Substance Use Disorders & Sexual Dysfunctions: Definitions, Causes, and Treatments

Substance abuse

Using a drug so much it wrecks your relationships, work, or safety — but you keep doing it.

Substance dependence

Your whole life revolves around a drug. More severe than abuse.

Tolerance

You need MORE of a drug to feel the same effect.

Withdrawal

Nasty symptoms (shaking, sweating, pain) when you stop using a drug.

Depressants

Drugs that SLOW the brain down. Includes alcohol, sedatives, and opioids.

Alcohol (mechanism)

Alcohol is a GABA agonist — it calms neurons, loosening you up at first, then killing your coordination, judgment, and memory.

Why women get more drunk than men on the same amount

Women have less of the enzyme (alcohol dehydrogenase) that breaks down alcohol before it hits the blood.

Sedative-hypnotic drugs

Chill-out drugs. Low dose = calm. High dose = sleep. Examples: barbiturates, benzodiazepines.

Barbiturates - key danger

Tolerance builds for the SEDATIVE effect, but the LETHAL dose stays the same. Easy to accidentally overdose. Withdrawal can cause fatal seizures.

Opioids

Drugs that cause a warm "rush" then hours of pleasure ("high"). Includes heroin, morphine, oxycodone, fentanyl.

Fentanyl

Synthetic opioid — 100x stronger than morphine. #1 cause of overdose deaths. Narcan (naloxone) can reverse it if given fast enough.

Stimulants

Drugs that SPEED the brain up — raise heart rate, energy, and alertness. Main ones: cocaine, amphetamines, caffeine, nicotine.

Cocaine (mechanism)

Blocks dopamine reuptake, so dopamine floods the brain → euphoric rush. Also spikes norepinephrine and serotonin.

Cocaine intoxication

Too much cocaine = mania, paranoia, hallucinations, and delusions. Followed by a crash (depression).

Amphetamines

Lab-made stimulants (like meth). Energy up, appetite down. Tolerance builds fast. Coming off them causes serious depression.

Caffeine

World's most popular stimulant. Boosts dopamine, serotonin, norepinephrine. Too much = intoxication. Quitting suddenly = headaches, fatigue, low mood.

Hallucinogens

Drugs that warp your senses and perceptions ("trips"). Natural: mescaline, shrooms. Synthetic: LSD, MDMA.

LSD - mechanism and effects

Binds to serotonin receptors → altered vision, emotions, and senses within 2 hours. Can cause synesthesia. Effects last ~6 hours.

Synesthesia

Senses get crossed — you might "see" sounds or "hear" colors. Can happen on LSD.

Flashbacks

Random re-experiences of a trip that pop up long after (even a year+) without taking the drug again.

Cannabis

Weed/marijuana. Active ingredient is THC. Has mixed depressant, stimulant, AND hallucinogenic effects.

Cannabis intoxication

Low dose: relaxed and happy. High dose: visual distortions, hallucinations. Some people feel anxious or paranoid.

THC potency over time

1969 weed was ~1% THC. Today's flower is 15%+. Concentrates can be 60-90% THC.

Long-term effects of early high-dose THC

Messes up the prefrontal cortex in young people → memory loss, poor decision-making, emotional issues. Also linked to psychosis, anxiety, and depression.

Polydrug use

Using more than one drug at a time. Can lead to dangerous interactions.

Synergistic drug effect

Two drugs together hit HARDER than either alone. Example: mixing alcohol + opioids can stop your breathing and kill you.

Antagonistic drug effect

Mixing stimulants + depressants: they cancel each other's high, so you take MORE — but both build up in your body to dangerous levels.

Sociocultural causes of substance disorders

Living in poverty or a community/family where drug use is normal or accepted.

Psychodynamic cause of substance disorders

Unmet emotional needs from childhood drive people to fill that void with substances.

Cognitive-behavioral cause of substance disorders

Drugs feel SO good (conditioning) that use keeps escalating in dose and frequency.

Biological cause of substance disorders

Dopamine reward pathway gets hijacked; genes also play a role.

Behavioral strategies for substance use

BSCT, RPT, contingency management, aversion therapy, covert sensitization.

BSCT (Behavioral Self-Control Training)

Track your use and what triggers it → learn coping skills → set limits. DIY sobriety toolkit.

RPT (Relapse-Prevention Training)

Plan AHEAD for risky situations so you don't slip. Used mainly for alcohol.

