Chapter 11: Substance Related Disorders


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



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:


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 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).


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:



Agoston, C., Urban, R., Horvath, Z., van den Brink, W. & Demetrovics, Z. (2022). Self-medication of ADHD symptoms: Does caffeine have a role? Frontiers in Psychology, 13(8). doi: 10.3389/fpsyt.2022.813545

Alamia, A., Timmermann, C., Nutt, D., VanRullen, R.,  Carhart-Harris, R. (2020) DMT alters cortical travelling waves. eLife 9:e59784

AlAteeq, D., Alotaibi, R., Saqer, R., Alharbi, N., Alotaibi, M., Musllet, R., & Alraqibah, R. (2021). Caffeine consumption, intoxication, and stress among female university students: a cross-sectional study. Middle East Current Psychiatry, 28(30).

American Psychiatric Association (2022). Addiction and substance use disorders. Retrieved on August 26, 2022 from

American Psychological Association (2022). Amphetamines. APA Dictionary of Psychology.

American Psychological Association (2022). Alcohol use disorder. APA Dictionary.

American Psychological Association (2022). Caffeine. APA Dictionary of Psychology.

American Psychological Association (2022). Cannabis. APA.

American Psychological Association (2022). Cocaine. APA Dictionary of Psychology.

American Psychological Association (2022). Hallucinogen. APA.

American Psychological Associations (2022). LSD. APA.

American Psychological Association (2022). Peyote. APA.

Arluk, S., Matar, M.A., Carmi, L. et al.(2022) MDMA treatment paired with a trauma-cue promotes adaptive stress responses in a translational model of PTSD in rats. Transl Psychiatry 12, 181 .

Bahji, A. (2019, December 2). Is marijuana bad for your brain? [Video]. YouTube.

Bearman, A. & Schwan, A. (2022). Psychology of Addiction. Pressbooks.

Biondich, A. & Joslin, J. (2016). Coca: The history and medical significance of an ancient Andean tradition. Emergency Medicine International.

Black, D. W., & Grant, J. E. (2014). DSM-5® Guidebook : The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: Vol. Fifth edition. American Psychiatric Association Publishing.

Australian Government (2020). Standard drinks guide. About Alcohol.

Bodnar, V., Nagy, K, Cziboly, A., & Bardos, G. (2021). Alcohol and placebo: The role of expectations and social influence. International Journal of Mental Health and Addiction, 19,

“Caffeine” (2022, July 9). Wikipedia. Retrieved July 14, 2022 from

Carboni E, Carta AR, Carboni E & Novelli A (2021) .Repurposing Ketamine in Depression and Related Disorders: Can This Enigmatic Drug Achieve Success? Frontiers in Neuroscience, 15:657714. doi: 10.3389/fnins.2021.657714

Casarett, D. (2017, May 17). A doctor’s case for medical marijuana [Video]. YouTube.

Cleveland Clinic (2019, October 11). Inhalant abuse. Retrieved on August 26, 2022

Cort, B. (2018, September 25). What commercialization is doing to cannabis [Video]. YouTube.

Cusack, P. (2020, May 14). Addiction of Caffeine and Sugar. Open Access Journal of Addiction and Psychology, 3(5). DOI: 10.33552/OAJAP.2020.03.000575

dakota of earth (2021, January 2). Drinking psychedelic peyote juice in Mexico [Video’]. YouTube.

Dandelion Medical Animation (2021, December 25). Digestion of alcohol is not like other food [Video]. YouTube.

dePaula, J. & Farah, A. (2019). Caffeine consumption through coffee: Content in the beverage, metabolism, health benefits and risks. Beverages, 5(2), 37.

Ermakova, A., Whiting, C., Trout, K., Clubbe, C., Fowler, N., Terry, M. (2020). Ecology and conservation of peyote in Texas, USA: Comparative survey of Lophophora williamsii populations in Tamaulipan Thornscrub and Chihuahuan Desert. Journal of the Botanical Research Institute of Texas.

