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SUBSTANCE ABUSE

TERMINOLOGY
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.

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.

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. The term is no
longer included in the official nomenclature,
having been replaced by the term dependence,
but it is a useful term in common usage.

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. The
syndrome is characterized by physiologic signs
and symptoms in addition to psychological
changes, such as disturbances in thinking,
feeling, and behavior. Also called abstinence
syndrome or discontinuation syndrome.

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.

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.

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.

DEVELOPMENT OF DEPENDENT SYNDROME:
There are four important patterns of drug
use disorders, which may overlap with each
other.

Acute intoxication
Withdrawal state
Dependence syndrome, and
Harmful use

CLASSES OF PSYCHOACTIVESUBSTANCES
The following 11 classes of psychoactive
substances are associated with substance-use
and substance-induced disorders:
1. Alcohol
2. Amphetamines and related substances
3. Caffeine
4. Cannabis
5. Cocaine
6. Hallucinogens
7. Inhalants
8. Nicotine
9. Opioids
10. Phencyclidine (PCP) and related substances

CLASIFICATION F10--F19

Mental and behavioral disorders due to
psychoactive substance use

F10.-Mental and behavioral disorders due to use
of alcohol
F11.-Mental and behavioral disorders due to use
of opioids
F12.-Mental and behavioral disorders due to use
of cannabinoids
F13.-Mental and behavioral disorders due to use
of sedatives or hypnotics
F14.-Mental and behavioral disorders due to use
of cocaine

F15.-Mental and behavioral disorders due to
use of other stimulants, including caffeine
F16.-Mental and behavioral disorders due to
use of hallucinogens
F17.-Mental and behavioral disorders due to
use of tobacco
F18.-Mental and behavioral disorders due to
use of volatile solvents
F19.-Mental and behavioral disorders due to
multiple drug use and use of other
psychoactive substances.

Etiology of Substance-Related
Disorders

Biologic Theories