7 Addictive Disorders - Key Concepts

Drug: Any substance other than food affecting our bodies or minds, including alcohol, tobacco, and caffeine.
Illicit Drug: Illegal drugs, pharmaceutical drugs used non-medically, or other inappropriately used substances.
Substance Intoxication: Changes in behavior, emotion, or thought caused by substances (DSM-5-TR).
Substance Use Disorders: Maladaptive behavior patterns and reactions caused by repeated substance use.
Common Illicit Drugs in Australia (2022–2023): Cannabis (11.5%), cocaine (4.5%), hallucinogens (2.4%).
Frequent Use: Cannabis (51%) and methamphetamine/amphetamine (37%).
Drug-Induced Deaths (2023): 1,635 deaths (6.1 per 100,000 population).
Opioids: Most common drug class present in drug-induced deaths (4.0 per 100,000 in 2022).
Substance Use Disorder Criteria: At least two symptoms within a 12-month period causing significant distress or impairment.
Includes taking substance in larger amounts, unsuccessful attempts to reduce use, focus on obtaining/using/recovering, failure to fulfill obligations, interpersonal problems, reduced activities, use in dangerous situations, continued use despite problems, cravings, tolerance, and withdrawal.
(2-3 symptoms = Mild; 4-5 symptoms = Moderate; 6 or more symptoms = Severe).
Tolerance: Need for increased amounts or diminished effect with the same amount.
Withdrawal: Unpleasant symptoms upon cessation, or taking the substance to alleviate symptoms.

Depressants: Slow CNS activity, reduce tension/inhibitions (alcohol, sedative-hypnotics, opioids); increase GABA activity.
Alcohol Use Disorder: Affects cognition, social life, and work; causes brain damage; leads to tolerance and delirium tremens (DTs).
Sedative-Hypnotic Drugs (Benzodiazepines): Reduce anxiety, aid sleep; long-term use can cause cognitive impairment; increase GABA activity; can lead to sedative-hypnotic use disorder.
Opioids: Natural (opium, heroin, morphine, codeine) and synthetic (methadone); cause CNS depression; attach to endorphin-related brain receptors.
Opioid Use Disorder: Rapid tolerance and dependence; withdrawal includes anxiety, restlessness, twitching, aches, fever, vomiting, diarrhea, and weight loss; increased doses needed to avoid withdrawal.

Stimulants: Increase CNS activity, blood pressure, heart rate, and alertness (cocaine, amphetamines, methamphetamine).
Hallucinogens (Psychedelic Drugs): Alter sensory perception; bind to serotonin receptors (LSD, MDMA/Ecstasy).
Cannabis: Hemp plant varieties; active ingredient is tetrahydrocannabinol (THC); produces hallucinogenic, depressant, and stimulant effects.
Cannabis Use Disorder: Influenced by regular use; current varieties more potent (higher THC content).

Broad Debate: Impaired control vs. choice theories.
Disease Model: Addiction as a medical disorder with loss of control.
Choice Theory: Addictive behaviors reflect rational choice.
Psychodynamic Factors: Early dependency needs, lack of parental nurturing, "substance abuse personality"; limited correlational research.
Vulnerability Personality Factors: Novelty seeking, harm avoidance, reward dependence.
Biological Factors: Genetic component, impact on brain's reward system.
Irregular dopamine-2 (D-2) receptor gene; reward circuit deficiency.
Hypersensitivity to substances with repeated stimulation.
Neurotransmitter-Focused Explanation: Tolerance and withdrawal caused by reduced neurotransmitter production.

Cognitive-Behavioral Views: Outcome Expectancy Theory; learning and conditioning (classical and operant).
Sociocultural Views: Stressful socioeconomic conditions, family influences, peer influences, availability, cost, social acceptability.
Comorbidity: Approximately 35% of those with a substance use disorder also have other mental disorders; may be due to self-medication or other factors.

Treatment Challenges: Different disorders pose different problems; high dropout rates; some recover without intervention; small % receive treatment (9%).
Barriers: Comorbid mental health conditions, low motivation, withdrawal fear, access to treatment.
Psychodynamic Approaches: Address underlying needs and conflicts; more useful in multidimensional programs.
Cognitive Behavioral Approaches: Change behaviors and cognitions; aversion therapy, relapse-prevention training, acceptance and commitment therapy (ACT), stress management, skill development.
Motivational Interviewing: Express empathy, develop discrepancy, roll with resistance, support self-efficacy.
Biological Approaches: Detoxification (systematic withdrawal), medications (antagonist, agonist).
Sociocultural Approaches: Social context, self-help programs (AA), culture- and gender-sensitive programs, community prevention programs.

Definition: Persistent and recurrent problematic gambling behavior leading to impairment and distress.
Criteria: Need to gamble with increasing amounts, irritability when cutting back, unsuccessful attempts to control gambling, preoccupation, gambling when distressed, attempts to "get even", concealing behavior, jeopardizing relationships/employment, relying on others for finances.
Similarities to Substance Use Disorder: Tolerance and withdrawal symptoms.
Adolescents/Young Adults & Males: Higher rates of pathological gambling.
Gender Differences: Females motivated by negative emotions; males by winning and excitement.

Biological Factors: Serotonin, dopamine, noradrenaline.
Psychological Factors: Impulsivity/sensation seeking, comorbid personality disorders, learning theory, cognitive models.
Social and Cultural Factors: Parental modeling, cultural attitudes, availability.
Integrated Pathways Model: Behaviorally conditioned, emotionally vulnerable, biologically based.
Treatment: Public health model, Gamblers Anonymous, pharmacological interventions (SSRIs, opioid antagonists, mood stabilizers), behavioral and cognitive interventions (CBT).