4-14-10 Introduction to Substance Use Disorders (SUDs) 1.

List the SUDs and describe the diagnostic criteria for each. SUDs are chronic relapsing brain disorders that manifest as a compulsive drive to take a drug despite serious adverse consequences. They can be classified into two broad categories: Substance abuse: patients who cant resist the urge to use the substance despite previous negative effectslegal, social, or occupational. DSM IV criteria: one or more of the following occurring within a 12-month period: Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (absences, poor work performance, neglect of children/household) Recurrent substance use in situations where it is physically hazardous (while driving or operating a machine when impaired by substance) Recurrent substance-related legal problems (arrests for substance-related disorderly conduct) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (arguments with spouse, physical fights) The symptoms must not meet the criteria for Substance Dependence. Substance Dependence: more severe in intensity than substance abuse, and has overcome the normal process of judgment and decision making. Life evolves around the use. DSM IV criteria: three or more of the following occurring within a 12-month period: Tolerance as defined by: A need for markedly increased amounts of the substance to achieve intoxication or the desired effect Markedly diminished effect with continued use of the same amount of substance Withdrawal as manifested by: Characteristic withdrawal symptoms for the substance Relief of symptoms when taking the substance or a closely related one Substance is taken in larger amounts over a longer period than was intended Persistent desire or unsuccessful efforts to cut down or control substance use Great deal of time spent in activities necessary to obtain the substance, using the substance, or recovering from its effects Important social, occupational, or recreational activities given up or reduced because of substance abuse. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (such as continued cocain use

despite recognition of cocaine-induced depression, or continued drinking despite recognition of ulcer made worse by alcohol) 2. Explain the gene-environment effect on the pathogenesis of SUDs. Describe the neuronal pathways involved in the pathogenesis of SUDs. GENETICS Imaging studies have revealed an underlying disruption to brain regions that are important for the normal processes of motivation, reward, and inhibitory control in addicted individuals. This provides the basis for a the view that drug addiction is a disease of the brain, and the associated abnormal behavior is the result of dysfunction of brain tissue. Damage to the orbitofrontal cortex (OFC) will result in improper inhibitory control and compulsive behavior, and damage to the myocardium will result in improper blood circulation. At the molecular levels, Dopamine has been consistently associated with the reinforcing effects of most drugs of abuse. Drugs tend to increase extracellular dopamine concentrations in the limbic regions including the nucleus accumbens (NAc) ENVIRONMENTAL FACTORS Low socioeconomic class, poor parental support, and drug availability are associated with propensity to self-administer drugs Stress increases the risk of drug abuse, possibly due to stress-responsive corticotrophinreleasing factors effects on the amygdala and pituitary-adrenal axis Imaging as a means to analyze the effect of environmental factors: D2-receptor expression in the brain is affected by social status. Animals who achieve a dominant status in the group will have increased numbers of D2 receptors and are reluctant to administer cocaine