Evens R, Reiche S, Marek RM, Moon DU, Groß RE, Romanello A, Jalilzadeh Masah D, Scicchitano Böckheler M, Gutwinski S, Montag C, Mick I and Majić T (2021) Psychedelic Experiences During the Early COVID-19 Pandemic: Findings From an International Online Survey. Front. Psychiatry 12:732028. doi: 10.3389/fpsyt.2021.732028

Ferruci, M., Limanaqi, F., Ryskalin, L., Biagioni, F., Busceti, C., & Forni, F. (2019). The effects of amphetamine and methamphetamine on the release of norepinephrine, dopamine, and acetylcholine from the brainstem reticular formation. Frontiers in Neuroanatomy, 13(48).

Foundation for a Drug-Free World (2022). Alcohol: A short history. A Foundation for a Drug-Free World.

Franke, A., Koller, G., Krause, D., Proebtstl, L., Kamp, F., Pogarell, O., Jebrini, T., Manz, K., Chrobok, A., &  Soyka, M. (2021) Just “life coffee” or neuroenhancement by stimulants. Frontiers in Public Health, 9.

Grace, S., Rossetti, M.G., Allen, N. et al. (2021). Sex differences in the neuroanatomy of alcohol dependence: hippocampus and amygdala subregions in a sample of 966 people from the ENIGMA Addiction Working Group. Translational Psychiatry 11, 156 .

Graves, B., Johnson, T., Nishida, R., Dias, R., Savareear, B., Harynuk, J., Kazemimanesh, M., Olfert., J. & Boies, A. (2020). Comprehensive characterization of mainstream marijuana and tobacco smoke. Scientific Reports 10,

Grossman, E., Benjamin-Neelon, S., & Sonnenschein, S. (2020). Alcohol consumption during the COVID-19 pandemic: A cross-sectional survey of US adults. International Journal of Environmental Research and Public Health, 17(24).

Harker, N., Londani, M., Morojele, N., Williams, P., Parry, C. (2020). Characteristics and predictors of heavy episodic drinking (HED) among people aged 16-25: The international alcohol control study (IAC), Tshwane, South Africa. International Journal of Environmental Research and Public Health, 17(10).

Heilig, M., MacKillop, J., Martinez, D., Rehm, J., Leggio, L, & Vandershuren, L. (2021). Addiction as a brain disease revised: Why it still matters, and the need for consilience. Neuropsychopharmacology, 46,

Hinojosa, S. (2018). Peyote veneration in challenging times: Issues of land and access in South Texas. Arcadia, 19,

“History and culture of substituted amphetamines” (2022, July 9). Wikipedia. Retrieved July 14, 2022 from

Inaba, D. (2011). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs. CNS Productions.

International Union of Basic and Clinical Pharmacology / British Pharmacological Society (2022). Amphetamine. IUPHAR/BPS Guide to Pharmacology. Retrieved on July 14, 2022 from

Jahn, Z. W., Lopez, J., de la Salle, S., Faber, S., & Williams, M. T. (2021). Racial/ethnic differences in prevalence of hallucinogen use by age cohort: Findings from the 2018 National Survey on Drug Use and Health, Journal of Psychedelic Studies, 5(2), 69-82. Retrieved Aug 26, 2022, from

Jones, G., Ricard, J.A., Lipson, J. et al. (2022). Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample. Sci Rep 12, 4099

Jurado-Barba R, Sion A, Martínez-Maldonado A, Domínguez-Centeno I, Prieto-Montalvo J, Navarrete F, García-Gutierrez MS, Manzanares J and Rubio G (2020). Neuropsychophysiological Measures of Alcohol Dependence: Can We Use EEG in the Clinical Assessment? Front. Psychiatry 11:676. doi: 10.3389/fpsyt.2020.00676

Latif, Z & Garg, N. (2020) The impact of marijuana on the cardiovascular system: A review of the most common cardiovascular events associate with marijuana use. Journal of Clinical Medicine, 9(6).

Lippold KM, Jones CM, Olsen EO, Giroir BP. Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid–Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:967–973. DOI: icon.

Lowe, H., Toyang, N., Steele, B., Grant, J., Ali, A., Gordon, L., & Ngwa, W. (2022). Psychedelics: Alternative and potential therapeutic options for treating mood and anxiety disorders. Molecules, 27(8).

