Chapter 4 – Substance Use and Related Disorders

Vocabulary flashcards covering key terms, criteria, mechanisms, clinical features and treatments across substance-related and behavioral addictions discussed in the lecture notes.

Substance Use Disorder (SUD)

A prolonged, maladaptive pattern of substance use producing clinically significant impairment or distress.

Behavioral dependence

Compulsive, substance-seeking behavior despite adverse consequences.

Physical dependence

Physiologic adaptation to a drug, manifested by tolerance and a withdrawal syndrome.

Psychological dependence

Craving for a substance or use to avoid dysphoria or emotional discomfort.

Addiction

Chronic, relapsing pattern of compulsive drug use that engages common brain reward circuitry.

DSM-5 substance-related categories

(1) Substance Use Disorder, (2) Substance Intoxication, (3) Substance Withdrawal, (4) Substance-Induced Mental Disorder.

Four symptom clusters of SUDs

Pharmacologic symptoms, impaired control, social impairment, and risky use.

Tolerance

Need for markedly increased amounts of a substance to achieve desired effect or diminished effect with continued use of the same amount.

Withdrawal

Substance-specific syndrome occurring after cessation or reduction of heavy, prolonged use.

Craving

Strong desire or urge to use a substance; one of the core diagnostic criteria in DSM-5.

DSM-5 SUD diagnostic threshold

Two or more criteria within a 12-month period causing impairment or distress.

Severity specifiers (SUD)

Mild (2–3 symptoms), Moderate (4–5), Severe (6 or more).

In a controlled environment

Specifier indicating the individual is in a setting where access to the substance is restricted.

Stages of Change model

Pre-contemplation, Contemplation, Preparation, Action, Maintenance.

Relapse Prevention Therapy (RPT)

Cognitive-behavioral approach that teaches coping skills to maintain abstinence and manage “slips.”

Comorbidity in SUD

Up to 50 % of treatment-seeking patients meet criteria for another psychiatric disorder, often antisocial personality disorder.

Alcohol Use Disorder (AUD)

Pattern of problem drinking leading to impairment or distress, diagnosed using substance-specific DSM-5 criteria.

Blood Alcohol Concentration (BAC) legal limit

80–100 mg/dL in most U.S. jurisdictions.

Delirium Tremens (DTs)

Severe alcohol withdrawal with delirium, autonomic hyperactivity, and high mortality if untreated.

Alcohol withdrawal timeline

Tremor 6–8 h, perceptual symptoms 8–12 h, seizures 12–24 h, DTs within 72 h after last drink.

Wernicke encephalopathy triad

Ataxia, confusion, and ocular motor abnormalities due to thiamine deficiency.

Korsakoff syndrome

Chronic anterograde amnesia with confabulation following untreated Wernicke encephalopathy.

Blackout

Transient anterograde amnesia during acute alcohol intoxication.

Gamma-glutamyl transpeptidase (GGT)

Liver enzyme; values >35 U/L suggest heavy alcohol use.

Carbohydrate-deficient transferrin (CDT)

Serum biomarker; >3 % indicates chronic heavy drinking.

Fetal Alcohol Syndrome (FAS)

Preventable congenital disorder with microcephaly, facial anomalies, and intellectual disability from maternal alcohol use.

Disulfiram

Aldehyde-dehydrogenase inhibitor producing aversive reaction if alcohol is consumed.

Naltrexone (alcohol)

Opioid receptor antagonist that reduces alcohol craving and relapse risk.

Acamprosate

Glutamatergic modulator used to ease protracted alcohol withdrawal and support abstinence.

Cannabis Use Disorder (CUD)

Problematic pattern of cannabis use causing impairment or distress.

Δ9-tetrahydrocannabinol (THC)

Primary psychoactive cannabinoid responsible for cannabis effects.

CB1 receptor

Cannabinoid receptor in basal ganglia, hippocampus, and cerebellum mediating cannabis effects; absent in brainstem.

Cannabis intoxication

Recent use with behavioral changes plus symptoms such as conjunctival injection, increased appetite, dry mouth, tachycardia.

