Psychoactive substance related disorders Behavioral addictions

1. Psychoactive substance related disordersBehavioral addictions Katalin Tolvay DEOEC English Program

2. Substance-Related Disorders (DSM-IV, 2000) Substance Abuse Substance Dependence Substance Intoxication Substance Withdrawal Substance-Induced Mental Disorders Delirium, Persisting Dementia, Persisting Amnestic Disorder, Psychotic Disorder, Mood Disorder, Sexual Dysfunction, Sleep Disorder, Hallucinogen Persisting Perception Disorder Substance Use Disorder, Not Otherwise Specified

3. ICD-10 Mental and behavioral disorders due to psychoactive substance use F10-F19 • F1..00 acute intoxication • F1..10 harmful use • F1..20 dependence syndrome • F1..30 withdrawal state • F1..40 withdrawal state with delirium • F1..50 psychotic disorder • F1..60 amnestic syndrome • F1..70 residual and late onset psychotic disorder • F1..80 other • F1..90 unspecified

4. ICD-10 Mental and behavioral disorders due to psychoactive substance use F10-F19 • F10 Alcohol related disorders • F11 Opioid related disorders • F12 Cannabis related disorders • F13 Sedative, hypnotic, or anxiolytic related disorders • F14 Cocaine related disorders • F15 Other stimulant related disorders • F16 Hallucinogen related disorders • F17 Nicotine dependence • F18 Inhalant related disorders • F19 Other psychoactive substance related disorders Behavioural syndromes associated with physiological disturbances and physical factors F50-59 • F55 Abuse of non-dependence-producing substances (e.g. antidepressants, pain killers, laxatives)

5. Substance Abuse Maladaptive pattern of substance use, characterized by 1 (or more) of following symptoms in a 12-month period: Recurrent substance use resulting in failure to fulfill major role obligations Recurrent substance use in situations in which it is physically hazardous Recurrent substance-related legal problems Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance ** The symptoms have never met the criteria for Substance Dependence for this class of substance

6. Substance Dependence Maladaptive pattern of substance use, characterized by 3 (or more) of following symptoms in a 12-month period: Tolerance (need for more or diminished effect) Withdrawal (characteristic syndrome or avoidance of symptoms) Substance taken in larger amounts or over a longer period than intended Persistent desire or unsuccessful efforts to cut down or control substance use Great deal of time spent obtaining, using, or recovering from effects of the substance Important social, occupational, or recreational activities are given up or reduced because of substance use Substance use continued despite knowledge of having a persistent or recurrent physical or psychological problem that was likely caused or exacerbated by the substance

7. Substance-related disorders • Symptoms are substent specific due to different effects on CNS • Physical and psychological withdrawal • Personality changes

8. Addiction • Obsessive,ritual behavior • Intensive desire for consumption and effects of the substance – OR equal situations • Increasing anxiety while doing the ritual • Immediate and brief relief during consumption OR carrying on the addictive behavior • Tendency to consumption after withdrawal OR fast return of desire

9. ICD-10 Disorders of adult personality and behaviour F60-69 F63Habit and impulse disorders • F63.00 Pathological gambling • F63.10 Pathological fire-setting (pyromania) • F63.20 Pathological stealing (kleptomania) • F63.30 Trichotillomania

10. Dependency in behavioral addictions: • Tolerance – need to spend increasing amounts of time on gambling, computer activity, shopping etc. • Withdrawal – psychological discomfort if not acting the behavior • Compulsive behavior – inability to regulate or moderate use…out of your control

11. Comorbidity • Bipolar disorder (BIP II) • Major depression • Anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder) • Personality disorders • Primary versus secondary addiction

12. Why Does Addiction Occur? • Some drugs of abuse can release 2 to 10 times the amount of dopamine as natural rewards • In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards • This creates a much stronger effect on the brain's pleasure circuit than those produced naturally (e.g., food, sex) • The effect of such a powerful reward strongly motivates people to take drugs again and again

13. Motivation and Addiction • Acute Drug Effects • reward • Chronic Drug Effects • plasticity/neuroadaptations • tolerance • physical dependence • sensitization

14. Treatments for addiction • The decision • Denial met by intervention or reality • Cognitive changes (Prochaska, DiClemente & Norcross, 1992) • Precontemplation: No problem! • Contemplation: Maybe there’s a problem… • Preparation • Action • Maintenance • Relapse

15. Treatment goals • Abstinence: The 12-step approach • Controlled use • Harm reduction • Substitute addictions • Methadone • Gum-chewing • Needle exchanges • Water supply

16. . Treatment stages • Detoxification (Detox) • Radical • Gradual • With pharmacological support • Active treatment • Relapse prevention

17. More treatments • Medication-assists • Antagonist blockade • Treat contributing conditions • Substitution • Antabuse • Partial receptor agonists (varenicline) • Craving reduction • Outpatient drug-free programs

18. Relapse prevention • Risk of relapse is reduced by • Frequent review of the decision • Avoiding drug-related cues by moving and dumping drug-using friends • Social connections with non-users • Getting a job • Learning substitute activities • Developing structure for life