Makunts T, Jerome L, Abagyan R., & de Boer A (2022). Reported cases of serotonin syndrome in MDMA users in FAERS database. Frontiers in Psychiatry 12:824288. doi: 10.3389/fpsyt.2021.824288

Marcus, D. & Bruchas, B. (2021) Antidepressants: Where ketamine and dopamine collide eLife 10:e70148

Matzopoulos R, Morlock R, Morlock A, Lerer B and Lerer L (2022). Psychedelic mushrooms in the USA: Knowledge, patterns of use, and association with health outcomes. Frontiers in Psychiatry 12:780696. doi: 10.3389/fpsyt.2021.780696

Meredith, S. E., Juliano, L. M., Hughes, J. R., & Griffiths, R. R. (2013). Caffeine Use Disorder: A Comprehensive Review and Research Agenda. Journal of caffeine research, 3(3), 114–130.

Munis, J., Prieto, J., Gonzalez, B., Sosa, M., Cadet, J., Scorza, C., Urbano, F., Bisagno, V. (2017). Cocaine and caffeine effects on the conditioned place preference test: Concomitant changes on early genes within the mouse prefrontal cortex and nucleus accumbens. Frontiers in Behavioral Neuroscience.

Mills, L., Dar-Nimrod, I., & Colagiuri, B. (2017). Effect of genetic information and information about caffeine content on caffeine withdrawal symptoms. Scientific Reports 7(8407).

National Institute on Alcohol Abuse and Alcoholism (2022). Alcohol topics A to Z. NIAAA.

National Institute on Alcohol Abuse and Alcoholism (2022). Treatment for alcohol problems: Finding and getting help. NIAA.

National Institute on Drug Abuse (2015). Hallucinogens and dissociative drugs. NIDA. Retrieved July 21, 2022 from

New Zealand Drug Administration (2022, February 17). Did you know: MDMA [Video]. YouTube.

NIDA. 2016, November 1. Effective Treatments for Opioid Addiction. Retrieved from on 2022, August 26

NIDA. 2019, April 22. Hallucinogens DrugFacts. Retrieved from on 2022, August 26

Oehen P and Gasser P (2022) Using a MDMA- and LSD-group therapy model in clinical practice in Switzerland and highlighting the treatment of trauma-related disorders. Frontiers in Psychiatry 13:863552. doi: 10.3389/fpsyt.2022.863552

Pantoni, M.M., Kim, J.L., Van Alstyne, K.R. et al. (2022). MDMA and memory, addiction, and depression: dose-effect analysis. Psychopharmacology 239, 935–949.

Paz-Graniel, I., Kose, J., Babio, N., Hercberg, S., Galan, P., Touvier, M., Salas-Salvadó, J., et al. (2022). Caffeine Intake and Its Sex-Specific Association with General Anxiety: A Cross-Sectional Analysis among General Population Adults. Nutrients, 14(6), 1242. MDPI AG. Retrieved from

Philips, R. (2020, January 2020). A brief history of alcohol [Video]. YouTube.

Pribish, A., Wood, N., & Kalava, A. (2020). A review of nonanesthetic uses of ketamine. Anesthesiology Research and Practice.

Rawat, R., Tunc-Ozcan, E., McGuire, T.L. et al. (2022). Ketamine activates adult-born immature granule neurons to rapidly alleviate depression-like behaviors in mice. Nature Communications, 13, 2650.

Rodríguez Arce JM & Winkelman MJ (2021) Psychedelics, Sociality, and Human Evolution. Frontiers in Psychol. 12:729425. doi: 10.3389/fpsyg.2021.729425

Rootman, J.M., Kiraga, M., Kryskow, P. et al. (2022). Psilocybin microdosers demonstrate greater observed improvements in mood and mental health at one month relative to non-microdosing controls. Scientific Reports 12, 11091 .

Rosenkranz, M., O’Donnell, A., Verthein, U., Zurhold, H., Addison, M., Liebregts, N., Rowicka, M., Bartak, M/, Petruzelka, B., Kaner, E., Martens, M-S. (2019). Understanding pathways to stimulant use:  A mixed-methods examination of the individual, social, and cultural factors shaping illicit stimulant use across Europe: Study Protocol. BMJ Open, 9.

