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Substance-Related Disorders

Madiha Anas

Institute of Psychology

Beaconhouse National University

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To many people, the word drug has connotations of danger, yet most of us use some form of

Psychoactive drugPsychoactive drug a drug that alters one’s psychological state. Painkillers: Aspirin etc.

SubstanceSubstance is a chemical that alters a person’s mood or behavior when

it is smoked, injected, drunk, inhaled, snorted or swallowed in form of a pill.

Substance related disordersSubstance related disorders are disorders of intoxication, dependence, abuse and

substance withdrawal caused by various substances

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Substance Abuse vs. Substance Dependence

SUBSTANCE DEPENDENCE Tolerance Withdrawal Taken in larger amts or over longer periods of time than intended Desire to cut down / Unsuccessful attempts Great deal of time is spent obtaining Activities are given up

SUBSTANCE ABUSE Recurrent use resulting in failure to meet obligations Recurrent use in hazardous situations Recurrent use-related legal problems Cont. use despite impact on social situation (e.g., family)

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Substance Intoxication vs. Substance Withdrawal

Substance Intoxication: temporary maladaptive experience of behavioral or

psychological changes due to the accumulation of the substance in the body.

Substance Withdrawal: A person in the state of substance withdrawal

experiences significant distress or impairment at home, at work, or in other important life contexts.

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Substance Tolerance

The dependent user desires the substance ("craving") and needs more of the substance to achieve the effect that a lesser amount of the substance induced in the past.

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Main Categories of Substances1. Depressants –

1. Result in behavioral sedation

2. (e.g., alcohol, sedative, anxiolytic drugs)

2. Stimulants – 1. Increase alertness and elevate mood

2. (e.g., cocaine, nicotine, caffeine)

3. Opiates – 1. Primarily produce analgesia and euphoria

2. (e.g., heroin, morphine)

4. Hallucinogens –1. Alter sensory perception

2. (e.g., marijuana, LSD)

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1. Depressants

Alcohol

Sedatives

Hypnotics

Anxiolytics

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Alcohol-related disorders

groups of disorders that can result in persons who are long-term users of alcohol.

can affect metabolism, gastrointestinal tract, nervous system, bone marrow (the matter in bones) can cause endocrine (hormone) problems. can result in nutritional deficiencies.

People with anxiety, depression, or bipolar disorder may consume alcohol for temporary relief from their symptoms.

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Sedatives, Hypnotics, or Anxiolytics

The Nature of Drugs in This Class Sedatives – Calming Hypnotics – Sleep inducing (e.g., barbiturates) Anxiolytics – anti-Anxiety(e.g benzodiazepines)

Effects of Such Drugs Are Similar to Large Doses of Alcohol

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Sedatives

Sedatives are compounds that cause physiological and mental slowing of the body.

They have many legitimate medical uses. However, people who use them improperly may

develop symptoms of abuse, dependence, and withdrawal.

Sedatives are often referred to as tranquilizers Other classes of compounds, produce effects and

disorders similar to those of sedatives sleep-promoting drugs (hypnotics) anti-anxiety (anxiolytic) drugs

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Sedatives

The most widely prescribed and best-studied sedatives belong to a group called benzodiazepines.

Prescription benzodiazepines and their relatives include Alprazolam (Xanax) Diazepam (Valium)

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How Depressants work

These drugs work in the brain by increasing the amount of the neurotransmitter gamma-aminobutyric acid (GABA).

Neurotransmitters help to regulate the speed at which nerve impulses travel.

When the amount of GABA increases, the speed of nerve transmissions decreases.

Thus these drugs depress the nervous system and cause reduced pain, sleepiness, reduced anxiety, and muscle relaxation.

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2. Stimulants

Amphetamine

Cocaine

Nicotine

Caffeine

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Stimulants

Most widely consumed drug in the United States

Such drugs increase

Alertness

energy

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Amphetamines

Effects of Amphetamines Produce elation, vigor, reduce fatigue

Such effects are followed by a “crash” (e.g., feeling depressed and tired)

DSM-IV Criteria for Amphetamine Intoxication Psychological symptoms

Physiological symptoms

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Amphetamines were initially produced for medical use, and were first

used in nasal decongestants and bronchial inhalers. Early in the 1900s, they were also used to treat

several psychiatric conditions attention-deficit disorders, Obesity depression.

They are still used to treat these disorders today. some over-the-counter drugs used as appetite

suppressants also have amphetamine-like action Affects Dopamine in the mesolibmic system of brain

which affects reward and desire

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Case Example:Amphetamine Catherine is a 23 years old salesperson who tried for three years

to lose weight. Her physician prescribed amphetamines but cautioned her about the possibility that she might become dependent on them. She did begin to lose weight, but she also discovered that she liked the extra energy and good feelings caused by the diet pills. When Catherine returned to her doctor after having lost the desired weight, she asked him for a refill of her prescription to help her maintain her new figure. When he refused, Catherine asked around among her friends until she found the name of a physician who was willing to accommodate her wishes for ongoing refills of the prescription. Over the course of a year, Catherine has developed a number of psychological problems, including depression, paranoid thinking, and irritability. Despite the fact that she realizes that something is wrong, she feels driven to continue using the drug.

