Chapter 11: Substance Related Disorders

Overview

Substance related disorders are many, divided into several classes. One common elements is that all “drugs taken in excess activate the brain’s reward circuitry” (Black & Grant, 2014). Addiction is a complex situation, changing how the brain functions and the effects of substance abuse will be felt by the individual long after the substance is eliminated from their system (American Psychiatric Association, 2022).

Drug addiction includes, but is not limited to, the following behaviors and symptoms in order to diagnose (Mayo Clinic, 2022):

  • Urge to use substance is felt regularly, potentially blocking out other thoughts
  • Individual will need more of the substance in order to feel the same way, over time
  • Overspending on the drug of choice
  • Significantly impairing work or other responsibilities
  • Individual may behave outside of their norm, like stealing
  • Experiencing withdrawal
  • Failing in attempts to abstain
  • Physical appearance may decline

Alcohol

Caffeine

Caffeine is a socially acceptable stimulant that is widely used to increase alertness and performance (Agoston et al., 2022; Munis, et al., 2017). It is a plant-derived, bitter substance that is found in seeds, fruits, nuts, or leaves in plants indigenous to Africa, East Asia, and South America (“Caffeine”, 2022) (APA, 2022). Caffeine acts as a defense mechanism for plants, due to its bitter taste, keeping plant-eaters away and outliving the competition. The best known source of caffeine is coffee, which millions of people consume daily (often many times daily!) (“History”, 2022). It is the most widely consumed (and sanctioned) psychoactive drug in the world because it is legal and unregulated nearly everywhere in the world (Franke et al. (2021). Caffeine has its own slew of positive and negative affects. Review the graphic below to learn more about the pros and cons of consuming caffeine.

Pros of coffee: Increased alertness, Reduced fatigue, More clear thoughts, Reduces cold symptoms, Enhance cognitive performance, Less stigmatized, Elevates mood, & Pain reliever. Cons of Coffee: Dependence, Withdrawal, Tolerance, Self-medication, Impulsivity, Aggression, Diuretic, Dehydrant (AlAteeq, et al, 2021; Cusack, 2020; dePaula and Farah, 2019; Mills, et al., 2017; Rosenkranz, et al., 2019; Temple, et al., 2017)
Pros of coffee: Increased alertness, Reduced fatigue, More clear thoughts, Reduces cold symptoms, Enhance cognitive performance, Less stigmatized, Elevates mood, & Pain reliever. Cons of Coffee: Dependence, Withdrawal, Tolerance, Self-medication, Impulsivity, Aggression, Diuretic, Dehydrant (AlAteeq, et al, 2021; Cusack, 2020; dePaula and Farah, 2019; Mills, et al., 2017; Rosenkranz, et al., 2019; Temple, et al., 2017)

Criteria to Diagnose: The criteria required to diagnose caffeine use disorder include: high doses of caffeine consumption, five or more behavioral symptoms like restlessness, diuresis, rambling, and heart racing, the symptoms must be severe enough to impact functioning and are not a result of another condition or disorder.

"Caffeine-2378" by Greg_Rodgers is licensed under CC BY 2.0.
“Caffeine-2378” by Greg_Rodgers is licensed under CC BY 2.0.

Typical Demographics: According to research, those diagnosed with this disorder are middle-aged, females, and white.  These individuals often had other substances that they used like tobacco, alcohol, or cannabis (Sweeney et al., 2020).

Treatment, Medication, and Therapy: Some treatment includes a daily caffeine diary, counseling, education, and a caffeine reduction plan. There are not many treatments for this disorder, so more research needs to be done in this area (Meredith et al., 2013)

Case Studies to Review:

Hallucinogen

Review each of the nine hot spots below to learn more about hallucinogens.

Treatment, Medication, and Therapy: There is not one prescribed treatment program for this substance abuse, but behavioral treatments can be helpful. More research needs to be done regarding these treatments. Note that not all hallucinogens are considered addictive substances, hence the lack of addiction treatment (NIDA, 2021)

Case Studies to Review:

Inhalants

Inhalants include a wide range of substances and side effects and are inhaled through the nose or mouth. These substances include gasoline, lacquers, spray paints, glues, aerosols, paints, and cleaning fluids. In addition to the high, intoxicating feeling, users may also experience confusion, disorientation, nausea, fatigue, and other negative side effects (Queensland Government, 2018; Verma, 2011). These substances are easy to obtain and conceal, which promotes their use and addiction. This type of substance abuse occurs worldwide, no socioeconomic class or development status left unaffected (Verma, 2011).

Criteria to diagnose: Individuals will experience significant impairment of functioning occurring within 12 months (Black & Grant, 2014).

Typical Demographics: According to the National Survey on Drug Use and Health (SAMHSA, 2021), about 2.4 million people, 12 years and old, report using inhalants. It is the highest among those aged 12-17.

Treatment, Medication, and Therapy: Typical treatment methods include CBT, interventions, group counseling, engagement programs, and 12-step programs (Cleveland Clinic, 2019).

Opioids

Opiates, are either naturally or synthetically derived from opium (APA, 2022). Opioids are the naturally occurring opiates (like morphine) and synthetic versions (like heroin). Users may experience positive effects, when used clinically as pain relievers, anesthesia, cough suppressants, and antidiarrheal drugs. But, as with all drugs we are discussing, opioids  are prone to abuse and dependence in the long-term; symptoms include pain relief, fatigue, euphoria, respiratory depression, and reduced function in the gastrointestinal system (APA, 2022; Bahmutsky, et al., 2020).

Criteria to Diagnose: The symptoms provided at the top of the chapter must occur within a 12-month time period (Black & Grant, 2014).

Typical Demographics: Over two million Americans suffer from opioid use disorder (NIDA, 2016). There is significant data on racial, ethnic, and age groups that use opioids. Review this information from a 2019 report from the CDC to learn more and review all of their data: Racial/ethnic and age group differences in opioid and synthetic opioid-involved overdose deaths among adults aged [older than] 18 years in metropolitan areas (2019)

Treatment, Medication and Therapy: There are effective medications available to treat this disorder. Medications are recommended to be combined with counseling, like CBT (NIDA, 2016).

Case Studies to Review:

Stimulants

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