● BACKGROUND ASSESSMENT DATA
The substance-related disorders are composed of two groups: the substance-use disorders (dependence and abuse) and the substanceinduced disorders (intoxication and withdrawal). Other substanceinduced disorders (delirium, dementia, amnesia, psychosis, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorders) are included in the chapters with which they share symptomatology (e.g., substance-induced mood disorders are included in Chapter 6; substance-induced sexual dysfunction is included in Chapter 10, etc.).
● SUBSTANCE-USE DISORDERS Substance Abuse
Defined The DSM-IV-TR (APA, 2000) defines substance abuse as “a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of the substance.” Symptoms include use of substances in physically harmful circumstances, impaired role performance (school, work, or home), repeated encounters with the legal system for substancerelated conduct, and experiencing personal problems related to substance use.
Defined Dependence is defined as a compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled (Townsend, 2006). Dependence on substances is identified by the appearance of unpleasant effects characteristic of a withdrawal syndrome when a drug is discontinued. Dependence on substances can also be associated with tolerance, in which there is a 65
ALTERATIONS IN PSYCHOSOCIAL ADAPTATION
need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose. The individual who is dependent on substances continues to increase the amount consumed in order to achieve the desired effect and to relieve or avoid withdrawal symptoms.
● SUBSTANCE-INDUCED DISORDERS Substance Intoxication
Defined Intoxication is defined as a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor (Townsend, 2006). With substance intoxication, the individual experiences a reversible syndrome of symptoms that occur with ingestion of a substance and that are specific to the substance ingested. The behavior changes can be attributed to the physiological effects of the substance on the central nervous system (CNS).
Defined Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance (Townsend, 2006). The symptoms of withdrawal are specific to the substance that has been ingested and occur after prolonged or heavy use of the substance. The effects are of sufficient significance to interfere with usual role performance.
● CLASSIFICATION OF SUBSTANCES Alcohol
Although alcohol is a CNS depressant, it will be considered separately because of the complex effects and widespread nature of its use. Low to moderate consumption produces a feeling of well-being and reduced inhibitions. At higher concentrations, motor and intellectual functioning are impaired, mood becomes very labile, and behaviors characteristic of depression, euphoria, and aggression are exhibited. The only medical use for alcohol (with the exception of its inclusion in a number of pharmacological concentrates) is as an antidote for methanol consumption. Examples: Beer, wine, bourbon, scotch, gin, vodka, rum, tequila, liqueurs. Common substances containing alcohol and used by some dependent individuals to satisfy their need include liquid cough medications, liquid cold preparations, mouthwashes, isopropyl rubbing alcohol, nail polish removers, colognes, aftershave and preshave preparations.