Substance Abuse

Brain on drugs:

• Drugs activate neurons in the brain’s reward system to release excessive amounts of dopamine 

• Direct trigger to reward system 

• 4 different ways of consuming drugs 

  • Orally

  • Smoking 

  • Inhaling 

  • Intervanously 

Substance related disorder & adduction 

• Primary drugs responsible for overdoses in the US:

  • Fentanyl 

• COVID-19 

• DSM 5 classification system 

  • Based on pattern of use & associated behavioral & psychological factors 

• 3 types:

  • Substance use disorders 

  • Intoxication disorders

  • Withdrawal disorders 

Types of Disorders 

• Substance use disorders 

  • Irreversible brain circuit changes, repeated behavioral relapses, & strong cravings in the presence of substance usage 

• Intoxication disorders 

  • Short term symptoms associated with usage of substance 

• Withdrawal disorders 

  • Symptoms that occur following individual stop heavy use of substance 

Substance/ medication induced disorders

• Usually reversible 

• Severe, temporary & brief 

• Related to ingesting substance

• Disappears within ~1 month following cessation of substance 

• Disorders: 

  • Intoxication 

  • Withdrawal 

  • Other substance/medication induced mental disorders

    • Psychotic disorder 

    • Depressive disorder 

    • Bipolar disorder 

    • Anxiety disorder 

    • OCD

    • Sleep problems

    • Sexual dysfunction 

    • Delirium 

    • Dementia 

Intoxication Disorders

• Changes in perception, wakefulness, attention, thinking, judgment, psychomotor behavior behavior & interpersonal behavior 

• Most intense & quickest forms of intoxication (short acting substances) 

  • Intravenously 

  • Smoking 

  • intranasal/snorting 

• Short acting substances = high potential for the development of withdrawal symptoms 

Withdrawal Disorders 

• Physical & psychological changes when an individual stops use of consuming substance

• Specific behaviors, psychological, & physical symptoms that can last hours to weeks & can cause significant distress in occupational dysfunction 

Classes of drugs

1. Alcohol 

2. Caffeine 

3. Cannabis 

4. Hallucinogens

5. Inhalants 

6. Opioids

7. sedatives/hypnotics/anxiolytics

8. Stimulants 

9. Tobacco 

10. Other substance & non substance (gambling) 

Diagnosis 

• DSM criteria for diagnosing 

  • Impaired control 

  • Social impairment 

  • Risky use 

  • Pharmacological criteria 

    • Tolerance 

    • Withdrawal 

  • Addiction = tolerance + withdrawal 

Etiology 

• Factors that can explain causes & origin or substance use:

  • Biological 

  • Genetic 

  • Psychological 

    • Childhood trauma 

    • Temperament 

  • Sociocultural & environmental factors 

  • Age (adolescents & older adults) 

• Protective factors can interrupt addiction cycle 

Childhood Trauma & other adverse childhood experiences (ACE) 

• Tally of different types of abuse, neglect or negative household experience that impacts early childhood experiences 

• The higher the score = the rougher the childhood

• Strong relationship between early childhood trauma & problems with health & wellbeing later in life 

***ACE test 

Adverse childhood experiences have a tremendous impact on future violence victimization & perception & lifelong health and opportunity 

Course & Prognosis 

Alcohol 

• Can be reversed but might have lasting physical & psychological problems 

• Familial alcoholism has early onset with poorer prognosis than nonfamilial alcoholism 

• Women & alcohol:

  • Later onset 

  • Drinks smaller amounts, but more often 

  • Disease progression is quicker 

• Unsafe alcohol & drug use linked to increased levels of violence & conflict = presence of conflict increases risky behavior with alcohol and/or drugs 

• Prognostic factors 

• Alcohol use disorder linked to conduct disorder (violent behaviors) 

  • 90% develop alcohol use disorder before 40 years old 

• Fetal alcohol syndrome 

  • CNS is impacted in development of the fetus 

Caffeine

• Symptoms of short lived & do not have long term effects 

• Older adults are more sensitive to caffeine

Inhalants 

• 10% of children 13-17 y/o report usage of inhalants 

• <0.5% of individuals progress to inhalant use disorders & exhibit multiple mental health problems 

Cannabis 

• Development of disorder most common in adolescents/ early adulthood 

• Early onset of cannabis = serious risk factor for internalizing & externalizing mental health disorders

Phencyclidine (PCP) 

• Primary hallucinogenic drug 

• Continued use can lead to higher risk of injury, suicide, psychosis, intense rage, memory/language/cognition deficits, hemmorhage, & cardiac arrest 

Opioids 

• Seen more in later adolescents & early adulthood 

• Adolescents can become addicted quicker than adults 

• 2% mortality rate annually 

Sedatives, Hypnotics, Anxiolytics 

• 2 typical courses individuals usually go through 

• Effects:

  • Long term cognitive & interpersonal difficulties 

  • Severe withdrawal symptoms 

Stimulants

• More common in 12-25 y/s 

• Patterns of use 

• The more stimulants = the more decrease in pleasure & increase in dysphoria 

Tobacco 

• By the age of 20, most adolescents have experimented with tobacco 

• Symptoms = appear quickly following use

• Smoking cessation 

• 10 year shorten lifespan 

Gambling 

• Develop gradually over years

• More common in AMAB than AFAB

• AFAB more commonly have additional psychological conditions 

• Frequency & amount of money do not determine severity of disorder 

• Can increase stress response, depression, substance use or abstinence 

Medical Management 

• Treated with a combination of medications & psychological support groups 

• Most common form of treatment = self help groups 

• Evidence based psychological support for substance use disorder 

• Usually treated with medications = alcohol, opioid, & tobacco 

• Alcohol

  • 4 FDA approved drugs (located in book) 

• Opioid 

  • Several medications available 

  • Most common = methadone 

• Tobacco 

  • Many OTC medications available that target tobacco addiction 

Impact on Occupational Performance 

ADLs:

• Hygiene 

• Grooming 

• Time management 

• Sexual activity 

IADLs:

• communication management 

• Driving 

• Community mobility 

• Health management 

• Financial management 

• Home management 

Rest:

• Rest

• Sleep preparation 

• Sleep participation 

Education/ Work 

Play/ Leisure 

Social Participation