Ryu, I.S.; Kim, O.-H.; Lee, Y.E.; Kim, J.S.; Li, Z.-H.; Kim, T.W.; Lim, R.-N.; Lee, Y.J.; Cheong, J.H.; Kim, H.J.; Lee, Y.S.; Steffensen, S.C.; Lee, B.H.; Seo, J.-W.; Jang, E.Y. (2020). The Abuse Potential of Novel Synthetic Phencyclidine Derivative 1-(1-(4-Fluorophenyl)Cyclohexyl)Piperidine (4′-F-PCP) in Rodents. International Journal of Molecular Science , 21, 4631.

SAMHSA (2021) Results from the 2020 national survey on drug use and health.

Sanger N, Bhatt M, Singhal N, Panesar B, D’Elia A, Trottier M, Shahid H, Hillmer A, Baptist-Mohseni N, Roczyki V, Soni D, Brush M, Lovell E, Sanger S, Samaan MC, de Souza RJ, Thabane L and Samaan Z (2020) Treatment Outcomes in Patients With Opioid Use Disorder Who Were First Introduced to Opioids by Prescription: A Systematic Review and Meta-Analysis. Front. Psychiatry 11:812. doi: 10.3389/fpsyt.2020.00812

Sanvisens, A., Hernandez-Rubio, A., Zuluaga, P., Fuster, D., Papaseit, E., Galan, S., Farre, M., & Muga, R. (2021). Long-term outcomes of patients with cocaine use disorder: A 18-years addiction cohort study. Frontiers in Pharmacology, 12.

Shahar S, Lynch S, Klepacz L, Ferrando SJ (2020) Case Report: Relapsing Opioid Use Disorder in the Context of COVID-19. Ann Case Report 5: 557. DOI: 10.29011/2574-7754.100557

Substance Abuse and Mental Health Services Administration (2022). Alcohol, tobacco, and other drugs. US Department of Health and Human Services.

Seitz, H. & Neuman, M. (2021). The history of alcoholic liver disease: From an unrecognized disease to one of the most frequent diseases in hepatology. Journal of Clinical Medicine, 10(4).

Stock, A. (2017). Braking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology.

Sweeney, M., Weaver, D., Vincent, K. Arria, A. & Griffiths, R. (2020). Prevalence and correlates of caffeine use disorder symptoms among a United States example. Journal of Caffeine and Adenosine Research 10(1).

Tait, R., McKetin, R., Kay, Lambkin, F., Carron-Arthur, B., Bennett, A., Bennett, K., Christensen, H., & Griffiths, K. (2014). A web-based intervention for users of amphetamine-type stimulants: 3-Month outcomes of a randomized controlled trial. JMIR Publications, 1(1).

Temple, J.,  Bernard, C., Lipshultz, S., Czachor, J., Westphal, J., Mestre, M. (2017). The safety of ingested caffeine: A comprehensive review. Frontiers in Psychology, 8(80). doi: 10.3389/fpsyt.2017.00080

Timmermann C, Roseman L, Williams L, Erritzoe D, Martial C, Cassol H, Laureys S, Nutt D and Carhart-Harris R (2018) DMT Models the Near-Death Experience. Frontiers in Psychology. 9:1424. doi: 10.3389/fpsyg.2018.01424

Tran, M., Luong, Q., Minh, G., Dunne, M., & Baker, P. (2021). Psychosocial interventions for amphetamine type stimulant use disorder: An overview of systematic reviews. Frontiers in Psychology, 10.

Tribble, K. (2021, July 21). How marijuana reform could repair, reclaim, and restore communities [Video]. YouTube.

Yavi, M., Lee, H., Henter, I.D. et al. (2022). Ketamine treatment for depression: a review. Discover Mental Health 2, 9.

Vertava Health (2022). Cocaine use statistics by age. Cocaine Addiction Treatment.

Wang, S., Chen, Y., Chen, S., Lee, C., & Cheng, C. (2020). Alcohol addiction, gut microbota, and alcoholism treatment: A review. International Journal of Molecular Sciences, 21(17).


Icon for the Creative Commons Attribution 4.0 International License

Psychopathology by Andrea Bearman and Jackie Delagrange is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Share This Book