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Substance Use Disorders: Introduction

Substance use disorder is the diagnostic term for the prolonged use & abuse of a substance. Behavioral, Physical & Psychological dependence are the hallmark of substance use disorder.

1. Behavioral Dependence:

Behavioral dependence refers to substance seeking activities.

2. Physical Dependence:

Physical dependence refers to the physical effects of multiple episodes of substance use.

3. Psychological Dependence:

Psychological dependence refers to intense desire for the substance to avoid a dysphoric state.

DSM-5 criteria for Substance Use Disorder

  1. Tolerance (Needing more substance to achieve effects equivalent to previous ones )
  2. Withdrawal (symptoms resulting from abrupt cessation of use of substance)
  3. Craving to use
  4. Using more than intended
  5. Difficulty stopping or reducing
  6. Spending a lot of time getting, using or recovering from substance use
  7. Continuing to use despite acknowledging health problems
  8. Continuing to use despite social, occupational or other adverse consequences
  9. Neglecting relationships because of substance use
  10. Neglecting work, home or school because of substance use
  11. Using substance even when it puts them in danger

Substance Intoxication

Substance intoxication is characterized by specific signs & symptoms resulting from recent ingestion or exposure to the substance.

Aetiology

Factors determining 1st time use:

  1. Drug availability
  2. Social acceptability
  3. Family history of substance dependence
  4. Peer pressure

Comorbidity

  • About 50% of patients with substance abuse have a comorbid Psychiatric disorder.
  • About 35-60% of patients with substance abuse have a comorbid antisocial personality disorder. These patients are less satisfied with their lives, are more impulsive, isolated & depressed than patients with antisocial personality disorder alone.

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