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Substance Use Disorders (SUDs)

Updated: Dec 4, 2020



Of significance, there are more deaths, illness and disabilities due to alcohol and drug use than any other preventable health condition.

Approximately one in four deaths can be attributed to alcohol, tobacco or illicit/illegal drug usage. SUDs are linked to a variety of health problems including cancer, heart disease, liver disease, dementia, depression, gout, infectious diseases (e.g. HIV; Hepatitis B and C; Tuberculosis), pancreatitis and seizure disorders.

SUDs are linked to poorer performance on the job or at school, difficulty keeping a job and relationship problems. As usage increases, so does the likelihood of being involved in a traffic or workplace accident, legal and financial troubles, violence, crime and homelessness.

Of note, SUDs are chronic remitting and relapsing brain disorders for which there is no current cure. SUDs are similar to chronic medical disorders such as Diabetes Mellitus, heart failure and cancers, in that if they are left unmanaged, will lead to many negative physical and mental health consequences and in many instances, death.

How common is SUDs ?


In 2013 in the U.S.A., an estimated 21.6 million persons or 8.2% of the population aged 12 or older, were classified with substance abuse or dependence in the past year based on DSM-IV criteria (2013, SAMSHA, National Survey on Drug Use and Health).

Moreover, in 2013 an estimated 2.8 million persons aged 12 or older used an illicit/illegal drug for the first time within the past 12 months, or an average of 7,800 new users per day (2013, SAMSHA, National Survey on Drug Use and Health)


Definitions


SUD: A disorder characterized by the continued use of a specific psychoactive substance despite physical, psychological or social harm. This may or may not include tolerance, withdrawal and dependence and is identified by certain other behaviours such as:

· The drug is used more than intended despite the negative physical and mental health consequences

· There is inability to control drug usage (compulsive drug use)

· Great effort is expended to obtain the drug despite the negative legal ramifications (going to great lengths to purchase an illegal drug; prescription drug misuse/off label use of prescription drugs)

· Important activities are replaced by drug usage (impairment in functioning in life arenas-occupational; social; family; educational and social)

Tolerance: A state in which an increased dosage of the psychoactive substance is needed to produce a desired effect

Withdrawal: A physiological state (preponderance of undesirable physical symptoms and psychological effects) produced as a result of the sudden/abrupt cessation of or the reduction in the dose/quantity/frequency of use, of the psychoactive substance being misused.


Abuse:

The harmful use of a specific psychoactive substance (overuse of psychoactive substance despite harmful effects and hazardous usage)


Dependence:

A physiological state of adaptation to a specific psychoactive substance characterized by the emergence of a withdrawal syndrome during drug abstinence or abrupt reduction in usage, which may be relieved by the re-administration of the substance

Who becomes addicted?

Anyone can be addicted to a substance that they prefer, at any time. The face of the addicted person is one of a grandparent, mother, father, brother, teacher, lawyer, doctor, actor, pastor, priest, ship captain, police officer, marine, airline pilot, electrician, plumber, engineer or politician.

The Addicted Person Can Be Anyone from Anywhere:


Risk factors for the onset of SUDs include:


Genetic Risk Factor:

The body of research has found that children of alcoholics are much likely to become alcoholics themselves (alcohol use disorders run in families).

Twin studies have shown a vastly greater chance of one twin developing an alcohol use disorder, even if the other twin has the disorder and even if the twins were raised in different homes.

Other Biological and Psychological Risk Factors;

· Family history of Alcohol Use Disorder (alcohol addiction/alcoholism)

· Growing up in a dysfunctional family i.e. emotionally abusive home and physically abusive home

· Lack of adequate family education about appropriate societal norms

· Having childhood & adolescence traits of antisocial personality disorder

· Childhood or Adolescent diagnosis of Panic disorder or Bipolar Disorder or Schizophrenia

· Having peers and friends with heavy drinking behaviours in the teenage years; adolescent period and young adult life

· Person has impulse control issues (difficulty in self-regulating; inability to set limits and boundaries; codependent relationships)

Characteristics of Addicted Person


· Loss of control over when and how much of a substance is used

· Spending an inordinate amount of time thinking about and obtaining the substance they prefer

· Use of the substance is more engaging than seeking authentic relationships; going to work or living up to life’s responsibilities and commitments

· Person with SUD is in DENIAL (blaming others around them; minimizing their actions and behaviours)

· Person uses the substance that they prefer, despite the resulting physical, emotional, spiritual and social harms


Neurobiology of Addiction




For most of time, addiction has been viewed as moral weaknesses or character defects or a lack of willpower of the addicted persons. According to the current body of research, addictions occur as a result of significant changes deep within the brain, specifically within the “pleasure center” also known as the mesolimbic dopamine system-MDS.

The MDS is a nerve pathway running near the bottom of the brain between the right and left hemispheres. It is understood that people susceptible to addictions may experience changes in the interaction of the brain’s chemical messengers such as dopamine and their receptors in the MDS.

It is postulated that there is too much or too little dopamine or an abnormality in the production or breakdown of dopamine and other chemical messengers within the brain. Further, it is postulated that there maybe changes in the receptors and altercations in how the chemical messengers interact at the receptor sites.

For persons having a predisposition to addiction, the introduction of a substance bringing a pleasurable feeling may begin to disrupt the receptor/chemical messenger function of the nerve cells in the MDS, when the substance is used again and again.

What once was a source of pleasure becomes a desperate need for the substance bringing pleasure. The disorder of addiction may bring with it distinct molecular and biological changes in the human brain (specifically in the MDS region of the brain).


