Substance Abuse Disorders

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Introduction

Abuse is reckless use, while dependence is loss of control.

Substance abuse is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within one year:

recurrent use in hazardous circumstances
failure in obligations at work, school, or home
legal issues related to recurrent use
despite problems with social or interpersonal relationships

Substance dependence is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as maifested by three or more of the following, occurring within one year:

withdrawal
amount: substance is taken in larger amount, or with greater frequency, than intended
social, occupational, or recreational activities are given up or reduced
tolerance: need for markedly increased amounts, or markedly decreased effects with continued use
much time spent obtaining, using, or recovering from substance use
persistent efforts to cut down or control substance use
despite problems with social/interpersonal relationships, or psychological/physical issues

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

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Causes and Risk Factors

Various drugs of abuse or dependence

caffeine
alcohol
nicotine
marijuana
benzodiazepines
opiods
MDMA
GHB
ketamine
amphetamines
LSD, msuchrooms

Substance Induced Disorders

intoxication, withdrawal, delerium, mood, anxiety psychotic disorders,

Club Drugs

Raves ave been around for 10-15 years. Has to do with subcultures. By 2000, raves become harder, with increased aggression, more poly drugs, more individualistic and hedonistic. are club drugs non-deviant drug use?

Emergency Management of Substance Use

If you know someone has taken something, there is a set management plan:

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Pathophysiology

Most or all addictive drugs act on brain reward circuitry
Neural plasticity involved
The mesolimbic dopamine projection is a major component of this
- projections leave the ventral tegmental area and project to the nucleus accumbens, where changes in c-Fos and CREB occur
- important target genes include proenkephalin, prodynorphin, c-fos, others

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