Velez College

F. Ramos Street, Cebu City

Special Topic Report

Substance-Related Disorder and Substance Abuse

Submitted to:

Ms. Adeline C. Famador

Submitted by:

Beloria, Euka Maria

Lagulao, Jermyn Mae

BSOT-IV

  1. Definition

As characterized by the presence of at least one specific symptom indicating that substance use has interfered with the person’s life. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one of the following, occurring within a 12-month period;

  1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
  2. Recurrent substance used in which it is physically hazardous.
  3. Recurrent substance-related legal problems.
  4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  1. Epidemiology

A large recent survey showed that the life time prevalence of a diagnosis of substances abuse or dependence among US population older than age 18 was 16.7. The life time prevalence for alcohol abuse or dependence was 13.8% for non-alcohol substances, it was 6.2%. In 1995, 6.1% of the population age 12years or older were current elicit drug users are the mist commonly used, substances but marijuana, hashish and cocaine are also commonly used. However, for all four of these substances alcohol marijuana, cigarettes, and cocaine-there has been gradual but consistent decrease in use from a high around 1980 to 1992. Abuse and dependence on substances are common in men and women, substances abuse is also higher among people who are unemployed and among some minority groups than among people who are employed and among majority groups, and are not limited to adults. A recent survey of high school seniors showed that about 30% had tried a non-alcohol substance at least once and about 16% had tried a non-alcohol, non-marijuana substance such as amphetamines, inhalants, hallucinogens, sedatives or cocaine at least once. Substance is more common among medical professionals than among non-professionals of equal levels of training. Possible explanation is simply the relatively easy access that medical professionals have to some classes of substances.

  • Illicit Drug Use

-Estimated 12.8 million people in the United States were current illicit drug users, having used an illicit in the month preceding the interview. Between 1994 and 1995,the rate past month illicit drug use among adolescents increased,from 8.2 to 10.9%.

-An estimated 2.3 million people started using marijuana in 1994.the annual number of marijuana initiates has risen since 1991.marijuana is the most common illicit drug,used by 77%of current illicit drug users.57% of current illicit drug users used marijuana only 20% used marijuana and another illicit drug and the remaining 23% used only an illicit drug other than marijuana in the past month. However, has sharply declined from 7.1 million in 1985 to 2.5 million in 1995.

  • Alcohol Use

-111 million people in the United States age 12 and older had used alcohol in the past month. About 32million engaged in binge drinking, 11million were heavy drinkers. About 10million current drinkers were under age 21 in 1995.

-Of these, 4.4million were binge drinkers including 1.7million heavy drinkers.

  • Cigarette Use

-The rate of current cigarette smoking did not change between 1994cand 1995. And estimated 20% youths ages 12-17 were current smokers in 1995

-Current smokers are more likely to be heavy drinkers and illicit drug users than are non-smokers. Among smokers in 1995, 12.6% were heavy drinkers, and 13.6% were illicit drug users. Among non-smokers, 2.7% were heavy drinkers, 3.0% were illicit drug users.

  • Women of Child Bearing Age

-Overall, 7.3% of women ages 15-44 in 1995 had used an illicit drug in the past month. The corresponding age of men ages 15-44 was 11.6% of the 4.3million ages 15-44 who were current illicit drug users in 1995, more than 1.6million had children living with them including 390,000 with at least one child younger than two years of age.

-Among women ages 15-44 who had no children and were not pregnant, 9.3% were current illicit drug users. Only 2.3% of pregnant women were current drug users. Women may reduce their drug use when they got pregnant but women who recently gave birth and a rate of used 5.5%. Many women thus resume their drug used after giving birth.

  • Ages

-Among adolescent age 12-13, 4.5% were current illicit drug users. The highest rate was found among young people ages 16-17 and ages 18-20.

-Rates of use were lower in each successive age group, with only about 1% of those age 50 and older reporting current illicit drug use.

  • Race and Ethnicity

-The rate of current illicit drug use for blacks was 7.9% higher than for whites was 6.0%, Hispanics 5.1% in 1995. However, the rates were used about the same for the three groups; most current illicit drug users were white. Estimated 9.6million whites, 1.9million blacks and 1.0million Hispanics were current illicit drug users in 1995.

