Substance Abuse

 Presence of substance-related disorders and

psychiatric disorders concurrently
Addiction  Diagnosis is complicated as one disorder may mask
the other disorder.
 A person problem, not a chemical problem
 Used is determined by the experience the drug Substance Withdrawal
creates for the user.
 The development of substance-specific syndrome
Definitions: due to the cessation of or reduction in the substance
use that has been heavy and prolonged.
Addiction  The substance-specific syndrome causes clinically
significant distress.
 A pattern out of control
 Or a compulsive use of psychoactive substances in Substance Intoxication
which use continues despite negative consequences.
 The development of a reversible-specific syndrome
Psychoactive Substances due to recent ingestion or exposure to substance.
 Clinically significant maladaptive behavioral or
 Drugs or chemicals that alters one or several of the psychological change that are caused by the effect of
following: the substances on the CNS and develop during or
o Perception shortly after.
o Awareness
o Consciousness Detoxification
o Thinking
o Judgment  Controlled withdrawal from an abusive substance in
o Decision making a medically prescribed program using gradually
tapered sedations, a controlled environment and
Substance Dependence nutritional supplements.

 A cluster of cognitive behavioral and physiologic Codependence

symptoms indicating continued use of substance
despite significant life problems r/t the use.  The enabling behaviors of individuals in the family
or social system of a substance dependent person.
Tolerance  These interventions inadvertently promote
continued use by protecting the individual from the
 Pharmacologic property of some abuse substances in consequences of his actions.
which increased amounts over time are required to
achieve similar results as in earlier use. Denial

Withdrawal Syndrome  Integral part of addiction

 Clients minimizes or disconnects from reality of
 Substance specific signs and symptoms negative impact of chemical use
 Precipitated by the abrupt cessation or reduction of  May insist there are no problems
a substance that produces tolerance and  Expressions of concerns are viewed unwelcome
dependence after prolonged use. meddling.

Relapse
Dual Diagnosis
 o Drug abuse come later in life
 Implies a return to using substance in a dependent o Preexisting psychiatric disorder often
manner. present
o Become involved with drugs
Recovery
 Men
 Process of experiencing life without the use of o Drug use is two times than that of females
substances with abuse potential. o Dependence more commonly a primary
disorder
 Lifestyles focused on wellness within the context of
o Seek treatment more often due to illegal
healthy spiritual and interpersonal relationships.
problems brought by abuse.

Abstinence
Theories r/t Substance abuse
 Avoid substances with abuse potential.
1. Classic Theory
The DSM-IV-TR lists 11 diagnostic classes of
 Alcoholism is a chronic, progressive disorder or
substance abuse:
disease that follows a predictable natural history.
 Moves away from alcoholism as a problem of
1. Alcohol
flawed character
2. Amphetamines or similarly acting sympathomimetics
 Addict is seen as someone in need for help
3. Caffeine
4. Cannabis
2. Psychodynamic Theory
5. Cocaine
6. Hallucinogens  Ego
7. Inhalants o Regulates thinking
8. Nicotine
o Controls instinctive drives
9. Opioids
o Protects against anger, boredom, emptiness
10. Phencyclidine (PCP) or similarly acting drugs
and rage.
11. Sedatives, hypnotics, or anxiolytics
 Addicts lack mature ego defense and do not cope
well.
Categorizes substance-related disorders into
two groups:
 Influences
o Peers
1. disorders of abuse and dependence
o Cultures
2. substance-induced disorders
o Beliefs about the substances may
Intoxication, withdrawal, delirium, dementia,
encourage or inhibit use
psychosis, mood disorder, anxiety, sexual
o Availability
dysfunction, and sleep disorder.
o Cost
Epidemiology:
3. Psychobiological
Tobacco
 Tendency to become alcoholic is inherited
 20-30% of adults and high school students smoke
 Increased vulnerability to addiction to drugs when
cigarettes
family history is present.

o Does not guarantee development but

increase risk
Gender
 Women
 o SD’s are not genetic disorders as of current Nicotine
state of scientific knowledge.
 If you smoke, you inhale carbon dioxide which
4. Substance-induced Neurobiological changes reduces oxygen in the blood
 Tar contains carcinogens
 Addiction is pathological brain disease
Cocaine
 Dysregulation in complex neural
mechanism of learning and  Popular recreational drug because of the intense
memory r/t to quest of rewards and immediate feeling of euphoria it produces
and cues that predicts them.
Amphetamines
 Brain is unable to maintain proper neurochemical
balance  “Uppers”
 Used to lose weight and to stay awake.
 Decrease amount of GABA ad
dopamine results in anxiety and
depression. Hallucinogens

 Distort the user’s perception of reality and produces

Cultural Considerations symptoms similar to psychosis.

