SUBSTANCE USE AND

ADDICTIVE DISORDERS
Prepared by: Gielyssa Marie A Sotto, RMT
To be discussed:
Substance Dependence and Substance Abuse
■ Alcohol- Related Disorder
■ Caffeine- Related Disorder
■ Cannabis- Related Disorder
■ Hallucinogen- Related Disorder
■ Inhalant- Related Disorder
■ Opioid- Related Disorder
■ Sedative-, Hypnotic-, or Anxiolytic- Related Disorder
■ Stimulant- Related Disorder
■ Tobacco- Related Disorder
■ Anabolic- Androgenic Steroid Abuse
■ Other Substance Use and Addictive Disorder
■ Gambling Disorder
Good to know!
■ Dependence = The repeated use of a drug or chemical substance, with or without
physical dependence. Physical dependence indicates an altered physiologic state
caused by repeated administration of a drug, the cessation of which results in a
specific syndrome.
■ Abuse = Use of any drug, usually by self-administration, in a manner that deviates
from approved social or medical patterns.
■ Intoxication = A reversible syndrome caused by a specific substance that affects one
or more of the following mental functions: memory, orientation, mood, judgment,
and behavioral, social, or occupational functioning.
■ Withdrawal = A substance- specific syndrome that occurs after stopping or reducing
the amount of the drug or substance that has been used regularly over a prolonged
period. The syndrome is characterized by physiological signs and symptoms in
addition to psychological changes, such as disturbances in thinking, feeling, and
behavior. Also called “abstinence syndrome or discontinuation syndrome.”
Etiology:
Psychodynamic Factor
■ Defense to anxious impulse or manifestation of oral regression
■ Substance abuse = “masturbatory equivalent” (sexual orgasm)
■ Disturbed ego functions (inability to deal with reality)
■ Form of medication

Genetic Factor
Neurochemical Factors
■ Dopamine “Brain- reward circuitry”
■ γ-aminobutyric acid (GABA)
 ADDICTION

“Brain Disease”
Four Major Diagnostic Categories
■ Substance Use Disorder
= diagnostic term applied to the specific substance abused (ex. Alcohol use disorder)
■ Substance Intoxication
= diagnosis used to describe a syndrome characterized by specific signs and symptoms
resulting from recent ingestion/ exposure to the substance (ex. Alcohol intoxication)
■ Substance Withdrawal
= diagnosis used to describe a substance specific syndrome that results from the abrupt
cessation of heavy and prolonged use of a substance (ex: Opioid Wthdrawal)
■ Substance- Induced Mental Disorder
Substance Use Disorder
Criteria: 2 or more of the following maladaptive pattern, occurring within a 12 month
period
■ Recurrent substance use resulting in a failure to fulfill major role obligations at work,
school, or home (ex. Repeated absences or poor work performance related to
substance use)
■ Recurrent substance use in situations in which it is physically hazardous (ex. Driving
an automobile or operating a machine when impaired by substance use)
■ Continued substance use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of the substance (ex.
Physical fights)
■ Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to achieve intoxication or
desired effect
b. Markedly diminished effect with continued use of the same amount of the
substance
■ Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
b. The same (or a closely related) substance is taken to relieve or avoid withdrawal
symptoms.
■ The substance is often taken in larger amounts or over a longer period than was
intended.
■ There is persistent desire or unsuccessful efforts to cut down or control substance
use.
■ A great deal of time is spent in activities necessary to obtain the substance, use the
substance, or recover from its effects.
■ Important social, occupational, or recreational activities are given up or reduced
because of substance use.
■ The substance use is continued despite knowledge of having a persistent or
recurrent physical or psychological problem that is likely to have been caused or
exacerbated by the substance
■ Craving or a strong desire or urge to use a specific substance.
Treatment and Rehabilitation
Treatment of Comorbidity
■ Comorbidity = is the occurrence of two or more psychiatric disorders in a single
patient at the same time. (ex. Mentally ill person who are also drug dependent)

Antipsychotic drugs Therapeutic community principles

Treatment of Comorbidity

 Integrated Treatment – more effective than…….

