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Chapter XVII.docx

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University of Toronto St. George
Martha Mc Kay

Chapter XVII: Substance-Related Disorders Substance: Any natural or synthesized product that has psychoactive effects (changes perceptions, thoughts, emotions, ad behaviours) - Trends in the use of common substances (tobacco, alcohol, cannabis) were very similar in US and Canada, but American students prefer cocaine and Canadian students prefer LSD. Society and Substance Use - Societies differ in their attitudes: some see it as a matter of individual choice, others see it as a grave public health and security concern - Muslim cultures may impose strict sanctions for the use of any drugs; China certainly did at the time of the Cultural Revolution. - In the UK, drug abuse is viewed as a medical problem. - Holland (Dutch) makes a clear distinction between soft (cannabis) and hard (cocaine, heroin) drugs. - Many South Americans, Middle Easterners, and East Africans regularly chew khat and see nothing deviant in doing so. - First Nations groups in Canada and the US use psychoactive agents as a part of religious ceremonies. - Substances used for their psychoactive effectsindividuals begin build their lives around using the substancesinability to function in daily lives substance-related disorder Definitions of Substance-Related Disorders - Substance intoxication: Experience of significant maladaptive behavioural and psychological symptoms due to the effect of a substance on the CNS. - Substance withdrawal: Experience of clinical significant distress in social, occupational, or other areas of functioning due to the cessation or reduction of substance use. - Substance abuse: Diagnosis given when recurrent substance use leads to significant harmful consequences. - Substance dependence: Diagnosis given when substance use leads to physiological dependence or significant impairment or distress. - 5 categories of substances: 1. CNS depressants (alcohol, barbiturates, benzodiazepines, inhalants) 2. CNS stimulants (cocaine, amphetamine, nicotine, caffeine) 3. Opioids (heroin, morphine) 4. Hallucinogens and phencyclidine (PCP) 5. Cannabis + Club drugs (ecstasy, GHB, ketamine, rohypnol) - Intoxication, withdrawal, abuse, and dependence can occur with most but not all of these substances Withdrawal do not occur with inhalants, hallucinogens, PCP, cannabis Caffeine induces intoxication ONLY Nicotine induces withdrawal and dependence - Other substance-related disorder: use of other substances (ex. lead, pesticides, nerve gas, antifreeze, CO 2 CO) for intoxicating effects that more rarely lead to substance-related disorders but people experience significant problems in cognition and mood, anxiety, hallucinations, delusions, and seizures when exposed. - Intoxication: A set of behavioural and psychological changes that occur as a direct result of the physiological effects of a substance on the central nervous system Intoxication begins to decline as the substance in blood/tissue declines, but the symptoms may last for hours/days after it is no longer detectable in the body Specific symptoms depend on the type, amount, tolerance, and time that a substance has been taken Acute and chronic intoxications can produce different symptoms Peoples expectations of the effects also influence the types of symptoms shown The setting in which a substance is taken can influence symptoms shown and how maladaptive the intoxication is Diagnosis made when behavioural and psychological changes t are significantly maladaptive (substantially disrupt social & family relationships, cause occupational/financial problems, or significant risk for adverse effects) - Withdrawal: A set of behavioural and physiological 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 Typically the opposite of the symptom of intoxication Diagnosis made when the withdrawal symptoms cause significant distress or impairment in a persons everyday functioning Can begin a few hours after a person stops taking substances that break down quickly More intense symptoms usually end within a few days-few weeks Some may develop several weeks after Subtle physiological signs may persist for many weeks/months - Abuse: Repeated problems in 1 of the following within 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. 2. Repeated use of the substance in situations in which it is physically hazardous to do so. 3. Repeated legal problems as a result of substance use. 4. Confirmed use of the substance despite repeated social or legal problems as a result of use. Some individuals become dependent, then substance dependence is diagnosed instead, but some can abuse for years without becoming dependent - Dependence: Closest to what often refer to as drug addiction A person is physiologically dependent on a substance when intolerance or withdrawal develops Risk of tolerance varies: high in alcohol, opioids, stimulants, nicotine; low in cannabis and PCP Sometimes withdrawal symptoms are so severe that they must be withdrawn gradually to prevent symptoms from becoming overwhelming or dangerous take substances to relieve or avoid withdrawal symptoms Physiological dependence is not required for diagnosis Diagnosis given when the maladaptive pattern of substance use leads to 3 of: 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. (May have a high blood concentration of the substance but feels no effects) 2. Withdrawal, as manifested by either: the characteristic withdrawal syndrome for the substance; the same or closely related substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended. 4. There is a persistent desire or unsuccessful efforts to cut back or 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 substance use. 7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by the substance. - Routes of administration that produce rapid and efficient absorption (ex. injecting, smoking, snorting)more intense intoxication & greater likelihood of dependence - Substances that act more rapidly on the CNSfaster intoxication & greater likelihood of dependence or abuse - Substances whose effects wear off quicklygreater likelihood of dependence or abuse Depressants: - Slow the activity of the CNSModerate doses (relaxation, sleepy, reduced concentration, impaired thinking & motor skills), heavy doses (stupor) I. Alcohol - Effects of alcohol occur in 2 distinct phases: Low doses: more self-confident, more relaxed, slight euphoric, less inhibited Increasing doses: fatigue & lethargy, decreased motivation, sleep disturbances, depressed mood, confusion - Intoxication: slurred speech, unsteady walk, poor memory, may have blackout once sober (amnesia of the events that occurred during intoxication) - Depends on stomach full or empty effects are faster on an empty stomach rapidly absorbed into the body - Legal definition: .08 blood-alcohol concentration; MTO warn range .05 - .08 - Drinking large quantities of alcohol can result in death even in non-chronic abusers - Most deaths come from automobile accidents, private plane and boat accidents, and drowning - Alcohol abuse and dependence Those given the diagnosis of abuse use alcohol in dangerous situations, fail to meet important obligations, and have recurrent legal or social problems Those given diagnosis of dependence typically have all the problems identified in abusecharacteristics match alcoholism 3 distinct patterns of alcohol use: Large amounts daily and plan days around drinking Abstain for long periods of time then binge (5 drinks within a couple of hours) for days or weeks; when begin drinking again, may be able to control for a while, but may soon escalate until severe problems develop Sober during the week, binge during evenings or on weekends Study: More Canadian students drink, but American students drink more living on campus was associated with heavy alcohol use Binge drinking increasing among school-age adolescents Most commonly consumed drug within students Binge drinking steadily increases by grade Alcohol dependence is a heterogeneous disorder, different subtypes have different causes and prognoses Antisocial alcoholics have more severe symptoms of alcoholism, tend to remain alcoholic for longer, poorer social functioning, more marital failures, heavier drug involvement, more likely to have a family
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