There are three types of Substance Related Disorders: Substance Abuse Disorders, Substance Dependence Disorders, and Substance-induced Disorders. The Substance-induced Disorders can coexist with either Substance Abuse or Substance Dependence Disorders. (American Psychiatric Association, 1994)
1. Substance Abuse Disorders marked by serious psychosocial problems related to alcohol and drug use that do not meet the criteria of a Substance Dependence Disorder. Abuse Disorders may result from initial experimentation with mind altering substances, involvement in a lifestyle or subculture where alcohol and drug problems are a social norm, or as a consequence of related personality or mental disorders. Patterns of substance abuse may be self-limiting or they may become chronic. The severity of problems associated with substance abuse can vary in response to the seriousness of stress and related life problems. In some cases substance abuse will progress into substance dependence.
2. Substance Dependence Disorders marked by an abnormal biological responses to the ingestion of mind altering substances that results in progressive tolerance and withdrawal that causes a a pattern of compulsive use of the substance to develop which impairs the ability to control substance use and results in the development of substance related life problems.
3. Substance-induced Disorders: There are number of reversible disorders that can be caused by the frequent and heavy use of alcohol and other drugs that common that commonly coexist with substance use disorders. These substance related disorders may be associated with either substance abuse disorders or substance dependence disorders. If these Substance Induced Disorders are not identified and stabilized they can interfere the successful treatment of before both substance abuse and substance dependence disorders. The Substance-induced Disorders are: Intoxication, withdrawal, and Substance-induced Mental Disorders.
(1) Intoxication: Intoxication is a reversible set of substance-specific symptoms that are caused by the recent ingestion of alcohol or other drugs. The symptoms consist of significantly maladaptive behaviors caused by impairments in the ability to think clearly, manage feelings and emotions, and self-regulate behavior. Intoxication is often marked by severe impairments in judgment and impulse control. The symptoms persist as long as the blood alcohol or drug level is high enough to cause them. Different substances can cause similar symptoms or interact synergistically to create distortions of the symptoms commonly associated with each drug when used separately. (American Psychiatric Association 1994 pp. 183 – 184)
(2) Withdrawal: Withdrawal is a reversible set of substance- specific symptoms that are caused by the cessation or reduction in heavy and prolonged substance use. (American Psychiatric Association 1994 pp. 184 – 187; NIAAA 1989)
(3) Substance-induced Mental Disorders: Substance-induced Mental Disorders are symptoms caused by the long term effects of frequent and heavy use of alcohol or other drugs. These effects cause impairments to the brain & nervous system; impaired cognitive & affective functioning; or problems with behavioral control and regulation. The symptoms may be related to intoxication, acute withdrawal, post acute withdrawal (PAW), or long-term brain dysfunction caused by alcohol or drug use. PAW and long-term brain dysfunction are described as Substance-induced Persisting Disorders in DSM-IV. (American Psychiatric Association 1994 pp. 192 – 195) The primary Substance-induced Mental Disorders are:
· Substance-induced Delirium: Perceptual problems that include: difficulty maintaining environmental awareness; difficulty focusing and sustaining attention on a task or object; difficulty shifting attention from one central focus to another; difficulty maintaining orientation tom person, place, time and context; and problems understanding and communicating ideas verbally and in writing. The symptoms are caused by the effects of substance use that extends beyond the period of intoxication and acute withdrawal. There are two common types of Substance-induced Delirium – Intoxication Delirium and Withdrawal Delirium. (American Psychiatric Association 1994 pp. 127 – 129) If not properly treated, mild to moderate symptoms of Substance- induced Withdrawal Delirium may persist for as long a 60 to 180 days following the cessation of substance use and become worse during periods of high stress.