 Parallel Treatment
 Sequential Treatment
Alcohol- Related Disorder

“ALCOHOLISM”
Etiology:
■ Psychological Theories
■ Psychodynamic Theories
■ Behavioral Theories
■ Sociocultural Theories
■ Childhood History
■ Genetic Theories
DISORDERS
Alcohol Use Disorder
Mark, a 45-year-old divorced man, was examined in a hospital emergency room because he
had been confused and unable to care for himself of the preceding 3 days. His brother, who
brought him to the hospital, reported that the patient has consumed large quantities of beer
and wine daily for more than 5 years. His home and job lives were reasonably stable until his
divorce 5 years prior. The brother indicated that Mark's drinking pattern since the divorce
has been approximately 5 beers and a fourth of wine a day. Mark often experienced
blackouts from drinking and missed days of work frequently. As a result, Mark has lost
several jobs in the past 5 years. Although he usually provides for himself marginally with
small jobs, 3 days earlier he ran out of money and alcohol and resorted to panhandling on
the streets for cash to buy food. Mark had been poorly nourished, having one meal per day
at best and was evidently relying on beer as his prime source of nourishment.
On examination, Mark alternates between apprehension and chatty, superficial warmth. He
is pretty keyed up and talks constantly in a rambling and unfocused manner. His recognition
of the physician varies; at times he recognizes him and other times he becomes confused
and believes the doctor to be his other brother who lives in another state. On two occasions
he referred to the physician by said brother's name and asked when he arrived in town,
evidently having lost track of the interview up to that point. He has a gross hand tremor at
rest and is disoriented to time. He believes he's in a parking lot rather than a hospital.
Efforts at memory and calculation testing fail because Mark's attention shifts so rapidly.
Alcohol Intoxication
■ a.k.a Simple Drunkenness
■ Recent ingestion of ethanol
■ Maladaptive behavior
■ At least 1 of the following physiological correlates of intoxication
a. Slurred speech
b. Dizziness
c. Incoordination
d. Unsteady gait
e. Nystagmus
f. Stupor or coma
g. Double vision
 Alcohol Withdrawal
Classic Sign
a. Tremulousness- commonly called the “shakes” or the “jitters”
6 to 8 hours
b. Psychotic and Perceptual Symptoms (delusions and hallucinations)
8 to 12 hours
c. Seizures
12 to 24 hours
Medication: Benzodiazepine, Carbamazepine
d. Delirium Tremens (DTs) – alcohol delirium in DSM-5; most severe form of withdrawal
syndrome
Any time during the first 72 hours
Prevention – best treatment
Medication: Benzodiazepine
Alcohol- Induced Persisting Dementia
Alcohol- Induced Persisting Amnestic
Disorder
1. Wernicke- Korsakoff Syndrome Classic names for alcohol
a. Wernicke’s encephalopathy = set of acute symptoms – induced persisting
b. Korsakoff’s syndrome = a chronic condition amnestic disorder
2. Blackouts

Treatment: Thiamine – oral administration

Alcohol- Induced Psychotic Disorder

Alcohol- Induced Mood Disorder
Alcohol- Induced Anxiety Disorder
Alcohol- Induced Sexual Dysfunction
Alcohol- Induced Sleep Disorder
Unspecified Alcohol- Related Disorder
Comorbidity:
■ Other substance-related disorders
■ Antisocial Personality Disorder
■ Mood Disorders – Major Depressive Disorder
■ Anxiety Disorders
Treatment and Rehabilitation:
Three General Steps
1. Intervention = called “confrontation”
Family – can be a great help in the intervention
ex. Al –anon Group
2. Detoxification
First step:
Physical Examination
Second Step:
Rest, adequate nutrition, and multiple vitamins (especially containing THIAMINE)
3. Rehabilitation
Three Major Components
a. Continued efforts to increase and maintain high levels of motivation for abstinence.
b. Work to help the patient readjust to a lifestyle free of alcohol
c. Relapse prevention
Caffeine- Related Disorder

