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Chapter 17

Chapter 17.docx

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Stephanie Cassin

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Chapter 17: Substance-related disorders
Substance: any natural or synthesized product that has psychoactive effects (changes
perceptions, thoughts, emotions, and behaviors)
- A person need not be physically dependent on drug to have problems from taking
- Some stats:
o cocaine use higher in US, LSD higher in Canada
o illicit drug use highest in young adults
o men more likely than women to have used substance in lives
o but once women use substance are at least as likely to become dependent on it
and may suffer greater physiological damage than men
o peaked in 1970s
Society and substance use
- strict any drug laws in China
- in Great Britain, substance addiction considered medical disease, treated by
o traffickers are prosecuted, but users given treatment
- Dutch system
o Soft drugs (cannabis) versus hard drag
o Both illegal, but cannabis rarely prosecuted
o Based on belief that if enforce strict prohibition of soft drugs, would go
underground and more likely to get hard drugs too
- "needle park" in Zurich, Switzerland allowed by authorities. Now closed.
- Medicinal purposes
o 1500 B.C. natives chewed coca leaves to increase endurance (cocaine)
o In twentieth century, cocaine in Coca Cola and other drinks used to relieve
o Opium (from poppy plant) used to relieve pain
o Khat plant used in Middle East, South America, Africa to relieve fatigue
o Modern derivatives of khat used to make amphetamines
Class of drugs used to treat ADD, narcolepsy, obesity, over-the-
counter cold remedies, appetite suppressants
- Religious ceremonies
o Peyote cactus causes visual hallucinations. Used by Aztecs
Substance related disorder: use of substances leads to significant problems in ability to
function in daily lives
Alcohol is associated with over half of traffic accident deaths, 30% of all suicides
- Costs Canada $14 billion per year
Substances grouped into FIVE categories

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1) Central nervous system depressants
a. Alcohol, barbiturates, benzodiazepines, inhalants
2) Central nervous system stimulants
a. Cocaine, amphetamines, nicotine, caffeine
3) Opiods
a. Heroin, morphine
4) Hallucinogens and phencyclidine (PCP)
5) Cannabis
Also have mixed group called club drugs -> ecstasy, GHB, ketamine, rohypnol
And also other substances used for intoxicating effects that rarely lead to substance related
- Most people don't experience any or only mild psychoactive and transient effects, but
some do
- Given diagnosis of other substance-related disorder
SEE PAGE 603 tables!!!
FOUR substance-related disorders
1) Substance intoxication
2) Substance withdrawal
3) Substance abuse
4) Substance dependence
1) Substance intoxication
-> set of behavioral and psychological changes that occur as a direct result of the
physiological effects of a substance on the CNS
- Perceptions change, attention diminished, good judgment gone, can't think straight
- Can't control bodies as well as they normally can
- Either want to sleep a lot or not at all
- Interpersonal interactions change -> more aggressive or more withdrawn
Intoxication begins to decline as amount of a substance in blood or tissue declines, but
symptoms may last for hours or days after substance no longer in body.
- Specific symptoms depend on what substance is taken, how long, user's tolerance
- For example, short term cocaine -> outgoing, friendly, upbeat
o Chronic use -> withdrawn, less gregarious
- Also expectations about substance can alter symptoms
o Those who are frightened about disinhibition of marijuana may experience
- Also setting in which substance is taken can influence symptom types and how

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Diagnosis only given if significantly maladaptive and disrupt person's life
2) Substance withdrawal
-> set of physiological and behavioural symptoms that result when people who have been
using substances heavily for prolonged periods of time stop using them or greatly reduce their
- Symptoms are typically the opposite of intoxication symptoms of same substance
Only get diagnosis if cause significant distress or impairment in functioning
- For example, caffeine withdrawal (nervousness, headaches) is annoying but NOT
including in DSM!
Symptoms can begin a few hours after stop taking drug that breaks down quickly
- More intense symptoms usually end within a few days to few weeks
- However, seizures for example can develop several weeks after take high doses of
substance that takes a while to leave body (such as some antianxiety substances)
- Subtle signs (problems in attention, perception, motor skills) may be present for many
weeks or months after
3) Substance abuse
-> When a person's recurrent use of a substance results in significant harmful consequences
Four categories of harmful consequences
i) Fails to fulfill important obligations at work, school, or home
ii) Repeatedly uses substance in situations where it is physically hazardous to do so
(like driving)
iii) Repeatedly has legal problems as a result of substance use
iv) Continues to use the substance, even though he or she has repeatedly had social or
legal problems as a result of the use
- Person has to show repeated problems in at least one of these for 12 month period for
- Can evolve into dependence which is considered a more advanced condition that
4) Substance dependence
-> closest to what is referred to as drug addiction
Physiologically dependent when he or she shows either tolerance or withdrawal from the
- Tolerance: experience less and less effect from the same dose and needs greater
doses to get intoxicated
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