SET 8: Substance Use Disorders

Identify the levels of substance use.

1. Substance Use: Ingestion of moderate amounts of a substance.

2. Substance Intoxication: Temporary effects that occur after ingestion.

3. Substance Abuse: When it starts to cause problems in your life.

4. Substance Dependence: Continued use despite these problems.

List common misconceptions about drugs and substance use.

Myth #1: Drugs have no positive effects.

Myth #2: If you try a drug once, you will become addicted.

Myth #3: Cannabis is a gateway drug.

Myth #4: Prohibition decreases drug availability.

Myth #5: Only former drug users are effective counsellors.

Explain what it means to have a substance use disorder and how it is diagnosed.

To have a substance disorder means having a pattern of substance use that causes significant impairment and/or distress. It is diagnosed when a person shows a maladaptive pattern of substance use with ≥2 symptoms within a 12-month period. 

Symptoms include:

• Using too much or using it for too long.

• Wanting to stop but not being able to.

• Spending a lot of time getting it, using it, or recovering from it.

• Cravings or strong urges to use it.

• Problems at work, school, or home because of it.

• Using it even when it causes relationship problems.

• Giving up on important things because of it.

• Using it in dangerous situations.

• Using it even if it could cause or worsen your problems.

• Needing more to get the same effect (tolerance).

• Taking more of it to get rid of withdrawal symptoms.

Identify and describe substances classified as depressants, including intoxication, withdrawal, and mechanism of action.

Alcohol

• Intoxication: Initial sense of well-being and reduced inhibition, but can lead to decreased motor control, coordination, and reaction time, poor judgement, and blackouts.

• Withdrawal: Tremors, nausea, anxiety, insomnia, hallucinations, delirium tremens (DTs).

• Mechanism of Action: ↑ GABA, ↑ dopamine, and ↓ glutamate.

Sedatives, Hypnotics, and Anxiolytics

• Intoxication: Initial sense of well-being, muscle relaxation, sleepiness, and reduced inhibition, but can lead to slurred speech, decreased motor control, poor judgement and concentration, and even death due to suffocation from muscles being too relaxed.

• Withdrawal: Similar to alcohol.

• Mechanism of Action: ↑ GABA.

Identify and describe substances classified as stimulants, including intoxication, withdrawal, and mechanism of action.

Amphetamines / Cocaine

• Intoxication: Initial increase in euphoria, alertness, insomnia, and energy, but can lead to hallucinations, agitation, vomiting, weight loss, seizures, and even coma.

• Withdrawal: Apathy, boredom, depression, sleepiness, irritability.

• Mechanism of Action: ↑ norepinephrine and ↑ dopamine.

Tobacco (Nicotine)

• Intoxication: Relieves stress and improves mood, but can lead to blurred vision, confusion, and convulsions.

• Withdrawal: Depressed mood, insomnia, anxiety, difficulty concentrating, restlessness, increased appetite/weight gain.

• Mechanism of Action: Acts on nicotinic acetylcholine receptors (nAChRs), causing ↑ dopamine, ↑ serotonin, and ↑ norepinephrine.

Identify and describe substances classified as opioids, including intoxication, withdrawal, and mechanism of action.

Painkillers, Heroin, and Fentanyl.

• Intoxication: Euphoria, drowsiness, and slowed breathing (can cause death).

• Withdrawal: Nausea, chills, diarrhea, insomnia, muscle aches, anxiety.

• Mechanism of Action: Acts on the brain’s natural opioid system.

Identify and describe substances classified as hallucinogens, including intoxication, withdrawal, and mechanism of action.

LSD / Psilocybin Mushrooms

• Intoxication: Hallucinations, depersonalization, distorted sensory perception, increased heart rate and perspiration, and rapid tolerance.

• Withdrawal: None, although “bad trips” may occur.

• Mechanism of Action: ↑ serotonin

Cannabis (Marijuana)

• Intoxication: Euphoria, loss of time, heightened sensory experiences, mood swings, anxiety, memory impairment, paranoia, hallucinations, and dizziness.

• Withdrawal: Irritability, appetite loss, and difficulty sleeping.

• Mechanism of Action: Acts on the body’s natural endocannabinoid system.

Identify biological factors implicated in substance use disorders.

• Stronger genetic influence for men.

• Genes may influence pleasure response.

• Some genes may be protective (e.g., low ADH → flushing, difficulty metabolizing alcohol).

• Hijacks the brain’s reward centre (drug → dopamine → pleasure → reinforced use).

Identify psychological factors implicated in substance use disorders.

• The high feels good (positive reinforcement).

• Using it removes withdrawal symptoms (negative reinforcement).

• When you take a drug, your body produces the opposite response to counteract its effects (opponent process theory).

• Cues associated with drug use trigger pre-emptive withdrawal effect (conditioned compensatory response).

Describe difficulties in the treatment of substance use disorders.

Treating substance use disorders is difficult because they affect the brain, behaviour, decision-making, and social functioning, so recovery requires comprehensive, multi-step care that includes detox, motivation enhancement, biological treatments, and therapeutic / social interventions. Treatment is further complicated by co-morbid conditions, high likelihood of lapses / relapses, low rates of seeking help, and the high cost of inpatient care.

Describe biological approaches to the treatment of substance use disorders.

• Substitution Therapies: Swap the bad drug with a safer one.

• Antagonists: Drugs that can block the effects of the bad drug.

• Aversive Treatment: Makes ingesting the bad drug extremely unpleasant.

Describe psychological approaches to the treatment of substance use disorders.

• Motivational Interviewing (MI): Helps people prepare for treatment and explores personal reasons for change.

• Cognitive-Behavioural Therapy (CBT): Emphasizes relapse prevention, beliefs about substances, and building alternative coping skills.

• Alcoholics / Narcotics / Cocaine Anonymous: 12-step programs which subscribe to a disease model and emphasize complete abstinence.

Describe harm reduction approaches to the treatment of substance use disorders.

Harm reduction approaches aim to minimize the harm of substance use rather than going cold turkey, focusing on safer-use practices through strategies such as controlled drinking programs and supervised injection sites.