PSY 240 Lecture 9
Substance Use Disorders
Slide 1: Introduction
Slides 2-3: Learning Objectives
1. Discuss the diagnostic criteria for substance use disorders.
2. Distinguish between the different types of substances (e.g., depressants, stimulants).
3. Discuss specific substances, their effects, and the disorders associated with them.
4. Discuss biological theories of substance use disorders.
5. Discuss psychological and sociocultural theories of substance use disorders.
6. Discuss biological treatments for substance use disorders.
7. Describe the Alcoholics Anonymous approach to treatment.
8. Discuss psychological treatments for substance use disorders.
Slide 4: Cartoon
We live in a culture of socially sanctioned addictions.
Canada is a drug culture:
We wake up to coffee or tea
We drink more coffee or colas to say alert throughout the day
We drink alcohol to relax and become more social
We take aspirin to reduce pain
Many substances come from plants and have been used for medicinal, spiritual, and
endurance purposes for centuries.
Opium is produced from the poppy plant and has been used for hundreds of years to
Natives in the Andes chewed coca leaves to increase their endurance. Coca leaves can be
manufactured into cocaine. Cocaine was used throughout Europe and America at the turn
of the century to relieve fatigue and was used in the original coca-cola drink.
Aztecs and other native groups in the U.S. and Canada chewed Peyote cactus to
experience visual hallucinations.
There are wide cultural variations in attitudes toward substance use, patterns of substance
use, accessibility of substances, physiological reactions to substances, and prevalence of
substance-related disorders. Some groups forbid the use of any drugs, whereas others accept
or even encourage drug use. The evaluation of an individuals pattern of substance use must
take these factors into account. 2
Slide 5: DSM-IV Disorders
Prior to 1980 and the introduction of DSM-III, the discussion of alcoholism and drug abuse
were considered part of sociopathic personality disturbances
There are four substance-related conditions recognized by the DSM-IV:
Slide 6: Substance Intoxication
Development of reversible symptoms and maladaptive behavioural or psychological changes
due to the direct physiological effects of a substance on the CNS. For example:
Mood labilitye.g., Cocaine
Psychomotor behavioure.g., Amphetamine
Interpersonal behaviour (e.g., belligerence)e.g., Alcohol
The diagnosis of substance intoxication is only given when the behavioural and
psychological changes cause significant disruption in the persons social and family
relationships, occupational or financial problems, or place the person at risk for adverse
effects (e.g., accidents, medical ailments, legal problems)
Slide 7: Substance Intoxication Cartoon
Slide 8: Factors Affecting Intoxication
Factors affecting intoxication:
Type of substance & route of administration
History of use
Tolerance - related to body size, gender, history of use, drug metabolism
Expectations of use e.g., people who expect marijuana to make them relaxed may
experience relaxation, whereas people who are afraid of becoming disinhibited may
Environment or setting in which substance is ingested - e.g., a few drinks at a party leads
to greater gregariousness whereas a few drinks at home lead to tiredness or sadness, or a
few regretted phone calls or e-mails
Signs and symptoms of intoxication may persist for hours or days beyond the time when the
substance is detected in body fluids. 3
The route of administration of a substance is an important factor in determining its effects
and likelihood of tolerance and withdrawal.
Routes of administration that produce more rapid and efficient absorption into the
bloodstream (e.g., intravenous, smoking, or snorting) tend to result in a more intense high
and greater risk of dependence. These routes of administration quickly deliver a large
amount of the drug to the brain and so are associated with higher levels of substance
consumption and toxic effects (i.e., OD).
Rapidly acting and short-acting drugs are more likely to lead to dependence (e.g., crack).
Slide 9: Substance Abuse
The diagnosis of SA is given when the persons recurrent use of a substance results in
significant harmful consequences
There are four categories of harmful consequences that suggest SA in DSM-IV
Failure to fulfill major role obligations (e.g., repeated absences or poor work/school
performance; neglect of children or household).
Substance use in situations in which it is physically hazardous (e.g., driving a car,
operating machinery, swimming, rock climbing).
Legal problems (e.g., arrests for substance-related disorderly conductstreaking at a
football game, physical fights, driving under the influence).
Social or interpersonal problems caused or worsened by the substance (e.g., physical
fights, arguments about the consequences of intoxication, marital difficulties, nagging
Need to meet 1 (or more) criteria within a 1-year period.
Problema lot of people meet criteria using this definition. Can be in a car with an
intoxicated driver twice, drive a lawnmower down a country road twice, or miss two classes
or work shifts due to a hangover and meet criteria.
Note: Unlikely to get a diagnosis of substance abuse for many legal drugs (e.g., cigarettes,
pain killers, diet pills). They would not meet criteria for substance abuse, but easily qualify
for a diagnosis of dependence.
Slide 10: Substance Dependence
The diagnosis of SD preempts the diagnosis of substance abuse since dependence is
considered a more advanced condition than abuse.
This diagnosis is what is usually described as addiction.
Toleranceneed to increase amount to get same effect or much less effect if use the
same amount. The degree to which tolerance develops varies greatly across substances
(e.g., very pronounced for opioids, stimulants, and alcohol).
Withdrawaleither experience withdrawal symptoms or take the substance to relieve or
avoid withdrawal symptoms (e.g., eye-opener, hair of the dog). The degree to which
withdrawal is experienced varies greatly across substances (e.g., absent for
hallucinogens; moderate for amphetamines, cocaine, nicotine, and marijuana; severe for
alcohol, opioids, sedatives, and anxiolytics).
Substance is taken in larger amounts or over a longer period of time than intendedthis
one is rare for marijuana because they often require less due to sensitivity