1 Substance-Related and Addictive Disorders - PowerPoint Presentation

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Substance-Related and Addictive Disorders

Substance-related disorders are composed of two groups:

The

substance use disorders (substance addiction) the substance-induced disorders (intoxication, withdrawal, delirium, neurocognitive disorder , psychosis, bipolar disorder, depressive disorder, obsessive-compulsive disorder [OCD], anxiety disorder, sexual dysfunction, and sleep disorders). This part of the lectures we will explain intoxication, and withdrawal. The remaining substance-induced disorders were explained in the previous lectures.

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Classes of Psychoactive Substances

The DSM-5 lists diagnostic criteria for addiction to specific

substances, including

:AlcoholCannabisHallucinogensInhalantsOpioidsSedative/ HypnoticsStimulantsTobacco4

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Substance Addiction

Individuals

are considered to have a substance-use disorder when

use of the substance interferes with their ability to fulfill role obligations.There is an intense craving for the substance.An excessive amount of time is spent trying to procure more of the substance or recover from the effects of its use.Individuals with substance-use disorders often participate in hazardous activities when impaired by the substance, and continue to use the substance despite knowing that its use is contributing to a physical or psychological problem.

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Substance Addiction

Addiction

is evident when

tolerance develops and the amount required to achieve the desired effect continues to increase.Tolerance: The need for larger amounts of the substance to get the same effect. OR A markedly diminished effect with continued use of the same amount of the substance.Addiction may occur with physiological dependence (evidence of tolerance or withdrawal) OR without physiological dependence (no evidence of tolerance or withdrawal).

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Substance-Induced Disorders

-Substance

Intoxication-

Substance intoxication: The development of a reversible syndrome of symptoms following excessive use of a substance. The symptoms are drug-specific, and occur during or shortly after the ingestion of the substance. There is a direct effect on the CNS, and a disruption in physical and psychological functioning occurs. Judgment is disturbed, resulting in inappropriate and maladaptive behavior, and social and occupational functioning are impaired.

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Substance-Induced Disorders

-Substance Withdrawal-

Substance withdrawal: occurs upon abrupt reduction

or discontinuation of a substance that has been used regularly over a prolonged period of time.The substance-specific syndrome includes clinically significant physical signs and symptoms as well as psychological changes, such as disturbances in thinking, feeling, and behavior.8

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Predisposing Factors

Biological Factors: Genetics; Biochemical

Psychological

Factors: Developmental Influences; Personality FactorsSociocultural Factors: Social Learning; Conditioning; Cultural and Ethnic Influences9

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Biological Factors

Genetics

An apparent hereditary factor is involved in

the development of substance-use disorders. This is especially evident with alcoholism, but less so with other substances. BiochemicalA second biological hypothesis relates to the possibility that alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction. These substances are formed by the

reaction of biologically active amines (e.g

., dopamine

, serotonin) with products of

alcohol metabolism

, such as acetaldehyde

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Psychological Factors

Developmental

Influences :

The psychodynamic approach to the etiology of substance abuse focuses on a punitive superegoIndividuals with punitive superegos turn to alcohol to diminish unconscious anxiety and increase feelings of power and self-worth.

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Personality

Factors:

Certain

personality traits have been associated with an increased tendency toward addictive behavior. some clinicians believe a low self-esteem, frequent depression, passivity, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances. This may be explained by the inability of the individual to anticipate the aversive consequences

of his or

her behavior. Achievement of relief

then provides the positive reinforcement

to continue

abusing the substance.

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Sociocultural Factors

Social Learning

The effects of modeling, imitation, and identification on behavior can be observed from early childhood onward.

the family appears to be an important influence. Peers often exert a great deal of influence in the life of the child or adolescent. Modeling may continue to be a factor in the use of substances once the individual enters the work force13

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Conditioning

Another important learning factor is the effect

of the

substance itself. Many substances create a pleasurable experience that encourages the user to repeat it. Cultural and Ethnic InfluencesFactors within an individual’s culture help to establish patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of

the

substance. Incidence

of alcohol addiction among Asians

is relatively

low. This may be a result of a

possible genetic

intolerance of the substance.

