Substance use disorders
Download
1 / 73

Substance Use Disorders - PowerPoint PPT Presentation


  • 372 Views
  • Updated On :
loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Substance Use Disorders' - Jims


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Substance use disorders l.jpg

Substance Use Disorders

Theodore M. Godlaski


Biopsychosocial and spiritual view of alcohol dependence l.jpg

biomedical

psychological

behavioral

social

spiritual

Elevated liver tests, tenderness in lower abdomen, hypertension, hyperlipidemia, bruising, peripheral neuropathy, chronic headaches, probable sleep apnea, poor muscle tone, erectile dysfunction, rapid pulse, pulmonary edema, multiple recent upper respiratory infections

Impaired self-esteem, labile mood, irritability, anger over job conflicts, feeling of guilt, anhedonia, occasional sense of futility and apathy, belief that children and spouse hate him, occasional thoughts of suicide.

Drinks increasing amounts of alcohol daily, agitation alternating with lethargy, elicits arguments with spouse and children, occasional angry outbursts at home and work, frequently absent or tardy at work, multiple unsuccessful efforts to change drinking behavior refuses to have contact with former friends and extended family

Significant marital and family conflict, neglectful and possibly abusive parenting, serious financial problems, social isolation, withdrawal from healthy recreational activities, serious conflict with co-workers and supervisor at work

Sense of futility and hopelessness, near despair, feelings of abandonment, inability to express acceptance for self or others, pervasive sense of guilt and resentment, increasing hatred and hostility toward those he sees as different than himself, guarded and angry unwillingness to know or be known.

Biopsychosocial and Spiritualview of alcohol dependence


Slide3 l.jpg

Biomedical

observer

Boundary of

The phenomenon

Psychological

observer

Social

observer

Spiritual

observer

Behavioral

observer


Synthetic rewards l.jpg
Synthetic Rewards

  • The use of specific substances can be highly rewarding.

  • In some individuals use of such substances can lead to uncontrolled use, displacement of more normal activity, and continued use despite painful and even life threatening consequences.


Slide12 l.jpg

Nesler, E & Melenka, R. (2004) The addicted brain. Scientific American, March: 78-85


Slide13 l.jpg

Nesler, E & Melenka, R. (2004) The addicted brain. Scientific American, March: 78-85


Epidemiology l.jpg
Epidemiology Scientific American, March: 78-85

  • Rates vary depending on the population studied and the measurement.

  • The one thing that seems certain is that lifetime prevalence rates in the United States are very high.

  • Additionally, rates for men are significantly higher than for women.


Lifetime prevalence of substance use disorders national comorbidity survey l.jpg

Male Lifetime Scientific American, March: 78-85

Female Lifetime

Total Lifetime

Alcohol Abuse

12.5%

6.4%

9.4%

Alcohol Dependence

20.1

8.2%

14.1%

Drug Abuse

5.4%

3.5%

4.4%

Drug Dependence

9.2%

5.9%

7.5%

Any Substance Use Disorder

35.4%

17.9%

26.6%

Lifetime Prevalence of Substance Use Disorders,National Comorbidity Survey

Kessler, McGonagle, et al. (1994). Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders

in the United States. Arch of Gen Psychiatry, 51:8.


Lifetime prevalence of substance use disorders 1980 1984 epidemiologic catchment area study l.jpg

Substance Abuse/Dependence Scientific American, March: 78-85

Lifetime Prevalence

Any drug

6.2%

Cannabis

4.4%

Stimulants

1.7%

Sedatives

1.2%

Opioids

0.7%

Hallucinogens

0.4%

Cocaine

0.2%

Alcohol

13.8%

Tobacco

36%

Lifetime Prevalence of Substance Use Disorders (1980-1984),Epidemiologic Catchment Area Study

Kandel (1992). Epidemiological trends and implications for understanding the nature of addiction.

In O’Brien & Jaffe. Research Publications: Association for Research in Nervous and Mental disease,

vol. 70, p. 23. N.Y.:Raven.


