Lecture Notes on Addiction and Substance Use

Overview of Substance Use

• Commonality of Substance Use: 90% of people in the U.S. use psychoactive substances regularly.
• Health Impact: While many can use substances without negative effects, a significant minority develop problems.

Types of Substance Problems

1. Intoxication

   • Acute influence of a psychoactive substance.
   • Each substance has a specific mix of signs/symptoms, referred to as its toxodrome.

2. Withdrawal

   • Acute physiological/psychological effects from suddenly stopping a substance.
   • Symptoms often opposite to intoxication effects.

3. Addiction

   • Chronic condition involving repeated substance use despite negative consequences.
   • Known as Substance Use Disorder (SUD).

Distinction Among Conditions

• Intoxication and addiction are closely related but should be considered separate diagnoses.
• Not everyone intoxicated is addicted, and vice versa.

DSM-5 Criteria for Substance Use Disorders

• 11 distinct criteria can be summarized with the mnemonic "Time to Cut Down Pal":
  • Time spent using/obtaining substances.
  • Cravings or urges to use.
  • Cannot cut down despite attempts.
  • Develop tolerance.
  • Dangerous results affecting others (interpersonal issues).
  • Withdrawal symptoms.
  • Neglecting responsibilities (work/family).
  • Physical/psychological problems worsened by use.
  • Giving up activities for excessive use.
  • Larger amounts or longer use than intended.

Three Components of Addiction: The Three Reapers

1. Repeated Use

   • Involves engaging in behavior (substance use, gambling, etc.) repeatedly.

2. Positive Reinforcers

   • Behaviors that provide pleasure or reward, increasing behavior frequency.

3. Negative Repercussions

   • Consequences such as job loss, legal trouble, health jeopardy are essential for diagnosing addiction.

Distinction Between Addiction and Compulsion

• Addiction: Repeated use of positively reinforcing substances despite negative repercussions.
• Compulsion: Repeated behavior to escape negative feelings (e.g., OCD behaviors).

Clinical Tools for Diagnosing Addiction

• Complete Substance History: Use the mnemonic "TRAPPED":

  • Treatment history
  • Route of administration
  • Amount used
  • Pattern of use
  • Prior abstinence
  • Effects of use (positive/negative)
  • Duration of use.

• Major Classes of Addictions:

  • Cannabis, Alcohol, Nicotine, Hallucinogens, Inhalants, Stimulants, Depressants, Opioids, Gambling, Other behavioral addictions.

Prevalence and Impact of Addiction

• Lifetime Prevalence: About 10% in the U.S.
• Commonality: Begins in adolescence/early adulthood.
• Gender Differences: Men are treated more often than women; women may have more legal substance addictions.
• Comorbidity: High rate of co-occurrence with other mental disorders.

Prognosis and Treatment

• Variability in Prognosis: Depends on the substance involved.

• Statistics on Addiction Dependence:

  • Cannabis <10%
  • Cocaine 15%
  • Heroin 25%
  • Nicotine >65%.

• Treatment Process:

  • Detoxification: Initial transition to sobriety.
    • Some substances may require medical monitoring due to withdrawal risks.
  • Rehabilitation: Focus on maintaining sobriety using therapy, medications, etc.

Motivational Interviewing for Treatment

• Motivational Interviewing: A technique to enhance treatment motivation.
• Relapse: Common and should not be viewed as a treatment failure.
• Social Support: Critical predictor of successful treatment; the opposite of addiction is connection and community.

Conclusion

• Addiction is a significant societal issue impacting many facets of life.
• Tools and understanding of addiction are essential for effective treatment and management.