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. • 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. Abuse
• Use of any drug, usually by self adminitration,
in a manner that deviates from approved
social or medical patters
6. Misuse
• Similar to abuse but usually applies to drugs
prescribed by physicians that are not used
properly
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. 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. 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. 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. 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. 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. 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
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. 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. 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. 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. 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. 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. DSM-IV-TR Criteria for Substance
Abuse
• 2. The symptoms have never met the criteria
for Substance Dependence for this class of
substance.
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. 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. 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. 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. 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. 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. 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. 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. Factors of Substance Abuse
• GENETIC FACTORS
• NEUROCHEMICAL FACTORS
• PATHWAYS AND NEUROTRANSMITTERS
32. Treatment and rehabilitization
• No formal treatment
• Less severe disorder -> brief intervention ->
cofnitive change (best impact)
• More severe -> variety of interventions
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
Editor's Notes
Repeated and increased use of substance, the deprivation gives rise to sympotoms of distress and an irresistable urge to use again the agent again w/c leads also to physical and mental deterioration
(e.g.,
diazepam
and
barbiturates)
(e.g., providing drugs directly or money to buy drugs)
e.g., belligerence, mood liability, cognitive impairment, impaired judgment, impaired social or occupational functioning
(e.g., repeated absences or poor work performance related to substance use; substance- related absences, suspensions, or expulsions from school; neglect of children or household)
(e.g., driving an automobile or operaIng a machine when impaired by substance use)
(e.g., arrests for substance-related disorderly conduct)
(e.g., arguments with spouse about consequences of intoxicaIon, physical fights)
(e.g., visiIng mulIple doctors or driving long distances)
e.g., chain- smoking
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 (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
(i.e., either Item 1 or 2 is present) withdrwal or tolerance
(i.e., neither Item 1 nor 2 is present)