Slide18 l.jpg

Distal Scientific American, March: 78-85

Antecedents

Peer group

Family interactions

Parental sub. use

Immediate

Antecedents

Laws

Social pressures

Availability

demographics

Adverse

Consequences

Toxic effect

Psychosocial

Dysfunction

Organic damage

Avoidance

learning

social

tolerance

Disposition

to use

Drug

use

Neuro-

adaptive

state

Distal

Antecedents

Early learning

Drug experience

Genitics

Developmental events

Immediate

Antecedents

Mood states

Self-efficacy

expectations

withdrawal

Reinforcing

Consequences

Mood enhancement

Psychosocial

facilitation

Approach

learning

individual

WHO schematic model of drug use and dependence


Comorbidity l.jpg
Comorbidity Scientific American, March: 78-85

  • Substance Use Disorders are often found together with other Axis I and Axis II Disorders:

    • Anxiety Disorders

    • Mood Disorders

    • PTSD

    • Antisocial Personality Disorder


Slide20 l.jpg

Comorbid Disorder Scientific American, March: 78-85

Alcohol Abuse

Alcohol Dependence

National Comorbidity Survey

1–year rate (%)

Odds ratio

1–year rate (%)

Odds ratio

Mood disorders

12.3

1.1

29.2

3.6

Major depressive disorder

11.3

1.1

27.9

3.9

Bipolar disorder

0.3

0.7

1.9

6.3

Anxiety disorders

29.1

1.7

36.9

2.6

GAD

1.4

0.4

11.6

4.6

Panic disorder

1.3

0.5

3.9

1.7

PTSD

5.6

1.5

7.7

2.2*

Kessler, McGonagle, et al. (1994). Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders

in the United States. Arch of Gen Psychiatry, 51:8.


Prevalence of other disorders in individuals diagnosed as having drug abuse or dependence l.jpg
Prevalence of Other Disorders in Individuals Diagnosed as Having Drug Abuse or Dependence

Kandel, D.B. (1992) Epidemiological trends and implications for the understanding of addiction. In

Addiction Studies, P. O’Brian & J. Jaffe (Eds.). Research Publication, New York: Vol 70, p23.


Criteria for substance dependence l.jpg
Criteria for Substance Dependence Having Drug Abuse or Dependence

  • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period.


Slide23 l.jpg

  • (1) tolerance, as defined by either of the following: Having Drug Abuse or Dependence

    • (a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

    • (b) markedly diminished effect with continued use of the same amount of the substance.


Tolerance l.jpg
Tolerance Having Drug Abuse or Dependence

  • With opioids and stimulants dramatic (10x) tolerance can develop.

  • With other drugs like alcohol, sedatives, and benzodiazapines tolerance is significant but not as dramatic.

  • With some drugs like PCP, hallucinogens, and possibly marijuana there may be little to no identifiable tolerance.

  • The picture can be further clouded if a person is using drugs of unknown purity and concentration.


Tolerance25 l.jpg
Tolerance Having Drug Abuse or Dependence

  • The initial tolerance to a drug and the rates at which tolerance develops can vary greatly from one individual to another.

    • In general, the higher the initial tolerance the greater the likelihood of later problems because of potential for exposure to larger doses.

  • Aging and tissue damage from toxic drugs can lead to an eventual reversal of tolerance.


Slide26 l.jpg


General criteria for substance withdrawal l.jpg
General Criteria for Substance Withdrawal Having Drug Abuse or Dependence

  • The development of a substance specific syndrome due to cessation of (or reduction in) substance use that has been heavy and prolonged.

  • The substance specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.


Alcohol sedative hypnotic or anxiolytic withdrawal l.jpg
Alcohol, Sedative, Hypnotic, or Anxiolytic Withdrawal Having Drug Abuse or Dependence

  • Two or more of the following:

    • autonomic hyperactivity (e.g. sweating or pulse rate >100)

    • increased hand tremor

    • insomnia

    • nausea or vomiting

    • transient visual, tactile, or auditory hallucinations or illusions

    • psychomotor agitation

    • anxiety

    • grand mal seizures


Amphetamine or cocaine withdrawal l.jpg
Amphetamine or Cocaine Withdrawal Having Drug Abuse or Dependence

  • Dysphoric mood and two (or more) of the following physiological changes:

    • fatigue

    • vivid, unpleasant dreams

    • insomnia or hypersomnia

    • increased appetite

    • psychomotor retardation or agitation


Nicotine withdrawal l.jpg
Nicotine Withdrawal Having Drug Abuse or Dependence

  • Four (or more) of the following:

