UNIT 1: SUBSTANCE ABUSE – ADULTS AND ADOLESCENTS

Alcohol, Drugs and Tobacco Abuse.

Note: This document presents possible questions which I think could be asked for 2 marks. Topics such
Prevalence, Etiology, Epidemiology, Differential Diagnosis could be asked, which is not added in this document.
Make sure you read them from maam’s ppt. All the best!

1. Substance use disorder (SUD): The Substance Abuse and Mental Health Services
Administration (SAMHSA) defines substance use disorders (SUDs) as occurring when:
“the recurrent use of alcohol and/or drugs causes clinically significant impairment,
including health problems, disability, and failure to meet major responsibilities at work,
school, or home.”

2. Major groupings of psychoactive substances and their meanings.

1. Stimulants–Drugs that increase the activity of the brain.
2. Depressants–Drugs that slow down the activity of the brain.
3. Hallucinogens–Drugs that change the way we see, hear and feel.
4. Cannabis–Drugs like Ganja, Hashish and Bhang produced from the hemp plant.
5. Opiates or drugs obtained from opium or artificially produced substitutes which
have opium like effects.
6. Tobacco

3. AUD is a chronic relapsing brain disorder characterized by an impaired ability to stop

or control alcohol use despite adverse social, occupational, or health consequences.

4. Comparison between DSM 4 and DSM 5 for Alcohol Use

 Two distinct disorders, alcohol abuse and alcohol dependence is combined into a single
Disorder called Alcohol Use Disorder.
 In DSM 4, abuse and dependence had separate criterias. In DSM 5 any 2 criterias out
of 11 during the same 12 month period will be diagnosed with AUD.
 Removes legal problem as a criterion.
 Adds craving as a criterion.
5. Addiction is defined as substance craving, seeking, and use, in the face of negative
health or social consequences. Primary elements: 3C’s: Compulsive use, Loss of
control, and Continued use despite adverse consequences.

6. Dependence is the development of withdrawal symptoms after use of a substance is

stopped. Two types: psychological dependence and physical dependence.

7. Tolerance is when the body becomes less responsive to a specific amount of a

substance, thereby causing the person to increase the amount of drug intake to achieve
the previous effect.
8. Mention and Define two groups of substance-related disorders: substance-use
disorders and substance-induced disorders.

9. Substance-use disorders are patterns of symptoms resulting from the use of a

substance that people continue to take, despite experiencing problems as a result.
Generally involve behavior patterns in which people continue to use a substance despite
having problems caused by its use.

10. Substance-induced disorders, including intoxication, withdrawal, and other

substance/medication-induced mental disorders, are detailed alongside substance use
disorders. Substance/medication-induced mental disorders are mental problems that
develop in people who did not have mental health problems before using substances.

11. Substance intoxication: Intoxication is the intense pleasure, euphoria, calm, increased
perception and sense, and other feelings that are caused by the substance. Intoxication
symptoms are different for each substance.

12. Substance Withdrawal: Substance withdrawal is the combination of physical and

mental effects that a person experiences after they stop using or reduce their intake of
a substance such as alcohol and prescription or recreational drugs.
13. Dependence Syndrome: The ICD-10 defines the dependence syndrome as being a
cluster of physiological, behavioural, and cognitive phenomena in which the use of a
substance or a class of substances takes on a much higher priority for a given individual
than other behaviors that once had greater value.

14. Disease Model - Argues that the origins of addiction lie in the individual him/herself.

15. Baumrind's theory is that there is a close relationship between the type
of parenting style and children's behavior. Based on extensive observation, interviews
and analyses, Baumrind initially identified these three parenting styles:
authoritative parenting, authoritarian parenting and permissive parenting. (Google)

16. Bowlby’s Attachment theory: originates with the seminal work of John
Bowlby (1958). He defined attachment as a 'lasting psychological connectedness
between human beings.' According to Bowlby, infants have a universal need to seek
close proximity with their caregiver when under stress or threatened (Prior & Glaser,
2006) (Google).

