Substance Use Disorders

What is often the root issue behind substance use?

Living in a reality that feels unbearable; substances help people cope with it.

What are psychoactive substances?

Substances that alter thinking, feeling, behavior, and psychological functioning.

What’s the difference between substance use and intoxication?

Use = occasional ingestion;

Intoxication = CNS effects leading to temporary psychological or behavioral changes.

What’s the difference between substance abuse and dependence?

Abuse = interference with life;

Dependence = physiological or psychological need (withdrawal/tolerance or drug-seeking).

What is tolerance?

Needing more of a substance to feel the same effect.

What is withdrawal?

Physical or psychological symptoms after stopping or reducing substance use.

What defines a Substance Use Disorder in DSM-5-TR?

A pattern of use causing distress or impairment, with at least 2 symptoms in 12 months.

Name some DSM-5-TR symptoms of Substance Use Disorder.

Larger use than intended, unsuccessful attempts to stop, cravings, tolerance, withdrawal, giving up activities, hazardous use.

What are the DSM severity levels for Substance Use Disorder?

Mild (2-3), Moderate (4-5), Severe (6+ symptoms).

What is the difference between early and sustained remission?

Early = 3–12 months sober;

Sustained = 12+ months sober with no symptoms.

What does it mean to be in a controlled environment?

The individual can’t access the substance (e.g., rehab or prison), so their sobriety cannot be fully verified.

Which behavioral addiction is officially in the DSM-5-TR?

Gambling Disorder.

What do substance and behavioral addictions have in common?

Reward system activation, cravings, tolerance, withdrawal, and life impairment.

How do behavioral addictions differ from substance addictions?

No intoxication, mostly psychological withdrawal, and treatment tends to be more behavioral than medical

How do substances create euphoria?

They flood the brain with dopamine, activating the VTA → Nucleus Accumbens → Prefrontal Cortex reward pathway.

How does the brain respond to long-term substance use?

It reduces dopamine production and receptor sensitivity, leading to tolerance and stronger withdrawal.

How do genetics affect addiction risk?

Having an alcoholic parent and genetic differences in alcohol metabolism can increase risk.

How do psychological factors influence substance use?

Learned behavior, peer reinforcement, and using substances to relieve social anxiety or negative affect.

What is the Opponent Process Theory?

The brain counters the high with a crash, requiring more drug for the same high over time.

How do cultural factors affect substance use?

Cultural attitudes, university norms, and religious prohibitions all influence use rates.

What environmental factors increase substance use risk?

Stress, trauma, poverty, homelessness, lack of healthcare, and substance availability.

What is the most common substance use disorder in Canada?

Alcohol Use Disorder (18%).

What are the prevalence rates of Cannabis and Nicotine Use Disorders?

Cannabis: 7%; Nicotine: 10–15%.

What is agonist substitution?

Using a safer drug similar to the abused one (e.g., methadone, nicotine patch).

What is antagonistic treatment?

Blocking the effects of the drug (e.g., naltrexone).

What is aversive treatment?

Making drug use unpleasant (e.g., Antabuse for alcohol).

Are biological treatments effective alone?

No, they work best when combined with psychological treatments.

What is motivational interviewing (MI)?

A therapy that helps resolve ambivalence and boost motivation for change.

What is contingency management?

Providing rewards for abstinence.

What role do community programs like AA play?

They offer social support, are widely accessible, and are free.

What are some social interventions for preventing substance misuse?

Accessible healthcare, housing support, safe recreational spaces, and social inclusion programs.

Why is addressing stress and trauma important in prevention?

These are major contributors to substance use as coping mechanisms.