Substance Related Disorders

Presented by: Jeannie Vargas and Toluwalase Ekundayo

Objectives
Definitions Diagnostic Criteria (DSM-IV TR) Substance Use vs. Substance Induced Treatment Plans Proposed Changes in DSM-5 Community resources References

Substance Use Disorders vs. Substance Induced Disorders

Substance Use Disorders includes substance dependence and substance abuse. Substance Induced Disorders includes substance intoxication, substance withdrawal, substance induced delirium, substance induced persisting dementia, substance induced persisting amnestic, substance induced psychotic disorder, substance induced mood disorder, substance induced anxiety disorder, substance induced sexual dysfunction, and substance induced sleep disorder.

Substance Related Disorders

Substance related disorders include disorders related to the taking of a drug of abuse, to side effects of a medication, and to toxin exposure. The DSM-IV TR has eleven classes of substance: alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics, or anxiolytics. Most of the eleven classes has criteria for either dependence, abuse, intoxication, or withdrawal. Substance related disorders are divided into two groups: the Substance Use Disorders and the Substance Induced Disorders.

Substance Use Disorder: Substance Dependence

Substance Dependence is a cluster of cognitive (tolerance), behavioral (withdrawal), physiological (compulsive drug-taking behavior) symptoms indicating that the individual continues use of substance despite significant substance related problems.

Dependence is defined as a cluster of three or more symptoms listed below occurring at any time in the same 12-month period.
Specifiers are provided to note the presence and absence with either with physiological dependence or without physiological dependence. Pgs: 192-197 can further explain the substance dependence and the six course specifiers and four remission specifiers.

Substance Use Disorder: Substance Abuse

Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substance.
In order for an Abuse criterion to be met, the substance-related problem must have occurred repeatedly during the same 12-month period or been persistent.

Substance Induced Disorder: Substance Intoxication

Substance Intoxication is the development of a reversible substance-specific syndrome due to the recent ingestion of a substance.
Examples of intoxication: belligerence, mood liability, cognitive impairment, impaired judgment, impaired social or occupational functioning

Substance Induced Disorder: Substance Withdrawal

Substance Withdrawal is the development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use. Withdrawal develops when doses are reduced or stopped, whereas signs and symptoms of Intoxication improve after dosing stops.

Diagnostic Criteria for Substance Abuse

A) Maladaptive pattern of substance abuse leading to clinically significant impairment as manifested by one (or more) of the following (in a 12 month period) 1)Failure to fulfill major role obligations 2) Physically hazardous 3) Legal problems 4)Social or interpersonal problems
B) The symptoms have never met the criteria for substance dependence for this class of substance

Diagnostic Criteria for Substance Dependence

A pattern of substance use, as manifested by three (or more) of the following, occurring at any time in the same 12-month period 1) Tolerance 2) Withdrawal 3) Substance taken in larger amounts over longer periods than intended 4) Persistent desire or unsuccessful efforts to cut down or control substance use 5) Great deal of time spent on activities necessary to obtain drugs 6) Important recreational, social, or occupational activities are given up or reduced 7) Use is continued despite knowledge of having persistent physical or psychological problems that have likely been caused by substance use.

Diagnostic Criteria for Substance Intoxication

A) Development of a substance specific syndrome due to recent exposure of a substance B) Clinically significant behavioral or psychological changes due to the effect of the substance on the central nervous system developed due to recent exposure of a substance
C) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Diagnostic Criteria for Substance Withdrawal

A) Development of a substance-specific syndrome due to the cessation of substance use that has been heavy and prolonged B) Development of a substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning C) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Proposed Changes in DSM-5

303.90 Alcohol Dependence 304.40 Amphetamine Dependence 304.30 Cannabis Dependence 304.20 Cocaine Dependence 304.50 Hallucinogen Dependence 305.00 Alcohol Abuse 305.70 Amphetamine Abuse 304.20 Cannabis Abuse 304.60 Cocaine Abuse 305.30 Hallucinogen Abuse 304.60 Inhalant Dependence 305.90 Inhalant Abuse 305.1 Nicotine Dependence 304.00 Opioid Dependence 305.5 Opioid Abuse 304.60 Phencyclidine Dependence 305.90 Phencyclidine Abuse 304.80 Polysubstance Dependence 304.10 Sedative, Hypnotic, or Anxiolytic Dependence 305.40 Sedative, Hypnotic, or Anxiolytic Abuse 304.90 Other (or Unknown) Substance Dependence 305.90 Other (or Unknown) Substance Abuse

Alcohol Abuse
Anybody can be dependent on alcohol and there are many factors why people abuse alcohol. But studies prove those who abuse alcohol the most report that they drink to relieve emotional and social problems. The screening tests that are used to determine if you have an alcohol problem is CAGE (Cut, Annoyed, Guilty, and Eye-opener) or TWEAK (Tolerance, Worried, Eye-opener, Amnesia, and Kut)

Treatment Plans
Behavioral TreatmentsBehavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. Residential treatmentTreatment programs in which the client stays at a rehabilitation or chemical dependency facility.

Treatment Plans continued

Outpatient behavioral treatmentencompasses a wide variety of programs for patients who visit a clinic at regular intervals. Sub Types include: Cognitive-behavioral therapy, Multidimensional family therapy, Motivational interviewing, And Motivational incentives

Medications
Opioids: Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Tobacco: A variety of formulations of nicotine replacement therapies now existincluding the patch, spray, gum, and lozengesthat are available over the counter. In addition, two prescription medications have been FDAapproved for tobacco addiction: bupropion and varenicline.

Medications continued
Alcohol: Three medications have been FDAapproved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram.

Community Resources
The Council for Alcohol and Drugs in Houston http://www.council-houston.org/Public/index.asp
Texas Department of Health & Human Services http://www.dshs.state.tx.us/sa/Cont_Res/SubstanceAbuseLi nks.shtm National Substance Abuse Resource Index http://nationalsubstanceabuseindex.org/ National Institute on Drug Abuse http://www.nida.nih.gov/infofacts/treatmeth.html

Community Resources
Memorial Herman Prevention and Recovery Center https://www.mhparc.org/ The Right Step Rehabilitation and Chemical Dependency Facility http://www.rightstep.com/ The Odyssey House- Adolescent Substance abuse treatment http://www.odysseyhousetexas.com/ Cheyenne Center- Residential & Outpatient chemical dependency treatment for men http://www.cheyennecenter.com/residential.asp Santa Maria Hostel- Residential & Outpatient chemical dependency treatment for women with children http://www.santamariahostel.org/

Case Vignette:
Intervention Clip:

References
Kuhn, C. Swartzwelder, S. and Wilson, W. (2008). Buzzed: The straight facts about the most used and abused drugs (3rd Ed.). New York: Norton. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR, (4th ed.). American Psychiatric Association. (DSM IV). Gray, S.W. & Zide, M.R. (2008). Psychopathology: A competency-based assessment model for social workers. Brooks and Cole. National Institute on Drug Abuse. (2009). Treatment approaches for drug addiction. Retrived on September 23, 2011: http://nida.nih.gov/Infofacts/treatmeth.html