Psychology of Drug Use and Abuse Midterm- DSM

Pharmacological Criteria

Tolerance Withdrawal

Substance Use Disorder Features

"A cluster of cognitive, behavioral and physiological symptoms indicating the individual continues using the substance despite significant substance-related problems." "Underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders." "Overall, the diagnosis of a substance use disorder is based on a pathological pattern of behaviors related to the use of the substance." Continued Use despite problems- core tenet neurotransmitters may be irreparable effected remoces the concept of self-blame estigmas of mental illness the cuestionable factor of alteres brain states and responsibility

DSM 5 Definition of a Mental Disorder

"A syndrome that is present in an individual and that involves clinically significant disturbance in behavior, emotion regulation, or cognitive function. These disturbances are thought to reflect dysfunction in biological, psychological, or developmental processes that are necessary for mental functioning. Mental Disorders are usually associated with significant distress or disability in key areas of functioning such as social, occupational, or other activities. Predictable or culturally approved responses to common stressors or losses are excluded. The dysfunctional pattern of behavior does not stem from social deviance or conflicts that the person has with society as a whole."

Withdrawal

A syndrome that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. Individuals are more likely to consume the substance while in withdrawal, at risk for relapse Symptoms vary across substances Symptoms range from mild to severe, lethal to nonlethal Physiological and Psychological

Substance Medication Induced Mental Disorders

A. The disorder represents a clinically significant symptomatic presentation of a relevant mental disorder. B. There is evidence from the history, physical examination, or laboratory findings of 1. The disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication; and 2. The involved substance/medication is capable of producing the mental disorder. C. The disorder is not better explained by an independent mental disorder (i.e., one that is not substance or medication-induced). D. The disorder does not occur exclusively during the course of a delirium E. The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. also includes intoxication and withdrawal persent the same as other mental disorders yet the sympotoms are the direct result of exosure to a drug both the loss of the drug in the system and intoxication may cause this to show Criteria C difficult as many disorders are comorbid with other mental disorders Delirium is similar to one using drugs To determine if their sympotoms are drug related comprehensiva screening must be done Cocaine withdrawal similar to major depressive disorder

Diagnostic Assesment Challenges

Active Use Self-Report Shame, Guilt, Withholding, Memory Challenges Polysubstance Abuse Denial Comorbid Psychiatric Conditions How to treat the actively using? Some programs will accept them but many require abstinence prior to beginning therapy Stigma- pregnant mothers, least likely to seek treatment comorbid conditions are often bi-directional and ongoing monitoring is nesecary to maintain them

Craving

An intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug previously was obtained or used. Involves classical conditioning Associated with specific reward structures in the brain Query-Has there ever been a time when you had such strong urges to take a drug that you could not think of anything else? Pavlovian conditioning- associative responses and learning to become addicted craving puts addicts at an increased risk for relapse

Caffine Related Disorders

Caffeine Related Disorders Caffeine Intoxication Caffeine Withdrawal Other Caffeine-Induced Disorders Unspecified Caffeine-Related Disorder Physiological reason for incluson yet blind due to its social aceptibility

Severity and Course Specifiers

Course Specifiers In early remission In sustained remission On maintenance therapy In a controlled environment Substance Use may present with a broad range of severity, from mild to severe Mild: 2-3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms

Differences Between DSM IV and 5

DSM-5 does not separate the diagnoses of substance abuse and dependence as in DSM-IV. Rather, criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance/medication-induced disorders, and unspecified substance-induced disorders, where relevant. The DSM-5 substance use disorder criteria are nearly identical to the DSM-IV substance abuse and dependence criteria combined into a single list, with two exceptions. The DSM-IV recurrent legal problems criterion for substance abuse has been deleted from DSM-5, and a new criterion, craving or a strong desire or urge to use a substance, has been added. In addition, the threshold for substance use disorder diagnosis in DSM-5 is set at two or more criteria, in contrast to a threshold of one or more criteria for a diagnosis of DSM-IV substance abuse and three or more for DSM-IV substance dependence. Cannabis withdrawal is new for DSM-5, as is caffeine withdrawal (which was in DSM-IV Appendix B, "Criteria Sets and Axes Provided for Further Study"). Of note, the criteria for DSM-5 tobacco use disorder are the same as those for other substance use disorders. By contrast, DSM-IV did not have a category for tobacco abuse, so the criteria in DSM-5 that are from DSM-IV abuse are new for tobacco in DSM-5. Severity of the DSM-5 substance use disorders is based on the number of criteria endorsed: 2-3 criteria indicate a mild disorder; 4-5 criteria, a moderate disorder; and 6 or more, a severe disorder. The DSM-IV specifier for a physiological subtype has been eliminated in DSM-5, as has the DSM-IV diagnosis of polysubstance dependence. Early remission from a DSM-5 substance use disorder is defined as at least 3 but less than 12 months without substance use disorder criteria (except craving), and sustained remission is defined as at least 12 months without criteria (except craving). Additional new DSM-5 specifiers include "in a controlled environment" and "on maintenance therapy" as the situation warrants. Addition of gambling disorder underlying neural substratos are the same way for addictions to substances concept of addictive personalities from alcohol to gambling

Substance Intoxication

Development of a reversible substance-specific syndrome due to the recent ingestion of a substance Symptoms are attributable to the physiological effects of the substance on the CNS and develop shortly after use of the substance. Common among those with a substance use disorder but also occurs frequently in individuals without a substance use disorder The category does not apply to tobacco Many substances may produce physiological or psychological changes that are not necessarily problematic. If there are symptoms without problems, this doesn't apply Intoxication may persist beyond the time when the substance is detectable in the body Usually the initial substance-related disorder and often begins in the teens.