“CAFFEINE”
Etiology:
 Pharmacological effects
 Caffeine’s reinforcing effects
 Genetic Predispositions
 Personal Attributes
DISORDERS
Caffeine Use Disorder
■ Included in Section III of DSM-5 = reserved for conditions that require further
research
Caffeine Intoxication
■ Recent consumption of caffeine excess of 250mg.
Symptoms: anxiety, psychomotor agitation, restlessness, irritability,
psychophysiological complaints (Muscle twitching, flushed face, nausea,
diuresis, gastrointestinal distress, excessive perspiration, tingling in the
fingers and toes and insomnia)
■ More than 1 gram
Symptoms: Rambling speech, confused thinking, cardiac arrhythmias,
inexhaustibleness, marked agitation, tinnitus, and mild visual
hallucinations
■ More than 10 grams
Symptoms: Tonic-clonic seizures, respiratory failure, and death
Caffeine Withdrawal
■ Most common symptoms : Headache and fatigue
■ Other Symptoms: anxiety, irritability, mild depressive symptoms, impaired
psychomotor performance, nausea, vomiting, craving for caffeine, and muscle pain
and stiffness.
■ Onset of symptoms: 12 to 24 hrs after the last dose
■ Peak: 24 to 48 hours
■ Resolve: within 1 week
Caffeine- Induced Anxiety Disorder
Caffeine- Induced Sleep Disorder
Caffeine- Related Disorder Not
Elsewhere Classified
Comorbidity:
■ Other Substance Related Disorder
Treatment:
■ Caffeine Withdrawal
Medications: Analgesic (Aspirin) – for headache and muscle aches
Fading schedule for caffeine consumption
Cannabis- Related Disorder

“Cannabis”
DISORDERS
Cannabis Use Disorder
Cannabis Intoxication
■ Heightens user’s sensitivities to external stimuli
■ Hypomania
■ High doses: Depersonalization and Derealization
Cannabis Withdrawal
■ Symptoms occurs: 1 to 2 weeks after cessation
* Irritability, cannabis cravings, nervousness, anxiety, insomnia, disturbed or vivid
dreaming, decreased appetite, weight loss, depressed mood, restlessness,
headache, chills, stomach pain, sweating, and tremors.
Cannabis Intoxication Delirium
Cannabis- Induced Psychotic Disorder
Cannabis- Induced Anxiety Disorder
Unspecified Cannabis- Related Disorders
Treatment and Rehabilitation:
■ Abstinence – through direct intervention i.e. hospitalization
■ Individual, Family and Group Psychotherapy
■ Antianxiety drug
Hallucinogen- Related Disorder

“Intoxicants”
“LSD and
Phencyclidine”
DISORDERS
Hallucinogen Use Disorder

■ Symptoms
a. dulled thinking
b. decreased reflexes
c. loss memory
d. loss of impulse control
e. depression
f. lethargy
g. impaired concentration
Hallucinogen Intoxication
■ Symptoms:
a. Maladaptive behavior
b. Perceptual changes
c. Physiological signs:
* Pupillary dilation
* Tachycardia
* Sweating
* Palpitations,
* Blurring of vision
* Tremors
* Incoordination
Hallucinogen Persisting Perception
Disorder
■ Flashback = spontaneous, transitory recurrences of the substance-induced experience.
Episodes of:
a. Visual Distortion
b. Geometric hallucinations
c. Hallucinations of sounds or voices
d. False perceptions of movement in peripheral fields
e. Flashes of colors
f. Trails of images from moving objects
g. Positive afterimages and halos
h. Macropsia and micropsia
i. Time expansion
j. Physical symptoms or relived intense emotion
Hallucinogen Intoxication Delirium
Hallucinogen-Induced Psychotic Disorder
Hallucinogen- Induced Mood Disorder
Hallucinogen- Induced Anxiety Disorder
Unspecified Hallucinogen- Related Disorder
Treatment:
■ Pharmacological approaches:
a. Oral administration of Diazepam (Valium)
b. Parenteral dose of Benzodiazepine such as Clonazepam (Klonopin), Valproic Acid
(Depakene) and Carbamazepine (Tegretol)
Inhalant- Related Disorder

“Volatile Substance
or Solvents”
Four Commercial Classes:
■ Solvents for glues and adhesives
■ Propellants (e.g., for Aerosol paint sprays, hair sprays, and shaving cream)
■ Thinners (e.g., for paint products and correction fluids)
■ Fuels (e.g., gasoline, propane)
DISORDERS
Inhalant Use Disorder
Inhalant Intoxication
■ Presence of Maladaptive Behavior
a. apathy
b. diminished social and occupational functioning
c. impaired judgement
d. impulsive and aggressive behavior
■ At least 2 physical symptoms
a. Nausea
b. Anorexia
c. nystagmus
d. depressed reflexes
e. diplopia
Inhalant Intoxication Delirium
Inhalant- Induced Persisting Dementia
Inhalant- Induced Mood Disorder
Inhalant- Induced Anxiety Disorder
Inhalant- Induced Psychotic Disorder
Other Inhalant-Related Disorder
Treatment:

