Psychoactive Substance Use Disorders

Overview of Psychoactive Substance Use Disorders:

The use of alcohol and other psychoactive substances has recorded throughout history, often with the primary aim of changing an individual’s mood or relieving the distress of harsh circumstances.

Early examples include the chewing of tobacco leaves or coca (cocaine) in North America and Peru, respectively.

Humans are clearly vulnerable to the desire to use substances; this is illustrate by the fact that alcohol and other psychoactive substances remain a leading cause of medical and social problems worldwide and cause psychoactive substance use disorders.

World Health Organization (WHO) statistics report that alcohol is the primary causative factor in 4 percent of the global burden of disease. [1]

Drug:

A drug is defined (by WHO) as any substance that, when taken into the living organism, may modify one or more of its functions. This definition conceptualises ‘drug’ in a very broad way, including not only the medic at ions but also the other pharmacologically active substances.

The words ‘drug addiction’ and ‘drug person with substance abuse disorder’ were dropped from scientific use due to their derogatory connotation. Instead ‘ drug abuse’, ‘ drug dependence’, ‘ harmful use’, ‘misuse’, and ‘psychoactive substance use disorders’ are the terms used in the current nomenclature.

A psychoactive drug is one that is capable of altering the mental functioning.

There are four important patterns of psychoactive substance use disorders, which may overlap with each other:

1. Acute intoxication
2. Withdrawal state
3. Dependence syndrome
4. Harmful use.

The other syndromes associated with the psychoactive substance use in ICD-10 include psychotic disorder, amnesic syndrome, and residual and late-onset (delayed onset) psychotic disorder.

Acute Intoxication In psychoactive Substance Use Disorder:

According to ICD-10, acute intoxication is a transient condition following the administration of alcohol or other psycho active substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses. This is usually associated with high blood levels of the drug. [2]

The disturbances are directly related to the acute pharmacological effects of the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. [3]
However, in certain cases where the threshold is low (due to a serious medical illness such as chronic renal failure or idiosyncratic sensitivity) even a low dose may lead to intoxication. The intensity of intoxication lessens with time, and effects eventually disappear in the absence of further use of the substance. The recovery is therefore complete, except where tissue damage or another complication has arisen.

codes

The following codes may be used to indicate whether the acute intoxication was associated  with any complications:

• Uncomplicated (symptoms of varying severity, usually dose-dependent, particularly at high dose levels);
• trauma or other bodily injury;
• other medical complications (such as haematemesis, inhalation of vomitus);
• delirium;
• perceptual distortions;
• coma;
• convulsions;
• Pathological intoxication (only for alcohol).  [2]

The nature of these complications depends on the pharmacological class of substance and mode of administration. [3]

Withdrawal State In psychoactive Substance Use Disorder:

A withdrawal state is characterized by a group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance.

The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. [3]

The withdrawal state may be complicated by convulsions. Typically, the patient reports that the withdrawal symptoms are relieved by further substance use.

The withdrawal state is further classified as:

i. Uncomplicated;
ii. With convulsions;
iii. With delirium. [2]

Dependence Syndrome In psychoactive Substance Use Disorder:

A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

The dependence syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol, or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of pharmacologically different psychoactive substances. [3]

A central descriptive characteristic of the dependence syndrome is the desire (often strong and sometimes overpowering) to take unpredictable active substances (which may or may not have been medically prescribed), alcohol, or tobacco.

There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with non dependent individuals.

Diagnosis of dependence

A definite diagnosis of dependence should usually be made only if at least three of the following have been experienced or exhibited at sometime during the previous year:

• A strong desire or sense of compulsion to take the substance.
• Difficulties in controlling the substance-taking behaviour in terms of its onset, termination, or levels of use.
• A physiological withdrawal state when the substance use has ceased or reduced, as evidenced by the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms.
• Evidence of tolerance, such that increase doses of the psychoactive substance are require in order to achieve effects originally produced by lower doses (clear examples of this found in the alcohol and opiate dependent individuals who may take daily doses that are sufficient to incapacitate or kill non-tolerant users).
• Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects.
• Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should made to determine that the user was actually, or could expect to be, aware of the nature and extent of the harm.

A narrowing of personal repertoire of patterns of psychoactive substance use has also described as a characteristic feature of the dependence syndrome (e.g. a tendency to drink in the same way on weekdays and weekends, regardless of the social constraints that determine appropriate drinking behaviour).

The dependence syndrome can be further coded as (ICD-10):

1. currently abstinent
2. The currently abstinent, but in a protected environment (e.g. in hospital, in a therapeutic community, in prison, etc.)
3. currently on a clinically supervised maintenance or replacement regime (controlled dependence, e.g. with methadone; nicotine gum or nicotine patch)
4. currently abstinent, but receiving treatment with aversive or blocking drugs (e.g. naltrexone or disulfiram); v. currently using the substance (active dependence)
5. continuous use
6. episodic use ( dipsomania).

