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Substance-Related
Disorders
Madiha Anas
Institute of Psychology
Beaconhouse National University
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To many people, the word drug has connotations of
danger, yet most of us use some form of
Psychoactive drug
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Substance
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a drug that alters one’s psychological state.
Painkillers: Aspirin etc.
is a chemical that alters a person’s mood or behavior when
it is smoked, injected, drunk, inhaled, snorted or swallowed
in form of a pill.
Substance related disorders
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are disorders of intoxication, dependence, abuse and
substance withdrawal caused by various substances
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Substance Abuse vs.
Substance Dependence
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SUBSTANCE DEPENDENCE
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Tolerance
Withdrawal
Taken in larger amts or over longer periods of time than intended
Desire to cut down / Unsuccessful attempts
Great deal of time is spent obtaining
Activities are given up
SUBSTANCE ABUSE
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Recurrent use resulting in failure to meet obligations
Recurrent use in hazardous situations
Recurrent use-related legal problems
Cont. use despite impact on social situation (e.g., family)
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Substance Intoxication vs.
Substance Withdrawal
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Substance Intoxication:
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temporary maladaptive experience of behavioral or
psychological changes due to the accumulation of
the substance in the body.
Substance Withdrawal:
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A person in the state of substance withdrawal
experiences significant distress or impairment at
home, at work, or in other important life contexts.
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Substance Tolerance
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The dependent user desires the substance
("craving") and needs more of the substance
to achieve the effect that a lesser amount of
the substance induced in the past.
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Main Categories of Substances
Depressants –
1.
1.
2.
Result in behavioral sedation
(e.g., alcohol, sedative, anxiolytic drugs)
Stimulants –
2.
1.
2.
Increase alertness and elevate mood
(e.g., cocaine, nicotine, caffeine)
Opiates –
3.
1.
2.
Primarily produce analgesia and euphoria
(e.g., heroin, morphine)
Hallucinogens –
4.
1.
2.
Alter sensory perception
(e.g., marijuana, LSD)
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1. Depressants
Alcohol
Sedatives
Hypnotics
Anxiolytics
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Alcohol-related disorders
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groups of disorders that can result in persons who
are long-term users of alcohol.
can affect
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metabolism, gastrointestinal tract,
nervous system, bone marrow (the matter in bones)
can cause endocrine (hormone) problems.
can result in nutritional deficiencies.
People with anxiety, depression, or bipolar disorder
may consume alcohol for temporary relief from their
symptoms.
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Sedatives, Hypnotics, or Anxiolytics
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The Nature of Drugs in This Class
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Sedatives – Calming
Hypnotics – Sleep inducing (e.g., barbiturates)
Anxiolytics – anti-Anxiety(e.g benzodiazepines)
Effects of Such Drugs Are Similar to Large
Doses of Alcohol
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Sedatives
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Sedatives are compounds that cause physiological
and mental slowing of the body.
They have many legitimate medical uses.
However, people who use them improperly may
develop symptoms of abuse, dependence, and
withdrawal.
Sedatives are often referred to as tranquilizers
Other classes of compounds, produce effects and
disorders similar to those of sedatives
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sleep-promoting drugs (hypnotics)
anti-anxiety (anxiolytic) drugs
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Sedatives
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The most widely prescribed and best-studied
sedatives belong to a group called
benzodiazepines.
Prescription benzodiazepines and their
relatives include
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Alprazolam (Xanax)
Diazepam (Valium)
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How Depressants work
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These drugs work in the brain by increasing the
amount of the neurotransmitter gamma-aminobutyric
acid (GABA).
Neurotransmitters help to regulate the speed at
which nerve impulses travel.
When the amount of GABA increases, the speed of
nerve transmissions decreases.
Thus these drugs depress the nervous system and
cause reduced pain, sleepiness, reduced anxiety,
and muscle relaxation.
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2. Stimulants
Amphetamine
Cocaine
Nicotine
Caffeine
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Stimulants
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Most widely consumed drug in the United
States
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Such drugs increase
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Alertness
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energy
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Amphetamines
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Effects of Amphetamines
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Produce elation, vigor, reduce fatigue
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Such effects are followed by a “crash” (e.g.,
feeling depressed and tired)
DSM-IV Criteria for Amphetamine
Intoxication
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Psychological symptoms
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Physiological symptoms
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Amphetamines
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were initially produced for medical use, and were first
used in nasal decongestants and bronchial inhalers.
Early in the 1900s, they were also used to treat
several psychiatric conditions
 attention-deficit disorders,
 Obesity
 depression.
They are still used to treat these disorders today.
some over-the-counter drugs used as appetite
suppressants also have amphetamine-like action
Affects Dopamine in the mesolibmic system of brain
which affects reward and desire
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Case Example:
Amphetamine
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Catherine is a 23 years old salesperson who tried for three years
to lose weight. Her physician prescribed amphetamines but
cautioned her about the possibility that she might become
dependent on them. She did begin to lose weight, but she also
discovered that she liked the extra energy and good feelings
caused by the diet pills. When Catherine returned to her doctor
after having lost the desired weight, she asked him for a refill of
her prescription to help her maintain her new figure. When he
refused, Catherine asked around among her friends until she
found the name of a physician who was willing to accommodate
her wishes for ongoing refills of the prescription. Over the course
of a year, Catherine has developed a number of psychological
problems, including depression, paranoid thinking, and irritability.
