substance-related and addictive disorder

DSM5 criteria; substance use disorder

• maladaptive pattern of substance use for at least 12 months that has led to significant impairment or distress

• minimum of 2 of the 11 criteria must be met

  • 2-3 is a mild substnace use disorder diagnosis

  • 4-5 is moderate

  • 6+ is severe

how is substance use disorder diangosis?

• based on a pathological pattern of behaviours related to use of the substance

how is the criteria cateogorized

• impairment of control (1-4)

• social impairment (5-7)

• risky use (8-9)

• pharmacological criteria (10 & 11)

impaired control over substance use (criteria 1-4)

• using greater amounts or using over a loner time period than intended

• persistent desire or unsucessful efforts to cut down or control substance use

• spending lots of time obtaining, using or recovering from using the substance

• craving

When are cravings for a drug most likely to happen, and why?

• Cravings often happen when:

  • You're in a place where you used the drug before

  • You're feeling stressed

• Why?

  • Classical conditioning: The brain links places/emotions with drug use

  • Reward system: The brain wants to feel the same pleasure again

What are the 3 signs of social impairment in substance use disorder (criteria 5–7)?

5. Can’t keep up with responsibilities (like school, work, or home).

6. Keep using even though it’s hurting relationships or causing fights.

7. Stop doing things you used to enjoy (hobbies, work, or seeing friends) because of using.

what is the RISKY USE of a substance (Criteria 8&9)

• Risky Use means someone keeps using even when it’s clearly unsafe or harmful.

8. Keeps using in dangerous situations (like driving or operating machines while high or drunk).

9. Keeps using even though it’s causing health or mental problems—and they know it.

⚠ Key point: The issue isn’t just the harm—it’s that the person won’t stop using, even though it’s making things worse.

what is the pharmcological criteria (10 and 11)

10. Tolerance

• Needing more of the substance to get the same effect

• Varies by person and substance

• Hard to tell just from someone’s history

11. Withdrawal

• Happens when substance use stops after heavy use

• Person may use again to relieve symptoms

• Symptoms vary a lot between people and drugs

are criteria 10 or 11 needed for diagnosis?

• Neither tolerance nor withdrawal is required for diagnosis

• If symptoms happen from prescribed meds, they don’t count

• History of withdrawal usually means a more severe case

what is polysubstance use disorder

• two or more drugs at the same time

• extra dangerous because drug effects can mix and make things worse (SYNERGISTIC)

• treatment usually starts with the drug that causing the most serious health issue

How is drug use and abuse viewed differently across cultures?

Drug use is culturally relative, meaning it depends on the culture:

• Some cultures have strict rules against any drug use

• In the UK, drug abuse is seen as a medical issue

• The Netherlands separates soft and hard drugs

• In parts of South America, the Middle East, and East Africa, people regularly chew khat, and it’s not seen as wrong

• Some Indigenous groups in North America use certain drugs in religious ceremonies

What are the effects of ethyl alcohol on the body and brain?

• Lowers anxiety, makes you feel happy or relaxed

• Lowers inhibitions (you feel bolder or more open)

• Effects can depend on what you expect to feel

• Goes straight into the bloodstream

• Measured by blood alcohol content (BAC)

• Broken down in the stomach by an enzyme

• Removed from the body by the liver

Short term effects of alcohol

• Depends on how much alcohol is in your bloodstream

• Alcohol has a biphasic effect (can make you feel good at first, then sleepy or worse)

Common short-term effects:

• Drowsiness

• Poor coordination and balance

• Slower reaction time

• Impaired memory and thinking

• Less sensitive to taste, smell, and pain

• Blackouts can happen if you drink a lot quickly

the hangover symptoms

• upset stomach

• fatigue

• headache

• thirst

• depression

• anxiety

• general malaise

why does alcohol make you thirsty?

• Alcohol pulls water out of your cells

• This causes your body to lose water

• That’s why you feel super thirsty after drinking — your cells are dehydrated

long term effects of alcohol abuse?