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Cocaine

Effects of Cocaine Produce short lived sensations of elation,

vigor, reduce fatigue

Cocaine use in the United States has declined over the last decade

Cocaine is highly addictive, but addiction develops slowly

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Cocaine extracted from the coca plant, which grows in Central and South

America. Cocaine is dangerously addictive, and users of the drug experience

a "high"— a feeling of euphoria or intense happiness, along with

hyper-vigilance, increased sensitivity, irritability or anger, impaired judgment, and anxiety.

a whitish crystalline powder : most common form In powder form, it is most commonly inhaled or "snorted.“ It may also be dissolved in water and injected. Crack

form of cocaine that can be smoked produces an immediate, more intense, and more short-lived high.

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Nicotine

Effects of Nicotine Stimulates the central nervous system

Results in sensations of relaxation, wellness, pleasure

Nicotine is highly addictive

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Nicotine disorders

are caused by the main psychoactive ingredient in tobacco.

Nicotine is a physically and psychologically addictive drug.

most influential dependence producing drug worldwide

can be absorbed through the skin, the lining of the mouth and nose, and the moist tissues lining the lungs.

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Caffeine

Effects of Caffeine – The “Gentle” Stimulant Used by over 90% of Americans

Found in tea, coffee, cola drinks, and cocoa products

Small doses elevate mood and reduce fatigue

Regular use can result in tolerance and dependence

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Caffeine

can be consumed from a number of different sources, including coffee, tea, caffeinated soda, weight loss aids.

Even half a cup of coffee can bring about slight improvements in the mood, alertness and clarity of thought.

If people know that caffeine has psychological effects then why they consume it regularly? To avoid the unpleasant withdrawal symptoms i.e.,

headache, decreased arousal, fatigue, anxiety, nausea, muscle tension and irritability.

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NEXT CLASS

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Opiates/Opioids

Heroin

Opium

Morphine

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Opioids The Nature of Opiates and Opiods

Opiate (natural) Natural chemical in the opium poppy with narcotic effects (i.e.,

pain relief)

Opiods (synthetic) Refers to a class of natural and synthetic substances with

narcotic effects

Such drugs are often referred to as analgesics Examples include heroin, opium, and morphine

Effects of Opiods Low doses induce euphoria, drowsiness, and slowed

breathing High doses can result in death Withdrawal symptoms can be lasting and severe

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Opioiods: Pakistan Chapter

Opioids preparation in Pakistan include madak (opium hookah) inhalation of the fumes or by injection

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Heroin Heroin, the most abused opioid, is synthesized from opium. Heroin is usually injected, either intravenously (into a vein) or

subcutaneously (under the skin), but can be smoked or used intranasally (i.e., "snorted").

The immediate positive effects of heroin are twofold. First is the rush lasting 5 to 15 minutes.

As one addict described it, “imagine that every cell in your body has a tongue and they are licking honey.”

The second effect is a simple state of satisfaction.

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Opium

Comes from the poppy plant sold on the street as a powder or dark brown

solid and is smoked, eaten, or injected. Initially used in medicines, very popular in the

Islamic Empire (Ar-Razi), traveled to parts of Europe as a medicine of choice.

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Morphine

Comes from Morpheus (Greek god of Dreams)

Also exists in nature as a natural endocrine product in humans and other animals.

acts directly on the CNS to relieve pain is highly addictive when compared to other

substances; tolerance, physical and psychological

dependences develop very rapidly.

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Hallucinogens

Cannabis: Marijuana and Hash

LSD

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Hallucinogens

Nature of Hallucinogens Substances that change the way the user

perceives the world May produce delusions, paranoia,

hallucinations, and altered sensory perception can be found naturally in some plants, and

can be synthesized in the laboratory. Most are abused as recreational drugs. also called psychedelic drugs.

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Cannabis : Marijuana

Cannabinoids substances that are derived from the cannabis plant. When the upper leaves, tops and stems of the plant are

cut, dried and rolled into cigarettes, the product is usually called marijuana.

Hashish is the dried stuff that seeps from the top and undersides of cannabis leaves.

In Pakistan it is known as bhang or charas or hashish or ganja. It is frequently used by young men although its use is

becoming common in girls.

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Marijuana Marijuana

Active chemical is tetrahydrocannabinol (THC) In the usual dosage, marijuana impairs short-term memory,

concentration, judgment and perception. Although it creates a sense of well-being, relaxation, mild

sleepiness and euphoria, sometimes unpleasant sensory experience and hallucinations may occur

It causes psychological but no physical dependence. The features are craving, fatigue, lethargy, restlessness,

agitation, low mood insomnia, apathy, depression, etc.

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LSD: lysergic acid diethylamide

LSD is most common form of hallucinogenic drug Tolerance tends to be rapid, and withdrawal

symptoms are uncommon Psychotic delusional and hallucinatory

symptoms can be problematic