    • dysphoric or depressed mood

    • insomnia

    • irritability, frustration, or anger

    • anxiety

    • difficulty concentrating


Opioid withdrawal l.jpg
Opioid Withdrawal Having Drug Abuse or Dependence

  • Three (or more) of the following:

    • dysphoric mood

    • nausea or vomiting

    • muscle aches

    • tearing or runny nose

    • dilated pupils, goose flesh, or sweating

    • diarrhea

    • yawning

    • fever

    • insomnia


Other drugs l.jpg
Other Drugs Having Drug Abuse or Dependence

  • There is no clearly defined withdrawal syndrome for the following:

    • Cannabis

    • Phencyclidine

    • Inhalants

    • Hallucinogens


Specifiers l.jpg
Specifiers Having Drug Abuse or Dependence

  • With Physiologic Dependence

    • if either tolerance or withdrawal are present

  • Without Physiologic Dependence

    • if neither tolerance nor withdrawal are present


Slide34 l.jpg


Slide35 l.jpg

  • (4) there is a persistent desire or unsuccessful efforts to cut down or control substance use.

    • The underlying concept here is that the drug use is no long fully under the conscious control of the individual.

    • This criteria can manifest as thoughts or wishes to stop, cutback, control, or do something about drug use or as actual unsuccessful attempts to do so.


Slide36 l.jpg

  • (5) a great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances), use the substance (e.g. chain smoking), or recover from its effects

    • The underlying concept is that the drug use assumes a very high priority in the life of the individual and all that surrounds the drug use is valued above other things.

    • It seems legitimate to include resources other than time.

    • “a great deal” is not specified.


Slide37 l.jpg

  • (6) important social, occupational, or recreational activities are given up or reduced because of substance use

    • The underlying concept is that the drug use assumes a very high priority in the life of the individual and all that surrounds the drug use is valued above other things.

    • There can be a problem here because for some, social and recreational activities include heavy use of substances and substance use itself can be seen as a form of recreation.


Slide38 l.jpg

  • Likewise, there can be difficulty applying this criterion to specific groups of individuals who do not fit a mainstream cultural norm.

    • Individuals who are chronically unemployed, work part-time irregular hours, or have been disabled for some time may not identify any occupational problems related to substance use.


Slide39 l.jpg

  • (7) The substance use is continued despite specific groups of individuals who do not fit a mainstream cultural norm.knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been cause or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

    • The critical issue is that the individual not only have physical or psychological problems but know that they are caused or worsened by substance use.


Alcohol related physical problems l.jpg
Alcohol Related Physical Problems specific groups of individuals who do not fit a mainstream cultural norm.

  • liver disease or jaundice

  • stomach disease or vomiting blood

  • tingling or numbness in the hands or feet

  • memory problems

  • pancreatitis

  • any other physical illness that could be made worse by drinking

    Robins, L., Cottler, B., Bucholz, K., Compton, W., North, C., & Rourke, K. (1999) Diagnostic Interview Schedule, St. Louis, MO, Washington University School of Medicine.


Alcohol related psychological problems l.jpg
Alcohol Related Psychological Problems specific groups of individuals who do not fit a mainstream cultural norm.

  • feeling uninterested in things

  • feeling depressed

  • feeling suspicious of others or paranoid

  • believing things that were not true

  • any other emotional problems that that could be made worse by drinking

    Robins, L., Cottler, B., Bucholz, K., Compton, W., North, C., & Rourke, K. (1999) Diagnostic Interview Schedule, St. Louis, MO, Washington University School of Medicine.


Drug related physical problems l.jpg
Drug Related Physical Problems specific groups of individuals who do not fit a mainstream cultural norm.

  • losing a lot of weight

  • numbness in hands or feet

  • seizures

  • persistent cough

  • eye problems

  • an injury or burn

  • heart pounding

  • sexual difficulties

  • overdose

  • infections

  • problems with veins

  • any other physical problems that is worsened by drug use.

    Robins, L., Cottler, B., Bucholz, K., Compton, W., North, C., & Rourke, K. (1999) Diagnostic Interview Schedule, St. Louis, MO, Washington University School of Medicine.