 Substance use moves and attitude tied to predictors

 Lysergic Acid dietylamide (LSD)
of thinking
 Prevalence of substance-related disorders is higher
in large cities  Ecstacy- “designer’s drug”
 Substantial disparity in availability of health care.
 PCP- phencyclidine- used as anesthetic agent acts
like hallucinogens.

 Intoxication/ overdose
Substance of Abuse and Dependence
o Anxiety, depression, paranoid ideations,
1. CNS Depressants ideas of reference, fear of losing one’s
mind, jumping out of the window, belief
 Alcohol that he can fly.
 Sedatives, hypnotics, anxiolytics
 Opiods  signs and symptoms
o sweating
2. CNS Stimulants
o tachycardia
 Caffeine o blurred vision
 Nicotine o lack of coordination
 Amphetamine
 Cocaine
 withdrawal symptoms
o flashbacks
o transient recurrence of perceptual
disturbances
Inhalants o “rophies”
Miscellaneous Substances of Abuse
 anesthetics, organic solvents, nitrates
 Causes significant brain damage, peripheral nervous 1. Phencyclidine- “angel dust”
system damage, liver disease. 2. Anabolic steroids- Anadrol, oxandrin, duraboline.
 CNS depressant
 Primarily used by adolescents
Alcohol
 Overdose/ intoxications
o Dizziness  Most commonly abused substance
o Nystagmus  Absorbed quickly in the stomach and small intestine
o Lack of coordination and metabolized in the liver
o Slurred speech  In concentrated form, toxic to nerve cells
o Unsteady gait  Diluted form, an irritant to nerve cells
o Blurred vision
o Stupor  Binge drinking
o Coma
o 5 or more drinks on the same occasion in
 Behavioral signs and symptoms the past month
o Aggression
o Apathy  Heavy drinking
o Impaired judgment
o 5 or more drinks on the same occasion on
o Inability to function
each of 5 or more days in the past month.
 Death- because of bronchospasm
 Blood Alcohol Level (BAL)

o Peaks within 50 minutes to 3 hours after

Cannabis
heavy drinking ends.

 Marijuana, mary jane, pot, weed

o Legal level
 popular because of its psychoactive resin
 0.08-0.10 g/dL
 contains more than 60 substance called
 80-100 mg/dl
cannabinoids
 at which delta-9 tetrahydrocannabinol is thought to
 Chemical effects of Alcohol
be responsible for psychoactive effects.
 Relieves nausea and vomiting associated with
Blood alcohol level (%) Physiologic Effects
chemotherapy as well as with anorexia and weight
Euphoria, decrease
loss in AIDS 0.05
inhibitions
 Dronabinol (Marinol), nabilone (Cesamet) has been Labile mood, talkative,
approved for treating nausea and vomiting from 0.10-0.15
impaired judgment
chemotherapy. Decrease motor skills,
0.15-0.20 slurred speech, double
Club Drugs vision
0.25 Altered perceptions
0.30 Altered equilibrium
 Ecstacy
0.35 Apathy inertia
 Rohypnol
0.40 Stupor, coma
o date rape drug Severe respiratory
o “roofies” 0.40-0.50
depression, death
 o Seizures
 Symptoms of alcohol Intoxication o Paranoia

o Slurred speech
o Unsteady gait
o Lack of coordination
o Impaired attention, concentration, memory,
judgment
o Aggressiveness, inappropriate sexual
behavior
o Flushing
o Blackout
o Wernicke’s encephalopathy
 Lack of Vit. B1
o Korsakoff’s Psychosis
 amnesia

 Withdrawal symptoms

o Mild Tremulousness (the shake)

 Can occur in 3 to 36 hours after the

last drink and is characterized by
anxiety, agitation, tremors,
anorexia, nausea, sweating,
increased BP and PR

o Severe alcohol withdrawal syndrome

 “delirium tremens”
 Occurs 24-72 hours

Sedatives, hypnotics, and anxiolytics

 CNS depressants

 Withdrawal symptoms

o Anxiety
o Irritability
o Insomnia
o Fatigue
o Headache
o Twitching

 Serious withdrawal symptoms

o Hallucinations
o Delirium