This presentation aims of understand the clinical picture of drug abuse and dependency. It covers the symptoms, levels of severity, DSM criteria and prevalence of each drug.

1. DRUG ABUSE AND
DEPENDENCE
MUSKAAN JOSHI
5620
CLINICAL PICTURE

2. CONTENTS
OPIATES
STIMULANTS
SEDATIVES
HALLUCINOGENS
CLINICAL PICTURE OF
1.
2.
3.
4.

3. OPIATES
OPIUM AND HEROIN

4. OPIUM AND HEROIN
Opium is a mixture of about 18
chemical substances known as
alkaloids.
it was discovered that if morphine was
treated with an inexpensive and readily
available chemical called acetic
anhydride, it would be converted into
another powerful analgesic called
heroin.
Heroin proved to be an even more
dangerous drug than morphine and
was very rapid and addictive.

5. LEVEL OF SEVERITY
Morphine and heroin are commonly introduced into the body by smoking, snorting
(inhaling the powder), eating, “skin popping,” or “mainlining.
Skin popping is injecting the liquefied drug just beneath the skin, while mainlining is
injecting the drug directly into the bloodstream.
Immediate effects of mainlined or snorted heroin is an intense feeling of euphoria.
vomiting and nausea have also been known to be part of the immediate effects of
heroin and morphine use.
Lethargy and needs for food and sex, are markedly diminished.
pleasant feelings of relaxation and euphoria tend to dominate.

6. DSM CRITERIA
OF OPIATES

12. Stimulant Use Disorder is a substance use disorder characterized by a problematic
pattern of stimulant use leading to clinically significant impairment or distress.
Epidemiology
For cocaine:
In the United States, the estimated prevalence is 0.3% in adults.
For amphetamine-type stimulants (prescription stimulants, “crystal meth”):
In the United States, the estimated prevalence is 0.2% in adults.
[2]Males are significantly more likely to have intravenous use than females (3:1)
Non-prescribed (i.e. - taken from a friend or family member) use of prescription stimulants
occurs in up to 9% of children through to high school, and is between 5 to 35% in college-
aged individual

13. Risk Factors
Some individuals may use stimulants to control weight or to improve performance in
school, work, or athletics.
For cocaine use, bipolar disorder, schizophrenia, antisocial personality, and other
substance use disorders are risk factors.
Predictors of cocaine use in teenagers include prenatal cocaine exposure, postnatal
cocaine use by parents, exposure to community violence during childhood, unstable
home environment, previous psychiatric disorders, and interactions with dealers and
users.
Stimulant smoking and intravenous use can lead to a rapid progression to severe-levels
of stimulant use disorder, which can escalate over weeks to months.
With chronic use, there is a significant decrease in pleasurable effects due to tolerance
and a significant increase in dysphoric effects

14. DSM CRITERIA

15. DSM-5 Diagnostic Criteria
Criterion A
A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to
clinically significant impairment or distress, as manifested by at least 2 of the following,
occurring within a 12-month period:
The stimulant is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.
A great deal of time is spent in activities necessary to obtain the stimulant, use the
stimulant, or recover from its effects.
Craving, or a strong desire or urge to use the stimulant.
Recurrent stimulant use resulting in a failure to fulfill major role obligations at work,
school, or home.

16. Continued stimulant use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the stimulant
Important social, occupational, or recreational activities are given up or reduced
because of stimulant use.
Recurrent stimulant use in situations in which it is physically hazardous.
Stimulant use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
the stimulant.
Tolerance, as defined by either of the following:
A. A need for markedly increased amounts of the stimulant to achieve intoxication or
desired effect.
B. A markedly diminished effect with continued use of the same amount of the stimulant.

17. Note: This criterion is not considered to be met for those taking stimulant medications
solely under appropriate medical supervision, such as medications for attention-
deficit/hyperactivity disorder or narcolepsy.
Withdrawal, as manifested by either of the following:
A. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of
the criteria set for stimulant withdrawal).
B. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal
symptoms.
Note: This criterion is not considered to be met for those taking stimulant medications
solely under appropriate medical supervision, such as medications for attention-
deficit/hyperactivity disorder or narcolepsy.

18. LEVEL OF SEVERITY
People with stimulant use disorder have difficulty controlling their stimulant use. They may
continue to use these substances even though they have negative effects on their health,
relationships, and functioning. They may experience legal and financial problems and
difficulty finding pleasure in other activities.
Using stimulants can have negative effects on a person’s physical and mental health. Long-
term use can lead to:
Nasal and lung damage
Dental problems
Insomnia
Anxiety and depression
Heart problems
Severe itching and skin sores
Paranoia
Psychosis

19. SEDATIVES

20. Sedative, hypnotics, or anxiolytic use disorder is a misuse of sedative, hypnotics, or
anxiolytic substances. Sedatives, hypnotics, or anxiolytics can be obtained legally and
illegally.
The addiction of these substances often occurs together with other drugs of abuse. This
usually reflects an effort to counteract the effects of those other drugs.
For example, people may abuse benzodiazepines to help them “come down” from the high
of cocaine.
Sedative, hypnotics, or anxiolytic dependence causes withdrawal symptoms, which makes
it difficult to stop taking them, consequently developing an addiction. Commonly abused
sedatives, hypnotics, or anxiolytics include valium, Ativan, Ambien, sleep aids,
barbiturates, etc.

