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Substance-Related Disorders

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Substance abuse is as common as it is costly to society. It is etiologic for many medical illnesses and is frequently comorbid with psychiatric illness. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) defines substance abuse and dependence independent of the substance.

Hence, alcohol abuse and dependence is defined by the same criteria as heroin abuse and dependence. This section defines abuse and dependence and provides clinical descriptions of each substance-related disorder. The DSM-IV recognizes the different signs and symptoms associated with various drug addictions.

We review the common substance-related disorders in sequence.

Substance-Related Disorders

 

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Alcohol-related disorders

Alcohol intoxication is defined by the presence of slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma, and clinically significant maladaptive behavioral or psychological changes (inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develop during or shortly after alcohol ingestion.

The diagnosis of alcohol intoxication must be differentiated from other medical or neurologic states that may mimic intoxication, for example, diabetic hypoglycemia; toxicity with various agents, including but not limited to ethylene glycol, lithium, and phenytoin; and intoxication with benzodiazepines or barbiturates.    

Opioid use Disorders

Opiates include morphine, heroin, codeine, meperidine, and hydromorphone. Heroin is only available illegally in the United States. Opiates are commonly used for pain control.

Opiate use and abuse are relatively uncommon in the United States. Lifetime prevalence in 1991 was 0.9% and point prevalence was less than 0.1 %, although more recent surveys indicate opiate use and abuse has been increasing during the past decade. Many of those who use opiates recreationally become addicted. The number of opiate addicts in the United States is estimated at 500,000.    

Cannabis and Miscellaneos Substance use disorders

Cannabis is widely used throughout the world in the forms of marijuana and hashish. The drug is usually smoked and causes a state of euphoria. Complications of cannabis include impaired judgement, poor concentration, and poor memory. Serious complications include delirium and/or psychosis.

Club Drugs are a group of drugs classified by the National Institute on Drug Abuse (NIDA) according to their popularity in dance clubs and other party venues. These drugs are of a wide variety of chemical classes, but are linked by their frequent use in social groups and the fact that they are commonly taken together. Because of their popularity and tendency for users to show up in emergency rooms, we review some of the more widely used Club Drugs below.    

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