April 6, 2023- Substance-related disorders

Substance
- Linked to substance external to person
DSM-5 substance related disorders
- Substance induced disorders
o Maladap ve reversible substance-specific symptom syndrome clearly
linked with inges on of substance
 Soma c disorders
 Anxiety
 Psychosis
- Substance use disorders
o Maladap ve behaviour pa erns directly resul ng from regular and
consistent use of substance (abuse)
o Use of substance is the disorder
 Addic on
- Not mutually exclusive
DSM 3 vs DSM 4 vs DSM 5
- DSM 3
o Was originally it’s own category
- DSM 4
o Now is under cogni ve and mental disorder category
- DSM 5
o Cogni ve disorders must be substance induced or due to medical
condi on
DSM 5
- Substance induced disorders
o Located throughout the DSM 5
- Substance use disorders
o Have own category
Categories of psychoac ve drugs
 - Depressants
o Behavioural seda on
o Alcohol, seda ves (anxioly cs)
 Used to treat anxie es
o Can create depression symptoms
- S mulants
o Alertness, ac va on, mood eleva on
o Amphetamines, cocaine, nico ne, caffeine
o Can create anxiety
- Opiates
o Temporarily reduce pain and cause euphoria
o Heroin, opioid, codeine, painkillers
o Can make people feel good
- Hallucinogens
o Alter sensory percep on
o Marijuana, LSD, inhalants, acid
o Can create psycho c symptoms
Class of psychoac ve substances
- Two categories of substances based on intent
- Usually
o Drugs with intoxica on or withdrawal effects= Deliberate inges on
o Toxins= inadvertent exposure
- Both toxin and drug: fetal alcohol effect
o Depends on intent
Toxins
- Carbon monoxide/dioxide
- Heavy metals
- Poisons
- Vola le substances (glue)
- Pharmaceu cal side effects or interac ons
Substance induced disorders
- Is clearly linked with exposure to substance
 - Due to physiological effects of substance on CNS
- Can be due to exposure
o Toxin
- Or inges on
o Drug
- Can be misdiagnosed very easily, especially if it was inten onally taken
Criterion for cause
- Purely temporal; link in me= cause
- Symptoms must appear during intoxica on due to exposure or within 6
months a er withdrawal from exposure
- Is a specifier for all diagnoses in DSM 5
- Big problem: meth/speed
o Looks like schizophrenia
Specifiers for substance-induced disorders
- Onset during intoxica on
o Symptoms can persist beyond me substance detectable in blood
 Con nued low concentra ons
 “hit and run” effect, recovery from altered physiological
process may take longer than elimina on of substance
 Neurons take longer to recover a er substance
- Onset during withdrawal
Irreversible effects
- What if substance exposure was in past, and we now see long-term
irreversible organic consequences
o Korsakoff’s syndrome- form of demen a associated with demen a
- Substance induced due to general medical condi on
Substance use disorders
- Results from regular and consistent use
- DSM 5 “substance use disorder” merges
o Substance abuse
o Substance dependence
 o Merged from prior DSM’s
- Plus adds mild, moderate, severe ra ng
o 2-3 symptoms= mild
o 4-5 symptoms= moderate
o 6-7 symptoms= severe
Comorbidity: Substance use disorders and other mental disorders
- In substance use disorders: high life me prevalence of comorbid Axis 1
disorders
- More likely to have another disorder
- Especially if it’s serious disorder, such as schizophrenia
Mechanisms of inter-rela onship
- Deliberately coping with substances: self-medica on
- Func onal: substance-use predisposes to other disorders (panic disorder)
o Somebody that takes s mulants may develop hyper sensi vity to
symptoms
- Social dri hypothesis
o Disorder > unemployment > low SES, risk
- Shared underlying diathesis
o Impulsivity, emo onal dysregula on
o Shared symptom that predicts both of them
In 12 months, 2 or more
- Classical substance abuse symptoms
o Recurrent substance use resul ng in failure to make obliga on at
school or work
o Becomes physically hazardous
 Drinking and driving
o Creates persistent or recurrent social/interpersonal problems
 Rela onship problems caused by substance abuse
- Substance “dependence” symptoms
o Tolerance
 Physical/physiological sign
  Need for markedly increased amounts of use to get same
affect
 Markedly diminished effect with con nued use
o Physiological withdrawal
 Withdrawal syndrome
 Same/similar substance sued to relieve/avoid withdrawal
symptoms
 Why bloody Mary’s were invented
o Substance is taken in larger amounts or longer than what was
planned
 Never have just one drink
o Persistent desire/unsuccessful efforts to cut down/control substance
use
o Time spent in ac vi es used to obtain it, use it, or recover from it
 Hiding the bo les
o Important stuff is given up/reduced due to substance use
 Giving up sports
o Substance use is con nued despite knowledge of problems with it
o Craving/strong desire
- All behavioral symptoms can be applied to many addic ons
Physiological models of alcohol abuse and dependence
Cogni ve paradigm
- Alcohol expectancies
o Actual physiological effects of alcohol are not strong predictors of
problem drinking
 Some people get intoxicated easily
 Most people have nega ve experience with alcohol
 Neither predict problem
o More important: beliefs about physical and psychological effects
 Schemas
 What do I expect for this to do to me?
 What reinforcement do I expected?
 Social approval
  More sociable
 Fit in
 Cope with anxiety
 Behave like other schemas
 Spreading ac va on
o If I ac vate one schema, it will trigger other
schemas that are connected through
experiences/memory
o Ac va on spreads to connected nodes
Cogni ve expectancies and development of problem drinking
- Adolescents begin drinking due to expectancies for social facilita on
o They view drinking as fun
 Commercials, media, friends, family
- Alcohol use becomes condi oned to social ac vi es
- Pa ern perpetuated through reciprocal reinforcement
Cogni ve interven ons: proac ve
- Alcohol expectancy challenges
o Social experiments
 Challenge beliefs about rewards of drinking
o Focus: people learn perceived posi ve side effects of alcohol are due
to expecta ons, rather than alcohol itself
o Reduces binge drinking in university students
Behavioural model: classical condi oning
- Countercondi oning
- An undesirable CR can be weakened by
o Pairing old CS with and UCS that produces a UCR incompa ble with
the og CR
 Original CR= appe te/desire
- Using aversion therapy
o Replace undesirable posi ve response with aversion response
(nausea)
o Exposure to alcohol now creates nauseous response
Sociocultural explana ons: Bales 3 factor cultural risk model
- Degree of stress and inner tension produced by culture
o Unemployment, rapid change
- A tudes towards drinking fostered by culture
- Degree to which culture provides alternate means of sa sfac on and coping
with stress
o Religion/spirituality
o Access to mental health care
Integra on
- No one treatment found highly affec ve
- Mixture of behavioral, cogni ve-behavioral and interpersonal interven ons
- Major predictors:
o Treatment of concurrent psychopathology
o Therapists’ grasp of role of drinking
o Personal mo va on to cease
o Concurrent social support (12 step)