9/15 phyc Substance Use and Addiction: Intro Notes
Introduction: Why people use drugs and alcohol
There are a million reasons; universal primary reason is coping with emotions and emotional pain.
Secondary reasons include cultural norms (what you grow up with, e.g., wine at dinner in some families).
Peer pressure is another factor, especially in high school; shift in influence in college vs younger years; some students report less pressure in their twenties.
Indirect social pressure and judgment can influence decisions to drink or use drugs.
In modern contexts, substance use is often demonized in some cultures, whereas in the past it was more normalized.
As people age (e.g., into 40s), less concern about others' opinions; social influence on drinking tends to diminish for some.
Summary: people use substances for many reasons, but the number one universal reason is coping with emotions; the second is cultural norm; third is peer pressure.
What drugs and alcohol do to emotions and consciousness
Substances are taken to change consciousness (awareness of external and internal states).
Consciousness in psychology is synonymous with awareness; substances alter awareness of external stimuli (outside the body) and internal states (inside the body).
External stimuli = things happening outside the body; internal states = thoughts, feelings, physiological states inside.
Examples of substances as anything that alters awareness when taken into the body.
There is a distinction between physical dependence (tolerance and withdrawal) and psychological dependence (emotional/cognitive/behavioral reliance on a substance).
Pregnant use and fetal impact discussed later (FASD).
Key psychology terms and definitions
Substance (psychology): drugs or alcohol or anything taken to alter consciousness/awareness.
Consciousness: awareness of self and environment.
External stimuli: events or cues outside the person.
Internal stimuli: thoughts, feelings, or bodily states inside the person.
Addiction definitions:
Physical dependence: presence of both tolerance and withdrawal.
Psychological dependence: persistence of dependence on a substance for emotional, cognitive, or behavioral stability.
Addiction: two core signs of physical dependence
Tolerance: the body needs more of the substance to achieve the same effect.
Example: daily marijuana or alcohol use leading to needing more to achieve the same high or effect.
Withdrawal: symptoms when the substance is not present; symptoms vary by substance and use history.
Common symptoms include headaches, nausea, vomiting, high temperature, chills, tremors, anxiety, hallucinations, seizures, diarrhea.
Criterion for being addicted/physically dependent: must have both tolerance and withdrawal.
Also introduced: physical dependence is also called physical dependence on a substance.
Psychological dependence: signs and symptoms
Anxiety when stopping addictive behavior or when access is limited.
Social anxiety in social situations and reliance on substances to cope with social stress (e.g., pregaming)
Depression when not using or trying to quit.
Irritability, mood swings, restlessness when not using or trying to quit.
Appetite changes (loss or increased appetite) and possible weight changes when stopping (e.g., smoking cessation often leads to weight gain).
Sleep problems when quitting or not using the substance.
Uncertainty about life without the substance (e.g., can I manage life without weed).
Denial about having a problem with substances.
Obsessive preoccupation with obtaining or using the substance.
Craving or urges (tied to both cognitive and physical experiences).
Difficulty meeting obligations (work, home, school) due to substance use.
Continued use despite relationship problems (abuse, dishonesty, trust issues) and risk-taking or unsafe behaviors.
Giving up important activities due to substance use.
Recurrent use despite physical danger (e.g., driving under influence) and medical/physical health problems.
Continued use despite recognizing a problem that substance use creates or worsens (e.g., liver disease, depression).
Tolerance (repeats) and withdrawal (repeats) are part of the broader picture of dependence.
Note: signs often co-occur with physical dependence; these symptoms help distinguish psychological dependence.
Diagnosis: Substance Use Disorder (DSM-based overview)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides criteria for Substance Use Disorder (SUD).
Diagnosis requires two main data points:
Distress: significant emotional pain or discomfort related to use.
Dysfunction: impairment in daily functioning (work, relationships, self-care).
DSM uses a list of 11 criteria to assess SUD; a clinician evaluates whether criteria are met.
Specifiers for severity (as discussed in class):
Mild: 2 or more criteria met.
Moderate: 4 or more criteria met.
Severe: 6 or more criteria met.
Some criteria overlap with physical dependence (tolerance and withdrawal) and with psychological dependence.
The diagnosis typically requires both physical and psychological dependence issues to be present.
Clinicians may use additional screening tools (e.g., CAGE) to assess risk before applying the full 11 criteria.