Biological treatments for substance disorders

Detox (slow taper or antagonist drugs like naltrexone) or maintenance drugs like methadone for opioids. Always paired with therapy.

Sexual dysfunctions

Problems with normal sexual response — causes distress and relationship issues.

Four phases of sexual response

Desire → Excitement → Orgasm → Resolution. Dysfunctions hit phases 1-3.

Hypoactive sexual desire disorder

Little to no interest in sex. Affects ~16% of men, ~33% of women.

Sexual aversion disorder

Total disgust or fear of sex. Rare in men, more common in women.

Biological causes of desire disorders

Hormone problems, chronic illness, certain meds (birth control, antidepressants, narcotics).

Psychological causes of desire disorders

Anxiety, depression, anger, trauma, or negative attitudes about sex.

Sociocultural causes of desire disorders

Stress from divorce, death, relationship conflict, or past sexual trauma.

Female sexual arousal disorder

Can't get or stay lubricated/swollen during sex. Affects 10%+ of women. Often comes with orgasm disorder.

Male erectile disorder (ED)

Can't get or keep an erection. Affects ~10% of men. Common cause: performance anxiety.

Performance anxiety & the spectator role

Man fears failing → watches himself instead of enjoying sex → fails → fears more. A vicious self-fulfilling cycle.

Rapid/premature ejaculation

Ejaculates with very little stimulation. Linked to anxiety, rushed habits, or serotonin receptor issues.

Male orgasmic disorder

Can't orgasm or it takes forever, even with normal arousal. Causes: anxiety, low testosterone, SSRIs.

Female orgasmic disorder

Delayed or absent orgasm after normal arousal. Affects ~25% of women. Linked to depression, trauma, or stress.

Vaginismus

Vaginal muscles clamp shut involuntarily — can make intercourse impossible. It's a learned fear response. Treated with muscle exercises + gradual exposure.

Dyspareunia

Severe genital pain during sex. Affects ~14% of women, ~3% of men. Usually has a physical cause (e.g., childbirth injury).

Masters and Johnson's sex therapy (1970)

Revolutionized sex therapy. Short-term (15-20 sessions), focuses on specific problems, not broad personality issues.

Key features of modern sex therapy

Shared responsibility, education, attitude change, reducing performance anxiety, improving communication, addressing medical factors.

Treatment for erectile disorder

Reduce anxiety (sensate focus/tease technique). Drugs: Viagra (sildenafil). Devices: VED. Surgery: penile implant.

Treatment for premature ejaculation

Stop-start technique or squeeze technique. SSRIs (like Prozac) can also slow things down.

Treatment for female arousal/orgasmic disorders

CBT, self-exploration, directed masturbation training, psychoeducation. Hormones/Viagra tried but not consistently helpful.

Gender Dysphoria

Feeling strongly that you were assigned the wrong biological sex. Linked to anxiety, depression, sometimes suicidal thoughts. Treatment: hormones and/or surgery.

First phase of sex therapy

Addressing communication issues

Psychosis

Losing touch with reality — perception and functioning are severely impaired.

Schizophrenia - demographics

Equally common in men and women (men more severe). More common in lower socioeconomic groups (stress + downward drift).

Positive symptoms of schizophrenia

Things added to behavior that shouldn't be there. Think: delusions, hallucinations, disorganized speech, inappropriate emotions.

Delusions

False, fixed beliefs. Types: persecution (being hunted), grandeur (you're special/powerful), reference (everything is about you), control (someone controls your thoughts/actions).

Loose associations (derailment)

Rapidly jumping between totally unrelated topics mid-sentence. Classic positive symptom.

Neologisms

Making up words that only you understand (e.g., "That's a cramstile"). Positive symptom.

Perseveration

Repeating the same word or phrase over and over. Positive symptom.

Clang

Speaking in rhymes (not on purpose). Positive symptom. E.g., "Well, hell, it's well to tell."

Hallucinations

Perceiving things that aren't there. Most common in schizophrenia: AUDITORY (hearing voices). Can also be visual, tactile, smell, or taste.

Types of hallucinations

Auditory (most common), visual, tactile (touch), somatic (body sensations), gustatory (taste), olfactory (smell).

Inappropriate affect

Laughing at something sad, crying at something funny. Emotions don't match the situation. Positive symptom.

Negative symptoms of schizophrenia

Things MISSING from behavior that should be there. Think: flat affect, no motivation, no speech, no pleasure, social withdrawal.