  • Gender

-As in 1994, men continued to have a higher rate of current illicit drug use than did women.

  • Region and Urbanicity

-The current illicit drug use rate changes from 7.8 in the West to 4.9% in the Northeast.

  • Education

-Illicit drug use rates remain highly correlated with educational status. Among young adults’ ages 18 to 34 years in 1995, those who had not completed high school and the highest rate of use and college graduates had the lowest rate of use.

  • Employment

-Current employment status is also highly correlated with rates of illicit drug use; 14.3%of unemployed adults were current illicit drug users in 1995, compared with 5.5% of full-time employed adults. The rate for full-time employed adults decreased significantly between 1994 and 1995.

  1. Etiology

Substance abuse and substance dependence result from a person’s taking a particular substance in an abusive pattern. As with all psychiatric disorders, the initial causative theories grew from psychodynamic models.

  • Psychodynamic Factors

-A masturbatory equivalent, a defense against homosexual impulses, or manifestation of oral regression. Use to depress or treat substance use as a reflection of disturbed ego functions.

-Psychodynamic approaches to people with substance abuse are more widely valued and accepted than they are in the treatment of patient with alcohol abuse. In contrast to alcoholic patient, individuals with poly substance abuse are more likely to have had unstable childhoods, more likely to self-medicate with substances and more likely to benefit from psychotherapy.

  • Co-addiction/Co-dependence

-When people, usually a couple have a relationship that is primarily responsible for maintaining addiction behavior in at least one of the persons. Each behavior that helpsperpetuates the situation and denial of the situation is a pre-requisite for such a dyadic relationship to develop.

  • Behavioral Theories

-A substance seeking behavior has for major principles. The first two principles are the positive reinforcing qualities and adverse effect of some substance. According to the third and fourth principle, a person must be able to discriminate the substance of abuse from other substance; most of all substance-seeking behavior is associated with cues that become connected with the substance-taking experienced.

  • Genetic Factors

-Genetic pattern in their development.

  • Neurochemical Factors

-Identified particular neurotransmitter through which, or neurotransmitter receptors on which the substance has their effects. The opiates, the long term use of a particular substance of abuse may eventually modulate receptor system in the brain, which requires the presence of the exogenous substance to maintain homeostasis. A receptor-level may be the mechanism for developing tolerate within the central nervous system.

  1. Pathophysiology

Several neurobehavioural effects of alcohol have been related to the development of alcohol dependence. The pleasurable and stimulant effects of alcohol are mediated by a dopaminergic pathway projecting from the ventral tegmental area to the nucleus accumbens. Repeated, excessive alcohol ingestion sensitises this pathway and leads to the development of dependence. Long-term exposure to alcohol causes adaptive changes in several neurotransmitter systems, including down-regulation of inhibitory neuronal gamma-aminobutyric acid receptors, up-regulation of excitatory glutamate receptors, and increased central norepinephrine (noradrenaline) activity.

Discontinuation of alcohol ingestion leaves this excitatory state unopposed, resulting in the nervous system hyperactivity and dysfunction that characterise alcohol withdrawal. It has also been suggested that withdrawal symptoms intensify as withdrawal episodes grow in number, a phenomenon called 'kindling'. Alcohol-dependent patients also experience craving, defined as the conscious desire or urge to drink alcohol. Craving has been linked to dopaminergic, serotonergic, and opioid systems that mediate positive reinforcement, and to the gamma-aminobutyric acid, glutamatergic, and noradrenergic systems that mediate withdrawal. Long-term use of alcohol is also proposed to enhance corticotrophin-releasing factor, neuropeptide Y, and other stress-producing neurotransmitters and hormones, so that continued alcohol use becomes necessary to relieve chronic stress and dysphoria.

Continuing to clarify the specific neurotransmitters associated with both the behavioural effects of alcohol and the development of alcohol dependence may yield potential targets for drug therapy to treat dependence.

