PSYCHOLOGY

EXIMIUS
SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE 2021
Dr. Pagaddu November 2019
OUTLINE: There are four major diagnostic categories in the Diagnostic and
A. Dependence Statistical Manual of Mental Disorders, fifth edition (DSM-5):
a. Behavioral 1. Substance Use Disorder;
b. Physical 2. Substance Intoxication;
c. Psychological 3. Substance Withdrawal; and
d. Other terms 4. Substance-Induced Mental Disorder
B. Substance Use Disorder
a. Substance Intoxication
b. Substance Withdrawal SUBSTANCE USE DISORDER
C. Alcohol Use Disorder - applied to the specific substance abused (e.g., alcohol use
a. Alcohol Withdrawal disorder, opioid use disorder) that results from the
b. Alcohol Induced Psychotic Disorder prolonged use of the substance
D. Cannabis-Related Disorders - A maladaptive pattern of substance use leading to
a. Cannabis Use Disorder clinically significant impairment or distress, as manifested
b. Cannabis Intoxication by 2 (or more) of the following, occurring within a 12-
c. Cannabis Withdrawal month period:
d. Cannabis Induced Psychotic Disorder 1. Recurrent substance use resulting in a failure to fulfill
E. Inhalant Related Disorders major role obligations at work, school, or home (e.g.,
a. Inhalant Use Disorder repeated absences or poor work performance related to
b. Inhalant Intoxication substance use; substance-related absences, suspensions,
c. Inhalant Withdrawal or expulsions from school; neglect of children or
d. Inhalant-Induced Psychotic Disorder household)
F. Stimulant Related Disorder 2. Recurrent substance use in situations in which it is
a. Stimulant Use Disorder physically hazardous (e.g., driving an automobile or
b. Stimulant Intoxication operating a machine when impaired by substance use)
c. Stimulant Withdrawal 3. Continued substance use despite having persistent or
d. Stimulant Induced Psychotic Disorder recurrent social or interpersonal problems caused or
G. Tobacco Related Disorders exacerbated by the effects of the substance (e.g.,
a. Tobacco Use Disorder arguments with spouse about consequences of
b. Tobacco Withdrawal intoxication, physical fights)
4. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the
DEPENDENCE
substance to achieve intoxication or desired
§ Behavioral dependence
effect
- substance-seeking activities and related evidence of
b. Markedly diminished effect with continued use
pathological use patterns are emphasized
of the same amount of the substance
5. Withdrawal, as manifested by either of the following:
§ Physical Dependence
a. The characteristic withdrawal syndrome for the
- refers to the physical (physiological) effects of multiple
substance
episodes of substance use
b. The same (or a closely related) substance is
taken to relieve or avoid withdrawal symptoms
§ Psychological Dependence
6. The substance is often taken in larger amounts or over a
- also referred to as habituation
longer period than was intended
- characterized by a continuous or intermittent craving
7. There is a persistent desire or unsuccessful efforts to cut
(i.e., intense desire) for the substance to avoid a
down or control substance use
dysphoric state
8. A great deal of time is spent in activities necessary to
obtain the substance, use the substance, or recover from
Behavioral, physical, and psychological dependence are the
its effects
hallmark of substance use disorders.
9. Important social, occupational, or recreational activities
are given up or reduced because of substance use
Other Terms
10. The substance use is continued despite knowledge of
§ Codependence, Coaddiction, Codependency having a persistent or recurrent physical or psychological
- used to designate the behavioral patterns of family problem that is likely to have been caused or exacerbated
members who have been significantly affected by another by the substance
family member's substance use or addiction 11. Craving or a strong desire or urge to use a specific
§ Enabling substance.
- family members feel that they have little or no control
over the enabling acts

