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  1. 1. Substance Related Disorders mamba
  2. 2. Definition of Terms
  3. 3. DEPENDENCE • The repeated use of a drug or chemical substance with or without physical dependence • Physical dependence indicates an altered physiologic state caused by repeated administration of drug – Cessation of which results in a specific syndrome
  4. 4. • BEHAVIORAL DEPENDENCE – Substance seeking activities and related evidence of pathological use and patterns are emphasized • PHYSICAL DEPENDENCE – PhysIological effects of multiple episodes of substance use. • PSYCHOLOGICAL DEPENDENCE (habituation) – Continuous or intermittent craving for the substance to avoid a dysphoric state
  5. 5. Abuse • Use of any drug, usually by self adminitration, in a manner that deviates from approved social or medical patters
  6. 6. Misuse • Similar to abuse but usually applies to drugs prescribed by physicians that are not used properly
  7. 7. Addiction • The term is no longer included in the official nomenclature, having replaced by the term dependence, but it is useful term in common language.
  8. 8. Intoxication • A reversible syndrome caused by a specific substance (alchohol) that affects one or more of the following mental functions: – Memory – Orientation – Mood – Judgement – Behavioral, social, or occupational functioning
  9. 9. Withdrawal • A substance specific syndrome that occurs after stopping or reducing the amount of the drug or substance that has been used regularly over a prolonged period of time. – Physiologic signs + psychological changes • Abstinence or discontinuation Syndrome
  10. 10. Tolerance • Phenomenon in which, after repeated administration, a given dose of drug produces a decreased effect or increasingly larger doses must be administered to obtain the effect observed with the original dose. • Behavioral Tolerance reflects the ability of the person to perform tasks despite the effect of the drug
  11. 11. Cross-tolerance • Refers to the ability of one drug to be substituted for another, each usually producing the same physiologic and psychological effect • Cross-dependence
  12. 12. Neuroadaptation • Neurochemical or neurophysiologic changes in the body that result from the repeated administraIon of a drug • NeuroadaptaIon accounts for the phenomenon of tolerance. Pharmacokinetic adaptation refers to adaptation of the metabolizing system in the body • Cellular or pharmacodynamic adaptation refers to the ability of the nervous system to funcIon despite high blood levels of the offending substance
  13. 13. Co-dependence • Term used to refer to family members affected by or influencing the behavior of the substance abuser • Related to the term enabler, which is a person who facilitates the abuser's addictive behavior • Enabling also includes the unwillingness of a family member to accept addiction as a medical-psychiatric disorder or to deny that person is abusing a substance
  14. 14. Diagnostic and Statistical Manual for Mental Examination
  15. 15. DSM-IV-TR Criteria for Substance Withdrawal • A. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged. • B. The 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.
  16. 16. DSM-IV-TR Criteria for Substance Intoxication • A. The development of a reversible substance- specific syndrome due to recent ingestion of (or exposure to) a substance. • Note: Different substances may produce similar or identical syndromes
  17. 17. DSM-IV-TR Criteria for Substance Intoxication • B. Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system () and develop during or shortly after use of the substance
  18. 18. DSM-IV-TR Criteria for Substance Intoxication • C. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder
  19. 19. DSM-IV-TR Criteria for Substance Abuse • 1. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: – recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home – recurrent substance use in situations in which it is physically hazardous
  20. 20. DSM-IV-TR Criteria for Substance Abuse – recurrent substance-related legal problems – continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance
  21. 21. DSM-IV-TR Criteria for Substance Abuse • 2. The symptoms have never met the criteria for Substance Dependence for this class of substance.
  22. 22. DSM-IV-TR Diagnostic Criteria for Substance Dependence • A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
  23. 23. DSM-IV-TR Diagnostic Criteria for Substance Dependence • 1. Tolerance, as defined by either of the following: – a need for markedly increased amounts of the substance to achieve intoxication or desired effect – markedly diminished effect with continued use of the same amount of the substance
  24. 24. DSM-IV-TR Diagnostic Criteria for Substance Dependence • 2. Withdrawal, as manifested by either of the following: – the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances) – the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
  25. 25. DSM-IV-TR Diagnostic Criteria for Substance Dependence • 3. The substance is often taken in larger amounts or over a longer period than was intended • 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use • 5. A great deal of time is spent in activities necessary to obtain the substance (), use the substance (), or recover from its effects
  26. 26. DSM-IV-TR Diagnostic Criteria for Substance Dependence • the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance ()
  27. 27. DSM-IV-TR Diagnostic Criteria for Substance Dependence • Specify if: – With Physiological Dependence: evidence of tolerance or withdrawal () – Without Physiological Dependence: no evidence of tolerance or withdrawal ()
  28. 28. Factors of Substance Abuse • MODEL OF DRUG DEPENDENCE – Dependence is a result of a process in which multiple interacting factors influence drug using behavior and loss of flexibility with respect to decisions about using a given drug. • Major determinants: – peer pressure, drug availability, and social acceptability
  29. 29. Factors of Substance Abuse • PSYCHODYNAMIC FACTORS – Classic theory: substance abuse is a masturbatory equivalent, a defense mechanism against anxious impulses, or a manifestation of oral regression. • Recent: related to disturbed ego functions. May also be used as a form of medication • ALEXITHYMIA -Some addicts have great difficulty recognizing their inner emotional states
  30. 30. Factors of Substance Abuse • GENETIC FACTORS • NEUROCHEMICAL FACTORS • PATHWAYS AND NEUROTRANSMITTERS
  31. 31. • COMORBIDITY – Occurrence of two or more psychiatric disorder in single patient at the same time.
  32. 32. Treatment and rehabilitization • No formal treatment • Less severe disorder -> brief intervention -> cofnitive change (best impact) • More severe -> variety of interventions
  33. 33. Characteristics of programs • Aimed at controlling withdrawal and consequences of recent drug use (detoxification) • Focused on a longer term behavioral change (pharmacologic) • Degree to which the program is based on individual psychotherapy or other therapeutic community principles. • Not all interventions are applicable to all varieties of substance abuse/ dependence

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