Substance Related Disorders;

Diagnosis and Treatment

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 Introduction
• Substance (drug) use have been part of human
existence for thousands of years
– Opium has been used for medicinal purposes for
at least 3,500 years
– Canabis can be found in ancient Chinese herbals
– Wine is mentioned in the Bible
– Native of the Western Hemisphere smoked
tobacco and chewed coca

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 Drugs can lead addiction
• There are 10 classes of drug can lead addiction
1. Alcohol 6. Opioids
2. Caffein 7. Sedatives, Hypnotics, or
Anxiolytics

3. Cannabis 8. Stimulants

4. Hallucinogens 9. Tobacco

5. Inhalants 10. Others

(DSM-5)
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 Some Terms
• Terms used in substance-related disorders
– Substance abuse: harmful or hazardouse use of
psychoactive substances, including alcohol and illicit
drugs
– Dependence: a cluster of behavioural, cognitive, and
physiological phenomena that develop after repeated
substance use and that typically include a strong desire
to take the drug, difficulties in controlling its use,
persisting in its use despite harmful consequences, a
higher priority given to drug use than to other other
activities and obligations, increased tolerance, and
sometimes a physical withdrawal state

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 – Misuse
– Addiction
– Intoxication
– Withdrawal
– Tolerance
– Cross-tolerance
– Neuroadaptation
– Codependence

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 Diagnoses in Substance Related Disorder

• The substance-related disorders are divided

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Substance Use Disoders
1. Taking the substance in larger amounts or over a
longer period than was originally intended
2. Expressing a persistent desire to cut down or
regulate substance use and may report multiple
unsuccessful efforts to decrease or discontinue use
3. Spending a great deal of time obtaining the
substance, using it, or recovering from its effects
4. Craving; an intense desire to obtain substance

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 5. Failure to fulfill major role obligations at work,
school, or home
6. Continuing substance use despite having
persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of
the substance
7. Important social, occupational, or recreational
activities may be given up or reduced because of
substance use

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 8. Recurrent substance use in situations in which it
is physically hazardous
9. Continuing substance use despite knowledge of
having a persistent or recurrent physical or
physiological problem that is likely to have been
caused or exacerbated by the substance
10. Tolerance is signaled by requiring a markedly
increased dose of the substance to achieve the
desired effect or markedly reduced effect when
the usual dose is consumed
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 11. Withdrawal, a syndrome that occurs when blood
or tissue concentration of substance decline in an
individual who had maintained prolonged heavy
use of the substance

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Substance-Induced Disorders
• Intoxication
– There is development of a reversible substance-specific
syndrome due to the recent ingestion of a substance
– There are behavioral or psychological changes that
due to the effect of the substance on CNS (such as
belligerence <aggressive behavior>, mood lability,
cognitive impairment, impaired judgment, impaired
social or occupational functioning) develop during or
shortly after use of the substance

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 – The symptoms are not due to general medical
condition and are not better accounted for by
another mental disorder

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• Withdrawal
– The development of substance-specific syndrome
due to the cessation of (or reduction) substance use
that has been heavy and prolonged
– The syndrome causes significant distress or
impairment in social, occupational, or other
important areas of functioning
– The symptoms are not due to a general medical
condition and are not better accounted for by
another mental disorder
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• Substance/Medication-Induced Mental Disorders
– The disorder represent symptoms of mental disorders
– There is evidence from the history, physical
examination, or laboratory findings of both of the
following
• The disorder developed during or within 1 month of
substance intoxication or withdrawal or taking a medication
• The involved substance/medication is capable of producing
the mental disorder

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 – the disorder is not better explained by an
independent mental disorder (not substance- or
medication-induced). Such evidence of an
independent mental disorder could include the
following:
• The disorder preceded the onset of severe intoxication
or withdrawal or exposure to the medication; or
• The full mental disorder persisted for a substantial
period of time (at least 1 month) after cessation of
acute withdrawal or severe intoxication or taking the
medication

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 – The disorder does not occur exclusively during
the course of a delirium
– The disorder causes significant distress or
impairment in social, occupational, or other
important areas of functioning

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Why do people take drugs? (NIDA)
• To feel good
– drugs can produce intens feelings of pleasure
– Cocaine: the high is followed by feelings of power,
self-convidence, increased energy
– Opioids: euphoria is followed by feelings of relaxation
and satisfaction
• To feel better
– Some people suffer from stress (social anxiety,
depression) start using drugs to try to feel less anxious

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• To do better
– Some people feel pressure to improve their focus
in school or at work or their abilities in sports
• Curiosity and social pressure
– Teens are more likely than adults to act in risky or
daring ways to impress their friends and show
their independence from parents and social rules

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 Etiology
• Social factors that cause some people to
decide using drug
– Peer groups
– Family interactions
– Parental drug use
– Licencing laws
– Social pressures
– Availability
– Demographic variables
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• Individual factors that cause some people to
decide using drugs
– Early learning
– Drug experience
– Genetic endowment
– Development events
– Mood states
– Withdrawal state
– Expectations
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• Individual factors that some people to contuinue
using drugs or not
– Reinforcing consequences:
• Mood enhancements
• Psychosocial facilitation
• Avoidance or relief of withdrawal symptoms
– Aversive consequences
• Toxic effects
• Reduced drug effect
• Organic damage
• Psychosocial dysfunction

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 Treatment
• Some persons who suffer substance-related
problems with less severe disorder (e.g nicotin
addiction) recover without formal treatment
 brief interventions often effective
• Brief interventions change the patient’s
motivation (cognitive change)
• Addictive behaviour do not change abruptly,
but through a series of stages

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• The series of 5 stages have been proposed:
– Pre-contemplation
– Contemplation
– Preparation
– Action
– Maintenance

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• There are procedures or techniques in treating
substance related disorder: individual therapy,
family therapy, group therapy, relaps
prevention, and pharmacotherapy
• Treatment held through the use of specific
procedures and involve several professional
diciplines as well as nonprofesionals who have
special skills or personal experience with the
substance problem being treated
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• Treatment programs grouped on the basis of
– Controlling acute withdrawal and consequences of
recent drug use
– Long-term behavioural change (MMT, outpatient
drug-free programs, therapeutic communities,
short-term inpatient program)

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• There are pharmacological agents for treating
substance addiction
– Disulfiram, naltrexone, acamprosate
– Methadone, buprenorphine
– Nicotine delivey device, bupropion

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References
Sadock BJ, Sadock VA, Ruiz P. 2015. Kaplan & Sadock’s
Synopsis of Psychiatry. 11th ed. Philadelphia: Wolters
Kluwer
Galanter M, Kleber HD, Brady KT. 2015. Textbook of
Substance Abuse Treatment. 5th ed. Washington, DC:
American Psychiatric Publishing
Herron AJ, Brennan TK. 2015. The ASAM Essentials of
Addiction Medicine. 2nd ed. Philadelphia: Walters Kluwer
Schuckit MA. 2006. Drug and Alcohol Abuse. 6th ed. San
Diego, CA: Springer

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 Terimakasih

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