Substance Related and Addictive Disorders

Classification of Substance-Related and Addictive Disorders

• Addiction – Impaired control over the use of a chemical substance, accompanied by physiological dependence.
• Physiological dependence – A condition in which the drug user’s body comes to depend on a steady supply of the substance.

The two diagnoses for Substance-Related Disorders in the DSM-5 are:

• Substance-induced disorders – Disorders, such as intoxication, that can be induced by using psychoactive substances.
• Substance-use disorders – patterns of maladaptive use of psychoactive substances that lead to significant levels of impaired functioning or personal distress.

Substance-Induced Disorders

• Substance intoxication – A pattern of repeated episodes of intoxication, which is a state of drunkenness or of being “high.”
• Withdrawal syndrome – A characteristic cluster of symptoms following the sudden reduction or cessation of use of a psychoactive substance after physiological dependence has developed.

Tolerance

• Tolerance – Physical habituation to a drug such that with frequent use:

1)  higher doses are needed to achieve the same effects,

or

2) the same amount of substance has a diminished effect.

Substance-Use Disorders

Substance-use disorders – Patterns of maladaptive use of psychoactive substances that are identified by the particular drug associated with problematic use (e.g., “alcohol use disorder”).

Characterized by a range of features that include the following:

• persistent problems cutting back or controlling use of the substance
• developing tolerance or a withdrawal syndrome
• spending an excessive amount of time seeking/using the substance
• using the substance in situations that pose a risk to the person’s safety or the safety of others (such as repeatedly drinking and driving).

Lifetime prevalence of drug dependence disorder by type of illicit drug

Nonchemical Addictions and Other Forms of Compulsive Behavior

The DSM-5 has included a category for nonchemical forms of addiction, including:

• gambling disorder
• kleptomania (compulsive stealing)
• pyromania (compulsive fire-setting).

These disorders were previously classified in the DSM-IV in a diagnostic category called Impulse Control Disorders.

Pathways to Drug Dependence

Although the progression to substance dependence varies from person to person, one common pathway involves a progression through the following stages (Weiss & Mirin, 1987):

• Experimentation
• Routine use
• Addiction or dependence

Drugs of Abuse

• Drugs of abuse are generally classified within three major groupings:
• Depressants, such as alcohol and opioids
• Stimulants, such as amphetamines and cocaine
• Hallucinogens

Depressants

• A depressant is a drug that slows down or curbs the activity of the central nervous system.
• It reduces feelings of tension and anxiety, slows movement, and impairs cognitive processes.
• In high doses, depressants can arrest vital functions and cause death.

Alchohol

• Alcohol is the most widely abused substance in the United States and worldwide.
• Alcoholism – An alcohol dependence disorder or addiction that results in serious personal, social, occupational, or health problems.
• The most widely held view of alcoholism is the disease model, the belief that alcoholism is a medical illness or disease.

A number of factors place people at increased risk for developing alcoholism and alcohol-related problems. These include the following:

• Gender
• Age
• Antisocial personality disorder
• Family history
• Sociodemographic factors

Barbiturates

• Barbiturates – Sedative drugs which are depressants with high addictive potential.
• About 1% of adult Americans develop a substance abuse or dependence disorder involving the use of barbiturates, sleep medication (hypnotics), or antianxiety agents at some point in their lives.

Opioids

• Narcotics – Drugs that are used medically for pain relief but that have strong addictive potential.
• Opioids include both naturally occurring opiates (morphine, heroin, codeine) derived from the juice of the poppy plant and synthetic drugs (e.g., Demerol, Darvon) that have opiate like effects.
• The ancient Sumerians named the poppy plant opium, meaning “plant of joy.”
• Two discoveries made in the 1970s show that the brain produces chemicals of its own that have opiate-like effects.
• One was that neurons in the brain have receptor sites that opiates fit like a key in a lock.
• The second was that the human body produces its own opiate-like substances that dock at the same receptor sites as opiates do.
• Endorphins – Natural substances that function as neurotransmitters in the brain and are similar in their effects to opioids.

Morphine

• Morphine – A strongly addictive narcotic derived from the opium poppy that relieves pain and induces feelings of well-being.
• Morphine—which receives its name from Morpheus, the Greek god of dreams—was introduced at about the time of the U.S. Civil War.
• Morphine, a powerful opium derivative, was used liberally to deaden pain from wounds.
• Physiological dependence on morphine became known as the “soldier’s disease.”

Heroin

• Heroin – A narcotic derived from morphine that has strong addictive properties.
• Heroin, the most widely used opiate, is a powerful depressant that can create a euphoric rush.
• Users of heroin claim that it is so pleasurable it can eradicate any thought of food or sex.

Stimulants

• Stimulants are psychoactive substances that increase the activity of the central nervous system, which enhances states of alertness and can produce feelings of pleasure or even euphoric highs.
• The effects vary with the particular drug.

Amphetamines

• Amphetamines – A class of synthetic stimulants that activate the central nervous system, producing heightened states of arousal and feelings of pleasure.
• Amphetamine psychosis – A psychotic state characterized by hallucinations and delusions, induced by ingestion of amphetamines.

Ecstasy

• The drug ecstasy, or MDMA (3,4-methylenedioxymeth-amphetamine) is a designer drug, a chemical knockoff similar in chemical structure to amphetamine.
• It produces mild euphoria and hallucinations and has become especially popular on college campuses and in clubs and “raves” in many cities.
• Ecstasy can produce adverse psychological effects, including depression, anxiety, insomnia, and even paranoia and psychosis.

Cocaine

• Coca-Cola was originally described as a “brain tonic and intellectual beverage,” in part because of its cocaine content.
• Cocaine is a natural stimulant extracted from the leaves of the coca plant—the plant from which the soft drink obtained its name.
• Crack – The hardened, smokable form of  cocaine that may be more than 75% pure.

Nicotine

• Habitual smoking is not merely a bad habit; it is also a physical addiction to a stimulant drug, nicotine, found in tobacco products including cigarettes, cigars, and smokeless tobacco.
• Smoking is also deadly, claiming more than 443,000 lives in the United States alone, most from lung cancer and other lung diseases, as well as cardiovascular (heart and artery) disease (Teo et al., 2006).
• The World Health Organization estimates that 1 billion people worldwide smoke and more than 3 million die each year from smoking-related causes.

Hallucinogens

• Hallucinogens – Substances that cause hallucinations.
• Hallucinogens, also known as psychedelics, are a class of drugs that produce sensory distortions or hallucinations, including major alterations in color perception and hearing.

LSD

• LSD is the acronym for lysergic acid diethylamide, a synthetic hallucinogenic drug.
• In addition to the vivid parade of colors and visual distortions produced by LSD, users have claimed it “expands consciousness” and opens new worlds—as if they were looking into some reality beyond the usual reality.
• Sometimes they believe they have achieved great insights during the LSD “trip,” but when it wears off they usually cannot follow through or even summon up these discoveries.

Phencyclidine (PCP)

• Phencyclidine, or PCP—which is referred to as “angel dust” on the streets—was developed as an anesthetic in the 1950s but was discontinued as such when its hallucinatory side effects were discovered.
• A smokable form of PCP became popular as a street drug in the 1970s.
• However, its popularity has since waned, largely because of its unpredictable effects.

Marijuana

• Marijuana – A hallucinogenic drug derived from the leaves and stems of the plant Cannabis sativa.
• Marijuana is derived from the Cannabis sativa plant.
• Marijuana is generally classified as a hallucinogen because it can produce perceptual distortions or mild hallucinations, especially in high doses or when used by susceptible individuals.

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