Substance Use Disorders

Substance Use Disorders

Overview

  • Focus on substance-related disorders and their impact on behavior and health.

Learning Goals

  • Define key vocabulary relevant to substance-related disorders.

  • Recognize clinical features of alcohol abuse and dependence.

  • Explain causal factors contributing to alcohol use disorder.

  • Identify effective treatment approaches for alcohol use disorder.

  • Recognize short-term effects and long-term consequences of commonly associated substance classifications.

Key Vocabulary

Substance Use Disorder

  • A maladaptive pattern of behavior related to excessive substance use leading to impairment and negative consequences.

Addiction

  • Refers to behavior based on a pathological need for a substance, often used in the context of alcoholism.

Psychoactive Substances

  • Chemical substances affecting mental functioning in CNS, altering mood and perception (can be legal like nicotine or illegal like cocaine).

Polysubstance Abuse

  • Use of multiple drugs concurrently by someone with a substance use disorder.

General Symptoms of Substance Use Disorders

  • Excessive substance use can lead to:

    1. Potentially hazardous behavior (e.g., driving intoxicated).

    2. Continued use despite social/psychological health problems.

  • Substance Dependence: Most severe form; involves physiological tolerance and/or withdrawal.

Tolerance and Withdrawal

Tolerance

  • The need for increased amounts of a substance to achieve desired effects; indicates physiological dependence.

Withdrawal

  • Physical symptoms experienced upon cessation of drug use (e.g., tremors, nausea).

  • Most severe withdrawal symptoms are associated with alcohol, opioids, and sedatives.

Distinguishing Characteristics of Substance Problems

  1. Patterns of pathological consumption.

  2. Negative consequences of prolonged abuse patterns.

  3. Physiological tolerance/withdrawal.

Clinical Features of Alcohol Abuse and Dependence

  • Cuts across age, educational, and socioeconomic boundaries.

  • Lifetime prevalence in the U.S. = 13%.

  • Commonly linked to accidents and violent crime; more frequent in men.

  • Over 37% of alcohol abusers have at least one coexisting mental disorder.

  • Alcohol functions as both a CNS stimulant and depressant.

Effects of Alcohol

Short-term Effects

  • Intoxication leads to slurred speech, impaired memory, and coordination issues.

  • Strong correlation between blood alcohol level and CNS effects; legal driving limit = 0.08%.

Long-term Consequences

  • Financial/legal problems, negative effects on relationships, chronic fatigue, and potential for Fetal Alcohol Syndrome if the abuser is pregnant.

  • Severe physical effects include malnutrition and liver cirrhosis.

Severe Alcohol Use Consequences

  • Alcohol Withdrawal Delirium: Occurs after prolonged drinking; symptoms include hallucinations, disorientation, and tremors.

  • Alcohol Amnestic Disorder: Memory loss due to excessive drinking, often linked to vitamin B deficiency (thiamine) resulting in irreversible damage if untreated.

Biological Factors Contributing to Alcohol Use Disorder

  • The mesocorticolimbic dopamine pathway (MCLP) is activated by psychoactive drugs, becoming rewarding over time.

  • Heredity plays a significant role; having a parent with alcohol issues increases risk, as shown in adoption studies.

Psychological Factors

  • Cognitive expectations influence alcohol use; perceived benefits can enhance consumption.

  • Individuals with stress or trauma may use alcohol as a coping mechanism, although this doesn’t explain all use cases.

Social Factors

  • Parental drug use, lack of guidance can increase risk among teens.

  • Cultural attitudes toward alcohol (e.g., social lubricant) can also play a role in patterns of abuse.

Treatment Approaches

Biological Treatments

  • Detoxification: Remove the dependent drug; usually involves withdrawal symptoms.

  • Medications:

    • Disulfiram (Antabuse): Causes vomiting with alcohol use.

    • Naltrexone: Reduces cravings by blocking pleasure effects.

Psychological Treatments

  • Cognitive-Behavioral Therapy (CBT): Education on alcohol, coping skills, and stress management.

  • Group Therapy: Confrontational settings help individuals accept their addiction and learn new coping strategies.

  • Environmental Intervention: Offers social support and transitional housing for recovery.

Other Approaches

  • Self-help Groups (AA): Provide support and structure; dropout rates are high, but can aid recovery.

  • Controlled Drinking vs. Abstinence: Ongoing debate about managing drinking levels versus total abstinence.

Common Substance Classifications

Opiates

  • Short-term: Euphoria followed by lethargy; risk of overdose.

  • Long-term: Cravings and significant life impairment.

Stimulants

  • Short-term: Elevated mood and alertness; risk of serious health issues or death.

  • Long-term: Possible onset of psychosis and severe relationship problems.

Nicotine

  • Short-term: Increased heart rate and blood pressure; can lead to severe health issues, including cancer.

Sedatives and Hypnotics

  • Short-term: Induce relaxation; risky sleep aids.

  • Long-term: Withdrawal can worsen anxiety and cognitive control.

Hallucinogens

  • Short-term: Alter sensory perception; may induce pleasant or traumatic experiences.

  • Long-term: Possible flashbacks and memory issues.

Regional Drug Use Patterns

  • Heavy opium use in Southeast Asia; cocaine in South America; widespread cannabis use globally.

Prevalence Rates in the U.S.

  • Alcohol use reported by 52.2% of Americans aged 12+, with specific binge drinking rates at 22.9%.

  • Drug use trends report that 21.6 million people reported illicit drug use in the past year.

  • Notably, most users do not develop dependence; lifetime prevalence rate for alcohol-related problems is approximately 20%.