A drug of abuse also referred to as a psychoactive substance can alter a person’s mood, perception, development, and impair brain functioning. There has been a long record of substance causing addiction thus leading to substance abuse.
What is Substance Abuse?
Substance Abuse is the excessive use of a substance which can cause a hazardous behaviour (ex. accidents while driving), and can lead to social, occupational, psychological or health related issues in a way harming the individual’s development in certain aspects.
These substances are majorly classified as CNS Depressants, CNS Stimulants, Opiates, Cannabinoids, Hallucinogens. Some examples of these are Alcohol, Marijuana, Methamphetamine, Cocaine, Opiates, etc.
The Diagnostic Statistical Manual of Mental Disorders have categorised these disorders into four categories that are, Substance Use Disorder, Substance Intoxication, Substance Withdrawal and Substance-Induced Mental Disorder.
What is a substance use disorder?
A substance use disorder is a cluster of cognitive, behavioural, and physiological symptoms indicating that the individual continues using the substance notwithstanding significant substance-related problems.
DSM 5 describes the criteria for Substance Disorder as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following, occurring within a 12-month period, the symptoms being,
- Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home
- Recurrent substance use in physically hazardous situations
- Continued substance use despite having persistent social or interpersonal problems exacerbated by the effects of the substance
- A developed tolerance: Urge for increased quantity of substance to achieve a desired level of satisfaction, decrease of effect with increase of consumption of the same amount of substance
- Withdrawal, as manifested by the characteristic withdrawal syndrome for the substance, a closely related or same substance is taken to relieve or avoid withdrawal symptoms
- Substance is consumed in large quantity over an extended period of time, than intended
- Failure in cutting down or stopping the consumption as well as a lot of time wasted in trying the same;
- Reduction in social, occupational, recreational activities because of substance use
- Continued Substance use despite knowledge of having a persistent physical or psychological problem that is likely to have been caused by the substance
- Craving or a strong desire to use and consume a specific substance.
Substance use disorders consist of a broad range of symptoms varying from mild to moderate to severe. A mild substance use is determined by the the presence of two to three symptoms, moderate by four to five symptoms, and severe by six or more symptoms.
Some of the disorders that come under Substance Abuse Disorder are:
- Alcohol use disorder (caused due to the problematic pattern of alcohol consumption)
- Cannabis use Disorder (caused due to dependence on Cannabis)
- Tobacco Use Disorder(caused due to maladaptive pattern of tobacco use)
What is Substance Intoxification?
Intoxification is the development of a reversible syndrome caused due to a substance that can affect one’s mood, memory, orientation, judgement and behavioural or occupational functioning. Substance Intoxification can occur due to the ingestion of a substance (ex. Alcohol, cannabis, marijuana, tobacco) causing clinically significant impairment and distress in an individual.
Common changes in substance intoxication are disturbances of perception, wakefulness, attention, thinking, judgment, psychomotor behaviour, and interpersonal behaviour. There are two different types of Substance Intoxification: Acute (short-term) and Chronic (long-term).
What is Substance Withdrawal?
Withdrawal is a substance specific syndrome that occurs due to the abrupt cessation(cutoff) of a substance after a prolonged use of the substance, often individuals face withdrawal symptoms leading to a crisis after quitting the substance they were into, these symptoms also cause significant distress in their day to day lives. These symptoms can differ from Autonomic Symptoms such as abnormal and increased heartbeat, dilated pupils, elevated blood pressure, nausea, diarrhoea to Motor Symptoms such as body tremors, seizures, unclear speech, clumsy movements to Awareness Symptoms such as Insomnia, Irritability, Agitation, Delirium and Disorientation to Psychiatric Symptoms such as Illusions, Delusions, Hallucinations, Paranoid Ideas, Anxiety, Disinhibition and Affective instability. It is important to understand that the above Substance Withdrawal and Intoxification symptoms are not due to general medical condition or another mental disorder in order to fall into the category of the above criteria. In individuals with severe disorders, it is observed that there is an underlying variation in their brain circuits that might persist even after they stop or cut down the substance, there are behavioural effects and intense craving when exposed to the drug related stimuli.
Etiology of Substance Disorders
The cause of these disorders can be stated according to different school of thoughts, such as classic psychodynamic thoughts – substance use in order to suffice masturbatory or oral fixation needs, neo – psychodynamic thoughts – failure to deal with reality leading to indulgence in addiction to escape from reality, behaviouristic thoughts – behaviour is a affect of the consequences faced by the individual, reinforcing antecedent behaviour to terminate certain uncomfortable or frightening state such as anxiety, pain, depression, rejection, gloominess through the operant reinforcement of a drug .
Treatment of Substance Use Disorder
One of the most effective therapies for substance abuse disorders is Behavioural Therapy:
Cognitive Behavioural Therapy and Dialectical Behavioural Therapy, can be used by therapists to restructure deep rooted beliefs, diminish patterns of addiction through recognizing, whereas DBT can help in letting the clients understand the effect substance abuse is causing on their interpersonal relationships as well as help them regulate emotions so that they avoid indulging in addictive behaviour to avoid their emotions. Another management technique can be Aversive therapy where a stimulus is introduced repeatedly to the point where unpleasant feelings can be associated with the stimulus in order to associate unpleasant feelings with substance. Psycho-pharmacological therapies such as Nicotine Replacement Therapies, Non-nicotine Medications, Combined Psychosocial and Pharmacological Therapy can also be effective treatment therapies in order to provide help throughout the withdrawal process. Skills Training and Relapse Prevention is also one of the necessary management techniques.
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