.

Unemployment and poverty, and

loss of the

religion that

some believe have led to the increased use

of alcohol

to fill the spiritual gap.

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1. Alcohol Use Disorder

Alcohol is a natural substance formed by the reaction of fermenting

sugar with

yeast spores. Although there are many alcohols, the kind in alcoholic beverages is known scientifically as ethyl alcohol and chemically as C2H5OH. Its abbreviation, ETOH, is sometimes seen in medical records and in various other documents and publications.By strict definition, alcohol is classified as a food because it contains calories; however, it has no nutritional value.Different alcoholic beverages are produced by using different sources of sugar for the fermentation process. For example, beer is made from malted barley, wine from grapes or berries, whiskey from malted grains, and rum from molasses. Distilled beverages (e.g., whiskey, scotch, gin, vodka,

and other

“hard” liquors) derive their name from further concentration of

the alcohol

through a process called distillation.

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Patterns of Alcohol Use

Phase

I. The Pre-alcoholic Phase

Phase II. The Early Alcoholic PhasePhase III. The Crucial PhasePhase IV. The Chronic Phase16

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Phase I. The Pre-alcoholic Phase

This

phase is characterized by the use of alcohol to relieve

the everyday stress and tensions of life. As a child, the individual may have observed parents or other adults drinking alcohol and enjoying the effects. The child learns that use of alcohol is an acceptable method of coping with stress. Tolerance develops, and the amount required to achieve the desired effect increases steadily.17

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Phase II. The Early Alcoholic Phase

This phase begins with

blackouts (brief periods of amnesia that occur during or immediately following a period of drinking. Is an early sign of alcoholism).Now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is required by the individual.Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts.The individual feels enormous guilt and becomes very

defensive about

his or her drinking. Excessive use of denial

and rationalization

is evident.

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Phase III. The Crucial Phase

In this phase, the individual has lost control, and physiological

addiction is clearly evident.This loss of control has been described as the inability to choose whether or not to drink. Binge drinking, lasting from a few hours to several weeks, is common. These episodes are characterized by sickness, loss of consciousness, squalor, and degradation. In this phase, the individual is extremely ill. Anger and aggression are common manifestations.Drinking is the total focus, and he or she is willing to risk losing everything that was once important, in an effort to maintain the addiction.By

this phase of the illness, it is common for the individual to

have experienced

the loss of job, marriage, family, friends, and most

especially, self-respect

.

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Phase IV. The Chronic Phase

This

phase is characterized by emotional and physical

disintegration.The individual is usually intoxicated more than he or she is sober.Emotional disintegration is evidenced by profound helplessness and self-pity.Impairment in reality testing may result in psychosis.Abstention (stopping) from alcohol results in a terrifying syndrome of symptoms that include hallucinations, tremors, convulsions, severe agitation, and panic. Depression and ideas of suicide are not uncommon

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Alcohol Use DisorderEffects on the Body

About

20% of a single dose of alcohol is absorbed directly

and immediately into the bloodstream through the stomach wall.Unlike other “foods,” it does not have to be digested. The blood carries it directly to the brain where the alcohol acts on the brain’s central control areas, slowing down or depressing brain activity.Only moments after alcohol is consumed, it can be found in all tissues, organs, and secretions of the body.

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Alcohol Use Disorder

Effects on the Body: Peripheral Neuropathy

Peripheral

Neuropathy: Peripheral nerve damage, results in pain, burning, tingling, or prickly sensations of the extremities. Researchers believe it is the direct result of deficiencies in the B vitamins, particularly thiamine. Nutritional deficiencies are common in chronic alcoholics because of insufficient intake of nutrients as well as the toxic effect of alcohol that results in malabsorption of nutrients.The process is reversible with abstinence from alcohol and restoration of nutritional deficiencies. Otherwise, permanent muscle wasting and paralysis can occur.

