when the use of substances becomes a disorder consider frequency amount impact on functioning and tolerance withdrawal variations among individuals of frequency and amount but the impact on functioning is the most important is this affecting school work relationships etc tolerance has their body developed a tolerance to the drug meaning that they need to use more of it to get a response withdrawal does their body respond negatively when they stop using i e tremors headaches seizures DSM IV vs DSM 5 distinction btwn abuse and dependence is no longer necessary in DSM 5 dependence when you have strong withdrawal symptoms substance abuse is defined by how significantly the substance use interferes w the user s life impact on functioning drug addiction dependence can be described in terms of physiological dependence building up a tolerance and going through withdrawal if you stop using the drug or in terms of drug seeking behaviors how far you ll go to get the drug problems w physical tolerance withdrawal assumption reliability of abuse diagnosis vs dependence is weak b c they often co occur DSM IV cannabis abuse cannabis dependence either one qualifies you for a disorder but you had to figure out which category they fell into DSM V cannabis use disorder idea of addiction rather than separating abuse dependence categories of substances and related addictions depressants behavioral sedation relaxation alcohol barbiturates benzos stimulants activation alertness energization mood elevation amphetamines meth MDMA cocaine nicotine caffeine opiates temporary analgesia reduced pain euphoria heroin opium codeine morphine hallucinogens alteration of sensory perception possible delusions paranoia hallucinations cannabis LSD other drugs don t fit neatly into one of above categories and produce a variety of psychoactive effects alter mood behavior or both inhalants anabolic steroids over the counter and prescription meds new to this category gambling disorder Alcohol Use Disorder at least 2 of the following 1 alcohol is often taken in larger amounts or over a longer period than was intended 2 there is a persistent desire or unsuccessful efforts to cut down or control alcohol use 3 a great deal of time is spent in activities necessary to obtain alcohol use alcohol or recover from its effects 4 craving or a strong desire or urge to use alcohol 5 recurrent alcohol use resulting in a failure to fulfill major role obligations at work school or home 6 continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol 7 important social occupational or recreational activities are given up or reduced b c of alcohol use 8 recurrent alcohol use in situations in which it is physically hazardous 9 alcohol use is continued despite knowledge of having a persistent or recurring physical or psychological problem that is likely to have been caused or exacerbated by alcohol 10 tolerance 11 withdrawal among those who binge drink 20 meet criteria for this disorder alcohol is a depressant slows you down slows down reaction time speech walking etc apparent stimulation is the initial effect of alcohol even though it s a depressant b c our inhibitory centers in the brain are initially depressed w continued drinking however alcohol depresses more areas of the brain which impedes our ability to function properly psychological and physical effects of alcohol influences several neurotransmitter systems such as GABA glutamate may be responsible for blackouts when drunk and serotonin specific target is inhibitory GABA system GABA receptors are sensitive to alcohol makes it difficult for neurons to communicate with each other GABA is related to anxiety when you drink your anxiety is reduced b c your inhibitions are lowered alcohol s anxiolytic effect may result from its interaction w the GABA system alcohol also affects vision motor control reaction time memory and hearing effects of chronic alcohol use withdrawal if people who drink every day try to stop drinking all at once they ll have a physical response including things like hand tremors vomiting hallucinations and delirium tremens frightening hallucinations and tremors withdrawal could be deadly long term medical consequences liver disease pancreatitis cardiovascular disorders brain damage associated brain conditions can lead to dementia and Wernicke s disease Wernicke Korsakoff syndrome loss of coordination confusion unintelligible speech fetal alcohol syndrome fetal growth retardation cognitive deficits behavior problems learning difficulties characteristic facial features the development of FAS may depend on whether there is a genetic tendency to have certain enzymes and children from certain racial groups may be more susceptible to FAS than others for example African Americans tend to have beta 3 ADH more than other racial groups and among children w FAS many of them have beta 3 ADH alcohol use patterns in the US over 90 of adults in the US consider themselves light drinkers alcohol use is higher among whites and men specifically alcohol addiction almost of ppl in the US report binge drinking at least 5 drinks in the past month spontaneous recovery rates some people w alcohol addiction sometimes suddenly no longer meet criteria for the disorder even without treatment they are able to stop drinking on their own without treatment about 20 of people w the disorder people s responsiveness to the sedative effects of alcohol may affect later use those who don t develop slurred speech staggering and other sedative effects of alcohol are more likely to abuse it later in other words people who are biologically better able to appreciate the initial highs of drinking and are less sensitive to the lows that come later are more likely to become alcoholics among chronically dependent alcohol users a general progression of alcohol related life problems is typical problems get more serious as they get older increasingly severe consequences of drinking association btwn violence and alcohol alcohol lowers inhibitions so we are more likely to act on certain impulses alcohol also impairs our ability to understand consequences treatments antagonistic treatment changes effect of alcohol on your body Naltrexone blocks positive effects of alcohol positive emotions etc by blocking endorphins so if alcohol doesn t feel as good you may not crave it as much aversive treatment Antabuse makes you feel nauseous when you