■ Usually requires no medical attention and resolves spontaneously

Opioid- Related Disorder

“Analgesic”

“Heroin”
DISORDERS
Opioid Use Disorder

Opioid Intoxication
Opioid Withdrawal
■ Morphine and Heroin
6 to 8 hours after the last dose
Peak: 2nd or 3rd day
Subsides: next 7 to 10 days, but some symptoms may persist for 6 months or longer
■ Meperidine
Begins quickly
Peak: 8 to 12 hours
Resolves: 4 to 5 days
■ Methadone
1 to 3 days after the last dose
Resolves: 10 to 14 days
Opioid Intoxication Delirium
Opioid- Induced Mood Disorder
Opioid- Induced Sleep Disorder
Opioid- Induced Psychotic Disorder
Opioid- Induced Sexual Dysfunction
Impotence = most common sexual dysfunction

Unspecified Opioid-Related Disorder

Comorbidity:

■ 90% with opioid dependence have an additional psychiatric disorder:

a. Major depressive disorder
b. alcohol use disorder
c. antisocial personality disorder
d. anxiety disorder
Treatment and Rehabilitation:
■ Overdose Treatment
Naloxone =administered intravenously; specific opioid antagonist
■ Opioid Withdrawal
Methadone
Levomethadyl
Buprenorphine
■ Psychotherapy
Sedative-, Hypnotic-, or Anxiolytic- Related
Disorder

“Anxiolytic or
sedative- hypnotic
drugs”
Three Major Groups of Drugs
■ Benzodiazepines
Ex: Diazepam
■ Barbiturates
Ex: Secobarbital (“reds”, “reds devils”, “seggies”, and “downers”
■ Barbiturate- like substances
Ex: Methaqualone = most commonly abused barbiturate-like substance
DISORDERS
Sedative, Hypnotic, or Anxiolytic Use Disorder
Sedative, Hypnotic, or Anxiolytic Intoxication
Sedative, Hypnotic, or Anxiolytic Withdrawal
Other Sedative, Hypnotic, or Anxiolytic Induced
Disorders
■ Delirium
■ Persisting Dementia
■ Persisting Amnestic Disorder
■ Psychotic Disorder

Unspecified Sedative, Hypnotic, or Anxiolytic

Related Disorders
Treatment and Rehabilitation:
■ Withdrawal
a. Carbamazepine
■ Overdose
a. Gastric Lavage = induced vomiting
b. activated charcoal = to delay gastric absorption
c. Careful monitoring of vital signs and CNS
Stimulant- Related Disorder

“Amphetamines
and Cocaine”
Etiology:
■ Genetic Factors
■ Sociocultural Factors
■ Learning and Conditioning
■ Pharmacological Factors
DISORDERS
Stimulant Use Disorder
Stimulant Intoxication
■ Signs and Symptoms:
1. Mydriasis
2. Psychomotor agitation or retardation
3. Tachycardia or bradycardia
4. Perspiration or chills
5. Cardiac arrhythmias or chest pain
6. Elevated or lowered blood pressure
7. Dyskinesias
8. Dystonias
9. Weight loss
10. Nausea or vomiting
11. Muscular weakness
12. Respiratory depression
13. Confusion, seizures, or coma
Stimulant Withdrawal
■ “Crash” =occurs with symptoms of anxiety, tremulousness, dysphoric mood,
lethargy, fatigue, nightmares, headache, profuse sweating, muscle cramps, stomach
cramps, and insatiable hunger.
■ Peak: 2 to 4 days
■ Resolves: 1 week
■ DEPRESSION – most serious withdrawal symptom (suiciadal ideation or behavior)