The dependence can be either psychic, or physical, or both. [2]

Harmful use In psychoactive Substance Use Disorder is characterised by:

1. Continued drug use, despite the awareness of harmful medical and/or social effect of the drug being use, and/or [2]
2. A pattern of psychoactive substance use that is causing damage to health. The damage may physical (as in cases of hepatitis from the self-administration of inject psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol). [3]

Harmful use is not diagnose, if a dependence syndrome is present. DSM-IV-TR uses the term substance abuse instead, with minor variations in description. [2]

Psychoactive Substance of Psychoactive Substance Use Disorders:

The major dependence producing drugs are:

1. Alcohol
2. Opioids, e.g. opium, heroin
3. Cannabinoids, e.g. cannabis
4. Cocaine
5. Amphetamine and other sympathomimetics
6. Hallucinogens, e.g. LSD, phencyclidine (PCP)
7. Sedatives and hypnotics, e.g. barbiturates
8. Inhalants, e.g. volatile solvents
9. Nicotine
10. Other stimulants (e.g. caffeine). [2]

There are mainly three causes of In Psychoactive Substance Use Disorders:

1. Biological Factors:

• Genetic vulnerability (family history of substance use disorder; for example in type II alcoholism).
• Co-morbid psychiatric disorder or personality disorder.
• Co-morbid medical disorders.
• Reinforcing effects of drugs (explains continuation of drug use).
• Withdrawal effects and craving (explains continuation of drug use).
• Biochemical factors (for example, role of dopamine and norepinephrine in cocaine, ethanol and opioid dependence).

2. Psychological Factors:

• Curiosity; need for novelty seeking.
• General rebelliousness and social non-conformity.
• Early initiation of alcohol and tobacco.
• Poor impulse control.
• Sensation-seeking (high).
• Low self-esteem (anomie).
• Concerns regarding personal autonomy.
• Poor stress management skills.
• Childhood trauma or loss.
• Relief from fatigue and/or boredom.
• Escape from reality.
• Lack of interest in conventional goals.
• Psychological distress.

3. Social Factors:

• Peer pressure (often more important than parental factors).
• Modelling (imitating behaviour of important others).
• Ease of availability of alcohol and drugs.
• Strictness of drug law enforcement.
• Intrafamilial conflicts.
• Religious reasons.
• Poor social/familial support.
• ‘Perceived distance’ within the family.
• Permissive social attitudes.
• Rapid urbanization. [2]

There are a myriad of reasons why someone might take a substance at a given time; however, some general reasons apply and are listed below.

The initial reason for taking a substance is often straightforward, but may become more complex and change over time.

Pleasurable experiences:

About one-fifth of drug use is primarily to gain pleasure, usually in the form of a buzz or high, numbness, drowsiness, or comfort. Those who experience energy and confidence will often use to try and relive the initial experience they encountered.

Availability:

The availability of most psychoactive substances is limit in one way or another.

If a substance is easily available people are more likely to use it; however, illegal substances also hold a particular fascination to some individuals. Psychoactive substances are usually obtained in one of three ways:

• Prescribed by doctors (e.g. benzodiazepines);
• Purchased legally (e.g. nicotine, alcohol, and, for adults, solvents);
• Purchased illegally: this category includes most of the other substances nicotine, alcohol, and solvents under certain age limits. Control of the availability of such drugs depends on political action and requires extensive activity by the police and other enforcement agencies to detect and control the importation and distribution of drugs.

Anxiety disorders:

They are the commonest form of psychiatric disorder and many people take drugs (especially alcohol and benzodiazepines) to reduce anxiety. Those with undiagnose social anxiety disorder are the most likely to do so.

Self-medication:

It is for psychiatric co-morbidities is extremely common, with the aim of reducing unwant symptoms. Alcohol is use in anxiety, depression, and stress-related disorders. Stimulants and cannabis commonly take by schizophrenics and those with bipolar disorder.

Relieving physical symptoms:

Such as pain is a relatively common reason for substance use. People with chronic pain syndromes or neurological conditions such as multiple sclerosis are the frequent users.

Boredom:

It is occasionally cite as a reason to take drugs, especially amongst young men in difficult social circumstances.

Peer pressure:

It may be prevalent amongst teenagers and university students. Personal vulnerability (a lack of personal resources needed to cope with the challenges of life) is a cause of the success of peer pressure.

Attitudes of the community:

Some social, cultural, and religious groups disapprove of drug taking, and this shared value helps to restrain its members. In other groups, drug taking is condoned or even encouraged and it gives a person status among his peers.

Dependence and tolerance:

It develop as time progresses, and a physical and psychological ‘need’ for the drug will take over from previous reasons for use. [1]

Frequently Asked Questions

What is Psychoactive Substance Use Disorders?

Psychoactive Substance Use Disorders caused by psychoactive drugs. It is also one that is capable of altering the mental functioning.

What causes of Psychoactive Substance Use Disorders?

• Biological Factors
• Psychological Factors
• Social Factors

What is withdrawal state of Psychoactive Substance Use Disorders?

A withdrawal state is characterized by a group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance.

Why do people use substances?

• Pleasurable experiences
• Availability
• Anxiety disorders
• Self-medication
• Relieving physical symptoms
• Boredom
• Peer pressure
• Attitudes of the community