Schedule III/IIIN Controlled Substances (3/3N) Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence. Schedule IV Controlled Substances Substances in this schedule have a low potential for abuse relative to substances in Schedule III. Schedule V Controlled Substances Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.
United States, their relative abuse potential, and the likelihood of causing dependence when abused. Schedule I Controlled Substances Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse. Schedule II/IIN Controlled Substances (2/2N) Substances in this schedule have a high potential for abuse, which may lead to severe psychological or physical dependence.
NEUROBIOLOGY OF SUBSTANCE USE DISORDERS
Substance use disorders (SUDs) are complicated physiologic and psychological disorders with multiple intersecting factors, such as drug use behaviors and poor judgment influenced by the pharmacodynamics and pharmacokinetic actions of the drug. The central element of drug dependence is the drug- using behavior. Drug use initiates a cascade of rewarding or aversive physical, psychological, and social consequences that determine the likelihood of subsequent use. 8 The development and persistence of SUDs are largely based on key components within the basal ganglia, amygdala (extended), and prefrontal cortex. The basal ganglia and its sub-networks are responsible for reward, pleasure, and formation of habitual substance use. 9 The amygdala is responsible for the uneasy feelings, anxiety, and irritability associated with withdrawal. The prefrontal cortex is involved in executive function and exerts control over the individual’s cognitive inability to reject substance use based on neurocircuitry, namely impulsivity and compulsivity. 10 These endophenotypes are found transdiagnostically across many psychopathologies. Impulsivity, when characterized as the failure to resist a drive or impulse potentially harmful to the self or others, is a core feature of several psychiatric disorders, including substance use disorder. 11 Impulsivity causes the individual to act without forethought, unable to reflect on previous behavior and seek immediate reward by choosing risky behavior. Compulsivity is characterized by inappropriate actions which persist regardless of
the situation. Over time, impulsive substance use becomes compulsive addiction as this dysregulation becomes a dependent conditioned response. The impulses in the ventral loop of reward and motivation migrate dorsally because of neuroplasticity and engage in a habit system, creating the conditioned response of addiction. 12 Impulsive drug use produces a high , which if experienced too often causes the migration to compulsive use (addiction) to reduce the unpleasant effects of withdrawal. The mesolimbic pathway is hypothesized to be the final common pathway of reward and reinforcement in the brain, where all addictive drugs increase dopamine, especially with habitual use. 13 Arising in the ventral tegmental area (VTA), it projects into the nucleus accumbens (NA) and prefrontal cortex (PFC). Apart from the LSD- and mescaline-like hallucinogens, functional dopamine agonism is the single pharmacological property that all addictive drugs share. 14 The psychology of substance use disorders reflects psychodynamic theories dating back 100 years. Disturbed ego functions, self-medication, and alexithymia (inability to describe feelings) are common among those with substance use. Aside from pharmacologic effects, positive reinforcement is gained from paraphernalia and associated behaviors with drug use. Conditioned responses (similar to Pavlovian phenomena) such as cravings and withdrawal promote relapsing behaviors. Individuals aged 18–24 years have a high prevalence rate for virtually every substance disorder. 15
IMPLICIT BIAS AND STIGMA IN SUBSTANCE USE DISORDERS
Language used by clinicians such as addict can stigmatize individuals with substance use disorders, reflecting misconceptions that these behaviors are choices rather than compulsions. Negative biases can dehumanize individuals, affecting the therapeutic alliance and ultimately the course of recovery. Clinicians who stereotype drug use as a criminal activity marginalize disadvantaged groups and negatively influence treatment plans, which may increase drug use. Fear about disclosing substance use, decreased quality of care, or reduced access to care are impacted by stigma and implicit biases. 16 To this end, the word addiction has been eliminated
from the DSM-5 in favor of the more neutral term substance use disorder. 4 Every member of our community may help to lessen stigma and prejudice against those who suffer from drug use disorders by: ● Understanding substance use disorders are chronic, treatable medical conditions. ● Changing stigmatizing language with more empowering, preferred language that doesn’t equate people with their condition or have negative connotations.
Book Code: MDCO1025
Page 47
Powered by FlippingBook