• beer belly

• toxic damage to most organs

• nutrient deficiency

• wernicke encephalopathy

• korsakoff psychosis

• alcohol-induced demetia

• deficts in memory, abstract thinking, problem solving; paranoia

• fetal alcohol spectrum disorder

what are some causes of alcohol use disorder

• Runs in families – 4 to 8 times more likely if a family member has it

• Linked to genes that affect brain chemicals (like dopamine, GABA, serotonin, glutamate)

• Some people have genes that affect how well they break down alcohol

• Tension reduction theory – people drink to cope with stress

• Sociocultural factors – culture, social norms, and environment can influence drinking

what are benzopiazepines and barbitrurates, and how they affect the body

• Barbiturates (aka “downers”):

  • Stopped being widely prescribed because they are very addictive

• Benzodiazepines:

  • Help calm the brain by boosting GABA (a calming chemical)

  • They open chloride channels in brain cells, making the cells harder to activate

  • Prescribed to treat anxiety and insomnia

who commonly abuses benzos and barbs

• teens for recreational use

• older adults and women who started on prescription but use more as the tolerance grows

short and long-term effects of benzos and barbs

• small doses; feel good (mild euphoria)

• large doses; slurred speech, poor coordination, bad judgment

• chronic use; feels like being drunk all the time

• long term use; depression, tiredness, mood swings, paranoia, memory problems

How does tolerance and dependency develop with benzos and barbs?

• Tolerance to barbiturates builds up quickly

• Tolerance to benzodiazepines builds more slowly

• If stopped suddenly, users can have severe withdrawal symptoms

How are benzo and barb addictions treated?

• Slowly lower the dose to avoid withdrawal

• Symptoms: abstinence syndrome

  • insomnia, headaches, body aches

• Support programs like therapy or NA (Narcotics Anonymous) are helpful

who commonly uses inhalants, whats the risk

• Mostly younger teen boys and Indigenous youth in Canada

• Health risks:

  • Breathing problems and skin rashes

  • Permanent damage to the brain (CNS) and organs

  • Can even lead to death

what are stimulants and how they affect the brain

• Have a stimulating or arousing effect on the central nervous system (CNS)

• Increase the uptake of dopamine, norepinephrine, and serotonin

• Stimulate the Nucleus Accumbens (brain's reward system)

• Among the most commonly used and abused addictive drugs

what are the effects of nictoine

• No DSM-5 diagnosis specifically for nicotine-related symptoms

• Acts on both the CNS and PNS

• Triggers release of multiple neurotransmitters, reinforcing use

• Dependence develops quickly

what are the treatments for nicotine

• Psychological: Cognitive or behavioral therapy

• Biological: Maintain steady nicotine levels to reduce cravings and withdrawal

what are effects of cocaine

• Behavioral changes

• Physiological responses

• Weight loss, nausea, vomiting

• Muscular weakness

• Slowed breathing, chest pain, confusion

• Seizures, coma, death

what is the mechanism of action of cocaine

• Blocks reuptake of dopamine (DA), increasing dopamine activity in the brain

what are the effects of amphetamines; methamphetamine

• cause euphoria and increased alertness

• raise body temp which can lead to heart problems and seziures

what are the effects of ecstasy (MDMA)

• Has stimulant and mind-altering (hallucinogenic) effects

• Can be neurotoxic

• Increases metabolic activity and stress

what is amphetamines used for and MOA

• Used for depression, fatigue, boosting energy and self-confidence; also found in diet drugs

• Cause the release of dopamine & norepinephrine and block their reuptake

• Effects resemble cocaine intoxication

amphetamines dose-dependant effects

• Low doses: Increased alertness and attention

• Moderate doses: Euphoria, extraversion, confidence

• High doses: Restlessness, anxiety

• Very high doses: Seizures, confusion, coma, toxic psychosis (hallucinations, paranoia, delirium)

what are the physical effects?

• Irregular/increased heart rate

• Fluctuating blood pressure

• Nausea, hot/cold flashes, weakness, dilated pupils

what are the effects of chronic amphetamine abuse and withdrawl

Withdrawal Symptoms:

• Fatigue

• Increased appetite

• Prolonged sleep

• Muscle pain

• Severe depression

Chronic Use Effects:

• Dehydration

• Weight loss

• Vitamin deficiencies

• Brain damage

what are the effects of caffiene

• Most heavily used stimulant

• Stimulates the central nervous system (CNS)

• Increases dopamine, norepinephrine, and serotonin levels

• No official caffeine use disorder in the DSM-5

what are opoids and ehat types exist?

