0. Substance –Related Disorders
Chapter 28
Substance –Related Disorders

1. Terms Related to Substance Abuse
Substance: A drug of abuse, a medication, or a toxin
Substance use: Ingestion of any chemical that affects the body
Abused substances: Chemicals that alter perception
Abuse: Use of substance to excess as determined by acting on CNS

2. Terms Related to Substance Abuse
Habituation: Dependency on a substance to provide pleasure or relief
Substance dependency: Need to take a “usual dose” to prevent the onset of withdrawal signs and symptoms
Addiction: Physical dependency on a substance

3. Substance Use and Age Pregnancy
An estimated 20% of pregnant women still use alcohol during pregnancy.
No drugs are safe for pregnant women.
Infancy
Exposure to cocaine in utero causes sleeping and eating disorders, unusual irritability and a high-pitched cry.
Other syndromes and developmental problems result from exposure to other drugs in utero.

4. Substance Use and Age Childhood Adolescence
Substance-abusing parents place children at an increased risk for injuries and developing drug problems themselves.
Children abuse substances too, but often the substances that are legal and easily available.
Adolescence
Alcohol is most frequently abused drug
Patterns of substance abuse vary.
Drugs are used in a recreational way, in social settings to induce relaxation or intoxication.

5. Substance Use and Age Adulthood Late adulthood
About 10% of population regularly abuse alcohol.
Substance use and abuse most common between ages 18 and 35 years.
Late adulthood
Significant numbers of older adults abuse alcohol and prescription medications.
Often feel isolated within social groups or families
More than 40% of all drug reactions occur in persons older than 65 as a result of the number of medications being taken.

6. Categories of Substance Abuse
Depressants
Alcohol
Narcotics
Heroin
Stimulants
Caffeine
Amphetamines
Hallucinogens
Lysergic acid diethylamide (LSD)
Phencyclidine (PCP)
Designer drugs
Ecstasy

7. Inhalants
Inhalants: Volatile substances or chemical gases that produce a “high”; they are popular with adolescents and young adults
They are legal.
They are inexpensive.
They are easily available.
Effects have rapid onset.
Dangers include sudden death due to cardiac dysrhythmia or respiratory depression.

8. Stages of Addiction Early stage
Individuals use and enjoy chosen substance
Desire to repeat pleasurable experience leads to frequent use
Being “high” becomes preferable to other activities
As excessive use becomes a habit, individual begins to ignore responsibilities and obligations
Individual may deny that a problem exists
Individual may become intoxicated

9. Stages of Addiction Intoxicating episodes increase in frequency.
Middle stage
Intoxicating episodes increase in frequency.
Tolerance develops: increasingly greater amounts of chemical needed to produce effect that one dose once produced.
Physical tolerance occurs when body has adjusted to living and functioning with the substance in the system.
Psychological tolerance develops when individual feels unable to function without the chosen chemical.

10. Stages of Addiction Late stage
Tolerance for chemical usually quite high
Need for substance leads to loss of control over behavior
Without the chemical, life is miserable
Daily living is a nightmare; every waking effort and energy focuses on obtaining and using addictive substance.

11. Criteria for Diagnosis of Substance Abuse
Pattern of substance use must be disabling and lead to significantly impaired functioning and distress.
Individual must demonstrate signs of tolerance, withdrawal, and dependency.
There is no classic clinical presentation of a substance abuser.
Each abuser has a unique variety of signs and symptoms, depending on chemical use and personal characteristics.

12. Treatment and Therapies
The disease model of treatment states that it is a disease and should be treated as such.
A 12-step program
Residential treatment program
The medical model addresses addictions from public health, and chronic and acute infectious disease perspectives.
The biopsychosocial framework for treating clients is a medical model that attempts to explain the problem.

13. Treatment and Therapies
Psychiatric models view substance abuse as an expression of an underlying emotional conflict or mental disorder.
Sociocultural models state that substance abuse can be treated by changing abuser’s environment and teaching them how to develop new responses to current environment.

14. Treatment and Therapies
First goal of treatment: abuser must recognize need for help
Client may have to go through detoxification—the process of withdrawing from a substance under medical supervision.
Uncover and treat existing emotional or mental health problems.
Assist abuser in changing behavior