 Terms Used in Dependence and Abuse

 Dependence The repeated use of a drug or

chemical substance, with or without physical
dependence.
Abuse: Use of any drug, usually by self-
administration, in a manner that deviates from
approved social or medical patterns.
Misuse Similar to abuse, but usually applies to
drugs prescribed by physicians that are not
used properly.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
 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.
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 of time.
 Also called abstinence syndrome or
discontinuation syndrome.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
 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 physiologic and
psychological effect (e.g., diazepam and
barbiturates). Also known as cross-dependence.


Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Substance dependence and substance abuse is
associated with the use of 11 designated classes of
pharmacological agents, namely:
❖ alcohol;
❖ amphetamines or similarly acting agents;
❖ Caffeine; A cup of coffee generally contains 100 to
150 mg of caffeine; tea contains about 1/3
❖ cannabis;
❖ cocaine;
❖ hallucinogens e.g. lysergic acid diethylamide ( LSD)
❖ inhalants;
❖ nicotine;
❖ opioids;
❖ phencyclidine (PCP) or similar agents; and
❖ A group that includes sedatives, hypnotics, and
anxiolytics.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Diagnostic Criteria for Substance Withdrawal
 The development of a substance-specific
syndrome due to the cessation of (or reduction
in) substance use that has been heavy and
prolonged.
 The substance-specific syndrome causes
clinically significant distress or impairment in
social, occupational, or other important areas
of functioning.
 The symptoms are not due to a general
medical condition and are not better accounted
for by another mental disorder.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Diagnostic Criteria for Substance Intoxication
 The development of a reversible substance-
specific syndrome due to recent ingestion of
(or exposure to) a substance.
 Clinically significant maladaptive behavioral or
psychological changes that are due to the
effect of the substance on the central nervous
system (e.g., violence, mood liability, cognitive
impairment, impaired judgment, impaired
social or occupational functioning) and develop
during or shortly after use of the substance.
 The symptoms are not due to a general
medical condition and are not better accounted
for by another mental disorder.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Diagnostic Criteria for Substance Abuse
A maladaptive pattern of substance use leading to
clinically significant impairment or distress, as
manifested by one (or more) of the following,
occurring within a 12-month period:
1 recurrent substance use resulting in a failure to fulfill
major role obligations at work, school, or home.
2 recurrent substance use in situations in which it is
physically hazardous (e.g., driving an automobile or
operating a machine when impaired by substance use)
3 recurrent substance-related legal problems (e.g., arrests
for substance-related disorderly conduct)
4 continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance (e.g.,
arguments with spouse about consequences of
intoxication, physical fights)
B The symptoms have never met the criteria for
Substance Dependence for this class of
substance.
Psychiatry Lecture Note by Abdissa
B. (Assist. Professor) 3/21/2024
Diagnostic Criteria for Substance Dependence
A maladaptive pattern of substance use, leading to
clinically significant impairment or distress, as
manifested by three (or more) of the following, occurring
at any time in the same 12-month period:
1 tolerance, as defined by either of the following:
a. a need for markedly increased amounts of the substance
to achieve intoxication or desired effect
b. markedly diminished effect with continued use of the
same amount of the substance
2 withdrawal, as manifested by either of the
following:
a. the characteristic withdrawal syndrome for the substance
b. the same (or a closely related) substance is taken to
relieve or avoid withdrawal symptoms
3 the substance is often taken in larger amounts or
over a longer period than was intended
Psychiatry Lecture Note by Abdissa
B. (Assist. Professor) 3/21/2024
4 there is a persistent desire or unsuccessful
efforts to cut down or control substance use
5 a great deal of time is spent in activities
necessary to obtain the substance (e.g.,
visiting multiple doctors or driving long
distances), use the substance (e.g., chain-
smoking), or recover from its effects
6 important social, occupational, or recreational
activities are given up or reduced because of
substance use
7 the substance 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
substance.
Psychiatry Lecture Note by Abdissa
B. (Assist. Professor) 3/21/2024
Etiology:
 Drug availability, social acceptability, and
peer pressures may be the major
determinants of initial experimentation with a
drug.
Psychodynamic Factors
 A defense against anxious impulses, or a
manifestation of oral regression (i.e.,
dependency).

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Learning and Conditioning
 Drug use, whether occasional or compulsive,
can be viewed as behavior maintained by its
consequences.
 special status or the approval of friends.
Genetic Factors
 Strong evidence from studies of twins,
adoptees, and siblings brought up separately
indicates that the cause of alcohol abuse has
a genetic component

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Neurotransmitters
 The major neurotransmitters possibly
involved in developing substance abuse and
substance dependence are catecholamine
(particularly dopamine), and γ-aminobutyric
acid (GABA) systems

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Comorbidity
Antisocial Personality Disorder
 In various studies, a range of 35 to 60 percent
of patients with substance abuse or substance
dependence also meets the diagnostic criteria
for antisocial personality disorder.
Depression and Suicide
 Depressive symptoms are common among
persons diagnosed with substance abuse or
substance dependence.

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
Treatment
 Controlling acute withdrawal and
consequences of recent drug use
(detoxification)
 Longer-term behavioral change;
 Pharmacological interventions; and
 Individual psychotherapy,
 Alcoholics Anonymous (AA)

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024
THANK YOU!

Psychiatry Lecture Note by Abdissa

B. (Assist. Professor) 3/21/2024