This document discusses substance use disorders and different categories of abused substances. It defines substance intoxication, withdrawal, abuse, and dependence according to DSM-IV criteria. It then outlines 11 criteria for substance use disorder and notes changes in the DSM-5 definition. The document proceeds to describe characteristics of five categories of substances - depressants, stimulants, opioids, hallucinogens/PCP, and cannabis. Specific substances like alcohol, cocaine, amphetamines, nicotine, caffeine, heroin, LSD, and marijuana are discussed. Inhalants are also covered.

1. {
Substance-
Use
Disorders

2. A substance is any natural or
synthesized product that has
psychoactive effects—it changes
perceptions, thoughts, emotions, and
behaviors.

3.  (1) central nervous system depressants, including
alcohol, barbiturates, benzodiazepines, and
inhalants
 (2) central nervous system stimulants, including
cocaine, amphetamines, nicotine, and caffeine
 (3) opioids, including heroin and morphine
 (4) hallucinogens and phencyclidine (PCP)
 (5) cannabis
Five categories of abused
substances

4. Substance intoxication:
Substance withdrawal:
Substance abuse:
Substance dependence:
Substance-Related Conditions
Recognized by the DSM-IV-TR

5. Substance intoxication: Experience of
significant maladaptive behavioral and
psychological symptoms due to the effect
of a substance on the central nervous
system.
Substance withdrawal: Experience of
clinical significant distress in social,
occupational, or other areas of functioning
due to the cessation or reduction of
substance use.

6. Substance abuse: Diagnosis given when
recurrent substance use leads to significant
harmful consequences.
Substance dependence: Diagnosis given
when substance use leads to physiological
dependence or significant impairment or
distress.
6

7. 7

8. Impaired centre control
1. The substance is taken in increasingly large
amount or over period of time than originally
intended.
2. The substance user craves the use of the
substance.
3. The substance user feels an ongoing desire to
cut down or control substance abuse.
4. Much time is spent in obtaining, using or
recovering from the substance.
Criteria for Substance Use Disorder

9. Social impairment
5. The ongoing use of the substance often
results in an inability to meet responsibilities
at home, work or school
6. Important social, work-related or
recreational activities are abandoned or cut
back because of substance use.
7. Ongoing substance use despite recurring
social or relationship difficulties caused or
made worse by the effects or the substance.
Criteria for Substance Use Disorder

10. Risky use
8. Ongoing substance use in physically
dangerous situations such as driving car
or operating machinery.
9. Substance use continues despite the
awareness of ongoing physical or
psychological problems that have likely
arisen or been made worse by the
substance.
Criteria for Substance Use Disorder

11. Pharmacological Criteria
10. Changes in the substance user’s tolerance of the
substance is indicated by the need for increased
amounts of the substance to achieve the desired effect
or by a diminished experience of intoxication over
time with the same amount of the substance.
11. Withdrawal is demonstrated by the characteristic
withdrawal syndrome of the substance and or taking
the same or similar substance to relieve withdrawal
symptoms.
Criteria for Substance Use Disorder

12. DSM-5
Substance abuse and dependence may be
combined in one diagnosis to be called
substance-use disorder.
Diagnostic criteria for substance-use disorder
will include:
 continued use of substances despite negative social,
occupational, and health consequences
 evidence of tolerance or withdrawal.
“Craving the substance” will be added because
it is a common symptom of abuse/dependence
“Legal problems” will be removed from the
criteria

13. Depressants
Depressants slow the central nervous
system.
In moderate doses, they make people
relaxed and somewhat sleepy, reduce
concentration, and impair thinking and
motor skills.
Includes alcohol, benzodiazepines,
barbiturates, and inhalants.
1. DEPRESSANTS

14. Alcohol
Alcohol abuse
Alcohol dependence
Binge drinking
Withdrawal
Depressants: Alcohol

15. Alcohol abuse
Alcohol dependence
Binge drinking
Withdrawal
Alcohol

16. 16

17. Gender Differences

18. Ethnic Differences in Alcohol Use in
the United States

19. Long-term Effects of Alcohol
Abuse
Low-grade hypertension
Alcohol-induced persisting amnesic
disorder
Wernicke’s encephalopathy
Alcohol-induced dementia
19

20.  cause decrease in blood pressure,
respiratory rate and heart rate.
 (overdose) can cause respiratory arrest or
cardiovascular collapse
Benzodiazepines and Barbiturates

21. Benzodiazepines and Barbiturates
Benzodiazepines (such as Xanax, Valium,
Halcion, and Librium) and barbiturates (such as
Quaalude) are legally manufactured and sold
by prescription, usually for the treatment of
anxiety and insomnia.
Two common patterns of abuse can develop
with these substances:
 1. adolescents using them for recreational purposes
 2. people (particularly women) using initially under
physician’s care but then increasing doses as
tolerance develops