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Alcohol Use Disorder

Effects on the Body: Alcoholic Myopathy

Alcoholic

Myopathy: may occur as an acute or chronic condition. In the acute condition, the individual experiences a sudden onset of muscle pain, swelling, and weakness; a reddish tinge in the urine caused by myoglobin, a breakdown product of muscle excreted in the urine; and a rapid rise in muscle enzymes in the blood.Muscle symptoms are usually generalized, but pain and swelling may selectively involve the calves or other muscle groups.Include a gradual wasting and weakness in skeletal muscles. Neither the pain and tenderness nor the elevated muscle enzymes seen in acute myopathy are evident in the chronic condition.Thought

to be a result of the same B vitamin deficiency that contributes to

peripheral neuropathy

. Improvement is observed with abstinence from alcohol and the return to

a nutritious

diet with vitamin supplements.

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Alcohol

Use

Disorder Effects

on the BodyWernicke’s Encephalopathy: represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue.Korsakoff’s Psychosis: a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke’s encephalopathy. Treatment is with

parenteral or

oral thiamine replacement.

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Alcohol

Use

Disorder Effects

on the BodyAlcoholic CardiomyopathyEsophagitis; GastritisPancreatitis (Acute pancreatitis usually occurs 1 or 2 days after a binge of excessive alcohol consumption)Alcoholic HepatitisCirrhosis of the Liver (end-stage of alcoholic liver disease, is a widespread destruction of liver cells, which are replaced by fibrous or scar tissue). Complications

include

Portal hypertension; Ascites;

Esophageal

varices;

&

Hepatic

encephalopathy)

Leukopenia

and Thrombocytopenia

Sexual

Dysfunction

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Alcohol

Use

Disorder Use

During PregnancyFetal Alcohol Syndrome: Prenatal exposure to alcohol can result in a broad range of disorders to the fetus, known as fetal alcohol spectrum disorders (FASDs), the most common of which is fetal alcohol syndrome (FAS).Fetal alcohol syndrome includes physical, mental, behavioral, and/or learning disabilities with lifelong implications.No amount of alcohol during pregnancy is considered safe, and alcohol can damage a

fetus at

any stage of pregnancy. Therefore, drinking alcohol should be avoided by women

who are

pregnant or by women who could become pregnant.

Children

with FAS may have the following characteristics: ■ Abnormal facial features (

see next

slide) ■ Small head size ■ Shorter-than-average height ■ Low body weight ■

Poor coordination

■ Hyperactive behavior ■ Difficulty paying attention ■ Poor memory

■ Learning

disabilities ■ Speech and language delays ■ Intellectual disability or low IQ ■

Poor reasoning

and judgment skills ■ Sleep and sucking problems as a baby ■ Vision or

hearing problems

■ Problems with the heart, kidneys, or bones.

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Alcohol

Intoxication and Alcohol Withdrawal

Alcohol

Intoxication: Symptoms of alcohol intoxication include disinhibition of aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. Intoxication usually occurs at blood alcohol levels between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/

dL

.

Alcohol

Withdrawal

: Within 4 to 12 hours of cessation of, or reduction in,

heavy and

prolonged alcohol use, the following symptoms may appear: coarse tremor

of hands

, tongue, or eyelids; nausea or vomiting; malaise or weakness;

tachycardia; sweating

; elevated blood pressure; anxiety; depressed mood or

irritability; transient

hallucinations or illusions; headache; and insomnia. A

complicated withdrawal

syndrome may progress to

alcohol withdrawal delirium.

Onset

of delirium

is usually on the second or third day following cessation of or reduction

in prolonged

, heavy alcohol use.

