PSY240 Lecture 7 June 13: Substance Abuse Disorders (Chapter 17)
Substance is any natural or synthesized product that has psychoactive effects it changes
perceptions, thoughts, emotions, behaviours
The societal cost of substance abuse
Nearly half of the U.S. population have tried an illegal substance; 15% have used one in the past
Similar patterns run across the U.S. and Canada, thought Canadians use less cocaine and more
LSD than do Americans
Illicit drug use higher in males than females; once women begin to use substance, they are as
likely to become dependent, and may suffer greater physiological damage from some substances
Stats Canada; Canadian Alcohol and Drug Use Monitoring Survey 2010
Among 15 years and older, prevalence of cannabis use decreased from 14.1% (2004) to 10.7%
Among 15 years and older, prevalence of cocaine/crack decreased from 1.9% (2004) to 1.2%
Hallucinogens (.0%), ecstasy (.7%) and speech (.5%) remained the same
Alcohol use (77%) remained the same
Rates of psychoactive pharmaceutical use remains the same (26% use, .3% use to get high)
Drug use and abuse across cultures:
o Muslim cultures may impose strict sanctions for the use of any drugs; China certainly
did at the time of the cultural revolution communists in 1940s made it major goal to
eradicate use of opium, executed traffickers, sent users to countryside for
o In the UK, drug abuse is viewed as medical problem, people who abuse
substances/dependent on substances are treated by physicians
o Holland makes distinction between soft (cannabis) and hard (cocaine/heroin) drugs
Based on belief that enforcing strict prohibition of soft drugs would drive
users to underground, putting them in closer contact to hard drug dealers
o Many South Americans, Middle Easterners, and East Africans regularly chew khat and
see nothing deviant in doing so (khat used to produced amphetamines)
o First Nations groups in Canada and in the US use psychoactive ages as part of religious
Text: Individuals who have great difficulty in using substances in moderation and begin to build
their lives around substance use, leading to significant problems in their abilities to function in
daily lives have a substance-related disorder
Many other substances are used for intoxicating effects that more rarely lead to substance
related disorders; people who experience significant problems in cognition, mood, anxiety,
hallucinations, delusions and seizures when exposed may be given diagnosis of other substance-
related disorder (this drugs include: antihistamines, anesthetics, antimicrobial medications, BP
medications, lead, pesticides, etc.)
In Canada, alcohol and illicit drugs cost society about $14 billion/year due to lost productivity,
legal costs, and health costs
There are 86,000 admissions to Canadian hospitals each year for alcohol-related health reasons
Alcohol is associated with more than half of traffic deaths and homicides and 30% of all
In 2002, 19.3% of all deaths in Canada could be attributed to alcohol, tobacco, or illicit drugs
Total cost of substance abuse in Canada 2002 = $40 billion
Categories of substances
1. Central nervous system depressants (alcohol, barbiturates, benzodiazepines, inhalants)
2. Central nervous system stimulants (cocaine, amphetamines, nicotine, caffeine)
3. Opiods (E.g., heroin, morphine)
4. Hallucinogens and phencyclidine (PCP)
59 Substance-related conditions recognized by the DSM-IV-TR
Substance intoxication: experience of significant maladaptive behavioural and psychological
symptoms due to the effect of a substance on the central nervous system.
o Perceptions change, they may see of hear strange things; attention is diminished, easily
distracted; good judgment is gone, unable to think straight; cannot control their bodies,
may stumble or be too slow/awkward in reactions; often want to sleep or not at all;
interpersonal interactions change (more gregarious, or withdrawn or aggressive/impulsive)
o People begin to be intoxicated soon aster they begin ingesting substance; more ingesting =
o Intoxication declines as amount of substance in persons blood/tissue declines but
symptoms of intoxication may last for hours, days after substance no longer detectable in
o Specific symptoms depend on type of substance, how much is taken, how long it has been
ingested, users tolerance
o Short-term/acute intoxication can produce different symptoms from long-term
o Peoples expectations about substances effects can also influence types of symptoms
o Diagnosis of substance intoxication only given when behavioural/psychological changes
person experiences are significantly maladaptive in that they substantially disrupt persons
social/family relationships, cause occupational/financial problems, place individual at
significant risk for adverse events
Substance withdrawal: experience of clinical distress in in social, occupational, or other areas
of functioning due to the cessation or reduction of substance use.
o Involves set of physiological and behavioural symptoms that result when people who have
been using substances heavily for prolonged periods of time stop using the substance or
greatly reduce their use
o Symptoms are typically opposite of intoxication with the same substance
o Diagnosis of substance withdrawal not made unless there is significant distress/impairment
in persons everyday functioning.
o Symptoms of withdrawal can begin few hours after person stops ingesting substances the
more intense symptoms usually end within few days to few weeks; however withdrawal
symptoms (like seizures) may develop several weeks after person stops taking high doses
of substances that take longer time to leave the body completely
See substance abuse below
See more on substance dependence below.
DSM-IV-TR criteria for substance abuse
Substance abuse: diagnosis given when recurrent substance use leads to significant harmful
One or more of the following occurs during a 12-month period, leading to significant
impairment or distress:
1. Failure to fulfill important obligations at work, home, or school as a result of substance
abuse (e.g. unable to concentrate, performs poorly, takes substance at work/school).
2. Repeated use of the substance in situations in which it physically hazardous to do so (e.g.
driving car or boat).
3. Repeated legal problems as a result of substance use (e.g. arrests for possession of illegal
substances or for drunk driving).
4. Confirmed use of the substance despite repeated social or legal problems as a result of use.
60DSM-IV-TR criteria for substance dependence
Substance dependence: diagnosis given when substance use leads to physiological dependence
or significant impairment or distress (with alcohol you test for abuse first; for substances, you
test for dependence first, then see if they meet criteria for abuse better).
Maladaptive pattern of substance use, leading to three or more of the following:
1. Tolerance, as defined by either: the need for markedly increased amounts of the substance
to achieve intoxication or desired effect; markedly diminished effect with continued use of
the same amount. Individual experiences less and less effect from same dose of substance,
needs greater and greater doses to achieve intoxication. Risk of tolerance varies; alcohol,
opioids, stimulants, nicotine = higher risks for tolerance, cannabis & PCP = lower risk.
2. Withdrawal, as manifested by either: the characteristic syndrome for the substance; the
same or closely related substance is taken to relieve or avoid withdrawal symptoms.
Symptoms may be so severe that the substance must be withdrawn gradually to prevent
symptoms from becoming overwhelming/dangerous.
3. The substance is often taken in larger amounts or over a longer period than was intended.
4. There is president desire or unsuccessful efforts to cut back/control use.
5. A great deal of time is spent in activities necessary to obtain the substance, use the
substance, or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of
7. The substance use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem cause or exacerbated by the substance.
NOTE: physiological dependence (i.e., evidence of tolerance/withdrawal) is not required for
diagnosis of substance dependence. Diagnosis can be given when person compulsively