The 11 DSM-5 criteria for Substance Use Disorder (summarized)
1) Taking the substance in larger amounts or for longer than intended.
2) A persistent desire or unsuccessful efforts to cut down or control use.
3) A great deal of time spent in activities necessary to obtain, use, or recover from the substance.
4) Craving or strong desire or urge to use the substance.
5) Recurrent use resulting in failure to fulfill major role obligations at work, school, or home.
6) Continued use despite persistent or recurrent social or interpersonal problems caused or worsened by substance.
7) Important social, occupational, or recreational activities given up or reduced because of use.
8) Recurrent use in situations in which it is physically hazardous (e.g., driving).
9) Continued use despite knowledge of a persistent or recurrent physical or psychological problem likely caused or worsened by the substance.
10) Tolerance (need for markedly increased amounts to achieve intoxication or desired effect).
11) Withdrawal symptoms, or the use of a substance to relieve or avoid withdrawal symptoms.
Important note from the lecture: some criteria are common to physical dependence (tolerance/withdrawal) and psychological dependence; the full diagnosis uses a combination of these criteria.
A common clinical approach is to assess with the 11 criteria but also use screening tools to avoid mislabeling.
The two D’s: Distress and Dysfunction (DSM concept)
Distress: emotional pain or discomfort associated with substance use.
Dysfunction: impairment in functioning across major life domains (work, school, relationships).
Substance Use Disorder is diagnosed when there is significant distress and dysfunction together.
CAGE screening questions ( alcoholism-focused tool)
CAGE stands for four quick questions:
C: Cut down — Have you ever felt the need to cut down on your drinking?
A: Annoyed — Have you ever felt annoyed by criticism of your drinking or people talking about your drinking?
G: Guilty — Have you ever felt guilty about drinking?
E: Eye-opener — Have you ever had an eye-opener, i.e., needing your first drink (or other substance) first thing in the morning to get going?
Interpretation:
If any item is affirmative, it may indicate a potential problem worth a fuller assessment.
The Eye-Opener can indicate dependence and blackout risk; coffee may also count as an eye-opener when used to wake up (non-judgmental recognition that caffeine is a substance).
Note from the talk: CAGE is a quick screening tool, not a definitive diagnosis.
Categories of substances: four main categories
Four categories and their general effects:
Stimulants (speed up body systems): increase heart rate, blood pressure, body temperature; increase alertness and energy; can cause agitation and paranoia at high doses; decrease appetite.
Examples: nicotine, caffeine, methamphetamine, ecstasy (MDMA), cocaine; nicotine-containing products (cigarettes, vapes) are stimulants.
Depressants / Downers / Sedative-hypnotics (slow down body systems): decrease heart rate, blood pressure, body temperature, and inhibitions.
Common agents: alcohol, benzodiazepines (e.g., Xanax), other sedatives; also note sedatives depress respiration.
Opioids (painkillers): decrease physical pain, decrease respiration, increase sleepiness and euphoria; high addiction risk.
Examples: heroin, fentanyl, oxycodone, hydrocodone (Vicodin), morphine; prescription and illegal forms.
Hallucinogens: alter perceptions of reality and time and can induce powerful experiences; may increase heart rate and blood pressure; often associated with vivid perceptual changes.
Examples: marijuana (cannabis), LSD, mescaline (peyote), psilocybin, PCP (angel dust).
Additional notes from the lecture:
Marijuana is categorized as a hallucinogen in this lecture.
Hallucinogens are being explored in some therapeutic contexts (e.g., PTSD, trauma processing); benefits vs risks include potential therapeutic value and addiction concerns due to illegality and misuse.
Overlap exists: stimulants and hallucinogens can both raise heart rate and blood pressure; what differentiates them is the perceptual effects (hallucinations, altered reality) for hallucinogens.
Special topic: Substance use during pregnancy and fetal effects
Fetal Alcohol Spectrum Disorder (FASD): a range of lifelong effects from maternal alcohol use during pregnancy.
Symptoms/impacts include: low birth weight, hyperactivity, organ dysfunction, lower IQ, speech/development delays, poor memory, poor coordination, poor impulse control.
Other consequences: uncertainty of pregnancy outcomes, long-term cognitive/behavioral problems.
