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Lecture 1 and 2 Introduction Definitions(1)

Substance abuse involves the harmful use of psychoactive substances, leading to dependence and addiction, which is characterized by compulsive use despite negative consequences. Addiction can affect various substances, including alcohol, opioids, and stimulants, and is associated with distorted thinking and behavior due to changes in brain function. Diagnosis of substance use disorder is based on criteria related to impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal.

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16 views

Lecture 1 and 2 Introduction Definitions(1)

Substance abuse involves the harmful use of psychoactive substances, leading to dependence and addiction, which is characterized by compulsive use despite negative consequences. Addiction can affect various substances, including alcohol, opioids, and stimulants, and is associated with distorted thinking and behavior due to changes in brain function. Diagnosis of substance use disorder is based on criteria related to impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal.

Uploaded by

shelomwangi123
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Substance abuse

Substance abuse refers to the harmful or hazardous use of psychoactive


substances, including alcohol and illicit drugs. Psychoactive substance use
can lead to dependence syndrome - a cluster of behavioural, cognitive, and
physiological phenomena that develop after repeated substance use and
that typically include a strong desire to take the drug, difficulties in
controlling its use, persisting in its use despite harmful consequences, a
higher priority given to drug use than to other activities and obligations,
increased tolerance, and sometimes a physical withdrawal state.

What Is Addiction?

Addiction is a complex condition, a brain disease that is manifested by


compulsive substance use despite harmful consequence. People with
addiction (severe substance use disorder) have an intense focus on using a
certain substance(s), such as alcohol or drugs, to the point that it takes over
their life. They keep using alcohol or a drug even when they know it will
causes problems. Yet a number of effective treatments are available and
people can recover from addiction and lead normal, productive lives.

People can develop an addiction to:

Alcohol

Marijuana

PCP, LSD and other hallucinogens

Inhalants, such as, paint thinners and glue

Opioid pain killers, such as codeine and oxycodone, heroin

Sedatives, hypnotics and anxiolytics (medicines for anxiety such as


tranquilizers)

Cocaine, methamphetamine and other stimulants


Tobacco

People with a substance use disorder have distorted thinking, behavior and
body functions. Changes in the brain’s wiring are what cause people to have
intense cravings for the drug and make it hard to stop using the drug. Brain
imaging studies show changes in the areas of the brain that relate to
judgment, decision making, learning, memory and behavior control.

These substances can cause harmful changes in how the brain functions.
These changes can last long after the immediate effects of the drug — the
intoxication. Intoxication is the intense pleasure, calm, increased senses or a
high caused by the drug. Intoxication symptoms are different for each
substance.

Over time people with addiction build up a tolerance, meaning they need
larger amounts to feel the effects.

According to the National Institute on Drug Abuse, people begin taking drugs
for a variety of reasons, including:

to feel good — feeling of pleasure, “high”

to feel better — e.g., relieve stress

to do better — improve performance

curiosity and peer pressure

People with addictive disorders may be aware of their problem, but be


unable to stop it even if they want to. The addiction may cause health
problems as well as problems at work and with family members and friends.
The misuse of drugs and alcohol is the leading cause of preventable illnesses
and premature death.
Symptoms of substance use disorder are grouped into four categories:

Impaired control: a craving or strong urge to use the substance; desire or


failed attempts to cut down or control substance use

Social problems: substance use causes failure to complete major tasks at


work, school or home; social, work or leisure activities are given up or cut
back because of substance use

Risky use: substance is used in risky settings; continued use despite


known problems

Drug effects: tolerance (need for larger amounts to get the same effect);
withdrawal symptoms (different for each substance)

Many people experience both mental illness and addiction. The mental
illness may be present before the addiction. Or the addiction may trigger or
make a mental disorder worse.

