Other Substance-Related Disorders

1. Concepts and principles:
   • Three interacting key factors give rise to dependence - psychopathology of the individual; frustrating environment; and availability of powerful, addicting, and temporarily satisfying drug.
   • According to conditioning principles, substance abuse and dependence proceed in several phases:
     1. Use of sedatives-hypnotics, CNS stimulants, hallucinogens and narcotics, for relief from daily tensions and discomforts or anticipated withdrawal symptoms.
     2. Habit is reinforced with each relief by drug use.
     3. Development of dependency - drug has less and less efficiency in reducing tensions.
     4. Dependency is further reinforced as addict fails to maintain adequate drug intake - increase in frequency and duration of periods of tension and discomfort.


2. Assessment:
   • Abuse
     1. Hallucinogens (LSD, marijuana, STP, PCP, peyote): euphoria and rapid mood swings, flight of ideas; perceptual impairment, feelings of omnipotence, “bad trip” (panic, loss of control, paranoia), flashbacks, suicide.
     2. CNS stimulants (amphetamines and cocaine abuse): euphoria, hyperactivity, hyperalertness, irritability, persecutory delusions; insomnia, anorexia —> weight loss; tachycardia; tremulousness; hypertension; hyperthermia —> convulsions.
     3. Narcotics (opium and its derivatives, e.g., morphine, heroin, codeine, meperidine HC1 [Demerol]): used by “snorting,” “skin popping,” and “mainlining.” May lead to abscesses and hepatitis. Decreased pain response, respiratory depression; apathy, detachment from reality; impaired judgment; loss of sexual activity; pinpoint pupils.
     4. Sedatives hypnotics (barbiturate abuse): similar to alcohol-induced behavior, e.g., euphoria followed by depression, hostility; decreased inhibitions; impaired judgment; staggering gait; slurred speech; drowsiness; poor concentration; progressive respiratory depression.
   • Withdrawal symptoms
     1. Narcotics (e.g., heroin): begins within 12 hours of last dose, peaks in 24-36 hours, subsides in 72 hours, and disappears in 5-6 days.
        • Pupil dilation.
        • Muscle: twitches, tremors, aches, pains.
        • Goose flesh (piloerection).
        • Lacrimation, rhinorrhea, sneezing, yawning
        • Diaphoresis, chills.
        • Potential for fever.
        • Vomiting, abdominal distress.
        • Dehydration.
        • Rapid weight loss.
        • Sleep disturbance.
     2. Barbiturates: maybe gradual or abrupt (“cold turkey”); latter is dangerous or life-threatening; should be hospitalized.
        • Gradual withdrawal reaction from barbiturates:
          1. Postural hypotension.
          2. Tachycardia.
          3. Elevated temperature.
          4. Insomnia.
          5. Tremors.
          6. Agitation, restlessness.
        • Abrupt withdrawal from barbiturates:
          1. Apprehension.
          2. Muscular weakness.
          3. Tremors.
          4. Postural hypotension.
          5. Twitching.
          6. Anorexia.
          7. Grand mal seizures.
          8. Psychosis-delirium.
     3. Amphetamines: depression, lack of energy, somnolence.
   • Difference between alcohol and other abused substances (e.g., opioid).
     1. Other abused substances may need to be obtained by illegal means, making it a legal and criminal problem as well as a medical and social problem; not so with alcohol abuse and dependency.
     2. Opium and its derivatives inhibit aggression, whereas alcohol releases aggression.
     3. As long as she or he is on large enough doses to avoid withdrawal symptoms, abuser of narcotics, sedatives, or hypnotics is comfortable and functions well, whereas chronically intoxicated alcoholic cannot function normally.
     4. Direct physiological effects of long-term opioid abuse and dependence on other abused substances are much less critical than those with chronic alcohol dependence.