Drug related psychological problems l.jpg
Drug Related Psychological Problems specific groups of individuals who do not fit a mainstream cultural norm.

  • depressed or uninterested in things

  • paranoid or suspicious

  • confused

  • anxious

  • irritable or angry

  • keyed up or overactive

  • seeing, hearing, smelling, or feeling things that weren’t there

  • laughing or crying for no reason

  • jumpy or easily startled

  • reckless or fearless

  • memory problems

  • flashbacks

    Robins, L., Cottler, B., Bucholz, K., Compton, W., North, C., & Rourke, K. (1999) Diagnostic Interview Schedule, St. Louis, MO, Washington University School of Medicine.


A concern about polysubstance use l.jpg
A Concern About Polysubstance Use specific groups of individuals who do not fit a mainstream cultural norm.

  • Although there is a unitary set of criteria for substance dependence and abuse, diagnosis is still tied to individual drugs.

  • If an individual is using multiple drugs with some frequency, how can the specific effects of each be identified?

  • In such cases Polysubstance Dependence is used when an individual is using at least three categories of drugs and none predominates.


Course specifiers l.jpg
Course Specifiers specific groups of individuals who do not fit a mainstream cultural norm.

  • Early Full Remission: for at least 1 month, but less than 12 months, no criteria of dependence or abuse are met.

1 month

dependence

0-11 months


Course specifiers46 l.jpg
Course Specifiers specific groups of individuals who do not fit a mainstream cultural norm.

  • Early Partial Remission: for at least 1 month, but less than 12 months, one or more criteria for dependence or abuse are met but not the full criteria for dependence.

I month

dependence

0-11 months


Course specifiers47 l.jpg
Course Specifiers specific groups of individuals who do not fit a mainstream cultural norm.

  • Sustained Full Remission: none of the criteria for dependence or abuse have been met for 12 month or longer.

11 months

dependence

12+ months


Course specifiers48 l.jpg
Course Specifiers specific groups of individuals who do not fit a mainstream cultural norm.

  • Sustained Partial Remission: the full criteria for dependence have not been met for 12 months or longer, but one or more criteria for dependence or abuse have been met.

11 months

dependence

12 + months


Course specifiers49 l.jpg
Course Specifiers specific groups of individuals who do not fit a mainstream cultural norm.

  • On Agonist Therapy: individual on prescribed agonist medication and no criteria for dependence or abuse have been met for 30 days. Also applies to those treated with agonist/antagonist drugs.

  • In a Controlled Environment: individual in environment where access to alcohol and drugs restricted and no criteria for dependence or abuse have been met for 30 days.


Compulsion and craving l.jpg
Compulsion and Craving specific groups of individuals who do not fit a mainstream cultural norm.

  • Although not included in the DSM-IV Criteria, compulsion and craving is mentioned in the text and has long been associated with Substance Dependence.

    • Compulsion seems to manifest as a preoccupation with substance use and a powerful and overwhelming drive to use a substance;

    • Craving as strong, dominantly physical, desire to use a substance even against a persons conscious judgement.

  • It is valuable to assess compulsion and craving since they effect the individuals ability to recover.


Alcohol and sedative intoxication l.jpg
Alcohol and Sedative Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent ingestion of alcohol or use of sedative, hypnotic, or anxiolytic.

  • Clinically significant maladaptive behavior or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood liability, impaired judgment, impaired social or occupational functioning) developing during, or shortly after, use.

  • At least one of the following signs, developing during or shortly after use:

    • (1) slurred speech

    • (2) incoordination

    • (3) unsteady gait

    • (4) nystagmus

    • (5) impairment inattention or memory

    • (6) stupor or coma

  • Not due to a general medical condition or better accounted for by another mental disorder.


Amphetamine cocaine intoxication l.jpg
Amphetamine/Cocaine Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent use of amphetamines or related substance.

  • Clinically significant maladaptive behavior or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hyper vigilance; interpersonal sensitivity; and anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning).


Amphetamine cocaine intoxication53 l.jpg
Amphetamine/Cocaine Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • At least two or more of the following, developing during, or shortly after, use:

    • (1) tachycardia or bradycardia

    • (2) pupillary dilation

    • (3) elevated or lowered blood pressure

    • (4) perspiration or chills

    • (5) nausea or vomiting

    • (6) evidence of weight loss

    • (7) psychomotor agitation or retardation

    • (8) muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias

    • (9) confusion, seizures, dyskinesia , dystonia , or coma.

