Substance-related disorders

The substance-related disorders include disorders of intoxication, dependence, and withdrawal. Substance dependence or addiction can be viewed as a chronic illness that can be successfully controlled with treatment, but cannot be cured, and is associated with a high relapse rate. 

Addiaion A primary chronic neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following 5Cs chronicity, impaired control over drug use, compulsive use, continued use despite harm, and craving. 

Intoxication Development of a substance-specific syndrome after recent ingestion and presence in the body of a substance, and it is associated with maladaptive behavior during the waking state caused by the effect of the substance on the CNS. 

Physical dependence A state of adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. 

Substance abuse A maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance. Substance dependence The characteristic feature is a continued maladaptive pattern of substance use in spite of repeated adverse consequences related to the repeated use. 

Substance abuse and related disorders represent a major problem area facing the clinician. Despite the war on drugs they continue to be a widespread problem. At least 5 percent of Americans are alcoholic, and stimulant abuse is a serious problem among teenagers and young adults. Any solution to these problems will undoubtedly involve social and political factors in addition to clinical programs. This chapter focuses on the differing types of clinical syndromes related to each commonly abused substance and medications that may be useful as an adjunct to treatment. 

Alcoholism plays a major role in the following causes of death accidents, homicide, suicide, and alcoholic cirrhosis. 

One million Americans are reported to be addicted to cocaine, and over five million use cocaine regularly. 

Billions of dollars are spent annually on the treatment and prosecution of drug users. 

30 to 50 percent of those in mental health treatment have a significant substance-abuse disorder. 

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Anxiety disorders and insomnia represent relatively common medical problems within the general population. These problems typically recur over a person s lifetime (3,4). Epidemiological studies in the United States indicate that the lifetime prevalence for significant anxiety disorders is about 15%. Anxiety disorders are serious medical problems affecting not only quaUty of life, but additionally may indirecdy result in considerable morbidity owing to association with depression, cardiovascular disease, suicidal behavior, and substance-related disorders. 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Chap. 33 - Substance-Related Disorders Universal Program Number 014-999-07-049-H04... 

DNLM 1. Substance-Related Disorders--physiopathology. 2. Brain-drug effects. 3. Neurotoxicity Syndromes—etiology. 4. Substance-Related Disorders—complications. WM 270 N4943 2007] I. Title. 

Netrakom P, Krasuski JS, Miller NS and O Tauma NA (1999). Structural and functional neuroimaging findings in substance-related disorders. Psychiatric Clinics of North America, 22, 313-329. 

Substance-Related Disorders CHAPTER 73 PHENCYCLIDINE AND KETAMINE... 

See Chap. 68, Substance-Related Disorders Overview and Depressants, Stimulants, and Hallucinogens, authored by Paul L. Doering and Lisa Boothby, and Chap. 69, Substance-Related Disorders Alcohol, Nicotine, and Caffeine, authored by Paul L. Doering, W. Klugh Kennedy, and Lisa A. Boothby, for a more detailed discussion of the topic. 

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR American Psychiatric Association, 2000) specifies that the symptoms of substance-related disorders may include tolerance withdrawal loss of control unsuccessful efforts to cut down or quit a great deal of time committed to finding, using, or recovering from using substances impairment in specific areas of one s life and continued use in spite of negative consequences. To meet criteria for dependence, the individual must have three or more of these... 

In DSM-IV parlance, psychiatric illnesses that result from substance use are called substance-related disorders. Within this broad spectrum are two distinct categories substance use disorders and snbstance-induced disorders. The substance use disorders consist of abusive patterns of nse that produce a myriad of problems in relationships, employment, medical or physical well-being, and legal matters. There is no predefined amount or frequency of substance use that defines these disorders instead, they are diagnosed when the consequences of substance use include an adverse impact on other areas of life. As noted earlier, in some instances, substance nse disorders lead to physical dependence that is manifested by tolerance and the potential for withdrawal symptoms. When anyone talks about addiction, it is typically snbstance nse disorders to which they refer. 

Comorbid dysthymia and substance disorder. A total of 642 patients were assessed. Thirty-nine had substance-related disorder and dysthymia (SRD-dysthymia) and 308 had SRD only. Data on past use were collected by a research associate using a questionnaire. The patients with SRD-dysthymia and SRD did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter use careers of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis... 

The National Library of Medicine. DSM-IV Criteria for Substance-Related Disorders. Available online. URL http //www.ncbi.nlm.nih.gov/ entrez/query.fcgi cmd=Search db=books doptcmdl=GenBookHL8rterm= DSM-IV+Criteria+for+Substance-... 

Doering, P. L. Substance-Related Disorders Overview and Depressants, Simulants and Hallucinogen. Pharmacotherapy A Pathophysiologic Approach. 4th ed. Stamford, Conn. Appleton and Lange, 1999. 

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