Despite the fact that she realizes that something is wrong, she
feels driven to continue using the drug.
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Cocaine
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Effects of Cocaine
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Produce short lived sensations of elation,
vigor, reduce fatigue
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Cocaine use in the United States has declined
over the last decade
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Cocaine is highly addictive, but addiction
develops slowly
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Cocaine
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extracted from the coca plant, which grows in Central and South
America.
Cocaine is dangerously addictive, and users of the drug experience
a "high"—
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a feeling of euphoria or intense happiness, along with
hyper-vigilance, increased sensitivity, irritability or anger,
impaired judgment, and anxiety.
a whitish crystalline powder : most common form
In powder form, it is most commonly inhaled or "snorted.“
It may also be dissolved in water and injected.
Crack
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form of cocaine that can be smoked
produces an immediate, more intense, and more short-lived high.
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Nicotine
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Effects of Nicotine
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Stimulates the central nervous system
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Results in sensations of relaxation, wellness,
pleasure
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Nicotine is highly addictive
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Nicotine disorders
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are caused by the main psychoactive
ingredient in tobacco.
Nicotine is a physically and psychologically
addictive drug.
most influential dependence producing drug
worldwide
can be absorbed through the skin, the lining
of the mouth and nose, and the moist tissues
lining the lungs.
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Caffeine
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Effects of Caffeine – The “Gentle”
Stimulant
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Used by over 90% of Americans
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Found in tea, coffee, cola drinks, and cocoa
products
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Small doses elevate mood and reduce fatigue
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Regular use can result in tolerance and
dependence
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Caffeine
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can be consumed from a number of different sources,
including coffee, tea, caffeinated soda, weight loss
aids.
Even half a cup of coffee can bring about slight
improvements in the mood, alertness and clarity of
thought.
If people know that caffeine has psychological effects
then why they consume it regularly?
 To avoid the unpleasant withdrawal symptoms i.e.,
headache, decreased arousal, fatigue, anxiety,
nausea, muscle tension and irritability.
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NEXT CLASS
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Opiates/Opioids
Heroin
Opium
Morphine
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Opioids
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The Nature of Opiates and Opiods
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Opiate (natural)
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Opiods (synthetic)
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Natural chemical in the opium poppy with narcotic effects (i.e.,
pain relief)
Refers to a class of natural and synthetic substances with
narcotic effects
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Such drugs are often referred to as analgesics
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Examples include heroin, opium, and morphine
Effects of Opiods
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Low doses induce euphoria, drowsiness, and slowed
breathing
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High doses can result in death
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Withdrawal symptoms can be lasting and severe
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Opioiods: Pakistan Chapter
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Opioids preparation in Pakistan include
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madak (opium hookah)
inhalation of the fumes
or by injection
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Heroin
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Heroin, the most abused opioid, is synthesized from opium.
Heroin is usually injected, either intravenously (into a vein) or
subcutaneously (under the skin), but can be smoked or used
intranasally (i.e., "snorted").
The immediate positive effects of heroin are twofold.
First is the rush lasting 5 to 15 minutes.
 As one addict described it, “imagine that every cell in your body
has a tongue and they are licking honey.”
The second effect is a simple state of satisfaction.
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Opium
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Comes from the poppy plant
sold on the street as a powder or dark brown
solid and is smoked, eaten, or injected.
Initially used in medicines, very popular in the
Islamic Empire (Ar-Razi), traveled to parts of
Europe as a medicine of choice.
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Morphine
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Comes from Morpheus (Greek god of
Dreams)
Also exists in nature as a natural endocrine
product in humans and other animals.
acts directly on the CNS to relieve pain
is highly addictive when compared to other
substances;
tolerance, physical and psychological
dependences develop very rapidly.
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Hallucinogens
Cannabis: Marijuana and Hash
LSD
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Hallucinogens
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Nature of Hallucinogens
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Substances that change the way the user
perceives the world
May produce delusions, paranoia,
hallucinations, and altered sensory perception
can be found naturally in some plants, and
can be synthesized in the laboratory.
Most are abused as recreational drugs.
also called psychedelic drugs.
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Cannabis : Marijuana
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Cannabinoids
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substances that are derived from the cannabis plant.
When the upper leaves, tops and stems of the plant are
cut, dried and rolled into cigarettes, the product is usually
called marijuana.
Hashish is the dried stuff that seeps from the top and
undersides of cannabis leaves.
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In Pakistan
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it is known as bhang or charas or hashish or ganja.
It is frequently used by young men although its use is
becoming common in girls.
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Marijuana
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Marijuana
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Active chemical is tetrahydrocannabinol (THC)
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In the usual dosage, marijuana impairs short-term memory,
concentration, judgment and perception.
Although it creates a sense of well-being, relaxation, mild
sleepiness and euphoria, sometimes unpleasant sensory
experience and hallucinations may occur
It causes psychological but no physical dependence.
The features are craving, fatigue, lethargy, restlessness,
agitation, low mood insomnia, apathy, depression, etc.
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LSD:
lysergic acid diethylamide
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LSD is most common form of
hallucinogenic drug
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Tolerance tends to be rapid, and withdrawal
symptoms are uncommon
Psychotic delusional and hallucinatory
symptoms can be problematic
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