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Substance abuse and related disorders

Definition

Substance-related disorders are disorders of intoxication, dependence, abuse, and substance withdrawal caused by various substances, both legal and illegal. These substances include: alcohol, amphetamines, caffeine, inhalants, nicotine, prescription medications that may be abused (such as sedatives), opioids (morphine, heroin), marijuana (cannabis), cocaine, hallucinogens, and phencyclidine (PCP).

Description

According to the mental health clinician's handbook, Diagnostic and Statistical Manual of Mental Disorders(the DSM), fourth edition text revised (DSMIV-TR), all of the substances listed above, with the exceptions of nicotine and caffeine, have disorders of two types: substance use disorders and substance-induced disorders. Substance use disorders include abuse and dependence. Substance-induced disorders include intoxication, withdrawal, and various mental states (dementia, psychosis, anxiety, mood disorder, etc.) that the substance induces when it is used.

Substance dependence is characterized by continued use of a substance even after the user has experienced serious substance-related problems. 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. This phenomenon is known as tolerance. The dependent user also experiences withdrawal symptoms when the substance is not used. Withdrawal symptoms vary with the substance, but some symptoms may include increased heart rate, shaking, insomnia, fatigue, and irritability.

Substance abuse is continued use of a substance in spite of school- or work-related or interpersonal problems, but the user has not gotten dependent on the substance. The individual who abuses a substance may experience legal problems and may have problems fulfilling responsibilities, such as caring for a child.

Intoxication is the direct effect of the substance after an individual has used or has been exposed to the substance. Different substances affect individuals in various ways, but some of the effects seen in intoxication might include impaired judgment, emotional instability, increase or decrease in appetite, or changed sleep patterns.

The DSM-IV-TRdoes not recognize caffeine abuse or dependence, but does recognize the caffeine-induced disorders caffeine intoxication (restlessness, nervousness, excitement, etc. after caffeine consumption), caffeine-induced anxiety disorder (feelings of anxiety or panic attacks after caffeine consumption), and caffeineinduced sleep disorder (usually insomnia, but some may experience excessive sleepiness when caffeine is not consumed). As for nicotine, the DSM-IV-TRrecognizes nicotine dependence and nicotine withdrawal.

The DSM-IV-TRlists disorders in the following categories:

• alcohol-related disorders
• amphetamine-related disorders
• caffeine-related disorders
• cannabis-related disorders
• cocaine-related disorders
• hallucinogen-related disorders
• inhalant-related disorders
• nicotine-related disorders
• opioid-related disorders
• phencyclidine-related disorders
• sedative-, hypnotic-, or anxiolytic-related disorders
• polysubstance dependence

See also Addiction; Alcohol and related disorders; Amnestic disorders; Amphetamines and related disorders; Anti-anxiety drugs and abuse-related disorders; Caffeine-related disorders; Cannabis and related disorders; Cocaine and related disorders; Denial; Disease concept of chemical dependency; Hallucinogens and related disorders; Inhalants and related disorders; Nicotine and related disorders; Opioids and related disorders; Phencyclidine and related disorders; Polysubstance dependence; Sedatives and related disorders; Substance Abuse Subtle Screening Inventory; Substance-induced anxiety disorder; Substance-induced psychotic disorder; Urine drug screening; Wernicke-Korsakoff syndrome

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.Fourth edition, text revised. Washington DC: American Psychiatric Association, 2000.