PYC3702 Ch 8 Substance-use Disorders

DSM-5 Criteria for a substance-use disorder

At least 2 of the following over 12 months causing significant impairment/distress:

• Using more or for longer than intended
• Unsuccessful attempts to control substance due to cravings
• Spending a lot of time getting, using or recovering from using
• Craving/strong desires to use
• Dropping out of responsibilities because of substance-use
• social and interpersonal harm
• impaired work, social and leisure activities
• physical endangerment due to substance use
• Continued use even though physical and psychological harm is occurring
• Tolerance causing increased need for the substance
• Withdrawal symptoms when the person tries to stop using, which trigger the person to start using again

What to remember

The essence is :

• impairment & distress,
• compelled by the substance/behavior
• keeps getting worse

Gambling addiction

The gaming industry tries to feed into the gambling industry as gamers will know – for gaming, sex, or eating addictions, you can use the same rules of thumb.

Minimum criteria for a diagnosis

4 of the symptoms for a year.

• Tolerance causing increased need to gamble more money
• Withdrawal symptoms of irritability & restlessness when the person tries to stop gambling
• Gambling more or for longer than intended
• Unsuccessful attempts to control gambling
• Spending a lot of time gambling, thinking about gambling, finding money for gambling etc
• Self-soothes with gambling when upset or distressed
• Can’t stop coming back, tries to win back losses
• Deceives others about the financial losses, extent of behavior etc
• Has lost jobs, relationships etc
• Has to get financial help because of gambling

Severity of gambling addiction

• mild: 4-5 symptoms
• moderate: 6-7
• severe 8-9

Substances that people abuse

Different substances have very different risk profiles and effects. Some people cannot touch any mind-altering substances at all -they are at high risk of developing a substance-dependency.

Some substances are dangerous to anyone who uses them. Heroin, for example, carries the risk of overdose or dependency once it is used past a particular fine line of quantity and number of doses, for any person at all.

Crack (crystalized cocaine) is instantly addictive for some people.

Human societies have been using mind-altering substances, such as alcohol, for thousands of years. Most people come through unscathed, but never all.

• Depressants:
  • Alcohol
  • opioids – heroin, opium, fentanyl, oxycontin etc
  • sedatives, hypnotics, anxiolytics
• Stimulants
  • caffeine
  • amphetamines – eg tik – crystal meth
  • cocaine
  • crack (cocaine crystals)
• Hallucinogens
  • LCD
  • psilocybin
  • mescaline
  • salvia
• Dissociative anaesthetics
  • Phencyclidine (PCP)
  • Ketamine, methoxetamine (MXE)
  • Dextromethmorphan
• Substances with multiple effects
  • nicotine
  • cannabis
  • inhalants
  • Ecstacy (MDMA)
  • Gamma hydroxybutyrate (GHB)

Etiology of substance-Use Disorders

The progression from substance-use to addiction is not always typical, but the typical progression goes something like this:

1. Initial use: The decision to experiment

2. Increasing use: Using the substance for a purpose – to numb painful emotions, to feel more confident or less anxious, to have fun, etc

3. Heavy Use: The brain chemistry begins to be altered, often causing physiological dependence, cravings, and withdrawal.

4. Drug Lifestyle: Lifestyle changes – life changes to follow the demands of the addiction, and as chronic use of the substance damages the person’s ability to function socially, professionally etc.

The 4 dimensions

Treatment

Substance-use disorder is entirely preventable, in theory anyway, by abstinence.

Recovery from active addiction is another matter entirely.

Narcotics Anonymous and Alcoholics Anonymous are long-standing peer-support organizations that help people recover from addiction.

There are also many drug rehabilitation organizations that help people. However, they are often very expensive.

To get clean, many people have to change their whole lives.

They need to find a sober social support network, end relationships with co-users, heal the emotional traumas and mental disorders that led them into addiction in the first place, and self-regulate intensely to avoid the exhaustion of will-power that leads to relapse.

Relapse is frequent, and usually leads back to usage of the substance. It is also very dangerous in the case of opioids, and frequently causes an overdose because the person can no longer tolerate the same dose as before.

Medications can help people through the withdrawal and early stages of abstinence.

Motivational enhancement therapy can help people in the process of making the decision of whether or not they want to get clean. The person needs to work through their ambivalence before starting the process, and this can help with this process, reducing the risk of relapse.

Drugs in South Africa – effects & risks

(Important for exams)

Parts of South African society are being destroyed by drugs, as we all know all too well. I am going to do my best to cut this down to what we may be examined on, not what we would like to understand better.