• Opioids are drugs derived from the opium poppy

• Exogenous opioids (from outside the body):

  • Morphine, Heroin, Codeine, Methadone

• Endogenous opioids (naturally produced in the body):

  • Endorphins

  • Enkephalins

What are the symptoms of opioid intoxication

• Behavioral changes

• Constricted pupils

• Drowsiness or coma

• Slurred speech

• Hallucinations/illusions

• Impaired attention and memory

What are the symptoms of opioid withdrawal?

• Dysphoric mood

• Nausea or vomiting

• Muscle aches

• Watery eyes / runny nose

• Dilated pupils, goosebumps, sweating

• Diarrhea, yawning, fever, insomnia

what are hallucinogens and what effects do they have?

• means; to dream or wander in the mind

• cause perceptual and cogntive distortions

• effects can be novel, stimulating or spirtually upliftin

• common hallucinogens include

  • LSD, mescaline, pslicybin, DMT, salvia

• effects variable between indivduals and situations

How does psilocybin (magic mushrooms) affect the brain?

• Increases activity in primitive brain networks linked to emotional thinking

  • Areas like the hippocampus and anterior cingulate cortex become more active

  • Brain activity resembles a dream-like state

• Decreases coordination in higher-level brain networks

  • Disrupts self-consciousness and logical thinking

• Leads to more disjointed and uncoordinated brain activity

What is PCP and how is it classified and used?

• Phencyclidine (PCP), also known as angel dust, is a dissociative anesthetic

• Commonly snorted or smoked in powder form

• Not officially a hallucinogen, but produces hallucinogenic effects, so it's often grouped with them

• Alters perception, mood, and consciousness

What are the effects and risks associated with hallucinogens and PCP?

• Effects mainly due to activation of serotonin receptors in the brain

• Generally not physiologically dangerous, but can be situationally dangerous

• Flashbacks may occur

  • If distressing, may qualify for DSM-5 diagnosis: Hallucinogen Persisting Perception Disorder (HPPD)

• No clear physical dependence or withdrawal

• Psychological dependence can develop

What is cannabis and what makes it psychoactive?

• Cannabis refers to any product of the Cannabis sativa plant

• Marijuana = unprocessed, dried leaves, flowers, and stems

• Hashish = a more potent form, made from the plant's resin

• Contains over 80 cannabinoids and 400+ other compounds

• The primary psychoactive compound is Δ⁹-tetrahydrocannabinol (THC)

  • THC is responsible for the drug's effects

What are the effects of cannabis intoxication?

• Most widely used illicit substance globally

• Intoxication may include feeling:

  • "High", relaxed, tranquil, sleepy, grandiose, or lethargic

  • Heightened awareness of environment

• Has depressant-like effects, but also increases heart rate

• Cognitive impairment occurs despite subjective feeling of clarity

• High doses may cause:

  • Hallucinations

  • Depersonalization

  • Paranoia

types of behavioural “addiction”

• Eating

• Gambling

• Internet

• Love

• Sex/Porn

• Exercise

• Work

• Shopping

• Video Games

What is problem gambling and how is it classified in the DSM-5?

• Defined as a pattern of gambling behavior that causes harm to an individual’s:

  • Personal or family life

  • Work, finances, or health

• DSM-5 includes it under “Behavioral Addictions”

  • This section recognizes non-substance-related addictive behaviors

  • May eventually include multiple types of behavioral addictions

What are key features and cognitive impacts of pathological gambling?

• Easier than ever to access gambling (e.g., online platforms)

• High comorbidity with:

  • Substance Use Disorders (SUDs) — especially alcohol

  • Psychological disorders — like Generalized Anxiety Disorder (GAD)

• Gamblers report:

  • Highs, cravings, and even withdrawal symptoms

• Cognitive and behavioral traits include:

  • Superstitious behavior

  • Impaired inhibition, working memory, planning, cognitive flexibility, and time management

What are the DSM-5 diagnostic criteria for gambling disorder (pathological gambling)?

