing

Methamphetamine

Synthetic drug with high risk of tolerance

Amphetamine psychosis

A condition that may occur in individuals using amphetamines, characterized by symptoms similar to schizophrenia.

Stimulant withdrawal

A syndrome that occurs when a person stops using stimulants like cocaine or amphetamines, leading to symptoms such as fatigue and depression.

Hallucinogens

Substances like LSD, peyote, and mushrooms that alter perceptual experiences and may cause sweating, heart palpitations, and blurred vision.

Neurotransmitter: Serotonin

A chemical in the brain that is affected by hallucinogens, influencing mood and perception.

Cannabis

A drug containing THC, which acts as a depressant, stimulant, and/or hallucinogen, leading to various effects including euphoria and impaired coordination.

Anandamide

A neurotransmitter in the brain that is decreased with heavy cannabis use.

Cannabis Withdrawal

A condition that occurs after stopping heavy cannabis use, characterized by symptoms like irritability, anxiety, and sleep difficulties.

Cannabis: Excessive Use

Heavy use of cannabis that may lead to panic reactions, accidents, poor concentration, and links to psychosis.

Opioids

A class of drugs that can lead to withdrawal symptoms such as dilated pupils and chills.

Polysubstance Use

The concurrent use of multiple drugs, which can enhance or negate the effects of each other and lead to dangerous levels in the body.

Gambling Disorder: Criteria

A set of symptoms including the need to gamble with increasing amounts of money and preoccupation with gambling, leading to significant distress.

Gambling Disorder: Mild

Characterized by meeting 4-5 criteria for gambling disorder.

Gambling Disorder: Moderate

Characterized by meeting 6-7 criteria for gambling disorder.

Gambling Disorder: Severe

Characterized by meeting 8-9 criteria for gambling disorder.

Gambling Disorder: Men vs. Women

Women experience later onset and faster progression to problematic gambling compared to men.

Etiology of SUD/GD: Causes

A variety of factors including sociocultural, psychodynamic, cognitive behavioral, and biological influences contribute to substance use disorders and gambling disorders.

Genetic link in Gambling Disorder

Evidence suggests a genetic predisposition to gambling disorder, particularly among non-white groups.

Dopamine and Gambling Disorder

Some individuals may experience onset of gambling disorder when taking medications that increase dopamine levels.

Sociocultural views

Those most likely to develop these disorders: Live in stressful socioeconomic conditions, Have families that value or tolerate drug use.

Psychodynamic views

Those most likely to develop these disorders: Have powerful childhood dependency needs, Display a "substance abuse personality."

Cognitive-behavioral views

Those most likely to develop these disorders: Are "conditioned" by tension-reduction, rewarding effects of drugs (self-medication), About 20% have a SUD and another disorder, Have rewards-produced expectancy that substances will be rewarding, May be influenced by classical conditioning when cues or objects are present during drug use.

Biological views - Genetic predisposition

Similarity of alcohol preferences among alcohol-preferring animals and their offspring, Alcoholism concordance rate in identical twins, Biological parent-adoptee child alcohol abuse rate, Abnormal form of dopamine-2 (D-2) receptor gene in people with substance use disorders.

Biological views - Neurotransmitters

Drug tolerance and withdrawal symptoms are caused by cutbacks in the brain's production of particular neurotransmitters during excessive and chronic drug use: Lower GABA production: Alcohol or sedative hypnotics, Lower endorphin production: Heroin, Lower dopamine production: Cocaine or amphetamines, Reduced anandamide production: Cannabis.

Biological views - Brain circuits

Dopamine is the key NT for most, Drugs stimulate structures directly and indirectly.

Incentive-sensitization theory

When substances repeatedly stimulate the reward center, it develops a hypersensitivity to substances.

Reward-deficiency syndrome

The reward center is not readily activated by "normal" life events so the person turns to drugs to stimulate this pleasure pathway, particularly in times of stress.

Developmental psychopathology view

Genetically inherited predisposition, Externalizing or internalizing temperament, Numerous stressors throughout childhood, Inadequate parenting, Rewarding substance use experiences, Relationships with peers who use drugs.

CAGE Assessment

1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Benefits of Treatment

Increase in physical and emotional wellbeing, Decrease in criminal activity (40-50% decreases), Increased productivity, Decrease in use of tax payers' $, One study estimated that rehab costs were paid back to society 12 fold when an addicted person was in treatment.

Cognitive Behavioral Treatment

Relapse Prevention is Part of CBT.

Cognitive Behavioral Treatment Goals

Identify maladaptive thoughts and modify them, Learn ways to cope with negative feelings and cravings that might result in drug use, Identify triggers for drug use, Prepare for high risk situations.

Relapse Prevention (CBT)

A cognitive-behavioral therapy approach that includes two important concepts: Abstinence violation effect (AVE) and Seemingly irrelevant decisions (SID).

Abstinence violation effect (AVE)

One slip results in a binge.

Seemingly irrelevant decisions (SID)

A person starts with one small, seemingly innocent decision which leads to other small decisions on the wrong path and eventually leads to using drugs and/or alcohol.

Acceptance and Commitment Therapy (ACT)

A type of cognitive-behavioral therapy that encourages acceptance of thoughts and cravings rather than trying to suppress them, using the metaphor of the mind as the sky and thoughts and cravings as clouds.

Motivational Interviewing (MI)

A technique and treatment that helps people clarify their feelings and motivation surrounding drug/alcohol use, with supportive and empathic therapists.

Behavior Therapy

Includes aversion therapy and contingency management; aversion therapy uses repeated pairings of an averse stimulus and drug.

Aversion therapy

Used sparingly, it involves repeated pairings of an averse stimulus and drug, such as shock and alcohol or alcohol use while on a drug that makes you vomit.

Contingency Management

Provides reinforcers for drug-free urines and is typically not used in isolation.

Biological Treatments

Include detoxification, antagonist medications, and agonist medications.

Detoxification

Medically supervised withdrawal, typically ineffective when done alone.

Antagonist medications

Medications that block or change the effects of the drug of choice.

Agonist medications

Mimic the effects of the drug of choice and are used as a safer substitute.

Common Medications

Include Antabuse for alcohol use disorder, Naltrexone for opioids and alcohol, Campral for alcohol, Narcan for opioid overdose, Methadone as a full opioid agonist, and Buprenorphine as a partial opioid agonist.

Antabuse

A medication that treats alcohol use disorder.

Naltrexone

Used for treating opioid and alcohol dependence.

Campral

Normalizes GABA and decreases craving for alcohol.

Narcan

Administered during an opioid overdose to block the effects.

Methadone

A full opioid agonist used as a substitute for opioids.

Buprenorphine

A partial opioid agonist that is also available with Narcan.

Common Approach: Harm Reduction

A strategy to reduce the negative effects of drug use while helping people get ready to engage in treatment.

Harm Reduction examples

May include free condoms, needle exchange programs, Narcan distribution programs, and 'wet shelters'.

Attitude of providers

Shown to be most helpful in getting people to start treatment.

Example of Portugal

Utilization of Motivational Interviewing (MI) in drug treatment.