Other illicit substances during pregnancy can cause miscarriage, preterm labor, birth defects, stillbirth, withdrawal symptoms in the newborn, higher risk of sudden infant death syndrome (SIDS), and poor fetal growth.
Important nuance: not every pregnant woman who drinks or uses substances will have a baby with FASD; the exact threshold and risk level are not precisely known, but the recommendation is to avoid alcohol entirely during pregnancy.
Maternal vs paternal contributions to pregnancy outcomes:
The placenta is the maternal organ that nourishes the fetus; paternal health or drug use does not directly affect placental development, but paternal health can affect sperm quality.
Fifty percent of infertility cases are attributed to sperm quality in men (mutations or suboptimal sperm function) that can affect pregnancy viability.
Secondhand smoke and secondhand marijuana smoke can impact fetal development and pregnancy outcomes.
Specific points raised in class:
The question of criminalizing alcohol use during pregnancy is debated; not illegal in many jurisdictions, but it is clinically and ethically problematic because it involves two bodies and often involves undisclosed pregnancies.
The impact of paternal drug use on pregnancy viability is more about sperm health than direct fetal programming, though paternal health can influence conception and early embryo development.
Clinical and ethical takeaway:
Addiction is a medical issue; pregnancies complicate with addiction require compassionate, non-judgmental care and support for both parents and the child.
Social support and resources are critical for successful treatment and reducing risk to the fetus.
Additional clinical and societal considerations
Treatment depends on the substance and the severity; often involves a combination of approaches (behavioral therapies, social support, medical management).
The clinician’s stance in the classroom example: maintain non-judgment to help patients engage in treatment and reduce stigma; judgment is not helpful for overcoming substance use.
Social supports like Alcoholics Anonymous (AA) or other support networks can facilitate sobriety and recovery.
The brain-behavior interplay: addiction can impact decision-making, impulse control, and overall functioning; substance use often changes priorities and risk assessment.
Summary points for exam readiness
The number one universal reason for drug/alcohol use is coping with emotions; the number two is cultural norm; peer pressure is a contextual factor.
Substances alter consciousness; conscious awareness is defined as awareness; external stimuli are outside, internal stimuli are inside the body.
Addiction requires both tolerance and withdrawal (physical dependence); psychological dependence involves cravings and emotional/cognitive reliance.
Distress and dysfunction are the two core diagnostic indicators for Substance Use Disorder using the DSM framework; the DSM lists 11 criteria and severity specifiers based on how many criteria are met.
CAGE is a quick screening tool for alcoholism that uses four questions and includes the concept of an Eye-Opener (morning use to start the day).
Four major substance categories with typical effects and examples:
Stimulants: increase alertness and energy; examples include caffeine, nicotine, meth, cocaine, MDMA; can reduce appetite and raise heart rate.
Depressants: slow body systems; examples include alcohol, benzodiazepines; decrease inhibitions and respiration.
Opioids: decrease pain and respiration; examples include heroin, fentanyl, oxycodone, morphine; high risk of addiction and overdose.
Hallucinogens: alter perceptions and create perceptual trip effects; examples include marijuana, LSD, psilocybin, mescaline, PCP.
FASD and other prenatal risks highlight the lifelong impact of substances during pregnancy; focus remains on prevention and non-judgmental care for pregnant persons.
Ethical considerations emphasize compassion, support, and evidence-based care rather than stigma or shaming; family dynamics and social support systems play critical roles in recovery outcomes.
Key terms (quick reference, with LaTeX formatting for numbers)
DSM-11 criteria for Substance Use Disorder: 11 criteria (2 = mild, 4 = moderate, 6 = severe).
Tolerance: body requires more of the substance to achieve the same effect.
Withdrawal: physical/s psychological symptoms when the substance is reduced or stopped.
Distress: emotional pain or discomfort related to substance use.
Dysfunction: impairment in daily functioning due to substance use.
Eye-Opener: needing a substance first thing in the morning to start the day (CAGE).
Fetal Alcohol Spectrum Disorder (FASD): lifelong impact from alcohol exposure in utero.
Paternal contribution to fertility: 50 ext{%} of infertility cases involve sperm quality.
Gestation length: typical duration is 40 ext{ weeks}.
SUD severity specifiers: mild (≥ 2 criteria), moderate (≥ 4 criteria), severe (≥ 6 criteria).