22. 2. STIMULANTS
 Activate the central nervous system, causing feelings
of energy, happiness, and power, a decreased desire
for sleep, and a diminished appetite
 Include cocaine and the amphetamines (including the
related drugs methamphetamines)
 Impart a psychological lift or rush
 Cause dangerous increases in blood pressure and heart rate,
alter the rhythm and electrical activity of the heart, and
constrict the blood vessels, which can lead to heart attacks,
respiratory arrest, and seizures
 Caffeine and nicotine
 Prescription stimulants, including Dexedrine and
Ritalin

23.  white powder extracted from coca
plant; one of the most addictive
substances known.
 people snort or inject it intravenously.
Cocaine

24. Crack- freebase cocaine usually smoked
in a water pipe or mixed in tobacco or
marijuana cigarette.
 produces instant rush intense euphoria;
heightened self-esteem; alertness; energy;
feelings of competence and creativity.
Cocaine

25.  When taken repeatedly:
 grandiosity, impulsiveness,
hyper sexuality, compulsive
behavior, agitation and anxiety
reaching to the point of panic and
paranoia.

26. Stimulants: Amphetamines
 Used to combat depression or fatigue or boost
energy and self-confidence; also in diet drugs
 Cause the release of dopamine and
norepinephrine and block reuptake
 Symptoms of intoxication are similar to cocaine
intoxication

27. Stimulants: Cocaine
Symptoms include:
– behavioral changes (e.g., euphoria or
affective blunting; impaired judgment)
– rapid heartbeat, dilation of pupils, elevated
or lowered blood pressure
– weight loss, nausea or vomiting
– muscular weakness
– slowed breathing, chest pain, confusion
– seizures, coma
27

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29. Stimulants: Nicotine
•No DSM-V diagnosis for the symptoms, but
nicotine operates on both the central and peripheral
nervous system
•Results in the release of several biochemicals that
may have direct reinforcing effects on the brain,
including dopamine, norepinephrine, serotonin, and
the endogenous opioids
29

30. Stimulants: Nicotine (continued)
• Withdrawal Symptoms
•dysphoria or depressed mood
•insomnia
•irritability
•frustration or anger
•anxiety
•difficulty concentrating
•restlessness
•decreased heart rate
•increased appetite or weight gain

32. Stimulants: Caffeine
•The most heavily used stimulant drug
•75% of caffeine ingested through coffee
•The average American drinks about
two cups of coffee per day; a cup of
brewed coffee has about 100 milligrams
of caffeine
•Caffeine stimulates the central nervous
system increasing levels of dopamine,
norepinephrine, and serotonin

33. Stimulants: Caffeine (continued)
•Symptoms: Restlessness, nervousness,
excitement, insomnia, flushed face, frequent
urination, stomach upset, muscle twitching,
rambling flow of thought or speech, rapid
heartbeat, periods of inexhaustibility,
psychomotor agitation
•Withdrawal Symptoms: Marked fatigue or
drowsiness, increased appetite or weight gain,
marked anxiety or depression, nausea or
vomiting

34. 3. Opioids-
derived from the opium poppy
•Morphine
•Heroin
•Codeine
•Methadone 34

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36. 4. Hallucinogens and PCP
 Hallucinogens are a mixed group of
substances including LSD, MDMA
(also called ecstasy), and peyote.
 PCP, also known as angel dust, is a
manufactured as a powder to be
snorted or smoked. Although not
classified as a hallucinogen, it has
many of the same effects.

37. 37

38. 5. Cannabis
 The leaves of the cannabis (or hemp) plant can be
cut, dried, and rolled into cigarettes or inserted
into food and beverages. In North America, the
result is known as marijuana, weed, pot, grass,
reefer, and Mary Jane
 Cannabis is the most commonly used illegal drug
in the United States, with about 40% of the
population reporting use of it at some time in their
lives, and 6% in the last month

39.  About 7% of the population would qualify for a
diagnosis of cannabis abuse, and 2 to 3% for a
diagnosis of cannabis dependence
 Occasional use is widespread: 30% of college
students say they have used cannabis in the last
year
Cannabis

40. 40

41. Inhalants
 Inhalants: solvents such as gasoline, glue, paint
thinners, and spray paints.
 Greatest users of inhalants are young boys between
10 and 15 years of age.
 Chronic users may have a variety of respiratory
irritations and rashes.
 Can also cause permanent damage to the central
nervous system, and can lead to organ failure and
death.

42. Inhalants have a variety of effects depending on the
specific drug:
Intoxications Symptoms
Behavioral changes: impaired judgment, belligerence,
assaultiveness, apathy.
Dizziness, Incoordination, Slurred speech, Unsteady
gait, lethargy, depressed reflexes, psychomotor
retardation, tremor, blurred vision, stupor, coma,
euphoria.