Substance-related and addictive disorders

Addiction

A chronic medical condition with roots in the environment, neurotransmission, genetics, and life experiences.

APA definition of SUD

A pathological use of a substance that leads to a disorder of use.

Symptoms of SUD

Impaired control, social impairment, risky use, physical effects (intoxication, tolerance, withdrawal)

DSM-5 TR diagnostic criteria

Alcohol, caffeine, cannabis, hallucinogen, inhalant, opioid, sedative, hypnotic, antianxiety, stimulant, tobacco

Intoxication

When people use a substance to excess

Tolerance

When a person no longer responds to a drug the way that they initially responded; need to take a higher dose to achieve the same initial response.

Withdrawal

A set of physiological symptoms that occur when a person stops using a substance; specific to the substance being used; mild to life threatening.

Schedule 1 drugs

High potential fo rabuse and have no acceptable medical use (heroin and LSD)

Schedule 2 drugs

High potential for abuse, are considered dangerous, and are only available by prescription (methadone, meperidine, and methylphenidate)

Schedule 3 drugs

Low to moderate potential for misuse and are only available by prescription (testosterone, acetaminophen/codeine, buprenorphine.

Schedule 4 drugs

Low-risk drugs and are available by prescription (Xanax, Ativan)

Schedule 5 drugs

Limited quantities of certain narcotics for the treatment of diarrhea, coughing, and pain (guaifenesin and ropitussin, pregabalin, available OTC.

Pathways in addiction

Pleasure and reward pathways that create a memory which contributes to a desire for repeated use.

Overactivation causes the brain to lower levels of…

Neurotransmitters

Biological risk factors for addiction

Genetic vulnerability to addiction, abnormal opioid function (too little natural activity or too much opioid antagonism)

Environmental risk factors for addiction

Poverty, lack of parental supervision, poor educational systems, disadvantaged neighborhoods, lack of support, ineffective coping mechanisms, peer pressure.

Comorbidities for addiction

Depression & anxiety, bipolar disorder, social disorders, other SUD’s, gender dysphoria, gambling (OCD’s)

Stimulants

Cocaine, methamphetamine

Cannaboids

Marijuana, cannabis

Depressants

Alcohol, benzodiazepines

Opioids

Heroin, oxycodone

Hallucinogens

LSD, psilocybin

Inhalants

Glue, paint, gasoline

Hashish

Concentrated form of the cannabis plant

Delta-9

mind altering chemical of the cannabis plant

Synthetic forms of cannabis

Prescribed to prevent nausea and to boost appetite as for some forms of epilepsy

THC

responsible for mind-altering effects in cannabis

Intoxication with cannabis

Conjunctival injection, increased appetite, dry mouth, tachycardia, paranoia, hallucinations and delusions can occur

Withdrawal from cannabis

Occurs within one week of last use. Symptoms include sad mood, irritability, anger, aggression, anxiety, restlessness, insomnia, abdominal pain, sweating, headache, fever.

Treatment for cannabis

Short-term antianxiety meds, therapy, treat underlying depression and anxiety.

Intoxication with sedatives

Slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking, mood fluctuation, impaired judgement, coma

Overdose treatment for sedatives

Gastric lavage, activated charcoal, possible intubation

Withdrawal from sedatives

rebound hyperactivity, tremors, anxiety, insomnia, seizures, onset depends on the half-life of the substance used

Treatment for sedatives

Slow taper, risk of seizures if stopped suddenly or tapered too quickly.

Opioids

Use generally begins in late teens to early twenties. Use causes significant impairment in life.

Opioid intoxication

Drowsiness, slurred speech, alteration in mood and attention, miosis (pinpoint pupils), decreased BP, and RR.

Overdose with opioids

Slow respiration, unresponsiveness, bradycardia, hypotension, coma, pinpoint pupils, extremely dangerous is overdose

Treatment for overdose of opioids

Narcan, short acting so may need a second dose

Opioid withdrawal

Nausea, vomiting, diarrhea, muscle aches, fever, lacrimation, rhinorrhea, dilated pupils, yawning, piloerection, insomnia, and low mood, very uncomfortable but rarely dangerous.

Treatment for opioid addiction

Methadone, buprenorphine, buprenorphine with naloxone, clonidine, therapy, support groups, NA, residential treatment.