Psychoactive Substance Use Disorders

14 th March, 2011 Introduction:

• In most societies, use of substances to alter mood, behaviours, perceptions etc is accepted. • In our culture, use of , and is widely accepted as normal. • Nevertheless, these substances can lead to all sorts of problems for the user. What are psychoactive substances?

• Psychoactive substances (chemicals which affect the central nervous system) become a problem when their consumption becomes habitual, when a craving develops, leading to and/or exacerbating persistent social, occupational, psychological and physical problems. Complexity of substance use disorders:

• Substance use disorders know no social class boundaries: people at all levels of society may fall victim. • Understanding and dealing with substance use is very difficult and complex because – Recreational drug use is widespread – Complex interactions of physical, chemical, psychological, socio-cultural variables are involved in drug use – Certain drugs (alcohol, ), although culturally accepted, pose serious dangers to users Dependence and Abuse:

• Dependence: cognitive, behavioural and physiological symptoms that indicate the person has impaired control over the psychoactive substance and continues to use the substance despite adverse consequences. • Symptoms: physiological tolerance to the drug and withdrawal reactions when the drug is not available. • Key component: impaired control Distinction:

• : when certain drugs are ingested for an extended period of time, the body habituates to the particular substance (tolerance). Thus, larger amounts are needed to achieve the same effects. If the amount of the drug is reduced the body (now habituated to the higher dosage) reacts with withdrawal: cramps, panic, restlessness, sweating, vomiting. Distinction:

• : other types of drugs, although frequently taken, do not alter the body’s tolerance for the drug. Nevertheless, the person may become psychologically addicted to the substance: they ‘need’ the drug to help them reduce or cope with stress, anxiety, depression or because it simply makes them feel good. Although there is no actual physical dependency, the need for the drug can be just as powerful, and just as disruptive and maladaptive DSM-IV TR Criteria

• According to the DSM-IV criteria for dependence, at least three (3) out of seven of the following criteria must be manifest during a 12 month period : – Tolerance – Withdrawal symptoms – Use in larger amounts or for longer periods than intended – Persistent desire or unsuccessful efforts to cut down on the substance – Time is spent obtaining the substance or recovering from effects – Social, occupational and recreational pursuits are given up or reduced because of substance use – Use is continued despite knowledge of substance-related harm (physical or psychological) Abuse:

• Abuse: refers to patterns of substance use that are not as extreme as seen in dependence, but that still warrant attention and concern. • This diagnosis is more likely with people who have just begun using psychoactive substances, or when the substances being used are less likely to produce withdrawal symptoms (and so the need to take the substances to avoid those symptoms) DSM IV TR Criteria

• A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: – 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) – 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) – Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) – 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) • Does not meet criteria for dependence Predictable Course:

Abstinence Experimentation

Habituation Social Use

Misuse Abuse

Addiction Predictable Course:

• Abstinence : There is no use, any use is accidental. • Experimentation : If you find it, you use it • Social use : You look for it but there is no pattern • Habituation : There is a definite pattern • Misuse : some negative consequences but not serious e.g. • Abuse : Continued use despite negative consequences • /Dependence : Loss of control DSM-IV-TR Substance Dependencies:

• 303.90 • 304.00 dependence • 304.10 , , or anxiolytic dependence (including dependence and dependence ) • 304.20 dependence • 304.30 dependence • 304.40 dependence (or amphetamine-like) • 304.50 dependence • 304.60 dependence • 304.80 • 304.90 Phencyclidine (or phencyclidine-like) dependence • 304.90 Other (or unknown) • 305.10 Effects of alcohol:

• The amount and consumption play a large part in determining the extent of intoxication. • For example, consuming alcohol after a heavy meal causes alcohol to absorb more slowly. • Hydration also plays a role, especially in determining the extent of . • The concentration of alcohol in blood is usually measured in terms of the blood alcohol content. Effects of Alcohol:

Immediate Long Term Overdose Effects Effects • • Alcohol Liver • Depressed • Reduced disease breathing Inhibitions • Cardiovascular • Abnormal • Lack of disease heartbeat coordination • Chronic • Amnesia • Slurred Speech pancreatitis • Coma • Impaired • Cancer • Death memory • Damage to nervous systems Long-term effects of alcohol use Decrease in blood cells leading to anemia, slow- healing wounds and other diseases Brain damage, loss of memory, blackouts, poor vision, slurred speech, and decreased motor control Increased risk of high blood pressure, hardening of arteries, and heart disease Liver cirrhosis, jaundice, and diabetes Immune system dysfunction Stomach ulcers, hemorrhaging, and gastritis Thiamine (and other) deficiencies Testicular and ovarian atrophy 16 Harm to a fetus during pregnancy

Psychological effects:

• Difficulty sleeping • Anxiety and agitation • Depression and inability to cope • Confusion and panic attacks • Alcoholic ‘blackouts’ • Suicide Social Effects:

• Domestic problems : loss of friends, marital problems, neglect of children • Occupational : lateness/absences from work, demotion/failure to gain a promotion • Financial : loss of regular income, hardship from money spent on alcohol, debt • Legal : drink-driving offences, property crime, assault