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 PSYCHOLOGY
SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE
Dr. Pagaddu November 2019
Substance Intoxication
- used to describe a syndrome (e.g., alcohol intoxication or
simple drunkenness) characterized by specific signs and
symptoms resulting from recent ingestion or exposure to
the substance
- 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.,
belligerence, mood lability, 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.
Substance Withdrawal
- the diagnosis used to describe a substance specific
syndrome that results from the abrupt cessation of heavy
and prolonged use of a substance (e.g., opioid
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.
ALCOHOL USE DISORDER
§ For abuse and dependence
- a need for daily use of large amounts of alcohol for
adequate functioning
- a regular pattern of heavy drinking limited to
weekends
- long periods of sobriety interspersed with binges of
heavy alcohol intake lasting for weeks or months
- show impaired social or occupational functioning
because of alcohol use (e.g., violence while
intoxicated, absence from work, job loss), legal
difficulties (e.g., arrest for intoxicated behavior and
traffic accidents while intoxicated), and arguments
or difficulties with family members or friends about
excessive alcohol consumption.
§ the drinking patterns are often associated with certain
behaviors:
- the inability to cut down or stop drinking;
- repeated efforts to control or reduce excessive
drinking by "going on the wagon" (periods of
temporary abstinence) or by restricting drinking to
certain times of the day;
- binges (remaining intoxicated throughout the day
for at least 2 days);
- occasional consumption of a fifth of spirits (or its
equivalent in wine or beer);
- amnestic periods for events occurring while
intoxicated (blackouts);
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EXIMIUS
2021
- the continuation of drinking despite a serious
physical disorder that the person knows is
exacerbated by alcohol use; and
- drinking nonbeverage alcohol, such as fuel and
commercial products containing alcohol.
Signs of Alcohol Intoxication
1. Slurred speech
2. Dizziness
3. lncoordination
4. Unsteady gait
5. Nystagmus
6. Impairment in attention or memory
7. Stupor or coma
8. Double vision
Alcohol Withdrawal
§ Tremulousness – classic sign; develops 6 to 8 hours after
the cessation of drinking
§ spectrum of symptoms can expand to include
- psychotic and perceptual symptoms (e.g., delusions
and hallucinations) beginning in 8 to 12 hours
- seizures in 12 to 24 hours after the cessation
- symptoms of delirium tremens (DTs ) for the first
week of withdrawal
- Other symptoms: general irritability,
gastrointestinal symptoms (e.g., nausea and
vomiting), anxiety, arousal, sweating, facial flushing,
mydriasis, tachycardia, and mild hypertension
Alcohol-Induced Psychotic Disorder
- experience auditory hallucinations or paranoid delusions
in the context of heavy drinking or withdrawal
- Hallucinations after alcohol withdrawal are considered
rare
CANNABIS-RELATED DISORDERS
- Cannabis is the most widely used illegal drug in the world
- Delta-9-tetrahydrocannabinol (delta-9-THC) is the
cannabinoid that is primarily responsible for the
psychoactive effects of cannabis
- The most potent forms of cannabis come from the
flowering tops of the plants or from the dried, black-
brown, resinous exudate from the leaves, which are
referred to as hashish or hash
Cannabis Use Disorder
- People who use cannabis daily over weeks to months are
most likely to become dependent
- The earlier the age of first use, the more often cannabis
has been used, and the longer it has been used, the
higher the risk of dependence.
Cannabis Intoxication
- Cannabis intoxication commonly heightens users'
sensitivities to external stimuli, reveals new details,
makes colors seem brighter and richer, and subjectively
slows the appreciation of time.
- In high doses, users may experience depersonalization
and derealization.
- Motor skills are impaired by cannabis use, and the
impairment in motor skills remains after the subjective,
euphoriant effects have resolved.
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 PSYCHOLOGY
SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE
Dr. Pagaddu November 2019
Cannabis Withdrawal
- cessation of use in daily cannabis users results in
withdrawal symptoms within 1 to 2 weeks of cessation
- symptoms include irritability, cannabis cravings,
nervousness, anxiety, insomnia, disturbed or vivid
dreaming, decreased appetite, weight loss, depressed
mood, restlessness, headache, chills, stomach pain,
sweating, and tremors
Cannabis-Induced Psychotic Disorder
- Rare
- transient paranoid ideation is more common
INHALANT-RELATED DISORDERS
§ Inhalant drugs (also called volatile substances or solvents)
are volatile hydrocarbons that vaporize to gaseous fumes
at room temperature and are inhaled through the nose or
mouth to enter the bloodstream via the transpulmonary
route.
§ Commonly found in many household products and are
divided into four commercial classes:
a. Solvents for glues and adhesives;
b. Propellants (e.g., for aerosol paint sprays, hair
sprays, and shaving cream);