21. Alcohol has some properties similar to
the above drugs, but alcohol is so
common that health experts classify
alcohol-related problems separately.
Regular use of these drugs often leads
to "drug tolerance." That is, the body
adjusts to them and it takes a higher
and higher dose to achieve the
desired effect. Dependence also can
develop, meaning withdrawal
symptoms will occur if the drug is
suddenly stopped.

22. LEVEL OF SEVERITY
A craving for the drug, often with unsuccessful attempts to cut down on its use
Symptoms of dependence on sedative, hypnotic or anxiolytic drugs:
1.
Physical dependence (development of physical withdrawal symptoms when a person
stops taking the depressant)
2. A continued need to take the drug despite drug-related psychological, interpersonal or
physical problems
3. People with drug dependence eventually develop physical tolerance (the gradual need
for greater amounts of the drug to feel the same effects). But addiction implies that the
person is also craving the drug's effect or relying on the drug for a reason other than the
intended therapeutic uses of the drug.

23. DSM-5 CRITERIA

25. HALLUCINOGENS

26. Hallucinogens are a group of substances that affect a person’s awareness of reality.
People report using hallucinogens for pleasure or as a way to “expand one’s mind.”
They are also used in some cultures for religious or healing purposes. In 2020, 7.1 million
(almost 3% of) Americans had used hallucinogens in the previous year.
Hallucinogen use disorder is a type of substance use disorder that can develop after a
person repeatedly uses hallucinogens.
People with hallucinogen use disorder will continue to take hallucinogens even though
they cause problems in many parts of their lives. These problems can negatively affect a
person’s relationships, work, and physical and mental health.

27. A hallucinogen is a type of substance that alters a person’s thoughts, feelings,
and sensations. There are many different hallucinogens. Some are human made,
and others are derived from plants. Hallucinogens have been used throughout
history for healing and religious purposes. Some people also consume them for
pleasure or stress relief.
People under the influence of hallucinogens may experience:
Changes in mood
Hallucinations (seeing, hearing, or feeling things that are not there)
Sense of detachment from self or the world
There are two types of hallucinogens: classic hallucinogens and dissociative
drugs.

28. DSM-CRITERIA

29. A group of substance-related disorders involving the ingestion of drugs classified broadly
as hallucinogens
In the DSM, hallucinogens are subdivided into two main categories:
Phencyclidine: Used for phencyclidine (PCP) and related compounds including: ketamine,
cyclohexamine, and dizocilpine
Other hallucinogen: Used for all other hallucinogens including phenylalkylamines (e.g.,
mescaline, DOM, and MDMA), indoleamines (e.g. psilocybin and DMT), ergolines (e.g., LSD
and morning glory seeds), and phenethylamines (e.g., 25I-NBOMe)
Disorders caused by PCP and related compounds are include:
Phencyclidine use disorder: Pattern of phencyclidine (PCP) or related substance (e.g.,
ketamine) use causing significant concern or harm, and decrease in functioning
Phencyclidine intoxication: Behavioral effects occurring after ingestion of PCP or a related
substance (e.g., ketamine)

30. Disorders caused by other hallucinogens include:
Other hallucinogen use disorder: Pattern of "other hallucinogen" use causing significant
concern or harm, and decrease in functioning
Other hallucinogen intoxication: Behavioral or psychological effects occurring after
ingestion of a hallucinogen (other than PCP).
Other hallucinogen-induced disorders
Other hallucinogen-induced psychotic disorder (see schizophrenia spectrum), other
hallucinogen-induced depressive disorder, other hallucinogen-induced bipolar affective
disorder, other hallucinogen-induced anxiety disorder, other hallucinogen intoxication
delirium
Unspecified hallucinogen-related disorder: A hallucinogen-related disorder causing
significant concern or harm, and decrease in functioning, not meeting full criteria for any
specific other hallucinogen-related disorders
Hallucinogen persisting perception disorder
Re-experiencing while sober the perceptual (often visual) disturbances experienced when
an individual was intoxicated with a hallucinogen

31. REFERENCES
Butcher, J.N., Hooley, J.M., & Mineka, S. (2014). Abnormal Psychology (16th Ed). New York:
Pearson
DSM-5
https://cdn.website-
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