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Counseling

Counseling on a one-to-one basis is often used

to help

the client who abuses substances. The relationship is goal-directed, and the length of the counseling may vary from weeks to years. The focus is on current reality, development of a working treatment relationship, and strengthening ego assets. The counselor must be warm, kind, and nonjudgmental, yet able to set limits firmly. In addition

to technical counseling skills, many

important therapeutic

qualities affect the outcome

of counseling

, including insight, respect,

genuineness, concreteness

, and

empathy.

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Counseling

Counseling of the client who abuses

substances passes

through various phases, each of which is of unspecified length. In the first phase, an assessment is conducted. the working phase of the relationship, the counselor assists the individual to work on acceptance of the fact that the use of substances causes problems in significant life areas and that he or she is not able to prevent it from

occurring

.

The

strength of the denial system is

determined by

the duration and extent of

substance related adverse

effects in the person’s life

.

Once the problem has been identified and sobriety is achieved, the client must have a concrete and workable plan for getting through the early weeks of abstinence

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Counseling

often includes the family or specific family members.

Referrals are often made to self-help groups.

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Group

Therapy

Group

therapy with substance abusers has long been regarded as a powerful agent of change. In groups, individuals are able to share their experiences with others who are going through similar problems. They are able to “see themselves in others,” and confront their defenses about giving up the substance. Some groups may be task-oriented education groups in which the leader is charged with presenting material

associated with substance

abuse and

its various effects on the person’s life.

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Self-help groups

The self-help

groups are

based on the concept of peer support acceptance and understanding from others who have experienced the same problems in their lives. The only requirement for membership is a desire on the part of the alcoholic person to stop drinking. (“AA” Alcoholics Anonymous is a major self-help organization for the treatment of alcoholism in United states).40

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The sole purpose of AA is to help members

stay sober

. When sobriety has been achieved, they

in turn are expected to help other alcoholic persons. The Twelve Steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety.AA accepts alcoholism as an illness and promotes total abstinence as the only cure, emphasizing that the alcoholic person can never safely return to social drinking. They encourage the members to seek sobriety, taking one day at a time. The Twelve Traditions

are the statements

of principles

that govern the organization

.

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Relapse prevention

Alcohol relapse is common among recovering alcoholics; however, preventative measures can greatly reduce the risk of relapse.

Common triggers of relapse among 

recovering alcoholics include:- Exposure to small amounts of alcohol.- Environmental triggers.- Stress. It is impossible to avoid all temptations and triggers, so recovery must include steps that will help them make the right decision when faced with a potential trigger.Relapse prevention measures for recovering alcoholics can include support groups, therapy, and medication.AA encourages members to follow or work with their 12-step program. These 12 steps are a list of suggested ideas and actions to help recovering alcoholics mend their lives and stay sober.

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2. Sedative, Hypnotic, or Anxiolytic Use Disorder

The sedative, hypnotic, and anxiolytic

are drugs capable

of inducing varying degrees of CNS depression, from tranquilizing relief of anxiety to anesthesia, coma, and even death.44

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2. Sedative, Hypnotic, or Anxiolytic Use Disorder

They are generally categorized as (1) barbiturates, (2)

nonbarbiturate

hypnotics, and (3) antianxiety agents. Originally prescribed to treat anxiety and insomnia.Intoxication: clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, use of one of these substances. Maladaptive changes may include inappropriate sexual or aggressive behavior, mood liability, impaired judgment, or impaired social or occupational functioning.45

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Withdrawal: Onset of the symptoms depends on the drug type. With short-acting sedative-hypnotics (e.g., alprazolam,

lorazepam

), symptoms may begin between 12 and 24 hours after the last dose, while longer half-lives (e.g., diazepam, phenobarbital,

chlordiazepoxide) may begin within 2 to 7 days, Withdrawal symptoms include autonomic hyperactivity (e.g,sweating or pulse rate greater than 100), increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, or grand mal seizures.46

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3. Stimulant Use Disorder

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The psychomotor stimulants induce stimulation by augmentation

or potentiation of the neurotransmitters norepinephrine, epinephrine, or dopamine. The general cellular stimulants (caffeine and nicotine) exert their action directly on cellular activity.Caffeine inhibits the enzyme phosphodiesterase, allowing increased levels of adenosine 3´,5´-cyclic phosphate (cAMP), a chemical substance that promotes increased rates of cellular metabolism. Nicotine stimulates ganglionic

synapses. This results in increased acetylcholine,

which stimulates

nerve impulse transmission to the entire autonomic

nervous system

.