  • Not due to a general medical condition and not better accounted for by another mental disorder.

  • Specify if with perceptual disturbance: auditory, visual, or tactile illusions; altered perceptions or hallucinations with intact reality testing


Cannabis intoxication l.jpg
Cannabis Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent use of cannabis.

  • Clinically significant maladaptive behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, sensation of slow time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use.

  • Two (or more) of the following signs, developing within two hours of cannabis use:

    • (1) conjunctival injection

    • (2) increased appetite

    • (3) dry mouth

    • (4) tachycardia

  • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

  • Specify if: with perceptual disturbance


Hallucinogen intoxication l.jpg
Hallucinogen Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent use of hallucinogens.

  • Clinically significant maladaptive behavior or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid aviation, in pair judgment, or impaired social or occupational functioning) that developed during or shortly after, hallucinogen in use.

  • Perceptual changes occurring in his State of full wakefulness and alertness (e.g., subjective intensification of perception, depersonalization, the realization, delusions, hallucinations, synesthesia) that developed during, or shortly after, hallucinogens use


Hallucinogen intoxication56 l.jpg
Hallucinogen Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Two (or more) of the following signs, developing during or shortly after hallucinogen use:

    • (1) pupillary dilation

    • (2) tachycardia

    • (3) sweating

    • (4) palpitations

    • (5) blurring of vision

    • (6) tremors

    • (7) incoordination

  • the symptoms are not due to a general medical condition and are not better accounted for by another mental disorder


Hallucinogen persisting perception disorder l.jpg
Hallucinogen Persisting Perception Disorder specific groups of individuals who do not fit a mainstream cultural norm.

  • The reexperiencing, following cessation of use of hallucinogen, of one or more of the perceptual symptoms that were experienced while intoxicated with hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive after images, halos around objects, macropsia and micropsia.


Inhalant intoxication l.jpg
Inhalant Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent intentional use or short term, high-dose exposure to volatile inhalants (excluding anesthetic gases and short acting vasodilators).

  • Clinically significant maladaptive behavioral or psychological changes (e.g., belligerence, assaultiveness, apathy, impaired judgment, impaired social or occupational functioning) that developed during, or shortly after use of or exposure to volatile inhalants.


Inhalant intoxication59 l.jpg
Inhalant Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure:

    • (1) dizziness

    • (2) nystagmus

    • (3) in coordination

    • (4) slurred speech

    • (5) unsteady gait

    • (6) lethargy

    • (7) depressed reflexes

    • (8) psychomotor retardation

    • (9) tremor

    • (10) generalized muscle weakness

    • (11) blurred vision or diplopia

    • (12) stupor or coma

    • (13) euphoria


Opioid intoxication l.jpg
Opioid Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent use of an opioid.

  • Clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, in pure judgment, or impaired social or occupational functioning) that developed during or shortly after, opioid use.

  • Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use:

    • (1) drowsiness or coma

    • (2) slurred speech

    • (3) impairment in attention or memory


Phencyclidine intoxication l.jpg
Phencyclidine Intoxication specific groups of individuals who do not fit a mainstream cultural norm.

  • Recent use of phencyclidine (or a related substance).

  • Clinically significant maladaptive behavioral changes (e.g., belligerents, assaultivness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, phencyclidine use.

  • We can an hour (less wins smoked, snorted, or used intravenously) two (or more) of the following signs:

    • (1) vertical or horizontal nystagmus

    • (2) hypertension or tachycardia

    • (3) numbness or diminished response to pain

    • (4) ataxia

    • (5) dysarthria

    • (6) muscle rigidity

    • (7) seizures or coma

    • (8) hyperacusis


Substance dependence vs substance abuse l.jpg
Substance Dependence vs. Substance Abuse specific groups of individuals who do not fit a mainstream cultural norm.

  • Substance Abuse contains no criteria related to tolerance, withdrawal, or compulsive use.

  • Substance Abuse criteria relate to the harmful effects of repeated drug use.

  • Diagnosis of Substance Abuse requires that an individual has never met criteria for Substance Dependence to the specific class of drugs.