Cannabis withdrawal

Irritability, insomnia, decreased appetite, craving, and headaches beginning after cessation of heavy use.

Cannabis-induced psychotic disorder

Acute psychosis (usually hallucinations and paranoia) temporally related to high-potency cannabis use.

Opioid Use Disorder (OUD)

Maladaptive pattern of opioid use leading to impairment or distress within 12 months.

Opioid intoxication triad

Respiratory depression, pinpoint pupils, and coma.

Opioid withdrawal key features

Myalgias, diarrhea, rhinorrhea, lacrimation, piloerection, dilated pupils, yawning, fever, hypertension.

Naloxone

Short-acting opioid antagonist used for emergency overdose reversal.

Methadone maintenance

Long-acting full opioid agonist therapy (80–120 mg/day) that reduces illicit opioid use and HIV risk.

Buprenorphine

High-affinity partial opioid agonist with a ceiling effect on respiratory depression; used for detox and maintenance.

Naltrexone (opioid)

Long-acting antagonist that blocks opioid euphoria; adherence limits effectiveness.

Antagonist-precipitated withdrawal

Severe, rapid withdrawal triggered by administering an antagonist to a person with opioids on board.

Sedative-Hypnotic-Anxiolytic Use Disorder

Problematic use of benzodiazepines, barbiturates, or related agents causing impairment or distress.

Flumazenil

Specific benzodiazepine receptor antagonist used to reverse BZD overdose.

Benzodiazepine discontinuation syndrome

Anxiety, insomnia, tremor, perceptual disturbances, and seizures after abrupt cessation of chronic benzodiazepine use.

Barbiturate withdrawal

Potentially life-threatening syndrome with seizures, delirium, and cardiovascular collapse.

Phenobarbital substitution

Strategy of converting short-acting barbiturate dependence to long-acting phenobarbital before gradual taper.

Stimulant Use Disorder

Problematic pattern of amphetamine-type, cocaine, or other stimulant use leading to impairment or distress.

Stimulant intoxication

Mydriasis, psychomotor changes, tachy‐ or bradycardia, hypertension, chest pain, paranoia, or seizures after recent use.

Formication

Tactile hallucination of insects crawling on or under the skin, common in stimulant psychosis.

Stimulant "crash"

Withdrawal phase characterized by fatigue, depression, hypersomnia, and intense craving.

Cocaine mechanism

Blocks dopamine, norepinephrine, and serotonin reuptake transporters, raising synaptic monoamines.

Methamphetamine mechanism

Promotes presynaptic release of dopamine and norepinephrine and blocks reuptake transporters.

Nicotine

Potent agonist at nicotinic acetylcholine receptors that rapidly activates dopaminergic reward pathways.

Tobacco Use Disorder (TUD)

Persistent tobacco use with dependence symptoms such as craving, tolerance, and withdrawal.

Nicotine withdrawal symptoms

Craving, irritability, anxiety, difficulty concentrating, increased appetite, insomnia, bradycardia.

5 A’s model

Ask, Advise, Assess, Assist, Arrange – brief clinician framework for smoking cessation.

Nicotine replacement therapy (NRT)

Patches, gum, lozenges, nasal spray, or inhaler delivering nicotine to reduce withdrawal and double quit rates.

Varenicline

Partial α4β2 nicotinic receptor agonist that lessens withdrawal and blocks nicotine reinforcement.

Bupropion SR

Dopamine-norepinephrine reuptake inhibitor antidepressant also approved for smoking cessation.

Caffeine intoxication

Restlessness, nervousness, insomnia, GI upset, tachycardia after >250 mg in a short period.

Caffeine withdrawal

Headache, fatigue, drowsiness, irritability, and depressed mood beginning 12–24 h after cessation.

Adenosine receptor antagonism

Primary neuropharmacologic action of caffeine leading to increased CNS arousal and vasoconstriction.

Hallucinogen-Persisting Perception Disorder (HPPD)

Recurrent perceptual disturbances (flashbacks) following cessation of hallucinogen use.

Lysergic acid diethylamide (LSD)

Potent 5-HT₂A partial agonist hallucinogen producing perceptual distortions and synesthesia.