Consequences of Addiction




v Physical harms and hazards i.e. accidents and injuries; substance specific withdrawal syndromes; overdose states; medical consequences- onset of chronic medical disorders; psychological disturbances-mood changes such as irritability, elevation of mood, depression; paranoia; sexually transmitted infections (STIs); DEATH


v Onset of Mental Disorders i.e. mood disorders; psychotic disorders; sleep disorders


v Loss of functioning in life arenas (occupational, social, family, educational and religious arenas)


v Loss of relationships i.e. loss of family support if person with SUD in denial


Substance Classification and Effects




Alcohol is a nervous system depressant and is the most commonly used and abused drug in the world


Effects

Loss of inhibitions, relaxation; loss of judgment; loss of coordination; increased aggression; decreased heart rate; slower respiration; sleep interference; damage to the brain, liver and other internal organs; depression; acute intoxication; mood disorders; psychotic disorders and sleep disorders; tolerance, withdrawal and addiction; overdose; death

Cocaine comes from the leaves of the South American Coca plant. The leaves are ground into a white powder or paste. Cocaine is inhaled (powder breathed in through the nasal passages); injected (mixed with water and injected into the bloodstream); or smoked (rolled with tobacco or marijuana or in a pipe in “crack” form). Its classified as a nervous system stimulant and is a very commonly misused substance.

Cocaine Effects


Brief feeling of euphoria; relief of depression and anxiety, constricted blood vessels, increase heart rate, respiratory problems, high body temperature, stroke or heart attack, nasal irritation and degeneration (holes in your nose), mental changes, depression symptoms may occur when coming off the “high”; violent behaviour, intoxication, tolerance and withdrawal syndrome, chronic addiction.

Marijuana comes from the plant known as Cannabis Sativa. The main active ingredient in the marijuana plant is a psychoactive chemical known as cis-delta-9-tetrahydrocannabinol (THC) which targets the central nervous system.

Todays marijuana is said to be seven to ten times more potent than the marijuana used in the 1960s (high THC content). Of note, marijuana tends to be the first illicit and illegal substance used by teenagers (after tobacco and alcohol) and is considered a “gateway drug” as well as a primary addictive substance. Marijuana differs from all other common drugs of abuse in that it stays in the body far longer than any other substance (about 6 to 8 weeks after last use/dose) owing to the fact that it is fat-based/lipophilic instead of water based/hydrophilic.


Effects


Include feelings of calm and relaxation, elevation of heart and pulse rate, drowsiness/sleepiness, bloodshot eyes, paranoia, decrease in memory and coordination, Amotivational Syndrome (loss of motivation and interest in life), risk of lung cancer, bronchitis, emphysema, infertility (for both men and women), decrease in school in school and work performance, acute intoxication, tolerance, withdrawal and addiction




Types of Treatment for SUDs

v Detoxification:

Patient requires medical monitoring or management for a definite period of time (one to two weeks as an inpatient at a general medical hospital or a psychiatric hospital)

v Inpatient/Residential

Patient admitted into a controlled environment to establish initial abstinence. Inpatient (hospital based) or residential (free-standing facility) treatment length of stay varies greatly, from one to two months. Treatment includes intensive group talk therapy; lectures; videos and onsite community support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous).

Inpatient care is focused on stabilization of the patient and preparation for return to the environment that supported the addiction in the past, but with increased awareness of relapse triggers and behavioural changes need to maintain abstinence.

Partial Hospitalization/Intensive Outpatient Program (IOP)

IOP is designed for those persons not needing residential care but who are likely to relapse without close assistance and monitoring. IOP has become the focus of most intensive treatment today

Traditional Outpatient and Outpatient Group

This includes individual and or group therapy for persons with substance use disorder- SUDs who need guidance in early recovery or to prevent or halt relapse of the underlying SUD. Traditional outpatient therapy uses the one-on-one session as the basis for treatment, augment by group experiences.

The best programs have a seamless system where group members can “step up or down” between weekly or multiple visits per week in group sessions, without changing group peers or therapists.

Group therapy can also increase a patient’s comfort in groups, paving the way to the community support groups.

Community Support Groups

Include Alcoholics Anonymous -AA and Narcotics Anonymous-NA programs. Treatment frequently uses the principles and language of AA and NA programs to prepare the patient for success in the recovering community.

Long Term Residential

For patients with the most progressed forms of SUD, long-term, therapeutic communities are sometimes necessary. These programs run from three to four months and provide a controlled environment with continuous access to others in recovery throughout the day.

Substitution Programs for Opioid Use Disorders

The use of buprenorphine (long-acting opioid partial agonist and antagonist) and methadone (long-acting opioid agonist) has been found to aid persons with opioid use disorders manage their lives. These programs can be initiated, at an outpatient medical clinic, under the close supervision of a psychiatrist and medical team. Patients would follow-up as outpatients with their assigned psychiatrist and care/case aid worker.


Interesting Research on Drug Use Disorders in The Bahamas: do copy link below & open in your web browser


https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/dr_k_christie_wimj.september.qxd__0.pdf



Contacts for Assistance with Drug Use Disorders: do call to make an appointment with the Drug Services Team


Community Counseling & Assessment Center (CCAC)- non-emergencies 323-3295/323-3296


PMH A&E department (for drug overdoses; drug withdrawal symptoms) 322-2861


Doctors Hospital A&E department (for drug overdoses; emergencies) 322-8411




For further enquiries, send your questions to info@kirkchristie.com or drkirkchristie@gmail.com

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