10 Addictive disorder

Chapter 10: Addictive Disorders

Understanding Substance Use

  • Substance Use Definition: Refers to the use of drugs for non-medical purposes, involving overuse of prescription medications.

  • Sources of Substances:

    • Prescriptions: Overuse of anti-anxiety medications like diazepam (Valium) through false symptom reporting.

    • Legal Substances: Alcohol, nicotine (cigarettes), cannabis.

    • Illegal Drugs: Heroin, cocaine, methamphetamine, LSD.

Mechanisms of Substance Use

  • General Mechanism: Substances introduce molecules into the bloodstream that interfere with normal brain function.

  • Example with Cocaine:

    • Prevents dopamine reuptake at the synapses.

    • Does not introduce new dopamine but significantly increases its availability.

    • Over time, dopamine availability falls below baseline leading to a crash.

Medical vs. Illicit Drugs

  • Medical Drugs:

    • Discovered for medical use, some with addictive potential (e.g., opiate painkillers).

    • Used in controlled environments to manage deficits (e.g., SSRIs for low serotonin).

  • Illicit Drugs:

    • Often commenced with illegal use first (e.g., hashish use traced back to 10th century Persia).

Medical Use vs. Misuse of Drugs

  • Medical Use:

    • Applied in the presence of deficits; low addictive potential and manageable dosages.

  • Misuse:

    • Used without deficits, aiming to achieve a high; involves high dosages leading to addiction and potential lethality.

Features of Substance Use Disorders

  • Substance Intoxication: Temporary changes in behavior, emotions, and thoughts after substance use.

  • Substance Use Disorder: Persistent maladaptive behaviors resulting from repeated substance use (APA, 2013).

Statistical Insights

  • Prevalence in Canada: 21.6% meet lifetime criteria for substance use disorder, primarily alcohol (18.1%);

  • Only 18% seek professional help; highlights the need for community and preventive interventions.

Personal Narrative on Substance Use

  • Duncan’s Story: Chronicles the progression from occasional drinking to addiction and eventual recovery through Alcoholics Anonymous, emphasizing the drastic changes in personal relationships and career due to alcohol misuse.

DSM Diagnostic Criteria for Substance Use Disorders

  • Core Features:

    • Evidence of maladaptive patterns leading to significant distress or impairment with at least 2 of:

      1. Craving for substance.

      2. Salience: Prioritizing substance over responsibilities.

      3. Tolerance: Need for increased amounts.

      4. Withdrawal symptoms.

      5. Harmful use despite known issues.

      6. Loss of control in attempts to use less.

Categories of Substance Use Disorders

  • Depressants: Slow down CNS activity.

  • Stimulants: Speed up CNS activity.

  • Cannabis: Produces mild euphoric effects but can have adverse effects as well.

Alcohol Abuse Overview

  • Types of Depressants: Alcohol, opioids—functions to reduce tension/inhibitions but may compromise judgment and cognitive functions.

  • Blood Alcohol Concentration (BAC): Affects behavior at different levels:

    • Low doses (0.06%): Improved mood, less tension.

    • Higher doses (0.09%): Deterioration of judgment, emotional instability.

Long-term and Fatal Consequences of Alcohol Use

  • Serious Health Risks: Chronic consumption leads to liver cirrhosis; significant annual fatalities attributed to alcohol-related issues.

  • Alcohol Use Disorder (AUD) Statistics: Its prevalence and impact, including societal effects, and health issues arising from excessive use.

Opioid Misuse and Addiction

  • Opioid Use Disorder: High prevalence, over-prescription leading to societal and health crises; characterized by significant withdrawal symptoms and tolerance needs.

  • Opioid Crisis: Rising deaths from overdoses and higher rates of transmission for infectious diseases linked to shared needle use.

Treatment Approaches

  • Cognitive Behavioral Therapy (CBT): Effective in managing substance use through skill development in coping and self-regulation.

  • Biological Treatments: Rarely sustain long-term improvement without supplementary psychotherapy.

  • Sociocultural Therapy: Alcoholics Anonymous promotes abstinence and signifies community support.

Continuous Needs and Community Awareness

  • Community Prevention Programs: Less than 20% of those in need seek help, highlighting the essential role of education and accessibility in preventing substance use issues.