  1. Signs and Symptoms

Alcohol may lead to:

  • health problems
  • social problems
  • morbidity
  • injuries
  • unprotected sex
  • violence
  • deaths
  • motor vehicle accidents
  • homicides
  • suicides
  • Physical dependenceorpsychological addiction.
  1. Course and Prognosis

Individuals who suffer from substance abuse tend to be more successful in recovery when they are highly motivated to be in treatment, are actively engaged in their own recovery, and receive intensive treatment services. Prognosis for substance abuse recovery is further improved by being able to easily access community-based social supports.

  1. Medical Management

Formal intervention is necessary to convince the substance abuser to submit to any form of treatment. Behavioral interventions and medications exist that have helped many people reduce, or discontinue, their substance abuse. From theapplied behavior analysisliterature,behavioral psychology, and from randomizedclinical trials, several evidenced based interventions have emerged:

-Behavioral marital therapy

-Motivational Interviewing

-Community reinforcement approach

-Exposure therapy

-Contingency management

-Pharmacological therapy

ALCOHOL-RELATED DISORDER

  1. Definition

The most frequently used brain depressant. Cause of considerable morbidity and mortality.

  1. Epidemiology

Drinking alcohol-containing beverages is generally considered an acceptable and common habit in the United States. 85% of all US residents have had an alcohol-containing drink at least once in their lives. 51% of all US adults are current users of alcohol. US stated that beer has one half of all alcohol consumptions, liquor for about one third and wine for about one sixth. About 10% of women and 20% of men have met the diagnostic criteria for alcohol abuse during their lifetime, and 3 to 5% of women and 10% in men have met the diagnostic criteria for the more serious diagnosis of alcohol dependence during their lifetimes. About 200,000 deaths each year are directly related to alcohol abuse. The common causes of deaths among people with alcohol-related disorders are suicide, cancer, heart disease and hepatic disease.

Alcohol use and alcohol-related disorders are also associated with about 50% of all homicides and 25% of all suicides.

  • Statistical Factors

-In 1995, approximately 111million people age 12 and over were current alcohol users; this number was about 52%of the total population of age 12 and older. About 32million people engaged in binge drinking and about 11million people were heavy drinkers. About 10million current drinkers were under 21 in 1995. Of these, 4.4million were binge drinkers, including 1.7million heavy drinkers. Alcohol usage rates were not significantly different between 1994 and 1995.

-Rates of current alcohol use were above 60% for age groups 21 through 25, 26 through 29, 30 through 34, 35 through 39, and 40 through 44 in 1995. For younger and older age groups rates were lower. Young adults’ drinkers were the most likely to binge or drink heavy. About half the drinkers in this age group were binge drinkers and about one in five was heavy drinkers.

Race and Ethnicity

  • Rates for Hispanics and blacks were 45% and 41%. Rate for binge use was lower among blacks 11.2% and among whites 16.6% and among Hispanics 17.2%

Gender

  • Men were much more likely than were women to be binge drinkers 23.8% and 8.5% and heavy drinkers 9.45 and 2.0%

Region and Urbanicity

  • The rate of current alcohol use was 59% in North Central Region, 54% in Northeast Region, 53% in West and 47% in South in 1995. Rates of binge use were 20% in North Central Region, 16% West and 14% in South and Northeast. Heavy alcohols were 7% North Central region, 5.6% West, 4.9 Northeast and 4.8 in South.

Education

  • 68% of adults with college degrees with current drinkers, 42% of those having less than a high school education. Rate of heavy alcohol use was 3.7% who had completed college and 7.1% among not completed high school.
  • Psychosocial Factors

-People who are stereotypical skid row alcoholics constitute less than 5% of those with alcohol-related disorders in the United States.

  • Comorbidity

Anti-social Personality Disorder

  • Particularly common in men with an alcohol-related disorder and can precede the development of alcohol-related disorder.

Mood Disorder

  • Depression is likely to occur in patients with alcohol-related d/o who have a highly daily consumption of alcohol and who have family history of alcohol abuse.
  • Depressive symptoms that remain after 2 to 3 weeks of sobriety to be treated with antidepressant drug. Pt. with bipolar I d/o are thought to be at risk for developing an alcohol-related d/o and may use alcohol to self-medicate their manic episodes. Dopamine metabolites and y-aminobutyric acid (GABA)

Anxiety Disorder

  • Use alcohol for its efficacy in alleviating anxiety. Phobias and panic d/o are particularly frequent comorbid diagnose in this pt.

