Substance Use Disorders

Substance Use Disorders

Substance-Related & Addictive Disorders (DSM-5-TR)

  • Categories:
    • "Substance" Use Disorder (specify severity: mild, moderate, severe)
    • "Substance" Intoxication
    • "Substance" Withdrawal
    • Other "Substance"-Induced Disorders
    • Unspecified "Substance" – Related Disorders
  • Substances to Specify:
    • Alcohol
    • Caffeine
    • Cannabis
    • Hallucinogen
    • Inhalant
    • Opioid
    • Sedative, Hypnotic, Anxiolytic
    • Stimulant
    • Tobacco
    • Other/unknown

Substance-Related Problems

  • Psychoactive Drug: A chemical substance that alters brain function, resulting in changes in consciousness, perception, and/or mood.
    • Need not be a medicine or be illegal (e.g., alcohol, tobacco, and caffeine).
    • Substances can cause temporary changes in behavior, emotion, or thought.

Substance Use Disorders (DSM-5-TR)

  • Patterns of maladaptive behaviors and reactions brought about by repeated use of substances.
  • Experiences often include:
    • Tolerance: Requiring an increased dose of a substance to achieve the desired effect or a markedly reduced effect when consuming the usual dose.
    • Withdrawal: Symptoms that occur when concentrations of a substance decline in an individual who maintained heavy use of the substance.

Dependence Definitions

  • Physical Dependence: The body becomes physically dependent on the drug.
  • Psychological Dependence: Emotional or motivational symptoms that include intense cravings for a drug, inability to concentrate on other nondrug-related activities, and/or feeling restless when not taking a drug.

Gender, Age, & Substance Use

  • 22 million people have used illegal substances within the past month.
  • About 9% of all teenagers & adults in the U.S. display a substance use disorder.
  • Illicit drug use is higher for males than females (marijuana, cocaine, and hallucinogens).
  • Smaller gap in adolescents ages 12 to 17.

Gender, Race/Ethnicity, Education, & Substance Use

  • Women:
    • Less likely to misuse but become dependent more quickly.
    • Substance use in women is associated with relationship issues.
    • Women who misuse are more likely to have psychiatric comorbidity.
  • Ethnicity:
    • Relatively little research on ethnicity and drug use.
    • Most findings are confounded with low socioeconomic status.
    • Influence of ethnicity and socioeconomic status must be viewed through a lens of intersectionality.
  • Illicit drug use lower among college graduates (6.7%) - psychostimulants.

Drug Overdose Deaths During COVID-19 Pandemic

  • April 2016: 56,517
  • April 2020: 78,056
  • April 2021: 100,306

Substance Use & Other Mental Illness

  • Adults aged 18 or older by mental illness status, 2021:
    • Illicit Drugs, Past Year:
      • Any Mental Illness: 39.7%
      • Serious Mental Illness: 50.2%
      • No Mental Illness: 17.7%
    • Marijuana, Past Year:
      • Any Mental Illness: 33.8%
      • Serious Mental Illness: 41.6%
      • No Mental Illness: 15.4%
    • Opioid Misuse, Past Year:
      • Any Mental Illness: 7.7%
      • Serious Mental Illness: 10.3%
      • No Mental Illness: 2.2%
    • Binge Alcohol, Past Month:
      • Any Mental Illness: 27.9%
      • Serious Mental Illness: 30.3%
      • No Mental Illness: 21.9%
    • Tobacco Products or Nicotine Vaping, Past Month:
      • Any Mental Illness: 32.6%
      • Serious Mental Illness: 37.3%
      • No Mental Illness: 20.9%

DSM 5-TR: Substance Use Disorders

  • Meet criteria with any 2 or more in a 12-month period.
  • Impaired Control:
    1. Individual expresses a persistent desire to cut down or regulate substance use; may report multiple unsuccessful efforts to do so.
    2. Individual spends a great deal of time obtaining the substance, using the substance, or recovering from its effects.
    3. Virtually all of the individual’s daily activities revolve around the substance.
    4. Craving (intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug was previously obtained or used).
  • Social Impairment:
    1. Recurrent substance use results in failure to fulfill major role obligations at work, school, or home.
    2. Individual uses the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
    3. Important social, occupational, or recreational activities may be given up or reduced because of the substance use.
  • Risky Use of Substance:
    1. Recurrent substance use in situations in which it is physically hazardous.
    2. Continue use of the substance despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use.
  • Pharmacological:
    1. Tolerance (markedly increased dose of substance needed to achieve desired effect/markedly reduced effect when the usual dose is consumed).
    2. Withdrawal (syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of a substance).

