Substance+Related+Disorders

=**Substance Related Disorders**=


 * 1. Define substance use, misuse, abuse, and dependency.**
 * Use** is defined as substance use which:
 * does not result in a failure to fulfill major role obligations
 * does not occur in situations in which it is physically hazardous
 * does not create recurrent legal problems
 * does not continue if social or interpersonal problems arise


 * Misuse** is at least one incident of substance use which:
 * results in a failure to fulfill major role obligations
 * occurs in situations in which it is physically hazardous
 * creates legal problems
 * results in social / interpersonal problems
 * Abuse** is a maladaptive pattern of substance use leading to a clinically significant impairment as manifested by more than one of the following within a **12 month period.**
 * recurrent substance use resulting in a failure to fulfill major role obligations
 * recurrent substance use in situations in which it is physically hazardous
 * recurrent substance related legal problems
 * continued substance use despite having persistent or recurrent social or interpersonal problems caused by / exacerbated by the effects of the substance
 * Dependence**: A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by more than three of the above criteria occurring at any time in the same **12 month period.**


 * 2. Describe the DSM-IV criteria for substance abuse and dependency.**


 * 3. Describe intoxication, tolerance, and withdrawal.**


 * Intoxication**:
 * Development of a reversible substance-specific syndrome due to recent ingestion of or exposure to substance
 * Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the CNS
 * Symptoms not due to general medical condition and not better accounted for by another medical disorder


 * Withdrawal**:
 * Development of a substance-specific syndrome due to the cessation (or reduction in) substance use that has been heavy and prolonged
 * The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
 * Symptoms are not due to a general medical condition and are not better accounted for by another general medical disorder


 * Tolerance**- as defined by either:
 * A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
 * Markedly diminished effect with continued use of the same amount of substance

Substances have an effect on the brain or CNS, primarily the reward system, disregulating normal feedback pathways. Misuse of a substance may lead to self correcting behavior, or trigger repeated episodes, leading to abuse or dependence. Subsequent abuse and dependence leads to interpersonal functioning that disconnects the social and/or physical environment negative feedback systems, leading to pathology.
 * 4. Discuss the self-regulation model of use, misuse, abuse, and dependency.**


 * 5. Discuss lifetime prevalence for use for various psychoactive substances.**


 * Alcohol:
 * 85% ever
 * 68% in the past year
 * 51% past month
 * Cigarettes:
 * 73% ever
 * 32% past year
 * 27% past month
 * Marijuana:
 * 33% ever
 * 10% past year
 * 5% past month
 * Cocaine:
 * 12% ever
 * 3% past year
 * < 1% past month
 * Hallucinogens:
 * 8.1% ever
 * 1.2% past year
 * .3% past month
 * Heroine:
 * 1.3% ever


 * 6. Describe different etiological perspectives of substance abuse and dependency.**
 * **Psychosocial**
 * classic: masturbatory equivalent, defense against homosexual impulses, manifestation of oral regression
 * recent substance use as a reflection of disturbed ego functions
 * research linked personality disorders with substance abuse / dependence
 * family / societal relationships- dysfunctional family systems / dysfunctional societal subcultures
 * **Behavioral**: 4 major principles
 * **Positive reinforcing qualities**- good experiences with substance
 * **Adverse effects**- hangover etc. can be negative feedback, but relieving hangover with alcohol can be reinforcing
 * **Discrimination of substance**- can tell that they got high with which substance
 * **Other cues** associated with the substance- important for “craving” process, which is what drives abuse
 * **Biological**- predisposed to being “reward deficient” and thus seeking to boost the reward system more so
 * **Genetic-** addiction has a genetic component
 * **Neurological disease**:
 * Dysregulations of neurotransmitter systems, second messenger function, and / or gene function
 * Prior to and / or subsequent to abuse / dependency
 * **Neurotransmitter:**
 * Opiate, catecholamine, GABA
 * Dopaminergic nerurons in ventral tegmental area is primary reward pathwayà projects to cortical, limbic (nucleus accumbens) areas


 * 7. Describe clinical screening for chemical dependency using the CAGE.**
 * C: have you ever felt the need to **cut down** on your drinking / drug use?
 * A: have you ever been **annoyed** at criticism of your drinking / drug use?
 * G: have you ever felt **guilty** about something you’ve done when you’ve been drinking / high from drugs?
 * E: have you ever had a morning **eye-opener?**

Biochemical components include detoxification treatments, and the maintenance of abstinence through biochemical means. Belief oriented treatments include psychodeducational, cognitive behavioral therapy, and spiritual-based approaches. Treatments centered on the behavioral aspect of abuse and dependency include abstinence, moderation and the building of a social support network to facilitate change. Another component is Patient-Treatment matching, which takes into account the degree of social support, any medical problems, the history of relapse, psychological impairment, and the level of dependence.
 * 8. Discuss treatment components for abuse and dependency.**

Treatment options: (highest to lowest intensity)
 * 9. Discuss levels of treatment intensity.**
 * long term residential program
 * inpatient rehab
 * inpatient detox
 * outpatient detox / rehab
 * trials of abstinence with follow up
 * physician follow up/ directed readings / family involvement / referred to counseling or detox / referral to self-help (AA, NA)
 * physician counseling/brief advice