When

used in moderation, these stimulants tend to increase alertness.

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Cocaine

is the most potent stimulant derived from nature. It is

extracted from

the leaves of the coca plant, which has been cultivated in South America. The coca leaves must be mixed with lime to release the cocaine alkaloid.The chemical formula for the pure form of the drug was developed in 1960. Physicians began using the drug as an anesthetic in eye, nose, and throat surgeries.It is illegally distributed as a white crystalline powder, often mixed with other ingredients to increase its volume and, therefore, create more profits. The drug is most commonly “snorted,” and chronic users may manifest symptoms

that resemble the congested nose of a common cold.

The intensely

pleasurable effects of the drug create the potential

for extraordinary

psychological addiction.

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Amphetamine

prescribed only to treat narcolepsy (a rare disorder resulting in

an uncontrollable

desire for sleep), hyperactivity disorders in children, and in certain cases of obesity. No specific medications have been found helpful in treatment.Because of their pleasurable effects, CNS stimulants have a high abuse potential.Many individuals who abuse or are addicted to CNS stimulants began using the substance for the appetite-suppressant effect in an attempt at weight control. Higher and higher doses are consumed in an effort to maintain the pleasurable effects.With continued use, the pleasurable effects diminish. However, there is a persistent craving for the substance, however, even in the face of unpleasant adverse

effects from the continued drug taking.

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Stimulant Intoxication:

produces

maladaptive behavioral and

psychological changes that develop during, or shortly after, use of these drugs.50

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Amphetamine and cocaine intoxication typically produce euphoria or affective blunting; changes in sociability;

hypervigilance

; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; or impaired

judgment.51

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Physical effects include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain,

cardiac

arrhythmias, confusion, seizures, dyskinesias, dystonias, or coma.52

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Intoxication from caffeine usually occurs following consumption in excess of 250 mg. Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation.

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Stimulant Withdrawal:

Cessation

or reduction of amphetamine (

or cocaine) use may lead to a withdrawal syndrome often referred to as a “crash.” Symptoms include fatigue and depression, nightmares, headache, profuse sweating, muscle cramps, and hunger. Withdrawal symptoms usually peak in 2–4 days. Intense dysphoria can occur, peaking between 48 and 72 hours after the last dose of the stimulant.54

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Withdrawal from nicotine results in dysphoric or depressed mood

; insomnia

;

irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain.55

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Treatment

of stimulant intoxication usually begins with minor

tranquilizers such

as chlordiazepoxide and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be administered with caution because of their propensity to lower seizure threshold. Repeated seizures are treated with intravenous diazepam.56

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Withdrawal treatment is usually aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as is needed or desired. Suicide precautions may need to be instituted. Antidepressant therapy may be helpful in treating symptoms of depression.

Desipramine

has been specially successful with symptoms of cocaine withdrawal and abstinence.

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. Inhalant Use Disorder

Inhalant disorders are induced by inhaling

the aliphatic and aromatic hydrocarbons found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners. Specific examples of these substances include gasoline, varnish remover, lighter fluid, airplane glue, rubber cement, cleaning fluid, spray paint, shoe conditioner, and typewriter correction fluid.Inhalant substances are readily available, legal, and inexpensive. These three factors make inhalants the drug of choice among poor people and among

children and

young adults.

