Substance-Related & Addictive Disorders, Part 2

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Overview – Substance-Related & Addictive Disorders, Part 2

Substance-Related & Addictive Disorders involve the persistent use of drugs despite substantial harm and adverse consequences. These disorders are characterized by an array of mental, emotional, physical, and behavioral problems such as chronic guilt; an inability to reduce or stop consuming the substance(s) despite repeated attempts; driving while intoxicated; and physiological withdrawal symptoms. Drug classes that are involved include alcohol; cannabis; phencyclidine and other hallucinogens, such as arylcyclohexylamines; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco products; and other or unknown substances.

Eleven symptoms have been identified to assist in characterizing the severity of an individual’s addiction. These help to differentiate between mild, moderate, and severe states of the disorders. For example:

  • One symptom suggests that the individual is at risk.
  • Two or three symptoms point to a mild substance use disorder.
  • Four or five symptoms indicate a moderate substance use disorder.
  • Six or more criteria identify a severe substance use disorder, which signals an addiction to that substance

Substance-Related & Addictive Disorders, Part 1, presented information on four types of disorders. These were:

  1. Alcohol Use Disorder
  2. Tobacco Use Disorder
  3. Cannabis Use Disorder
  4. Gambling Disorder

Substance-Related & Addictive Disorders, Part 2, presents information on four additional types of disorders, one type each day for four days. These are: 

Cocaine Use Disorder and Intoxication

Cocaine intoxication refers to the adverse and deleterious effects of cocaine on the mind, body, and behavior of users. These effects can develop over time with regular use or can result from an acute intoxication due to a single intake of the substance. Chronic use may lead to perforated nasal septum due to vasoconstriction and resulting ischemic necrosis. Cocaine dependence inevitably leads to effects of cocaine intoxication that can sometimes be completely reversed without negative consequences but that can also potentially kill the users. Cocaine interrupts the natural body chemistry and causes serious withdrawal symptoms when people try to stop using it. 

Three categories define the severity of Cocaine Use Disorder and Intoxication:

  • Mild: A minimum of two to three criteria symptoms
  • Moderate: Between four and five criteria symptoms
  • Severe: between six and seven criteria symptoms 
Methamphetamine Intoxication

Methamphetamine or METH is a dopamine, norepinephrine, and serotonin reuptake inhibitor. It is a substance use disorder characterized by compulsive meth-seeking and -taking despite serious negative consequences. It goes by a number of nicknames such as crystal meth, crank, speed, tweek, glass, and so on. Studies have shown that METH induces a dose-dependent brain and body hyperthermia, leakage of the BBB with associated edema, and widespread morphological abnormalities of brain cells, including neurons, glia, epithelial, and endothelial cells developing rapidly during acute METH intoxication.

Methamphetamine Intoxication occurs when there is a clinically significant problematic behavioral or psychological change that develops during, or shortly after use. Methamphetamine Intoxication differs from the other stimulant-induced disorders as the severity of the intoxication symptoms exceeds that associated with other stimulant-induced disorders. The symptoms warrant additional independent clinical attention. Stimulant intoxication delirium is characterized by a fluctuation in level of awareness and change in cognition.

Heroin Intoxication (opioids)

Opioid Intoxication is a diagnosis assigned to individuals who experience severe physical and mental symptoms that can occur within 12-24 hours after the last dose of an opioid drug. This may include any psychoactive chemical substance which has been either derived from opium (e.g., heroin, diamorphine or diacetylmorphine) or is a synthetic copy of opium such as Oxycodone, Fentanyl, Morphine, Codeine, Hydrocodone (alone or with acetaminophen), Oxycodone (alone or with acetaminophen), Oxymorphone, etc. 

Heroin produces an initial full-body orgasmic sensation when given by the Intravenous or Intranasal route, followed by several hours of a peaceful, warm, somnolence, soothing sensation. This pleasurable experience is accompanied by cravings for more Opioids. Tolerance develops in a relatively short time, weeks in some individuals. As tolerance diminishes the initial pleasurable sensation and prolonged feeling of relaxation, the user increases the dosage or seeks more potent opioids. Heroin Intoxication has the potential to result in life-threatening overdose, mainly due to respiratory depression. Withdrawal symptoms can be relieved almost immediately by the administration of another dose of opioids. This combination of reinforcement and punishment produces powerful conditioning to continue using, despite multiple adverse consequences. Between 1995-2020, nearly a million Americans died from the opioid Fentanyl alone. 

Acid Intoxication

Acid Intoxication occurs when there is a clinically significant problematic physiological, behavioral, or psychological change that develops during, or shortly after ingestion of a hallucinogen. These can include LSD (acid), Ecstasy (MDMA), Ketamine, magic mushrooms (Psilocybin), Peyote (Mescaline), etc. Depending on the specific hallucinogen, the episode of intoxication can last from minutes to hours or longer. Hallucinogen abuse can have a tremendous impact on the developmental health of younger individuals and lead to long-term disparities in their quality of life such as hindering education and career opportunities. 

Acid intoxication may lead to an increased risk for suicidality, although suicide is rare among users. Tolerance and dependency develop during the course of repeat cycles of abuse as a number of physiological adaptations to hallucinogen use and residual changes in brain and central nervous system functions take place. 

Diagnostic criteria for Acid Intoxication (other hallucinogen intoxication or “acid trip”) include:

A. Recent use of a hallucinogen (other than phencyclidine).

B. Clinically significant problematic behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of “losing one’s mind,” paranoid ideation, impaired judgement) that developed during, or shortly after, hallucinogen use.

C. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., subjective intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesia) that developed during, or shortly after, hallucinogen use.

D. Two (or more) of the following signs developing during, or shortly after, hallucinogen use:

  • Pupillary dilation.
  • Tachycardia.
  • Sweating.
  • Palpitations.
  • Blurring of vision.
  • Tremors.
  • Incoordination.

E. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

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