Suicide

  • Presence of major depressive episode, weak psychosocial support systems, a serious co-existing medical condition, unemployment and living alone.
  1. Etiology

All other psychiatric conditions probably represent a heterogeneous group of disease process. Psychosocial, genetic or behavioral factors may be important than any other factors. One element, a neurotransmitter receptor gene, may be more critically involved than other element.

  • Childhood History

-Children at high risk for alcohol-related d/o have been found to possess a range of deficits on neurocognitive testing, decreased amplitude of the P300 wave on evoked potential testing. A variety of abnormalities on EEG recordings.

-A childhood history of attention-deficit/hyperactivity d/o or conduct d/o or both increase a child’s risk for an alcohol-related d/o as an adult. Anti-social personality d/o predisposes a person to an alcohol-related d/o.

  • Psychodynamic Factors

-According to psychoanalytic theory, people with harsh super egos’ who are self-punitive turn to alcohol as a way of diminishing unconscious stress. Anxiety in people fixated at the oral stage may be reduced by taking substance, such as alcohol by mouth. The general personality of a person with an alcohol-related d/o as shy, isolated, impatient, irritable, anxious, hypersensitive and sexually repressed.

-Alcohol may be abused by some people to reduced tension, anxiety and psychic pain. Alcohol consumption can also lead to a sense of power and increased self-worth.

  • Social and Cultural Factors

-Social settings commonly lead to excessive drinking in college dormitories and military bases. Colleges and universities have recently tried to educate students about the health risks of drinking large quantities of alcohol. Some cultural and ethnic groups are more restrained than others about alcohol consumption.

  • Behavioral and Learning Factors

-Cultural factors can affect drinking habits, so can the habits within a family, specifically parental drinking habits. The positive reinforcing aspects of alcohol can induce feelings of well-being and euphoria and can reduce fear and anxiety which may further encourage drinking.

  • Genetic and Other Biological Factors

-The data for the heritability of alcohol-related d/o in men are stronger than are data for the heritability of alcohol-related d/o in women.

  1. Pathophysiology

Alcohol ismetabolized by a normalliverat the rate of about one ounce. An "abnormal" liver with conditions such ashepatitis,cirrhosis,gall bladderdisease, andcancerwill have a slower rate of metabolism.

As drinking increases, people become sleepy, or fall into astupor. After a very high level of consumption, the respiratory system becomes depressed and the person will stop breathing. Comatose patients may aspirate their vomit. CNS depression and impaired motor co-ordination along with poor judgement increases the likelihood of accidental injury occurring.It is estimated that about one third of alcohol-related deaths are due to accidents (32%), and another 14% are from intentional injury.

In addition to respiratory failure and accidents caused by effects on the central nervous system, alcohol causes significant metabolic derangements.Hypoglycaemiaoccurs due to ethanol's inhibition ofgluconeogenesis, especially in children, and may causelactic acidosis,ketoacidosisand acuterenal failure. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.

  1. Signs and Symptoms

Patient will often complain of difficulty of the following

  • interpersonal relationships
  • problems at work or school
  • legal problems
  • complain of irritability andinsomnia
  • Inebriation and poor judgment
  • chronic anxiety
  • alcohol poisoning
  • unintentional injuries
  • Suicide
  • Hypertension
  • Pancreatitis
  • sexually transmitted diseases
  • Meningitis among other disorders.
  1. Course and Prognosis

Alcohol abuse during adolescence, especially early adolescence may lead to long-term changes in the brain which leaves them at increased risk ofalcoholismin later yearsgeneticfactors also influence age of onset of alcohol abuse and risk of alcoholism. College/university students who are heavy binge drinkers (3 or more times in the past 2 weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more likely to be diagnosed with alcohol abuse compared to non-heavy episodic drinkers, though the direction of causality remains unclear. Occasional binge drinkers (one or two times in past 2 weeks), were found to be 4 times more likely to be diagnosed with alcohol abuse or dependence compared to non-heavy episodic drinkers.