Substance-Related Disorders
Substance use disorders 药物导致的
Definition: Problematic pattern of substance use leading to impairment or distress over a 12-month period (e.g., using larger amounts, failed attempts to quit, interference with responsibilities). 物质滥用问题导致身体受损或痛苦
Substance-induced disorders 药物诱发的副作用
Definition: Disorders caused directly by the effects of substances, such as intoxication, withdrawal, or other mental health conditions (e.g., anxiety caused by drug use). 由药物作用直接引起的疾病
Intoxication
Withdrawal
Terms to know
Psychoactive substances 精神活性物质: Chemicals that alter mood, perception, or behavior (e.g., alcohol, caffeine, heroin). 酒精、咖啡因、海洛因
Substance use: act of consuming substances, such as drinking alcohol or using drugs.
Substance intoxication 物质中毒: Temporary physical/mental changes caused by substance use (e.g., slurred speech from alcohol). 使用物质后引发的暂时性身体/精神改变（如喝酒后说话含糊）
Substance use disorder: significant impairment (social, occupation, educational) associated with substance use 如因酗酒缺勤
Substance dependence/addiction:
Dependence (physical dependence) 依赖,身体上需要物质以维持正常功能，包括耐受性和戒断症状
Tolerance: increasing greater amounts of substance to experience same effect
Ex: A person needs 3 beers to feel relaxed instead of 1 like before.
Withdrawal: negative physical response when substance is no longer ingested
Ex: Shaking and sweating after stopping heavy alcohol use.
Addiction: 成瘾 loss of control over the intense urges to take a substance even at the expense of adverse consequences (ex: drug-seeking behavior) 心理上渴望并无法停止使用，即使明知有害
Diagnostic issues
Historical view:
Seen as a symptom of other issues (e.g., "sociopathic personality disturbance").
moral weakness.
Biological and genetic influences were largely ignored.
Current view: complex biological and psychological processes
Acknowledges both environmental and genetic factors in its development
Five main categories of substances
Depressants 抑制剂，镇定剂
Depressants: alcohol, sedatives, hypnotic drugs, anxiolytic drugs 镇定剂(benzodiazepines)
What do they do?
Decrease central nervous system activity CNS + Promote relaxation and reduce anxiety.
Principle effect: reduce the body’s physical arousal and help people relax
Produce dependence, tolerance and withdrawal
Alcohol
Initial: Feelings of well-being, reduced inhibitions, sociability (due to reduced activity in inhibitory centers).
Long-Term: Impaired motor coordination, speech problems, liver damage, brain damage (e.g., Wernicke-Korsakoff syndrome), fetal alcohol syndrome (if used during pregnancy).
Effects: influences several neurotransmitter systems: GABA (inhibitory effects), glutamate & serotonin
GABA: brain’s brake pedal; Reduces brain activity, makes you feel calm and relaxed.
Alcohol increases GABA activity, which makes you feel relaxed and lower your inhibitions.
Glutamate: brain’s accelerator; Helps with learning, memory, and excitement by increasing brain activity.
Alcohol reduces glutamate activity, slowing down thinking and movement.
Serotonin: mood stabilizer; Regulates mood, sleep, appetite, and happiness.
Alcohol temporarily boosts mood but may lead to mood swings later.
Alcohol related disorders
Develops over time; early drinking or before age 11, increases risk for chronic use.
Doesn’t cause violence, but increase likelihood of impulsive behavior
Long term consequences: Liver disease, cardiovascular problems, neurotoxicity, dementia, Wernicke-Korsakoff syndrome (caused by thiamine deficiency), fetal alcohol syndrome
Sedatives, hypnotics and anxiolytics 镇静剂、催眠剂和抗焦虑剂
Act on GABA receptors in the brain which means that it make GABA more effective, helping people feel relaxed and less anxious
Effects:
Initial: calming, sleep inducing, anxiety reducing
Long term: Tolerance builds quickly; withdrawal can mimic alcohol withdrawal (e.g., tremors, anxiety).
Barbiturates
Effects (by dosage)
Low: relax the muscles, mild feelings of well-being
Larger: Impaired motor coordination, slurred speech, difficulty concentrating.
Extremely high: Risk of respiratory failure and death
Stimulants 兴奋剂
Stimulants: amphetamines, cocaine, nicotine, caffeine
Most widely consumed drugs in the US
Effect:
Increase alertness and energy.
Can produce euphoria, reduced fatigue, and heightened focus.
Stimulant intoxication
DSM-5 criteria:
Significant impairment or psychological changes
Accompanied by physical changes (ex: changes in HR/BP, dilated pupils, weight loss, vomiting, weakness, chills)
Amphetamine Type Substances
How do they work?
Stimulate the central nervous system (enhance activity of norepinephrine and dopamine)
Too much amphetamine cause hallucinations & delusions
Effect (low doses)
Feelings of euphoria and energy.
Low appetite and reduces fatigue.
Behavioral symptom: Euphoria, social sensitivity, anxiety, poor judgment, paranoia.
Physiological: Rapid heartbeat, sweating, nausea, vomiting, high blood pressure, muscle weakness.
Severe: hallucinations, panic, agitation, and paranoid delusions (ex: a friend of my father killed himself because of hallucinations and jumped from the top of the building)
Cocaine
Initial: Intense euphoria, increased energy, confidence.
Long-term: Paranoia, sleep disturbances, social withdrawal, brain aging.
