Chapter 4 part 2 PSYC

Introduction to Substance Use Disorders

• Transitioning into Chapter 4, focused on substance use disorders.

• Overview of how these disorders are diagnosed and categorized.

Diagnostic Manuals

• 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 Diagnosis

• 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.

Categories of Substances

• 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.

Stimulants

• 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.

Depressants

• 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.

Opiates

• 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.

Hallucinogens

• 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.

General Effects and Risks of Drug Use

• 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.

Conclusion

• 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.