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
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 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)
+ 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
A set of behavioural and psychological changes that occur as a direct
result of the physiological effects of a substance on the central nervous
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
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)
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
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
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
Closest to what often refer to as drug addiction
A person is physiologically dependent on a substance when intolerance or
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
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
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
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
- 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)
- Effects of alcohol occur in 2 distinct phases:
Low doses: more self-confident, more relaxed, slight euphoric, less
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
- Most deaths come from automobile accidents, private plane and boat accidents,
- 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
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
Sober during the week, binge during evenings or on weekends
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