Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
According to DSM-5-TR (APA, 2023), opioid-related disorders consist of:
Another dangerous situation arises from the potentiating effect of combining two or more substances within the CNS category. For example, a combination of alcohol with diazepam (e.g., Valium) or any other sedative-hypnotic is a common cause of accidental overdose and an agent of suicide, particularly among women (Straussner, 2014). Alcohol use disorders can cause significant problems, including but not limited to memory blackouts, heart and liver disease, depression, anxiety, insomnia, neuropathy, seizure, and other medical conditions. One of the most debilitating conditions related to long-term alcohol use is Wernicke-Korsakoff syn- drome, otherwise known as “wet brain,” which develops as a consequence of depletion of thiamine, or vitamin B 1 , in the brain. This condition makes it difficult for an individual to form and retain new memories, and, in severe form, is irrevers- ible (Doweiko, 2015). People who are physically dependent on alcohol or a benzo- diazepine are vulnerable to life-threatening seizures if they abruptly discontinue the use of these substances. Therefore, careful medical monitoring is required for individuals wishing to stop the use of such substances; clients who are heavy users of CNS depressants should never be encouraged to stop using them on their own. CENTRAL NERVOUS SYSTEM STIMULANTS The category of central nervous system stimulants includes: • Amphetamines and methamphetamine: Known variously as speed, ice, chalk, meth, crystal meth, crank, fire, or glass. • Cocaine and crack: Cocaine in crystal, as opposed to powder, form. • Prescription drugs such as dextroamphetamine (Dexedrine), amphetamine and dextroamphetamine combined (Adderall), and methylphenidate (Ritalin).
• Opioid use disorder. • Opioid intoxication. • Opioid withdrawal. • Other opioid-induced disorders. • Unspecified opioid-related disorders.
A fuller discussion of assessment and diagnosis of opioid- related disorders and disorders related to other substances will be provided in subsequent chapters. CENTRAL NERVOUS SYSTEM DEPRESSANTS The category of CNS depressants includes alcoholic beverages as well as: • Barbiturates (amobarbital, pentobarbital, secobarbital) and nonbarbiturate sedative- hypnotics (anxiolytic [anti-anxiety] and sleeping medications) such as phenobarbital (Luminal), secobarbital and amobarbital in combination (Tuinal), glutethimide (Doriden), methaqualone (Quaalude), ethchlorvynol (Placidyl), and methyprylon (Noludar). • Prescription drugs, such as benzodiazepines including clonazepam (Kolodin), chlordiazepoxide (Librium), diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril), clorazepate (Tranxene), flurazepam (Dolmane), and oxazepam (Serax). • Anesthetics such as chloroform, ether, and nitrous oxide. • Volatile solvents such as benzene, toluene, and xylene. • Low-potency doses of cannabinoids such as marijuana and hashish (which will be discussed later). All of these substances slow down, or sedate, the excitable brain tissues. Such sedation affects the brain centers that con- trol speech, vision, coordination, and social judgment. The individual also experiences increased agitation and excitability when coming off these drugs—a withdrawal effect commonly known as a hangover . Individuals under the influence of alcohol or other CNS depressants are likely to exhibit poor judgment, which is often manifested in inappropriate and even destructive behavior. Whereas low doses of a CNS depressant, particularly alcohol, block the usual inhibitions, making the person appear to be relaxed or unreserved, high doses slow down the heart rate and respiration, produce lethargy and stupor, and may result in death (Drug Enforcement Agency, 2020). Numerous descrip- tions of deaths among young people resulting from ingestion of massive amounts of alcohol in short periods of time (“binge drinking”) have been reported in the popular press.
• Caffeine • Nicotine
In varying degrees, these drugs increase or speed up the func- tion of excitable brain tissues, resulting in energized muscles, increased heart rate and blood pressure, and decreased appe- tite. Stimulant use disorders can cause permanent changes to the pleasure pathways in the brain by blocking the reuptake of dopamine. This blockage floods the gap between neurons with dopamine, resulting in an overabundance of dopamine in the brain and prolonging the feeling of pleasure. As is the case with other drugs, stimulant use can lead to tolerance, in which users must take more and more of the drug to reach the original high (Drug Enforcement Agency, 2020). Stimulant use impairs judgment and may lead to impulsive and unsafe decision making. Chronic use of stimulants also puts the user at risk for viral infections such as HIV and hepatitis C through needle sharing and other risky behaviors (Baier et al., 2014).
97
EliteLearning.com/Psychology
Powered by FlippingBook