17. Acculturation: the degree to which an individual identifies with his or her native
culture, is thought to be related to substance use and abuse.

18. Motivational enhancement therapy: based on social learning theory and the
transtheoretical framework of change. It is designed to enhance intrinsic motivation for
behavioral change through client-centered therapy.

19. Mention the Stages of Change by Prochaska & DiClemente,1986.

1. Pre-contemplation. 4. Action.
2. Contemplation. 5. Maintenance.
3. Decision. 6. Relapse.
Acronym : PC-DAM-R
20. Seeking Safety (SS): is a present-focused therapy aimed at treating trauma-related
problems (including PTSD) and substance use disorder simultaneously. Patients learn
behavioral skills for coping with trauma/post-traumatic stress disorder and substance
use disorder.

21. Integrated Group Therapy (IGT): is a treatment developed specifically for patients
with bipolar disorder and substance use disorder, designed to address both problems
simultaneously. This therapy is largely based on CBT principles and is usually an
adjunct to medication. The IGT approach emphasizes helping patients understand the
relationship between the two disorders, as well as the link between thoughts and
behaviors, and how they contribute to recovery and relapse.

22. Supportive-Expressive Psychotherapy: It is a time-limited, focused psychotherapy

that has been adapted for heroin- and cocaine-addicted individuals. The therapy has two
main components:
 Supportive techniques to help patients feel comfortable in discussing their
personal experiences.
 Expressive techniques to help patients identify and work through interpersonal
relationship issues.

23. Depressant substances reduce arousal and stimulation. They do not necessarily make
a person feel depressed. They affect the central nervous system, slowing down the
messages between the brain and the body.They can affect concentration and
coordination. They slow down a person’s ability to respond to unexpected situations.

24. Patterns of use of Alcohol Consumption:

1. Social drinking (1 W, 2M per day)
2. Binge drinking (In 2 hrs, 4/more in W, 5/more in M)
3. Harmful drinking (Psy/Phy changes)
4. Hazardous (Adverse Health Events)
5. Alcohol dependence (Beh/Cog/Phy changes)
25. Assessments for Alcohol Use Disorders
1. AUDIT: Alcohol Use Disorders Identification Test
2. CAGE: Cut Down , Annoyance, Guilt, Eye-Opener Questionnaire
3. MAST: Michigan Alcoholism Screening Test
4. ASSIST: the Alcohol, Smoking and Substance Involvement Screening Test

26. Detoxification is the process of weaning a person from a psychoactive substance in a

safe and effective manner by gradually tapering the dependence producing substance
or by substituting it with a cross-tolerant pharmacological agent and tapering it. This
process minimizes the withdrawal symptoms, prevents complications and hastens the
process of abstinence from the substance in a more humane way.

27. What can influence the resistance or susceptibility to the effects of alcohol
intoxication?
Amount, Frequency and pattern of alcohol use can influence the resistance or
susceptibility to the effects of alcohol intoxication.

28. Stages of Alcohol Intoxication

1. Sobriety 4. Confusion
2. Euphoria 5. Stupor
3. Excitation 6. Death

29. Assessments for Alcohol Withdrawal Syndrome: Clinical Institute Withdrawal

Assessment for Alcohol, Revised (CIWA-AR) scores.

30. Drug: A drug is a substance that affects feelings, thinking or behavior, initially due to
chemical reactions in the brain.

31. An opioid refers to any substance from a group of analgesic agents derived from the
ingredient opium. Opioids are a type of depressant, analgesic drug that slow down the
messages being sent through the central nervous system between the body to the brain.
32. Patterns of Drug Use
1. Experimental Use (Explore)
2. Situational use (Limited to certain situations)
3. Recreational use (Regular but non-dependent use)
4. Polydrug use ( Taken to potentiate the effects of another drug or manage its
unpleasant after effects)
5. Dependence use (Dependence syndrome has developed)
6. Dual Diagnosis use (Drug users also suffering from major mental illness)

33. Route of administration of drug.

1. Subcutaneous
2. Intramuscular
3. Intravenous

34. Opioid Use Disorder is defined in the DSM-5 as a problematic pattern of opioid use
leading to clinically significant impairment or distress. OUD was previously classified
as Opioid Abuse or Opioid Dependence in DSM-IV. OUD has also been referred to as
"opioid addiction”. It is also defined as opioid use and the repeated occurrence within
12 months of two or more of eleven problems.

