CHAPTER 11 – SUBSTANCE-RELATED AND OTHER ADDICTIVE

DISORDERS

Substance-Related Disorders:
 Psychoactive substances – substances that alter moods, thought processes, or other psychological
states
 Addiction – involves compulsive drug-seeking behaviour and a loss of control over drug use
 Psychological dependence – our bodies adapt and we need the substance to feel normal
 Withdrawal symptoms – negative psychological and physiological effects
 Tolerance – involves progressive decreases in the effectiveness of the substance
 According to the DSM-5, a SUD may be an appropriate diagnosis when at least 2 of the following
characteristics occur within a 12 month period and cause significant impairment or distress:
o The quantity of the substance used or the amount of time spent using is often greater than
intended
o Efforts to control use of the substance are unsuccessful due to a persistent desire for the
substance
o Considerable time is spent using the substance, recovering from its effects, or attempting to
obtain the substance
o A strong desire, craving, or urge to use the substance is present
o Substance use interferes with major role obligations at work, school, or home
o Use of the substance continues despite harmful social or interpersonal effects caused or
made worse by substance use
o Participation in social, work, or leisure activities is avoided or reduced due to substance use
o Substance use occurs in situations where substance use may by physically hazardous
o Continued substance use occurs even when the substance is causing physical or
psychological problems or making these problems worse
o Tolerance for the substance develops including a need for increasing quantities of the
substance to achieve intoxication or desired effects or a noticeable decrease in effects when
using the same amount of the substance
o After heavy or sustained use of a substance, reduction in or abstinence from the substance
results in withdrawal symptoms or precipitates resumption of use of the substance or
similar substances to relieve or avoid withdrawal symptoms

Substances Associated With Abuse:

Depressants:
 Cause the nervous system to slow down
 Individuals may feel relaxed and sociable due to lowered interpersonal inhibitions
 Alcohol:
o Moderate drinking – lower-risk patterns of drinking
o Heavy drinking
o Binge drinking – episodic
o Alcohol is quickly absorbed into the bloodstream and begins to depress central nervous
system functioning
o Frequently associated with suicide
o Withdrawal symptoms
 Headache
 Fatigue
 Sweating
 Body tremors
  Mood changes
 Delirium tremens
o Our bodies produce “clean-up” enzymes, including aldehyde dehydrogenase (ALDH), to
counteract toxins that build up as our bodies metabolise alcohol
 Production of ALDH is affected by gender and genetic make up
o Tolerance to alcohol develops rapidly
 Tolerance doesn’t decrease the toxicity of alcohol
 Although sustained abstinence can lead to cognitive impairment, those who were
heavy drinkers often demonstrate ongoing intellectual impairment
o High-functioning alcoholic
 Opioids:
o Narcotics
o Heroin, opium, morphine, codeine, oxycodone, and fentanyl
o Prescription opioids – gateway drugs
 Rationalise use because they are prescribed
o Produce both euphoria and drowsiness
o Tolerance builds quickly, resulting in dependency and a need for increased doses
o Withdrawal
 Restlessness
 Muscle pain
 Insomnia
 Cold flashes
o Lethargy, fatigue, anxiety, and disturbed sleep may persist for months
 Sedatives, hypnotics, and anxiolytics:
o Calming effects
o Prescribed to reduce muscle tension, insomnia, agitation, and anxiety
o Benzos
o Cause drowsiness, impaired judgement, and diminished motor skills
o Withdrawals
 Produce insomnia
 Nervousness
 Headaches
 Drowsiness

Stimulants:
 Speed up central nervous system activity
 Used to
o Produce feelings of euphoria and well-being
o Improve mental and physical performance
o Reduce appetite
o Prevent sleep
 Side effects
o Heart arrhythmias
o Dizziness
o Tremors
o Sweating
o Anxiety
o Restlessness
o Agitation
o Hostility
o Paranoia
  Caffeine:
o Symptoms
 Restlessness
 Nervousness
 Insomnia
 Cardiac arrhythmia
o Withdrawal
 Headache
 Fatigue
 Irritability
 Difficulty concentrating
 Amphetamines:
o “Uppers”
o Ritalin, Adderall, Dexedrine, meth
o Psychological changes
 Psychosis
 Depression
 Suicide
 Violent behaviour
 Cocaine:
o Crack
o Withdrawal
 Lethargy
 Depression
o Side effects
 Irregular heartbeat
 Heart attack
 Stroke
 Death
o Psychiatric symptoms
 Delusions
 Paranoia
 Hallucinations
 Anxiety
 Depression
 Sexual dysfunction
 Sleep disturbance

Hallucinogens:
 Produce vivid sensory experiences
 Derived from natural sources

Dissociative Anaesthetics:
 PCP, DXM and Ketamine
 Potential to produce a phencyclidine-use disorder
o Dissociative, stimulant, depressant, amnesic, and hallucinogenic properties
 DXM can result in hyperthermia, high blood pressure and heart arrhythmia; as with PCP and
ketamine, health consequences are intensified when DXM is combined with alcohol or other drugs

Substances With Mixed Chemical Properties: