Study Notes on Substance-Related Disorders

Understanding Substance-Related and Other Addictive Disorders
Learning Objectives

  • Describe DSM-5 criteria for substance-use disorders.

  • Identify substances associated with addiction; their properties and hazards.

  • Discuss development of substance-use disorders.

  • Outline effective interventions and treatments.

  • Examine gambling disorder and debate excessive internet gaming as an addiction.

Substance Abuse Overview

  • Definition: Harmful use of drugs/alcohol.

  • Substance-use disorder: At least two DSM-5 characteristics present in 12 months causing distress/impairment (7.4% of U.S. aged 12+ met criteria in 2018).

  • Commonly abused substances: Alcohol, marijuana, pain relievers, cocaine, heroin (most dangerous).

DSM-5 Substance-Use Disorder Criteria

  • Two out of the following characteristics within 12 months:

    1. Larger amounts/time than intended.

    2. Unsuccessful effort to control use.

    3. Significant time spent on substance-related activities.

    4. Craving for substance.

    5. Interference with obligations, social/recreational activities.

    6. Continued use despite harm.

    7. Hazardous use situations.

    8. Tolerance developed.

    9. Withdrawal symptoms occur after use reduction.

Applying DSM-5 Criteria: Case Scenarios

  • Scenario 1: Maria's Alcohol Use

    • Maria, a 30-year-old, has been drinking daily for the past 8 months. She often drinks more than she intends, sometimes missing work due to hangovers. Her family has expressed concern, but she feels she needs alcohol to relax. She has tried to cut back but hasn't succeeded for more than a few days.

    • Question: Based on the DSM-5 criteria, what symptoms does Maria exhibit, and would she meet the criteria for an alcohol-use disorder? Explain.

  • Scenario 2: John's Opioid Prescription

    • John was prescribed oxycodone after a back injury. Initially, two pills managed his pain, but now he needs four to achieve the same effect. He sometimes takes extra pills "just in case" his pain flares, even when he doesn't need them immediately. He worries about running out of his prescription early.

    • Question: Identify potential DSM-5 criteria relevant to John's situation. What concerns might a clinician have about his pattern of use?

Substances Associated with Abuse

  • Prescription Medications: For anxiety, insomnia, or pain.

  • Legal: Alcohol, caffeine, tobacco.

  • Illegal: Cocaine, heroin.

Types of Substances

Depressants

  • Alcohol: Moderate drinking defined, binge drinking constitutes multiple standard drinks in a session.

  • Effects: Impaired judgment, overdose risks, alcohol-use disorder prevalence.

Opioids

  • Includes heroin and prescription pain relievers (morphine, oxycodone).

  • Highly addictive, can lead to euphoria and drowsiness, severe misuse issues.

Stimulants

  • Increase CNS activity, improve performance, reduce appetite (e.g., cocaine, amphetamines).

  • Negative effects: Paranoia, anxiety, rapid tolerance.

Hallucinogens

  • Produce vivid perceptions; can have long-lasting effects beyond use.

Mixed Properties

  • Examples: Cannabis, nicotine, designer drugs with various psychoactive effects.

Etiology of Substance-Use Disorders

  • Progression: Experimentation to physiological dependence, altered brain chemistry, lifestyle changes.

  • Factors: Psychological, social, and biological influences increase risk (including stressors, peer influences, genetics).

Treatment Approaches for Substance-Use Disorders

  • General Goals: Sustained abstinence, productive functioning, integrated care addressing emotional difficulties.

  • Phases: Detoxification, preventing relapse (including motivational therapy and contingency management).

  • Specific treatments vary per substance (e.g., combined therapies for cannabis, counseling for stimulants).

Real-World Treatment Challenges

  • Challenge 1: Relapse Prevention for Sarah

    • Sarah has successfully completed detoxification for cocaine dependence and is attending support groups. However, she frequently encounters friends who still use cocaine in her neighborhood. She reports strong cravings when she sees them.

    • Question: What relapse prevention strategies could be most effective for Sarah, considering her social environment? How would motivational therapy be applied in her situation?

  • Challenge 2: Integrated Care for David

    • David is seeking treatment for alcohol-use disorder but also reports severe anxiety and depression. He's hesitant to discuss his mental health symptoms with his substance abuse counselor.

    • Question: Describe an appropriate integrated care approach for David. Why is it important to address both his anxiety/depression and alcohol use simultaneously?

Contemporary Trends

  • Research directions focus on risk factors, addressing systemic discrimination, and using technology for treatment assessment and enhancement.

Summary

  • Understand DSM-5 definition, substances causing addiction, etiology, and effective treatments for substance-use disorders, including the debate on behavioral addictions like gambling and gaming.