Stimulant Intoxication Delirium

Stimulant- Induced Psychotic Disorder
Stimulant- Induced Mood Disorder
Stimulant- Induced Anxiety Disorder
Stimulant- Induced Obsessive- Compulsive Disorder
Stimulant- Induced Sexual Dysfunction
Stimulant- Induced Sleep Disorder
 Comorbidity:
■ Most Commonly associated Psychiatric Disorder
1. Major Depressive Disorder
2. Bipolar II Disorder
3. Cyclothymic Disorder
4. Anxiety Disorder
5. Antisocial Personality Disorder
Treatment and Rehabilitation:
■ Psychotherapy
■ Antipsychotic Drugs
■ Relapse Prevention Therapy = to achieve the goal of abstinence
■ Psychosocial Therapies
Tobacco- Related Disorder

“Tobacco”
■ Tobacco does not cause behavioral problems, therefore, few tobacco- dependent
persons seek or are referred for psychiatric treatment.

■ Tobacco is a legal drug and most persons who stop tobacco use have done so
without treatment
DISORDERS
Tobacco Use Disorder
■ Characterized by craving, persistent and recurrent use, tolerance, and withdrawal if
tobacco is stopped.

Tobacco Withdrawal
■ Can develop within 2 hours of smoking the last cigarette
■ Peak: 24 to 48 hours and can last for weeks or months
■ Symptoms: Intense craving for tobacco, tension, irritability, difficulty concentrating,
drowsiness and paradoxical trouble sleeping, decreased heart rate and blood
pressure, increased appetite and weight gain, decreased motor performance, and
increase muscle tension.
Treatment:
■ Psychosocial Therapies
a. Behavior therapy = most widely accepted and well-proved psychological therapy
■ Hypnosis
■ Psychopharmacological Therapies
Anabolic- Androgenic Steroid Abuse

“AAS”
■ Family of hormones that includes testosterone, the natural male hormone with
numerous synthetic analogs of testosterone

■ Anabolic = muscle building

■ Androgenic = masculinizing effects
Etiology:
■ Major reason is to enhance either athletic performance or physical appearance
Diagnosis and Clinical Features

■ Steroids may induce: Euphoria and Hyperactivity

■ However, can become associated with increased anger, arousal, irritability, hostility,
anxiety, somatization, and depression (especially during times when steroids are not
used)
Treatment:

■ Abstinence
Other Substance Use and Addictive
Disorders

“Unknown or
Unspecified
Substance- related
disorders”
■ Gamma- Hydroxybutyrate = neurotransmitter in the brain related to sleep regulation
■ Nitrite inhalants = called “poppers”, amyl, butyl and isobutyl nitrite
■ Nitrous Oxide = commonly known as “Laughing Gas”

Other Substance
■ Nutmeg = can induce depersonalization and derealization
■ Catnip = produce cannabis like intoxication and LSD like intoxication in high dose
■ Betel Nuts = mild euphoria
■ Kava = sedation
■ Over the Counter Drug
■ Ephedra = substance found in herbal tea, acts like epinephrine
■ Chocolate
Treatment:

■ First
Abstinence from the substance
■ Second
Physical, Psychiatric, and psychosocial well- being of the patient
Gambling Disorders

“Persistent and
Recurrent
Maladaptive
Gambling”
Maladaptive Behavior
■ a preoccupation with gambling;
■ the need to gamble with increasing amounts of money to achieve the desired
excitement;
■ repeated unsuccessful efforts to control, cut back, or stop gambling;
■ gambling as a way to escape from problems;
■ gambling to recoup losses;
■ lying to conceal the extent of the involvement with gambling;
■ the commission of illegal acts to finance gambling;
■ jeopardizing or losing personal and vocational relationships because of gambling;
and
■ a reliance on others for money to pay off debts.
Etiology:

■ Psychosocial Factors
■ Biological Factors
Diagnosis and Clinical Features
■ Pathological gamblers often appear overconfident, somewhat abrasive, energetic,
and free spending. They often show obvious signs of personal stress, anxiety, and
depression. They commonly have the attitude that money is both the cause of, and
the solution to all their problems.
Comorbidity:

■ Mood Disorders, especially Major Depression and Bipolarity

■ ADHD
Treatment:
■ Gamblers Anonymous (GA) = founded in LA in 1957
GA is a method of inspirational group therapy that involves public confession, peer
pressure, and the presence of reformed gamblers (as with sponsors in AA) available to
help members resist the impulse to gamble.
THANK YOU!!!!!!