Chapter 4 part 2 PSYC

Introduction to Substance Use Disorders

DSM-5: The Diagnostic Statistical Manual of Mental Health Disorders, primary reference in the U.S. for mental health diagnoses.
- The DSM-5 was released in 2013, with a revised version, DSM-5 TR being released subsequently.
- Used to standardize diagnostic criteria that can be covered by insurance, with various mental health professionals relying heavily on it for diagnosis and treatment.
ICD (International Classification of Diseases): Used in many countries instead of, or alongside, the DSM.
- The ICD 11 focuses on all medical and mental health diagnoses, ensuring a global diagnostic agreement.
- Medical doctors tend to use ICD codes, while psychologists and therapists primarily use the DSM.
Revisions to DSM typically occur every 15-20 years, with minor revisions (TRs) occurring more frequently to reflect evolving research.

Substance use disorder (SUD) diagnosis encompasses compulsive patterns of drug use despite negative consequences.
- Involves both physical dependence (changes in body functioning) and psychological dependence (emotional reliance on the substance).
Symptoms Evaluated:
- Tolerance: Needing increased amounts of a substance for the same effect.
- Withdrawal: Negative symptoms experienced when substance use is reduced or ceased.

Major categories discussed: depressants, stimulants, hallucinogens (antipsychotics discussed in Chapter 16).
Drug Wheel Resource: A supplemental resource available that categorizes various drugs in more detail.

Examples: Cocaine, amphetamines (including ADHD medications like Adderall), methamphetamines, MDMA (ecstasy).
- Cause increased heart rate, blood pressure, and body temperature.
- Effects may vary based on individual factors (weight, hydration, etc.) and method of administration (ingested, inhaled, injected).
- Low doses may lead to alertness and euphoria; high doses can result in paranoia, hallucinations, and even brain toxicity.
Stimulant drug class is psychologically addictive due to increased dopamine levels, affecting reward pathways in the brain.
- For example, cocaine prevents the reuptake of dopamine, leading to a flood of this neurotransmitter in the synapses, reinforcing positive feelings and cravings.

Commonly include alcohol, barbiturates, and benzodiazepines.
- These substances depress nervous system activity, leading to decreased heart rate and blood pressure.
- Their use includes promoting relaxation but can also lead to memory loss, motor disturbances, and respiratory function impairment.
Depressants also act as GABA agonists, enhancing the effects of GABA, an inhibitory neurotransmitter, reducing anxiety and inhibiting neuron firing.
- Alcohol, for example, can impair reaction times, visual processing, and behavioral control; excessive consumption can result in severe health consequences.

This category includes heroin, fentanyl, morphine, oxycodone, and methadone.
- The most prevalent in the U.S. due to the ongoing opioid crisis, often arising from prescription abuse transitioning to illegal use.
Opiates act on endogenous opioid neurotransmitters to reduce pain and can also induce feelings of euphoria, leading to high addiction potential.
- Issues stemming from excessive dosing include tolerance, withdrawal symptoms, and the risk of death due to respiratory depression.
- Treatment options like methadone are controversial yet used to aid in managing withdrawal from stronger opioids.

Examples: LSD, mescaline, psilocybin, ketamine.
- Primarily alter perception and sensory input, affecting the activity of neurotransmitters like serotonin and glutamate.
- Experiences vary widely between individuals, often depending on the quantity and method of administration used.
- Ongoing research indicates potential therapeutic applications for hallucinogens in treating conditions such as PTSD.

Most substances can lead to psychological addiction, with some leading to serious physiological dependence and withdrawal risks.
Substance withdrawal can be exceptionally dangerous, sometimes requiring medical monitoring.
Individual differences play a significant role in the effects experienced, and it's important to understand the various impacts on mental and physical health.

Discussion on the complexities and nuances of substance use disorders, including treatment options and the importance of understanding both physiological and psychological dependencies.
Encouragement for further inquiry into specific substance usage and ongoing developments in treatment.