Difference in diagnosis of Substance Use Disorders in DSM-4 and DSM-5
In DSM-4 the word addiction did not appear, but does in DSM-5.
In SUBSTANCE RELATED DISORDERS, how many separate classes of drugs does it cover?
10 separate classes of drugs
What are some key features of substance addiction?
- Chronic disease of brain reward, motivation, memory and related circuitry
- Excessive pursuit of reward and/or relief
- Diminished control
- Compulsion/craving
- Increased tolerance and cycles of relapse
DSM-5 SUBSTANCE RELATED DISORDER criteria
A.
Impaired control
- use of amounts or for longer periods than intended
- repeated unsuccessful attempts to cut back/cease
- excessive time obtaining drug or recovery from use
- craving
Social impairment
- failure to meet obligations
- social and interpersonal problems
- social, occupational or recreational activities reduced
Risky use
- use in physically hazardous situations
- persistence despite awareness of physical or psychological problems exacerbated by use
Pharmacological
- tolerance
- withdrawal
Substance Use Comorbidities
60% of substance users have a co-morbid psychiatric disorder.
Usually with mood or anxiety disorders
Kitchen sink analogy with water as dopamine
Drugs act like rubber stopper: molecules block dopamine transporter and stop natural reuptake of dopamine into neurons.
This causes a large excess of dopamine in synapse and ‘overflow’ of dopamine causes pleasure and euphoria.
What 3 areas do drugs of dependence operate on?
Basal ganglia; extended amygdala; prefrontal cortex
Define Addiction
A primary, chronic disease of the brain reward, motivation, memory and related circuity.
What is the 3 stage cycle of addition?
- Binge/Intoxication
- Withdrawal/Negative Affect
- Preoccupational/Anticipation
Define Gambling
Risking item of value on outcome of events determine by chance.
Define Problem Gambling
Personal or social harm resulting from excessive gambling behaviour
Prevalence of gambling in general population
60-85% of general population
Which country has the lowest pathological gambling prevalence rate?
Norway at 0.2%
Which country has the highest pathological gambling prevalence rate?
Hong Kong at 5.3%
Average age of onset of gambling
12-15 years
Association percent between alcohol abuse and dependence in pathological gambling?
30-40%
Pathological Gambling comorbidities
Substance use disorder; mood disorder; anxiety disorder
What percent of problem gamblers seek formal treatment?
Less than 10%
DSM-5 SUBSTANCE RELATED DISORDERS criteria
A. four or more
- preoccupation (psychological dependence)
- increased amount gambled (tolerance)
- irritability/restlessness on cessation (withdrawal)
- escape from stress (negative reinforcement and motivation
- chasing losses
- lying
- repeated failure to cease (impaired control)
- risked significant relationship
- bailout
What are the 3 stages of Gambling?
- Early winning phase
- Losing phase
- Desperation phase
What is the early wining phase for gambling?
2/3 of pathological gamblers experience large wins prior to developing problems; this facilitates cognitions (this is so easy)
What is the losing phase for gambling?
Heightened preoccupation with gambling.
Growing losses and attempts to recoup (‘chasing losses’).
Increased stress, irritability, withdrawal.
What is the desperation phase for gambling?
Efforts to survive financially and psychologically become increasingly extreme.
60% have committed an offence to finance gambling. Suicide is also a real risk.
What are the 3 main pathways of Pathological Gambling?
Pathway 1 = behavioural conditioned problem gamblers
Pathway 2 = emotionally vulnerable problem gamblers
Pathway 3 = antisocial impulsivist problem gamblers