Diagnosis requires at least 4 of the following 9 criteria within a 12-month period, along with persistent and recurrent problematic gambling behavior:

1. Needs to gamble with increasing amounts of money for excitement

2. Restless or irritable when attempting to stop or reduce gambling

3. Unsuccessful attempts to cut down or stop gambling

4. Frequently preoccupied with gambling (e.g., reliving, planning)

5. Gambles when feeling depressed, anxious, or guilty

6. Tries to win back losses (Gambler’s fallacy: "I'm due")

7. Lies to hide gambling behavior

8. Jeopardizes relationships, jobs, or opportunities due to gambling

9. Relies on others for money to relieve gambling-related financial issues

What is hypersexual disorder and why is it controversial?

• Also known as sex addiction

• Controversial diagnosis: Debate over what constitutes "normal" sexual behavior

• High comorbidity with personality disorders (up to 100%)

• Involves compulsive sexual behaviors, such as:

  • Masturbation, affairs, prostitution, porn use

  • Cybersex, voyeurism, exhibitionism

  • In some cases, sexual harassment or offending

What are the proposed DSM-5 diagnostic criteria for sex addiction (hypersexual disorder)?

4 or more of the following for 6+ months:

1. Excessive time spent on sexual fantasies, urges, planning, or behavior

2. Sexual behavior used to cope with dysphoric mood states

3. Sexual behavior used to cope with stressful life events

4. Unsuccessful attempts to control or reduce behavior

5. Continued behavior despite risk of physical/emotional harm

Part B:

• Causes clinically significant distress or impairment in social, occupational, or other key areas

Part C:

• Not due to the effects of substances or a manic episode

Part D:

• Individual must be 18 years or older

What is the common neurobiological feature of behavioral addictions?

• Behaviors like shopping, video games, sex, and gambling all activate the brain's dopamine (reward) system

• Dopamine-enhancing medications (e.g., for Parkinson’s) can increase compulsive behaviors like:

  • Gambling

  • Shopping

  • Sexual activity

What biological and personality factors are associated with addiction risk?

Genetic Factors:

• Reactivity Theory: Some individuals have heightened brain reactivity to substances

• Addiction as a form of depression: Shared genetic vulnerabilities

• Pleasure & Reinforcement: Genetic predisposition to stronger reward responses

Personality Factors:

• Behavioral Disinhibition: Impulsivity, poor self-control

• Negative Emotionality (Neuroticism): Tendency toward anxiety, mood swings, and stress sensitivity

behavioural and cognitive theories

• modelling;

  • children and adolescents learn drug related behvaiours from the modeling of their parents and important others in their culture

• expectancy theory;

  • people who expect drugs to reduce their distress and who do not have other, more adaptive means of coping avaliable to them are more likely than others to use drugs when they are upset

What is the behavioral tolerance effect and how can it increase overdose risk?

• Classical conditioning plays a role in substance use

• Environmental cues become associated with drug use and begin to predict it

• This can lead to tolerance in familiar environments

• In new or unfamiliar settings, the body may not prepare for the drug
  → Can result in reduced tolerance and increased risk of fatal overdose

What are two major models of treating substance-related disorders, and what does harm reduction involve?

Two Models of Treatment:

• Disease Model: Focuses on abstinence

• Harm Reduction Model: Focuses on safe use and minimizing risks

Harm Reduction Strategies:

• Don’t share needles or straws

• Only accept drinks prepared in front of you

• Never leave drinks unattended

• Avoid drugs from unknown sources

What are key components of relapse prevention and the role of marital/family therapy in substance use treatment?

Relapse Prevention:

• Relapse is viewed as a failure of coping strategies, often linked to self-defeating thoughts

• Focuses on:

  • Avoiding relapse or managing it if it occurs

  • Identifying high-risk situations

  • Developing healthy coping skills

Marital & Family Therapy:

• Addresses maladaptive interactions, codependency, enabling, and conflict

• Involving family enhances treatment outcomes

• Helps rebuild supportive, functional relationships