12.1 Substance Use Disorders: Alcohol and Drugs

Substance use disorders involve impaired control, social issues, risky behavior, and physical dependence. They're diagnosed using specific criteria like tolerance and withdrawal. Different drug classes affect the brain and body in unique ways, from depressants slowing things down to stimulants speeding them up.

Various factors contribute to substance disorders, including psychological, social, and biological influences. The consequences can be severe, ranging from short-term impaired judgment to long-term health problems, mental health issues, and social difficulties. Understanding these aspects is crucial for effective treatment and prevention.

Substance Use Disorders

Diagnostic criteria for substance disorders

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• Impaired control
  • Using larger amounts or over a longer period than intended
  • Persistent desire or unsuccessful efforts to cut down or control use
  • Spending a great deal of time obtaining, using, or recovering from the substance (preoccupation)
  • Craving or a strong desire to use the substance (urges)
• Social impairment
  • Failure to fulfill major role obligations at work, school, or home due to substance use
  • Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the substance
  • Important social, occupational, or recreational activities are given up or reduced because of substance use (withdrawal from activities)
• Risky use
  • Recurrent use in situations where it is physically hazardous (driving under the influence)
  • Continued use despite knowledge of persistent or recurrent physical or psychological problems likely caused or exacerbated by the substance
• Pharmacological criteria
  • Tolerance: need for increased amounts to achieve desired effect or diminished effect with continued use of the same amount (higher doses needed)
  • Withdrawal: characteristic withdrawal syndrome or the substance is taken to relieve or avoid withdrawal symptoms (physical dependence)

Classes of drugs and effects

• Depressants (alcohol, benzodiazepines, barbiturates)
  • Slow down brain activity and central nervous system functioning
  • Effects: relaxation, sedation, slurred speech, impaired coordination, respiratory depression (shallow breathing)
• Stimulants (cocaine, amphetamines, methamphetamine)
  • Increase brain activity and central nervous system functioning
  • Effects: increased energy, alertness, euphoria, decreased appetite, increased heart rate and blood pressure (racing heart)
• Opioids (heroin, prescription painkillers)
  • Activate opioid receptors in the brain, producing analgesic and euphoric effects
  • Effects: pain relief, sedation, respiratory depression, constipation (slowed bowel movements)
• Hallucinogens (LSD, psilocybin, mescaline)
  • Alter perception, thought, and mood
  • Effects: altered sensory experiences (visual distortions), changes in thought patterns, heightened emotions, increased heart rate and blood pressure
• Cannabis (marijuana, hashish)
  • Activates cannabinoid receptors in the brain
  • Effects: relaxation, altered perception (time distortion), increased appetite ("munchies"), impaired memory and concentration

Risk Factors and Consequences

Factors in substance disorder development

• Psychological factors
  • Personality traits (impulsivity, sensation-seeking)
  • Mental health disorders (depression, anxiety, PTSD)
  • Stress and maladaptive coping mechanisms
  • Expectancies and beliefs about substance use (perceived benefits)
• Social factors
  • Peer influence and social norms (peer pressure)
  • Family environment and parental substance use (modeling)
  • Availability and accessibility of substances (ease of obtaining)
  • Socioeconomic status and cultural factors (poverty, community norms)
• Biological factors
  • Genetic predisposition and family history of substance use disorders (heritability)
  • Neurobiological changes in the brain's reward system (dopamine release)
  • Individual differences in metabolism and response to substances (sensitivity)
  • Comorbid medical conditions (chronic pain)

Consequences of alcohol and drug abuse

• Short-term consequences
  • Impaired judgment and decision-making (risky behaviors)
  • Increased risk of accidents and injuries (falls, burns)
  • Acute health problems (alcohol poisoning, overdose)
  • Risky sexual behaviors and increased risk of sexually transmitted infections (unprotected sex)
  • Aggression and violence (fights, domestic abuse)
• Long-term consequences
  • Physical health problems
    1. Liver disease (cirrhosis, hepatitis)
    2. Cardiovascular disease (hypertension, stroke, heart attack)
    3. Respiratory problems (chronic bronchitis, lung cancer)
    4. Neurological damage (memory impairment, cognitive decline)
  • Mental health problems
    • Substance-induced disorders (substance-induced psychosis)
    • Exacerbation of pre-existing mental health disorders (worsening symptoms)
    • Increased risk of developing depression, anxiety, and other psychiatric disorders
  • Social and occupational consequences
    • Strained relationships with family and friends (conflict, isolation)
    • Job loss and financial difficulties (unemployment, debt)
    • Legal problems (arrests, incarceration)