Substance Withdrawal

Development of a substance specific problematic behavioral change, with physiological and cognitive concomitants, that is due to the cessation of or reduction in, heavy prolonged substance use. Causes clinically significant distress or impairment Not due to another medical condition or better explained by another use disorder. Most individuals in withdrawal have an urge to re-administer the substance to reduce the symptoms

Substanced Induced Disorders

Includes: Intoxication, Withdrawal, and other Substance/Medication Induced Mental Disorders Issue since they present as if they have a different psychaiatric disorder

Generalizations

More sedating drugs can produce prominent and clinically significant depressive disorders during intoxication Anxiety conditions likely to be observed from withdrawal symptoms from these substances More stimulating substances are likely to be associated with substance-induced psychotic disorders and substance-induced anxiety disorders Substance induced major depressive episodes observed during withdrawal from these substances Cycles of withdrawal effects major depressive episodes psychatric wards need to differentiate between temporary drug induces mental disorders and long term non induces disorders

Tolerance and Withdrawal

Neither tolerance nor withdrawal is necessary for a diagnosis of substance use disorder. However, for most classes of substances a history of withdrawal is associated with a more severe clinical course Symptoms of tolerance and withdrawal occurring during appropriate medical treatment with prescribed medications are specifically not counted when diagnosing a substance use disorder. Individuals whose only symptoms are those that occur as a result of medical treatment should not receive a diagnosis solely on the basis of these symptoms. Prescription medications can be used inappropriately, and a substance use disorder can be correctly diagnosed when there are other symptoms of compulsive, drug-seeking behavior. Withdrawal- more severa clinical course, perscription medicines in normal usare can cause withdrawal

Addiction

Not applied as a diagnostic term Some clinicians will used the word to describe more extreme presentations, but the word is omitted from DSM due to uncertain definition, stigma and negative connotation. Patients differ in their use or avoidance of this label patients differ in those who accept or do not accept the label of addict

DSM 5 Substance Use Disorders

Overall, the diagnosis is based on a pathological pattern of behaviors related to the use of the substance A. Impaired control (1-4), social impairment (5-7), risky use (8-9), pharmacological criteria (10-11) The individual may take the substance in larger amounts or over a longer period than originally intended The individual may take express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use. The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects. Craving is manifested by an intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug was used. Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use. Recurrent substance use in situations in which it is physically hazardous The individual may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. Tolerance Withdrawal if mild consider the symptoms present

Substance medication Induced Mntal Disorders Continued

Potentially severe, usually temporary, but sometimes persisting CNS syndromes that develop in the context of the effects of substances of abuse, medications or toxins. May be induced by the 10 classes of substances that produce substance use disorders or by a great variety of medications used in medical treatment. Develop in the context of intoxication or withdrawal from substances of abuse Most often temporary and likely to disappear within 1 month or so of cessation of acute withdrawal, severe intoxication, or use of the medication. Some exceptions do occur ex. Alcohol-induced neurocognitive disorder; Hallucinogen persisting perception disorder which are longer term many are tmeporary but the long term effects are emphasized due to the probable scare tacitas related to sacring people away from drug usare

Recording

Record the specific substance- Example: Moderate Cocaine Use Disorder Other Use Disorder-Substances that do not fit into any class Other (or Unknown)-If the substance is unknown If criteria are met for more than one substance use disorder, all should be diagnosed Ex. Severe heroin use disorder; Moderate cocaine use disorder specify substance, analyze each seperately for diagnosis

Risky Use

Recurrent substance use in situations in which it is physically hazardous The individual may continue substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

Social Impairment

Recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home The individual may continue substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use.

Substance related disorders

Substance Related Disorders include 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other (or unknown substances). Substance Use Disorder can be applied to all ten classes included in the chapter except caffeine.

DSM 5 Substance Related and Addictive Disorders

Substance Related and Addictive Disorders include: Substance Use Disorders Mild-Severe based on number of symptom criteria Mild (2-3 symptoms); Moderate (4-5 symptoms); Severe (6 or greater) Course specifiers: in early remission, in sustained remission, on maintenance therapy, in a controlled environment. Substance-Induced Disorders Intoxication, Withdrawal, other substance/medication-induced mental disorders (psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, sleep disorders, sexual dysfunctions, delirium and neurocognitive disorders). Non-Substance Related Disorder: Gambling Disorder Note: other "behavioral addictions" (sex addiction, shopping) are not included due to insufficient peer reviewed evidence to establish diagnostic criteria.

Impaired control

The individual may take the substance in larger amounts or over a longer period than originally intended The individual may take express a persistent desire to cut down or regulate substance use and may report multiple unsuccessful efforts to decrease or discontinue use. The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects. Craving is manifested by an intense desire or urge for the drug that may occur at any time but is more likely when in an environment where the drug was used.

Risky Use ppt 2

The key issue in evaluating this criterion is not the existence of the problem, but rather the individual's failure to abstain from using the substance despite the difficulty it is causing. Speaks to maladaptive component of addiction

Pharmacological Criteria Tolerance

Tolerance varies across different individuals and substances Must be distinguished from individual sensitivities May involve central nervous system effects Difficult to determine by history alone Laboratory tests may be helpful Example: High blood levels without any behavioral, cognitive evidence of intoxication Extended period of usare people are more likely to use to prevent withdrawal differs by drug