Nicotine:
Stimulates nicotinic acetylcholine receptors in CNS
Sensations of relaxation, wellness, pleasure
Relation to mood
Short-term: improves mood
Long-term: depression and dependence
Tobacco withdrawal symptoms
Irritability, restlessness.
Increased appetite, trouble concentrating.
Anxiety, depression, insomnia.
Caffeine
Blocks adenosine receptors, preventing drowsiness and increasing alertness.
Effect (low dosage): elevate mood & reduce fatigue
Caffeine intoxication symptoms
Restlessness, nervousness, flushed skin.
Insomnia, gastrointestinal issues, muscle twitching.
Rapid/irregular heartbeat, excitement, psychomotor agitation.
Opioids 阿片类药物 (止痛)
What they do: activate body’s enkephalins and endorphins which reduce pain and create euphoria
Common types: heroin, hydrocodone (vicodin), oxycodone (percocet), morphine, codeine, fentanyl
Effects
Low: euphoria, drowsiness, slowed breathing
High: result in death (due to respiratory depression)
Hallucinogens 迷幻剂
What they do
Alter sensory perception, mood, and cognition.
Can cause delusions, paranoia, or hallucinations (e.g., seeing or hearing things that aren’t there).
Effects:
euphoria, enhanced sensory perception, paranoia, and reduced concentration.
Tolerance develops quickly, but withdrawal is uncommon.
Common types: LSD, psilocybin, mescaline, PCP
Cannabis
Effects: euphoria, mood swings, paranoia, hallucinations, reduced concentration
Other commonly misused substances
Inhalants 吸入剂
Glues, spray cans, paint thinner, gasoline, nitrous oxide (笑气)
Volatile substances inhaled for their psychoactive effects. 吸入的具有精神作用的挥发性物质。
Breathed into lungs directly (rapid absorption)
Effects
Similar to alcohol: euphoria, dizziness, slurred speech, loss of coordination.
Long-term: Organ damage, cognitive impairment, or death.
Anabolic-androgenic steroids 同化性类固醇
Synthetic forms of testosterone, used medically or to increase muscle mass. 睾丸素合成形式的睾丸素，用于医学上或增加肌肉质量
Effects
No "high" but leads to increased body mass.
Long-term: Mood disturbances, aggression (“roid rage”), and hormonal imbalances.
Designer drugs
Common types: ecstasy/molly, BDMPEA (nexus), ketamine (Special K), synthetic cathinones (bath salts)
Dissociative anesthetics 分离剂醉剂
Drugs that cause detachment from reality and reduce pain.
Cause drowsiness, pain relief
Often create sensory distortions. 感官扭曲
Substance use disorder
DSM-5 Criteria
Problematic use causing distress or impairment in 12 months
Key signs (at least 2 of them to be diagnosed): larger use than intended, failed attempts to stop, cravings, neglect of duties, tolerance, or withdrawal.
Other identifies criteria for
Use disorders
Intoxication
withdrawal
Etiology
Genetics
Genetic risk factors are shared across most addictive substances.
Genetics influence how people experience and metabolize substances.
Neurobiology
Substances affect the brain's pleasure pathway, especially dopamine.
Amphetamines & cocaine act directly on dopamine
Opiates (opium, morphine, heroin) inhibits GABA (inhibits its ability to turn off dopamine)
Alcohol, sedatives, hypnotics & anxiolytics enhances GABA (increase ability to turn of anxiety/fear responses)
Psychological
Positive Reinforcement: Substances are pleasurable.
Example: Drinking alcohol at a party makes you feel confident and sociable, so you drink again at the next event.
Negative Reinforcement: Substances reduce negative feelings (e.g., stress).
Example: Using marijuana to ease anxiety or drinking alcohol to numb feelings of stress.
Opponent-process theory: Positive effects are followed by negative withdrawal effects, leading to repeated use to avoid discomfort.
Example: After cocaine use, the crash feels unbearable, so you use again to avoid feeling low.
Cognitive factors: Expectations of substance effects (e.g., “This will make me feel better”).
Example: Believing "Smoking helps me relax" leads to continued smoking during stressful times.
Cravings: Triggered by mood, environment, or availability of substances.
Example: Seeing a bar or smelling cigarette smoke triggers a strong urge to drink or smoke.
Social and cultural influences
Media, family, and peers influence substance exposure.
Cultural norms shape attitudes toward substance use (e.g., binge drinking at parties).
Integrative model: Substance use results from a mix of genetics, biology, psychology, social context, and stressors
Treatment
Biological treatments:
Agonist Substitution: Use of a safer drug with a similar chemical structure (e.g., methadone for heroin).
Antagonistic Treatment: Drugs that block the effects of the substance (e.g., naltrexone for opioids).
Aversive Treatment: Drugs that make substance use unpleasant (e.g., disulfiram for alcohol).
Efficacy: Biological treatments are more effective when combined with psychosocial therapy.
Psychosocial treatment:
Inpatient vs. Outpatient: Both can be effective depending on the individual's needs.
Support Programs: (AA, NA) may be helpful; mixed results
Goals: Focus on abstinence or controlled use, depending on the individual.
Component Treatment: Combining multiple therapies, such as CBT and group therapy.
Motivational Enhancement Therapy (MET): Focuses on helping individuals connect treatment to personal values.
CBT: Identifies triggers and teaches coping strategies to resist use.
Relapse Prevention 防止恶化: Views relapse as a failure of coping strategies, not personal failure.
Education: Teaching about substance risks and the science of addiction.
Skill Building: Teaching life skills to manage stress and build healthy habits.
Culture Change: Changing societal attitudes about substance use (e.g., anti-smoking campaigns)