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. Inhalant Use Disorder

Methods of use include “huffing”—a

procedure in which a rag soaked with the substance is applied to the mouth and nose and the vapors breathed in.Another common method is called “bagging,” in which the substance is placed in a paper or plastic bag and inhaled from the bag by the user. The substancemay also be inhaled directly from the container or sprayed in the mouth or nose.60

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. Inhalant Use Disorder

Tolerance to inhalants has been reported

with heavy use. A mild withdrawal syndrome has been documented but does not appear to be clinically significant. Among children with inhalant disorder, the products may be used several times a week, often on weekends and after school. Adults with inhalant addiction may use the substance at varying times during each day, or they may binge on the substance during a period of several days.

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4. Inhalant Use Disorder

Inhalants

are absorbed through the lungs and reach the CNS very rapidly.

Inhalants can cause both central and peripheral nervous system damage. Neurological damage, such as ataxia, peripheral and sensorimotor neuropathy, speech problems, and tremor, can occur.Respiratory effects of inhalant use range from coughing and wheezing to dyspnea, emphysema, and pneumonia.Abdominal pain, nausea, and vomiting may occur. A rash may be present around the individual’s nose and mouth.Acute and chronic renal failure and hepatorenal syndrome have

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4

. Inhalant Use Disorder

Inhalant

Intoxication: clinically significant problematic behavioral or psychological changes that developed during or shortly after exposure to inhalants.Symptoms are similar to alcohol intoxication and may include the following: - Dizziness; Ataxia; Euphoria; Disinhibition; Slurred speech; Blurred vision; Hypoactive reflexes; Psychomotor retardation; Lethargy; Generalized muscle weakness; Stupor or coma.

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5. Opioids Use Disorder

Opioids

exert both a sedative and an analgesic effect, and their

major medical uses are for the relief of pain, the treatment of diarrhea, and the relief of coughing. These drugs have addictive qualities; that is, they are capable of inducing tolerance and physiological and psychological addiction.Opioid abusers usually spend much of their time nourishing their habit. Individuals who are addicted to opioids are seldom able to hold a steady job that will support their need. They must therefore secure funds from friends, relatives, or whoever. It is not uncommon for individuals who are addicted to opioids to resort to illegal means of obtaining funds, such as burglary, robbery, prostitution, or selling drugs.

Methods

of administration of opioid drugs include oral, snorting,

or smoking

, and by subcutaneous, intramuscular, and intravenous injection.

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5. Opioids Use Disorder

The

development of opioid addiction may follow one of two typical behavior patterns:The first occurs in the individual who has obtained the drug by prescription from a physician for the relief of a medical problem. Abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment.The second pattern of behavior associated with addiction to opioids occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. Opioids may be used alone to induce the euphoric effects or in combination with stimulants or

other drugs

to enhance the euphoria or to counteract the depressant effects

of the

opioid.

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5. Opioids Use Disorder

Opiates

are sometimes classified as narcotic analgesics. They exert their

major effects primarily on the CNS, the eyes, and the GI tract.Opioid Intoxication: Symptoms include initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Physical symptoms include pupillary constriction (or dilation due to anoxia from severe overdose), drowsiness, slurred speech, and impairment in attention or memory. Severe opioid intoxication can lead to respiratory depression, coma, and death. 67

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Opioid Withdrawal: Symptoms include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, diarrhea, yawning, fever, and insomnia.

With

short-acting drugs, such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days (Walton-Moss et al, 2010).

With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days. Withdrawal from the ultrashort-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 days68

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6. Hallucinogen Use Disorder

Hallucinogenic

substances are capable of distorting an individual’s perception

of reality.The hallucinations experienced by an individual with schizophrenia, however, are most often auditory, whereas substance-induced hallucinations are usually visualRecurrent use can produce tolerance, encouraging users to resort to higher and higher dosages.Hallucinogens are highly unpredictable in the effects they may induce each time they are used.Most common: Lysergic acid diethylamide (LSD) and Phencyclidine (PCP).Tolerance develop quickly and to a high degree. Recovery from the tolerance

also occurs

very rapidly.