Alogia (poverty of speech)

Barely talking — long pauses, short answers, or nothing at all. Negative symptom.

Anhedonia

Can't feel pleasure or enjoyment from anything. Negative symptom.

Loss of volition

No motivation or drive to do ANYTHING. Can't start or finish tasks. Negative symptom.

Psychomotor symptoms of schizophrenia

Odd movements, grimaces, weird gestures. Extreme version = catatonia.

Catatonia

Extreme movement disturbance — could be totally frozen (stupor/rigidity) OR wildly frenzied. A psychomotor symptom.

Three phases of schizophrenia

Prodromal (mild start) → Active (full symptoms) → Residual (symptoms fade but don't disappear). 1 in 4 fully recover.

Factors predicting better recovery

Good functioning before illness, stress-triggered onset, sudden onset, older age at onset.

DSM-5 diagnosis of schizophrenia

Symptoms for 6+ months; at least 2 symptoms for 1+ month (must include at least 1 positive symptom); functioning has declined.

Type I vs. Type II schizophrenia

Type I = mostly POSITIVE symptoms → better prognosis, linked to brain chemistry. Type II = mostly NEGATIVE symptoms → worse prognosis, linked to brain structure damage.

Dopamine hypothesis

Too much dopamine activity in certain brain pathways = schizophrenia. Proof: drugs that block dopamine reduce symptoms; too many stimulants or L-Dopa can CAUSE psychosis.

Genetic factors in schizophrenia

General public: 1% risk. First-degree relative: 10%. Identical twin: 48%. It's polygenic (many genes involved).

Brain structure abnormalities in schizophrenia

Enlarged ventricles, smaller frontal and temporal lobes. Linked to Type II (negative symptoms).

Viral hypothesis of schizophrenia

Prenatal flu exposure may damage the developing brain → schizophrenia later. More people with schizophrenia are born in winter months.

Diathesis-stress model

You're born with a biological vulnerability (diathesis), but you only develop schizophrenia if stress or life events trigger it.

Schizophrenogenic mother theory

Old, discredited idea that cold/controlling mothers caused schizophrenia. Not supported by evidence.

Double-bind hypothesis

Parent sends contradictory messages (you can't win either way) → child can't cope → contributes to schizophrenia.

Expressed emotion

Family is constantly critical, hostile, or smothering → relapse risk is 4× higher for the person with schizophrenia.

Social labeling and schizophrenia

Once you're labeled "schizophrenic," society treats you that way and it becomes a self-fulfilling prophecy.

Milieu therapy

Humanistic hospital approach — patients are treated with dignity, given responsibility, and encouraged to be productive. One of the 1950s breakthroughs.

Token economy

Behavioral hospital approach — good behavior earns tokens (redeemable for privileges). Worked on surface behaviors, but raised ethical questions and didn't always transfer outside the hospital.

Conventional antipsychotics (neuroleptics)

First-gen meds from the 1950s-80s. Cut positive symptoms in 65%+ of patients. Less effective for negative symptoms.

Extrapyramidal effects

Movement side effects from conventional antipsychotics blocking dopamine in motor areas. Includes Parkinson-like tremors, dystonia, and akathisia.

Dystonia

Weird, involuntary muscle movements — face, neck, tongue, back. Side effect of conventional antipsychotics.

Akathisia

Can't sit still — intense internal restlessness and agitation. Side effect of conventional antipsychotics.

Tardive dyskinesia

Long-term side effect of conventional antipsychotics: uncontrollable mouth, tongue, or body movements. Affects 10%+ of users. Often irreversible.

Neuroleptic malignant syndrome

Rare but life-threatening reaction to antipsychotics: muscle rigidity, high fever, confusion, autonomic dysfunction. Stop the drug immediately.

Atypical antipsychotics (2nd gen)

Newer meds. Better for negative symptoms, fewer movement side effects. Downside: risk of agranulocytosis and expensive.

Agranulocytosis

Dangerous drop in white blood cells — a serious risk of atypical antipsychotics. Can be fatal.

CBT for schizophrenia

Teaches patients about their hallucinations, challenges false beliefs, and helps them cope and feel more in control.

Family therapy for schizophrenia

Reduces expressed emotion, sets realistic expectations, educates the family. Lowers relapse rates.

Social therapy for schizophrenia

Practical life help — job coaching, housing, finances, social skills, medication management. Reduces rehospitalization.