Substance-Related, Addictive and Impulse-control Disorders

 Most of us, use some sort of Psychoactive Substance occasionally. Drinking a cup of coffee in the morning to wake-up or smoking a cigarette and having a drink with a friend to relax are examples of substance use, as is the occasional ingestion of illegal drugs such as cannabis, cocaine, amphetamines or barbiturates. For a person to become intoxicated depends on which drug is taken, how much is ingested, and the person's individual biological reaction.

Substances are grouped into six general Categories:

• Depressants: These substances results in behavioral Sedation and can induce relaxation. They include alcohol (ethyl alcohol) and the sedative and hypnotic drugs in the families of barbiturates (for example, Seconal) and benzodiazepines (for example, Valium, Xanax).

• Stimulants: These substances cause us to be more active and alert and can elevate mood. Included in this group are amphetamine cocaine, nicotine and caffeine.

• Opiates:  The major effect of these substance is to produce analgesia temporarily (reduce pain) and euphoria. Heroin, opium codeine and morphine are included in this group.

• Hallucinogens: These substances alter sensory perception and can produce delusions, paranoia, and hallucinations. Cannabis and LSD are included in this category.

• Other Drugs of Abuse: Other substances that are abused but do not fit neatly into one of the categories here include inhalants (for example, airplane glue), anabolic steroid and other over the-counter and prescription medications (for example, nitrous oxide). There substances produce a variety of psychoactive effects that are characteristic of the substances described in the previous categories.

• Gambling Disorder: As with the ingestion of the Substances just described, individuals who display gambling disorder are unable to resist the urge to gamble which in turn, results in negative personal consequences (e.g. divorce, loss of employment).

Common Symptoms of all substance - Addictive Disorders

1. Substance /Addictive are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control Substance / Addictive use.
3. A great deal of time is spent in activities necessary to obtain them, use them or recover from it’s effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent substance/ addictive use resulting in a failure to fulfill major role obligations at work, school of home.
6. Continued use substance / addictive despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance / Addictive.
7. Important Social, occupational or recreational activities are given up or reduced because of substance /Addictive use.
8. Recurrent substance / Addictive use in situation in which it is physically hazardous.
9. Substance /Addictive use is continued despite knowledge of having  persistent or recurrent physical or psychological problems that is likely to have been caused on exacerbated by the Substance / Addictive.
10.  Tolerance for increased amounts of the Substance/ Addictive to achieve intoxication or desired effect or diminished effect with continued use of the same amount of the Substance/Addictive.
11. The withdrawal Syndrome for substance /Addictive.
     

About Sedative-Hypnotic or Anxiolytic-Related Disorder:

SYMPTOMS

1. Inappropriate sexual or aggressive behavior.
2. Variable moods.
3. Impaired judgment.
4. Impaired social or occupational functioning.
5. Slurred speech.
6. Motor Coordination problems.
7. Unsteady gait.
8. Erectile dysfunction

 

CAUSES

Many kinds of problems can develop when people use and abuse substances that alter the way they think, feel and behave. Once seen as due to personal weakness, drug abuse and dependence are now thought influenced by Biological and Psychological factors.

• Biological Influences: Inherited genetic vulnerability affects (a) Body's sensitivity to drug (ADH gene) (b) Body's ability to metabolize drug (presence of specific enzymes in liver).
  Drugs activate natural reward center ("Pleasure Pathway”) in Brain'
  Neuroplasticity increases drug –seeking and Relapse.

• Psychological Influences: Not to use –

             Fear of Effects of drug use.
             Decision, not to use drugs.
             Feeling of confidence and self-esteem, without drug use.

?? Use  

• Drug use for pleasure, association with "feeling good" (positive reinforcement).
• Drug use to avoid pain and escape unpleasantness by "numbing out?” (negative re-inforcement).
• Feeling of being in control.
• Positive expectations /urges about what drug use will be like.
• Avoidance of withdrawal Syndrome.
• Presence of other Psychological disorders: mood anxiety etc

Social Influences: Trigger  

• Exposure to drugs - Through media, peers parents, or lack of parental monitoring - Versus no exposure to drugs.
• Social expectation and cultural norms for use.
• Family/culture / society and peers (all or some) Supportive Vs unsupportive of drug use.

TREATMENTS

Substance dependence is treated successfully only in a minority of those affected, and the best results reflect the motivation of the drug user and a combination of biological and psychosocial treatment. Always advised to get a better result, use multiple approaches.

Psychosocial Treatments

• Aversion Therapy – to create negative associations with drug use [shocks with drinking, imagining nausea with Cocaine use]
• Contingency management to change behaviors by rewarding chosen behaviors.
• Alcoholics Anonymous and its variations.
• Inpatient hospital treatment [can be expensive].
• Controlled use.
• Community reinforcement.
• Relapse prevention.

Biological Treatments

• Agonist Substitution
  Replacing one drug with a similar one [Methadone for heroin, Nicotine gum and patches for cigarettes].
• Antagonist Substitution
  Blocking one drug's effect with another drug [Naltrexone for opiates and alcohol]
• Aversive Treatments
  Making Taking drug very unpleasant [using Antabuse, which causes nausea and vomiting when mixed with alcohol, to treat alcoholism]
• Drugs to help recovering person deal with withdrawal symptoms [clonidine for Opiate withdrawal, Sedatives for alcohol, etc.]

Find Treatment Program here

REFERENCE