35. Assessments for Opioid Use.

1. COWS: Clinical Opioid Withdrawal scale.

36. Tobacco Use Disorder is diagnosed when an individual is dependent upon nicotine,
which is found in tobacco. A psychoactive drug (affects the mind), nicotine is a highly
addictive, central nervous system stimulant.

37. Assessments for Tobacco/Nicotine withdrawal.

1. Cigarette Dependence Scale (CDS-12)
2. The Nicotine Dependence Syndrome Scale
3. The Wisconsin Inventory of Smoking Dependence Motives
4. The Fagerstrom Test for Nicotine Dependence
 38. What is MPOWER?
Practical and cost effective way to scale up implementation of the main demand
reduction provisions of the WHO Framework Convention on Tobacco Control (WHO
FCTC) on the ground. The 6 MPOWER measures are:
1. Monitor tobacco use and prevention policies
2. Protect people from tobacco use
3. Offer help to quit tobacco use
4. Warn about the dangers of tobacco
5. Enforce bans on tobacco advertising, promotion and sponsorship
6. Raise taxes on tobacco.

(From Kaplan Book, Pg: 617)

39. Dependence: The repeated use of a drug or chemical substance, with or without
physical dependence. Physical dependence indicates an altered physiologic state caused
by repeated administration of a drug, the cessation of which results in a specific
syndrome.

40. Abuse: Use of any drug, usually by self-administration, in a manner that deviates from
approved social or medical patterns.

41. Misuse: Similar to abuse, but usually applies to drugs prescribed by physicians that are
not used properly.

42. Addiction: The repeated and increased use of a substance, the deprivation of which
gives rise to symptoms of distress and an irresistible urge to use the agent again and
which leads also to physical and mental deterioration.

43. Intoxication: A reversible syndrome caused by a specific substance (e.g., alcohol) that
affects one or more of the following mental functions: memory, orientation, mood,
judgment, and behavioral, social, or occupational functioning.
44. Withdrawal A substance-specific syndrome that occurs after stopping or reducing the
amount of the drug or substance that has been used regularly over a prolonged period.
The syndrome is characterized by physiological signs and symptoms in addition to
psychological changes, such as disturbances in thinking, feeling, and behavior. Also
called abstinence syndrome or discontinuation syndrome.

45. Tolerance: Phenomenon in which, after repeated administration, a given dose of drug
produces a decreased effect or increasingly larger doses must be administered to obtain
the effect observed with the original dose. Behavioral tolerance reflects the ability of
the person to perform tasks despite the effects of the drug. Cross-tolerance Refers to
the ability of one drug to be substituted for another, each usually producing the same
physiological and psychological effect (e.g., diazepam and barbiturates). Also known
as cross-dependence.

46. Neuroadaptation Neurochemical or neurophysiologic changes in the body that result

from the repeated administration of a drug. Neuroadaptation accounts for the
phenomenon of tolerance. Pharmacokinetic adaptation refers to adaptation of the
metabolizing system in the body. Cellular or pharmacodynamic adaptation refers to the
ability of the nervous system to function despite high blood levels of the offending
substance.

47. Codependence: Term used to refer to family members affected by or influencing the
behavior of the substance abuser. Related to the term enabler, which is a person who
facilitates the abuser's addictive behavior (e.g., providing drugs directly or money to
buy drugs). Enabling also includes the unwillingness of a family member to accept
addiction as a medical-psychiatric disorder or to deny that person is abusing a
substance.