Phencyclidine (PCP)

Dissociative anesthetic, NMDA antagonist causing nystagmus, hypertension, aggression, and psychosis.

Ketamine

Short-acting NMDA antagonist producing dissociation; used medically for anesthesia and as rapid-acting antidepressant.

Flashback

Spontaneous recurrence of hallucinogenic perceptual experiences after drug effects have worn off.

Inhalant Use Disorder

Maladaptive pattern of volatile solvent or gas inhalation leading to impairment or distress.

Sudden sniffing death

Abrupt fatal arrhythmia or respiratory arrest occurring during or right after inhalant use.

Toluene embryopathy

Fetal growth retardation and craniofacial anomalies resembling FAS due to maternal solvent inhalation.

Anabolic-Androgenic Steroids (AAS)

Synthetic derivatives of testosterone abused to increase muscle mass and performance.

Roid rage

Aggressive or violent behavior associated with high-dose anabolic steroid use.

Muscle dysmorphia

Body-image disorder marked by obsessive belief of insufficient muscularity despite large physique.

Gynecomastia

Breast enlargement in males caused by aromatization of exogenous anabolic steroids.

Hypogonadism (post-AAS)

Suppressed endogenous testosterone production leading to testicular atrophy and low libido after steroid cessation.

Gambling Disorder

Persistent, recurrent maladaptive gambling behavior meeting ≥4 DSM-5 criteria within 12 months.

Chasing losses

Common gambling behavior of returning to gamble to recover lost money.

Gamblers Anonymous (GA)

12-step peer-support program modeled after AA for individuals seeking abstinence from gambling.

Internet Gaming Disorder

Proposed diagnosis characterized by compulsive, excessive online gaming with impairment and withdrawal-like symptoms.

Reward circuitry

Mesolimbic dopamine pathway (VTA → nucleus accumbens) activated by most addictive substances and behaviors.

Conditioned cue reactivity

Limbic activation and craving triggered by environmental reminders of substance use.

Clonidine (opioid withdrawal)

α₂-adrenergic agonist that reduces autonomic symptoms during opioid detoxification.

Disulfiram reaction

Flushing, throbbing headache, nausea, vomiting, hypotension after alcohol ingestion while on disulfiram.

Protracted alcohol withdrawal

Extended phase of anxiety, insomnia, and dysphoria lasting weeks to months after acute detox.

Chlordiazepoxide

Long-acting benzodiazepine commonly used for alcohol detox to prevent seizures and DTs.

Formication (cocaine bugs)

Tactile hallucination of insects crawling, typical in cocaine intoxication or withdrawal.

Crack cocaine

Freebase form of cocaine that is smoked, producing rapid intense euphoria and high addiction potential.

Designer amphetamines (MDMA)

Synthetic amphetamine derivatives with stimulant and empathogenic effects; risk of serotonergic neurotoxicity.

Ceiling effect (buprenorphine)

Plateau in respiratory depression and euphoric effects at higher doses, increasing safety profile.

Flumazenil precautions

May precipitate seizures in mixed overdose or chronic benzodiazepine users; use cautiously.

Sleep architecture and alcohol

Acute alcohol reduces REM and slow-wave sleep and increases nocturnal awakenings.

Gamma-aminobutyric acid (GABA)

Primary inhibitory neurotransmitter; target of alcohol, benzodiazepines, and barbiturates.

N-methyl-D-aspartate (NMDA) receptor

Glutamatergic receptor inhibited by alcohol and blocked by PCP/ketamine.

Mesolimbic dopamine pathway

Neural circuit key to reinforcement and addiction; includes VTA and nucleus accumbens.

Locus coeruleus

Brainstem noradrenergic nucleus implicated in opioid withdrawal hyperactivity.

Conditioned place preference

Animal model demonstrating learned association between environment and drug reward.

Harm reduction

Public-health strategy aimed at minimizing adverse consequences of drug use without necessarily requiring abstinence.

Needle exchange programs

Harm-reduction service providing sterile syringes to prevent HIV and hepatitis transmission.