· Substance-induced Persisting Dementia: Cognitive impairments including: memory impairments involving the impaired ability to recall previously learned information and/or learn and retain new information (American Psychiatric Association 1994 pp. 152 – 155; NIAAA 1989b). The most common substance-induced cognitive impairments are:
Disturbances In Executive Functioning that make it difficult to plan, organize, sequence, abstract central organizing principles, apply past experience to current situations, and project logical consequences of current behavior into the future.
Language Disturbances (aphasia) that make it difficult to comprehend what is read and and understand complex or abstract verbal communication.
Motor Function Impairments (apraxia) resulting in problems with hand-eye and psychomotor coordination which often manifests in clumsiness, slowed reflexes, and mild disturbances in balance and gait.
Sensory Recognition Impairments (agnosia) that make it difficult to immediately recognize familiar objects by touching, hearing, or seeing them.
· Substance-induced Persisting Amnestic Disorder: Memory impairments that make it difficult to learn & recall new information, recall previously learned information, or recall past events. The memory impairments cause problems with interpersonal relationships, occupational functioning, or the performance of routine acts of daily living. (American Psychiatric Association 1994 pp. 161 – 162)
· Substance-induced Psychotic Disorder: Difficulty maintaining orientation to person, place, time, and context caused predominately by hallucinations and delusions. (American Psychiatric Association 1994 pp. 310 – 315)
Hallucinations can occur in any sensory modality causing people to see things that aren’t there such as poorly formed shapes or shadows to detailed objects and persons (visual hallucinations); hear things such as annoying poorly formed sounds to specific words and statements (auditory hallucinations); feel things such as bugs crawling on them (tactile hallucinations); smell things that aren’t there (olfactory hallucinations), taste things that aren’t there (gustatory hallucinations);
Delusions: Delusions are strongly held beliefs not supported by evidence and not affected by the presentation of evidence that demonstrates they are not true. Delusions may vary from mild to extreme and may include a variety of themes including: Beliefs about wellness when when presented with evidence of the symptoms of illness; Beliefs about normal functioning and the absence of problems when presented with evidence of dysfunction and problems; Beliefs about past accomplishes that are grandiose and exaggerated in the absence of evidence or when presented with contradictory evidence; Beliefs about being persecution when no such persecution exists; Beliefs of religious significance such as being God or being in direct communication with God or some other spiritual or religious being in the absence of evidence.
· Substance-induced Mood Disorder: A disturbance in mood characterized by either: depressed mood marked by: diminished interest in all or most activities; diminished ability to experience pleasure; manic mood marked by an extreme elevated sense pleasure and excitement, an expansive response to others, or extremely irritable reactions to others; or Manic Depressive Swings marked by rapid and unpredictable swings between depressed moods and manic moods. (American Psychiatric Association 1994 pp. 370 – 375)
· Substance-induced Anxiety Disorder: A state of excessive worry marked by a tendency to believe that negative experiences will occur in the future, difficulty controlling or distracting self from the worrying thoughts, restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating, having a tendency for the mind to go blank, irritability, severe muscle tension, and sleep disturbances that include difficulty falling, difficulty staying asleep, or restless unsatisfying sleep. (American Psychiatric Association 1994 pp. 439 – 444)
· Substance-induced Sexual Dysfunction: The inability to perform sexually as a result of the effects of intoxication, or withdrawal. (APA 1994 pp. 519 – 521)
· Substance-induced Sleep Disorder: Substance-induced Sleep Disorders (APA 1994 pp. 601-607) consist of difficulty with the sleep-wake cycle that include: insomnia marked by difficulty falling, difficulty staying asleep, or restless unsatisfying sleep (APA 1994 pp. 553 – 557); hypersomnia marked by excessive sleepiness marked by difficulty staying awake (APA 1994 pp. 557 – 562); parasomnia marked by the inappropriate activation of autonomic nervous system, motor systems, or cognitive processes during sleep, specific sleep stages, or sleep wake transitions such as nightmares, sleep terrors, excessive tossing and turning, and sleep walking. (APA 1994 pp. pp. 579 – 592)