Criteria for substance abuse l.jpg
Criteria for Substance Abuse specific groups of individuals who do not fit a mainstream cultural norm.

  • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring at any time in the same 12-month period.


Slide64 l.jpg

  • (1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance related absences, suspensions, or expulsions from school; neglect of children or household).

    • Where there is previous history of meeting responsibilities, “failure” is easier to identify.

    • Individuals who are unemployed, disabled, or self-employed; are unmarried; or live alone may be more difficult to assess.


Slide65 l.jpg

  • (2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use).

    • The important issue is that the behavior must occur more than once and the substance use must be sufficient to impair coordination or judgement.

    • The individual may or may not have actually been injured, the risk of injury is sufficient.


Slide66 l.jpg

  • (3) recurrent substance related legal problems (e.g., arrests for substance related disorderly conduct).

    • Legal problems must be related to the use of substances.

    • There is a question as to whether simple possession or trafficking while not under the influence would count.

    • More than one arrest must have occurred in a 12 month period.


Slide67 l.jpg

  • (4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

    • Problems must have occurred more than once in a 12 month period.

    • There is a question about whether the individual must be aware that the problems are related to substance use.


Polysubstance use l.jpg
Polysubstance Use recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

  • As with Substance Dependence, an individual may be using 3 or more drugs regularly and exhibiting behavior that meets criteria for Substance Abuse.

  • It may be difficult to identify what problems relate to what drugs.

  • Unfortunately, there is no diagnosis of polysubstance abuse.


Substance related disorders l.jpg
Substance Related Disorders recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

  • In addition to Substance Abuse, Dependence, Intoxication, and Withdrawal there are a number of other substance related disorders.

  • These substance related disorders are largely indistinguishable from their non-substance related counterparts except for the fact that they only occur in relation to substance use, intoxication, or withdrawal.

  • Some of these disorders are transient but a few are persist.


Slide70 l.jpg

Dependence recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

Abuse

Intoxication

Withdrawal

Intoxication

Delirium

Withdrawal

Delirium

Alcohol

X

X

X

X

I

W

Amphetamine

X

X

X

X

I

Caffeine

X

Cannabis

X

X

X

I

Cocaine

X

X

X

X

I

Hallucinogens

X

X

X

I

Inhalants

X

X

X

I

Nicotine

X

X

Opioids

X

X

X

X

I

PCP

X

X

X

I

Sedatives

X

X

X

X

I

W

Polysubstance

X

other

X

X

X

X

I

W


Slide71 l.jpg

Dementia recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

Amnestic

Disorder

Psychotic

Disorders

Mood

Disorders

Anxiety

Disorders

Sexual

Dysfunction

Sleep

Disorders

Alcohol

P

P

I/W

I/W

I/W

I

I/W

Amphetamine

I

I/W

I

I

I/W

Caffeine

I

I

Cannabis

I

I

Cocaine

I

I/W

I/W

I

I/W

Hallucinogens

I

I

I

Inhalants

P

I

I

I

Nicotine

I

Opioids

I

I

I/W

PCP

I

I

I

Sedatives

P

P

I/W

I/W

W

I

I/W

Polysubstance

other

P

P

I/W

I/W

I/W

I

I/W


Please note l.jpg
Please Note recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

  • There are a number of drugs not listed which are perfectly capable of causing psychopathology.

    • Anabolic steroids produce euphoria with episodic use, but repeated use often leads to fatigue, irritability, depression, and medical complications.

    • Nitrite inhalants produce mild euphoria, perceptual disturbances, and medical complications (e.g., immune system impairment, toxic reactions, respiratory problems).

    • Nitrous oxide produces lightheadedness, a floating sensation, confusion, and reversible paranoid states.

    • A long list of botanicals, some containing alkaloids, like Datura, Hawaii Wood Rose seeds, Ayhusca, Morning Glory seeds, nutmeg, and others; there are also some that contain substances that are unique like Catnip, Betel Nut, Khat, and Kava.


Please note73 l.jpg
Please Note recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).

  • Substance use can mimic virtually every psychiatric presentation known to humankind.

    • A substance etiology should always be at the top of the list in tracking down a differential diagnosis.

      • In younger individuals the most likely is drug abuse.

      • In older individuals medication side effects are frequently a cause.


ad