The Diagnostic Criteria For Substance Use Disorders (Addiction)

The DSM-5 establishes nine types of Substance-Related Disorders:

1. Alcohol

2. Caffeine*

3. Cannabis (e.g., marijuana)

4. Hallucinogens

5. Inhalants

6. Opioid (e.g., heroin)

7. Sedatives, Hypnotics, or Anxiolytics (e.g., valium, "qualudes")


8. Stimulants (cocaine, methamphetamine)

9. Tobacco

*Substance use disorder does not apply to caffeine.

Regardless of the particular substance, the diagnosis of a substance use


disorder is based upon a pathological set of behaviors related to the use of
that substance. These behaviors fall into four main categories:

1. Impaired control

2. Social impairment

3. Risky use

4. Pharmacological indicators (tolerance and withdrawal)

Let's review each of these key diagnostic criteria in greater detail.

1.A. Impaired control:

Impaired control may be evidenced in several different ways:

1) Using for longer periods of time than intended, or using larger amounts
than intended; 2) Wanting to reduce use, yet being unsuccessful doing so; 3)
Spending excessive time getting/using/recovering from the drug use; 4)
Cravings that are so intense it is difficult to think about anything else.
2.B. Social impairment

You may recall our definition of addiction: Addiction is repeated involvement


with a substance or activity, despite the substantial harm it now causes,
because that involvement was (and may continue to be) pleasurable and/or
valuable. Social impairment is one type of substantial harm (or consequence)
caused by the repeated use of a substance or an activity.

5) People may continue to use despite problems with work, school or


family/social obligations. This might include repeated work absences, poor
school performance, neglect of children, or failure to meet household
responsibilities.

6) Addiction may also be indicated when someone continues substance use


despite having interpersonal problems because of the substance use. This
could include arguments with family members about the substance use; or,
losing important friendships because of continued use.

7) Important and meaningful social and recreational activities may be given


up or reduced because of substance use. A person may spend less time with
their family, or they may stop playing golf with their friends.

3.C. Risky Use

The key issue of this criterion is the failure to refrain from using the
substance despite the harm it causes.

8) Addiction may be indicated when someone repeatedly uses substances in


physically dangerous situations. For instance, using alcohol or other drugs
while operating machinery or driving a car.
9) Some people continue to use addictive substances even though they are
aware it is causing or worsening physical and psychological problems. An
example is the person who continues to smoke cigarettes despite having a
respiratory disorder such as asthma or COPD.

4.D. Pharmacological indicators: Tolerance and Withdrawal

For many people, tolerance and withdrawal are the classic indicators of
advanced addiction. As such, these are particularly important concepts. This
criterion refers to the adjustment the body makes as it attempts to adapt to
the continued and frequent use of a substance. This adjustment is called
maintaining homeostatic balance.

10) Tolerance occurs when people need to increase the amount of a


substance to achieve the same desired effect. Stated differently, it is when
someone experiences less of an effect using the same amount. The "desired
effect" might be the desire to avoid withdrawal symptoms. On the other
hand, it may be the desire to get high. People experience tolerance
differently; i.e., people vary in their sensitivities to different substances.
Specific drugs will vary in terms of how quickly tolerance develops and the
dose needed for tolerance to develop.

11) Withdrawal is the body's response to the abrupt cessation of a drug,


once the body has developed a tolerance to it. The resulting cluster of (very
unpleasant and sometimes fatal) symptoms is specific to each drug. We
discuss these specific symptoms in each substance category. Although
withdrawal is very unpleasant, it does not usually require medical assistance.
However, withdrawal from some drugs can be fatal. Therefore, consult with a
medical professional before attempting to stop drug use after a period of
heavy and continuous use. This will ensure that quitting is as safe and
comfortable as possible.
If a person is experiencing withdrawal symptoms at the time they are being
evaluated for treatment, they will be diagnosed with both substance use and
substance withdrawal.

A person needs to meet at least 2 of these criteria to be diagnosed with a


substance-use disorder. The severity of addiction is determined by the
number of criteria met.

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