c. Thinners (e.g., for paint products and correction
fluids); and (
d. Fuels (e.g., gasoline, propane).
Inhalant Use Disorder
- Most persons probably use inhalants for a short time
without developing a pattern of long-term use resulting in
dependence and abuse.
- Nonetheless, dependence and abuse of inhalants occur.
Inhalant Intoxication
- intoxicated state : apathy, diminished social and
occupational functioning, impaired judgment, and
impulsive or aggressive behavior, and it can be
accompanied by nausea, anorexia, nystagmus, depressed
reflexes, and diplopia
- high doses and long exposures: can progress to stupor
and unconsciousness, and a person may later be amnestic
for the period of intoxication
- Clinicians can sometimes identify a recent user of
inhalants by rashes around the patient's nose and mouth;
unusual breath odors; the residue of the inhalant
substances on the patient's face, hands, or clothing; and
irritation of the patient's eyes, throat, lungs, and nose.
Inhalant Withdrawal
- Tolerance for the inhalants does develop for some users;
a withdrawal syndrome can accompany the cessation of
inhalant use.
- The withdrawal syndrome does not occur frequently;
when it does, it can be characterized by sleep
disturbances, irritability, jitteriness, sweating, nausea,
vomiting, tachycardia, and (sometimes) delusions and
hallucinations.
Inhalant-Induced Psychotic Disorder
- hallucinations or delusions as the predominant symptoms
- Paranoid states are probably the most common psychotic
syndromes during inhalant intoxication
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STIMULANT-RELATED DISORDERS
- Amphetamines and amphetamine-like drugs are among
the most widely used illicit substances, second only to
cannabis
- These drugs go by such street names as ice, crystal,
crystal meth, and speed.
- As a general class, the amphetamines are referred to as
analeptics, sympathomimetics, stimulants, and
psychostimulants.
- used to increase performance and to induce a euphoric
feeling
Stimulant Use Disorder
- Amphetamine dependence can result in a rapid
downward spiral of a person's abilities to cope with work-
and familyrelated obligations and stresses.
- A person who abuses amphetamines requires increasingly
high doses of amphetamine to obtain the usual high, and
physical signs of amphetamine abuse (e.g., decreased
weight and paranoid ideas) almost always develop with
continued abuse.
Stimulant Intoxication
- With high doses, symptoms of intoxication include
agitation, irritability, impaired judgment, impulsive and
potentially dangerous sexual behavior, aggression, a
generalized increase in psychomotor activity, and
potentially, symptoms of mania.
- The major associated physical symptoms are tachycardia,
hypertension, and mydriasis
Signs and Symptoms of Stimulant Intoxication
1. Mydriasis
2. Psychomotor agitation or retardation
3. Tachycardia or bradycardia
4. Perspiration or chills
5. Cardiac arrhythmias or chest pain
6. Elevated or lowered blood pressure
7. Dyskinesias
8. Dystonias
9. Weight loss
10. Nausea or vomiting
11. Muscular weakness
12. Respiratory depression
Confusion, seizures, or coma
Stimulant Withdrawal
- After stimulant intoxication, a "crash" occurs with
symptoms of anxiety, tremulousness, dysphoric mood,
lethargy, fatigue, nightmares, headache, profuse
sweating, muscle cramps, stomach cramps, and insatiable
hunger.
- The withdrawal symptoms generally peak in 2 to 4 days
and are resolved in 1 week.
- The most serious withdrawal symptom is depression,
which can be particularly severe after the sustained use
of high doses of stimulants and which can be associated
with suicidal ideation or behavior.
Stimulant-Induced Psychotic Disorder
- The hallmark of stimulant-induced psychotic disorder is
the presence of paranoid delusions and hallucinations
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 PSYCHOLOGY
EXIMIUS
SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE 2021
Dr. Pagaddu November 2019
TOBACCO-RELATED DISORDERS
- Tobacco use disorder is among the most prevalent,
deadly, and costly of substance dependencies.
- Tobacco does not cause behavioral problems; therefore,
few tobacco-dependent persons seek or are referred for
psychiatric treatment.
- Tobacco is a legal drug and most persons who stop
tobacco use have done so without treatment.

Tobacco Use Disorder

- characterized by craving, persistent and recurrent use,
tolerance, and withdrawal if tobacco is stopped.
- Dependence on tobacco develops quickly
- The development of dependence is enhanced by strong
social factors that encourage smoking in some settings
and by the powerful effects of tobacco company
advertising.
- DSM-5 does not have a diagnostic category for tobacco
intoxication

Tobacco Withdrawal
- symptoms can develop within 2 hours of smoking the last
cigarette; they generally peak in the first 24 to 48 hours
and can last for weeks or months
- common symptoms include an intense craving for
tobacco, tension, irritability, difficulty concentrating,
drowsiness and paradoxical trouble sleeping, decreased
heart rate and blood pressure, increased appetite and
weight gain, decreased motor performance, and
increased muscle tension.

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