Substance Use Disorders

symptoms of substance use disorders

◦Impaired control over substance

• Take more than intended

• Persistent desire to cut down

• Great deal of time getting/using substance

• Intense desire or urge for drug

◦Social Impairment

• Failure to fulfill role obligations

• Continued use despite interpersonal problems

• Give up activities because of substance use

◦Risky Use

• Use of substances causing physical danger

• Continued use despite physical/psychological problems

◦Pharmacological Criteria

• Tolerance symptoms

• Withdrawal symptoms

severity of substance use disorder symptoms

◦Mild 2-3 symptoms

◦Moderate 4-5 symptoms

◦Severe 6+ symptoms

describe mild substance use disorder symptom

2-3 symptoms

describe moderate substance use disorder symptom

4-5 symptoms

describe severe substance use disorder symptoms

6+ symptoms

substances that may be involved in substance use disorder

Alcohol, Cannabis, Hallucinogens, Inhalants, Opioids, Sedatives, Stimulants, Tobacco

do more males or females meet criteria for alcohol use disorder?

males

• 3:1 ratio

biological causes of substance use disorders

◦Genetic

• Increased risk for first degree relatives

• 40-60% heritability for alcohol abuse

◦Brain and Neurotransmitters

• Drugs of abuse activate meso-cortico-limbic dopamine pathway

• Includes ventral tegmentum, nucleus accumbens, and prefrontal cortex

• Pleasure/reward pathway

• Activate limbic pathways involved in GABA

• Reduction in anxiety

◦Individual differences in physiological response

• Higher initial response (“high”) and lower later response (sedative effects) increases likelihood of abuse

dependence means…

physiological need and physical withdrawal symptoms

psychological causes of substance use disorders

◦Personality factors

• High Sensation Seeking

• Low conscientiousness

• Low self-control/impulse control

◦Learning

• Drugs serve as positive reinforcement and negative reinforcement

• Exposure to learned cues increases craving

◦Expectancies about substances

• Substances will increase social success

• Substances will reduce tension/stress

socio-cultural causes of substance use disorders

◦Low social support

◦Family factors

• Lack of monitoring

• Low cohesiveness

• Parental inconsistency/lack of predictability

◦Cultural attitudes toward substance use

◦Peer substance use

◦Early life stress (sexual/physical abuse)

therapy for substance use disorders

Group (AA) and individual therapies (CBT, Motivational Enhancement Therapy) are effective but still see high levels of relapse

medication treatment for substance use disorder

◦Aversive treatment: meds cause vomiting/nausea when alcohol consumed

◦Antagonist treatment: blocking activation of reward pathway (naloxone)

◦Agonist treatment: safe alternative with same chemical make-up, reduces withdrawal symptoms (methadone)

◦Often combined with therapy

how many symptoms are required for a diagnosis of substance use disorder?

2