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Psychoactive substance
related disorders
Behavioral addictions
Katalin Tolvay
DEOEC English Program
Substance-Related Disorders
(DSM-IV, 2000)
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Substance Abuse
Substance Dependence
Substance Intoxication
Substance Withdrawal
Substance-Induced Mental Disorders
– Delirium, Persisting Dementia, Persisting
Amnestic Disorder, Psychotic Disorder, Mood
Disorder, Sexual Dysfunction, Sleep Disorder,
Hallucinogen Persisting Perception Disorder
• Substance Use Disorder, Not Otherwise
Specified
ICD-10
Mental and behavioral disorders due to psychoactive
substance use F10-F19
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F1..00 acute intoxication
F1..10 harmful use
F1..20 dependence syndrome
F1..30 withdrawal state
F1..40 withdrawal state with delirium
F1..50 psychotic disorder
F1..60 amnestic syndrome
F1..70 residual and late onset psychotic disorder
F1..80 other
F1..90 unspecified
ICD-10
Mental and behavioral disorders due to psychoactive substance use F10-F19
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F10
F11
F12
F13
F14
F15
F16
F17
F18
F19
Alcohol related disorders
Opioid related disorders
Cannabis related disorders
Sedative, hypnotic, or anxiolytic related disorders
Cocaine related disorders
Other stimulant related disorders
Hallucinogen related disorders
Nicotine dependence
Inhalant related disorders
Other psychoactive substance related disorders
Behavioural syndromes associated with physiological disturbances and physical
factors F50-59
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F55 Abuse of non-dependence-producing substances (e.g. antidepressants, pain killers,
laxatives)
Substance Abuse
Maladaptive pattern of substance use, characterized
by 1 (or more) of following symptoms in a 12-month
period:
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2.
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4.
Recurrent substance use resulting in failure to fulfill
major role obligations
Recurrent substance use in situations in which it is
physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance
** The symptoms have never met the criteria for Substance
Dependence for this class of substance
Substance Dependence
Maladaptive pattern of substance use, characterized
by 3 (or more) of following symptoms in a 12-month
period:
1.
2.
3.
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Tolerance (need for more or diminished effect)
Withdrawal (characteristic syndrome or avoidance of
symptoms)
Substance taken in larger amounts or over a longer period
than intended
Persistent desire or unsuccessful efforts to cut down or
control substance use
Great deal of time spent obtaining, using, or recovering
from effects of the substance
Important social, occupational, or recreational activities
are given up or reduced because of substance use
Substance use continued despite knowledge of having a
persistent or recurrent physical or psychological problem
that was likely caused or exacerbated by the substance
Substance-related disorders
• Symptoms are substent specific due to
different effects on CNS
• Physical and psychological withdrawal
• Personality changes
Addiction
• Obsessive,ritual behavior
• Intensive desire for consumption and effects
of the substance – OR equal situations
• Increasing anxiety while doing the ritual
• Immediate and brief relief during
consumption OR carrying on the addictive
behavior
• Tendency to consumption after withdrawal
OR fast return of desire
ICD-10
Disorders of adult personality and behaviour
F60-69
F63 Habit and impulse disorders
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F63.00 Pathological gambling
F63.10 Pathological fire-setting (pyromania)
F63.20 Pathological stealing (kleptomania)
F63.30 Trichotillomania
Dependency in behavioral addictions:
– Tolerance – need to spend increasing
amounts of time on gambling, computer
activity, shopping etc.
– Withdrawal – psychological discomfort if
not acting the behavior
– Compulsive behavior – inability to regulate
or moderate use…out of your control
Comorbidity
• Bipolar disorder (BIP II)
• Major depression
• Anxiety disorders (panic disorder,
social anxiety disorder, generalized
anxiety disorder)
• Personality disorders
• Primary versus secondary addiction
Why Does Addiction Occur?
• Some drugs of abuse can release 2 to 10 times the
amount of dopamine as natural rewards
• In some cases, this occurs almost immediately (as
when drugs are smoked or injected), and the effects
can last much longer than those produced by natural
rewards
• This creates a much stronger effect on the brain's
pleasure circuit than those produced naturally (e.g.,
food, sex)
• The effect of such a powerful reward strongly
motivates people to take drugs again and again
Motivation and Addiction
• Acute Drug Effects
– reward
• Chronic Drug Effects
– plasticity/neuroadaptations
• tolerance
• physical dependence
• sensitization
Treatments for addiction
• The decision
– Denial met by intervention or reality
– Cognitive changes (Prochaska, DiClemente &
Norcross, 1992)
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Precontemplation: No problem!
Contemplation: Maybe there’s a problem…
Preparation
Action
Maintenance
Relapse
Treatment goals
• Abstinence: The 12-step approach
• Controlled use
• Harm reduction
– Substitute addictions
– Methadone
– Gum-chewing
– Needle exchanges
– Water supply
. Treatment stages
• Detoxification (Detox)
– Radical
– Gradual
– With pharmacological support
• Active treatment
• Relapse prevention
More treatments
• Medication-assists
– Antagonist blockade
– Treat contributing conditions
– Substitution
– Antabuse
– Partial receptor agonists (varenicline)
– Craving reduction
• Outpatient drug-free programs
Relapse prevention
• Risk of relapse is reduced by
– Frequent review of the decision
– Avoiding drug-related cues by moving
and dumping drug-using friends
– Social connections with non-users
– Getting a job
– Learning substitute activities
– Developing structure for life