The

effects of hallucinogens are not always pleasurable for the user.

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6. Hallucinogen Use Disorder

Effects

on the Body: Physiological Effects

o Nausea and vomiting; Chills; Pupil dilation; Increased pulse, blood pressure, and temperature; Mild dizziness; Trembling; Loss of appetite; Insomnia; Sweating; A slowing of respirations; Elevation in blood sugar.Effects on the Body: Psychological Effectso Heightened response to color, texture, and sounds; Heightened body awareness; Distortion of vision; Sense of slowing of time; All feelings magnified: love, lust, hate, joy, anger, pain, terror, despair; Fear of losing control; Paranoia, panic; Euphoria; Projection of self into dreamlike images; Serenity, peace; Depersonalization; Derealization; Increased libido.

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Intoxication

: Maladaptive behavioral or psychological changes include

marked anxiety

or depression, ideas of reference, fear of losing one’s mind, paranoid ideation, and impaired judgment. Perceptual changes occur while the individual is fully awake and alert and include intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. Because hallucinogens are sympathomimetics, they can cause tachycardia, hypertension, sweating, blurred vision, papillary dilation, and tremors. Benzodiazepines (e.g., diazepam or chlordiazepoxide) may be prescribed to

prevent harm

to the client or others. Psychotic reactions may be treated with

antipsychotic medications

.

No

evidence of physical addiction is detectable when the drug is

withdrawn; however

, recurrent use appears to induce a psychological addiction, which

varies according

to the drug, the dose, and the individual user, and the environment

in which

the substance is used.

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. Cannabis Use Disorder

Occurs

naturally in the plant Cannabis sativa, which grows readily in warm climates. Marijuana, the most prevalent type of cannabis preparation, is composed of the dried leaves, stems, and flowers of the plant. Hashish is a more potent concentrate of the resin derived from the flowering tops of the plant. Hash is very concentrated made by boiling hashish in a solvent and filtering out the solid matter.Many people incorrectly regard cannabis as a substance of low abuse potential.Intoxication: Symptoms include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, and social withdrawal. Physical

symptoms include

conjunctival

injection, increased appetite, dry mouth, and tachycardia.

Withdrawal

: Symptoms are heavy and prolonged. Include: Irritability, anger, or

aggression; Nervousness

or anxiety; Sleep difficulty; Decreased appetite or weight loss;

Restlessness; Depressed

mood; Physical symptoms, such as abdominal pain, tremors, sweating,

fever, chills

, or headache.

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Dual

Diagnosis

If

it is determined that the client has a coexisting substance disorder and mental illness, he or she may be assigned to a special program that targets both problems.Counseling for the mentally ill person who abuses substances takes a different approach than that which is directed at individuals who abuse substances but are not mentally ill.Many counselors use direct confrontation of the substance-use behaviors. But with dual diagnosis programs take a more supportive and less confrontational approach.

Severe

psychiatric disorders often preclude full treatment in substance abuse clinics or

self

-

help

groups

. The addition of other [psychiatric] disorders to a substance use

disorder

greatly

complicates diagnosis and makes treatment more difficult.

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Implementation with clients who abuse

substances

is a long-term process, often beginning with detoxification and progressing to total abstinence. The following common major treatment objectives have been identified for clients with substance use disorders. Detoxification: Provide

a safe and supportive environment

for

the

detoxification process.

■ Administer substitution therapy as ordered.

Intermediate Care

■ Provide explanations of physical symptoms.

■ Promote understanding and identify the

causes

substance addiction.

■ Provide education and assistance in course

of

treatment

to client and family.

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Rehabilitation

■ Encourage continued participation in

long-term

treatment.■ Promote participation in out-patient support system (e.g., AA).■ Assist client to identify alternative sources of satisfaction.■ Provide support for health promotion and maintenance

.

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