DSM 5-TR: Substance Use Disorders – Specifiers

  • Specifiers:
    • Mild: Presence of 2-3 symptoms.
    • Moderate: Presence of 4-5 symptoms.
    • Severe: Presence of 6+ symptoms.
  • Course specifiers and descriptive features:
    • In early remission: No criteria met for at least 3 months and less than 12 months.
    • In sustained remission: No criteria met for 12+ months.
    • On maintenance therapy: If taking prescribed agonist medication (e.g., methadone for opioid use disorder).
    • In a controlled environment: If in an environment where a substance is not allowed (e.g., rehabilitation center; incarceration).

Depressants

  • Alcohol
  • Sedative-Hypnotic Drugs
  • Opioids

Depressants

  • Depressants slow the activity of the central nervous system (CNS).
    • Reduce tension & inhibitions.
    • May affect judgment, motor activity, & concentration.
  • The 3 most common depressants:
    • Alcohol
    • Sedative-Hypnotic Drugs (e.g., benzodiazepines)
    • Opioids

Alcohol

  • Binge-drinking episode: Consuming 5+ drinks (men); 4+ drinks (women) on a single occasion.
  • Ethyl alcohol intake effect in the bloodstream and CNS.
  • Alcohol helps GABA (an inhibitory messenger) shut down neurons, slows CNS and "relaxes" the drinker.

Alcohol

  • Level of impairment depends on BAC (blood alcohol content).
    • BAC > .55 = death in most cases
  • Typical course of drinking in one setting:
    • The brain area, which controls judgment and inhibition, is affected.
    • Additional areas in the CNS are affected, leaving the drinker even less able to make sound judgments, speak clearly, and remember well.
    • Motor difficulties increase as drinking continues, and reaction times slow.

Alcohol - Epidemiology

  • 12-month prevalence: About 7% display alcohol use disorder.
  • Lifetime prevalence: ~13% of adults.
  • After caffeine, alcohol is the most commonly used psychoactive substance.
  • Alcohol use peaks at age 22-23, after which rates decline steadily.
  • Alcohol use disorder is comorbid with mental disorders.
  • Higher rates in males (36%) versus females (22.7%).
  • Highest rates among Native American individuals, followed by White, Hispanic, Black, and Asian or Pacific Islander individuals.

Alcohol - Clinical picture

  • The drinking interferes with work and social functioning.
  • Individual patterns of alcohol use issues vary.
  • Withdrawal:
    • Hands, tongue, eyelids shake.
    • Feelings of weakness and nausea.
    • Sweaty and vomiting.
    • Rapid heartbeat.
    • Increased blood pressure.

Alcohol - Delirium tremens

  • Can occur when trying to cut back on drinking.
  • Disorientation.
  • Severe agitation.
  • High blood pressure.
  • Fever.
  • Confusion.
  • Terrifying hallucinations.
  • May involve severe/fatal medical complications.

Costs of Alcohol Use Problems

  • Alcohol use disorder affects and compromises millions of families, social relationships, and careers.
  • Plays a role in suicides, homicides, assaults, and accidents.
  • Seriously affects the children (some 30 million) of parents with alcohol use disorder.
  • Serious physical health damage; Cirrhosis, Korsakoff’s syndrome, Fetal alcohol syndrome.

Sedative-Hypnotic Drugs

  • Sedative-hypnotic drugs produce feelings of relaxation and drowsiness.
    • Act on GABA.
    • At low dosages, they have a calming or sedative effect.
    • At higher dosages, they function as sleep inducers or hypnotics.
  • Include Barbiturates and Benzodiazepines (e.g., Xanax, Valium, Klonopin).
  • Tolerance can build and become highly addictive.

Opioids

  • Among those described as “narcotics” e.g., heroin, morphine, codeine, oxycodone (Oxycontin), hydrocodone (Vicodin).
  • Smoked, inhaled, snorted, injected.
  • An injection quickly brings on a rush: a spasm of warmth and ecstasy that is sometimes compared with orgasm, followed by a “high”.
  • Tolerance builds quickly leading easily to addiction (withdrawal in 4-6 hours). Those are narcotics.