ABNORMAL PSYCHOLOGY (PSY 202) GROUP PRESENTATION

ON THE TOPIC: SUBSTANCE-RELATED AND ADDICTIVE

DISORDERS

AS PRESENTED BY GROUP 10:

Adeyemo Timothy O. – 220698, Physiotherapy
Adeyeye Olamide I. – 229487, Physiotherapy
Adeyinka Temiloluwa J. – 229488, Physiotherapy
Aijefo Michael O. – 229489, Physiotherapy
Ajayi Babatunde B. – 229490, Physiotherapy
Akanji Mueez O. – 229491, Physiotherapy
Akinola Stephen O. – 229492, Physiotherapy
Akintayo Zainab M. – 229493, Physiotherapy
Akintoye Theophilus – 229494, Physiotherapy
Alabi Olusola E. – 229495, Physiotherapy
Asaolu Ezekiel T. – 229496, Physiotherapy

ON: Thursday, 23rd November, 2023

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TABLE OF CONTENTS
Introduction and Prevalence…………………………………… 3
Classification of Substance-Related and
Addictive Disorders……………………………………………....4
Procedures for Diagnosis………………………………………...5
CNS Depressants…………………………………………………8
CNS Stimulants…………………………………………………...9
Hallucinogens……………………………………………………12
Addictive Disorders: Gambling Disorder……………………...15
Treatment Approaches………………………………………....16
Conclusion……………………………………………………….18
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Introduction
The DSM-V, published in May, 2013, classifies substance-related disorders along
with addictive disorders as a result of their similarities in pathological effects on
the brain’s reward system, which is in charge of reinforcing behaviours and
creating memories.
Substance-related disorders refer to disorders characterized by pathological
behaviour associated with substance use. Excessive use of these substances or
drugs intensely activate the brain’s reward system to the extent that normal
activities are neglected. While normally adaptive behavior is responsible for the
activation of the centres controlling the brain’s reward system, these drugs directly
activate them, giving the user a feeling usually described as a “high” – a state of
heightened pleasure and euphoria. The availability and ease of use of these drugs
are an added reason for their excessive use.
Substance use disorders are divided into two groups: Substance use disorders and
substance-induced disorders.
The DSM-V identifies only one addictive disorder – Gambling disorder - which
is characterized by maladaptive behaviour related to gambling activities which
activate the brain’s reward system to the extent of normal activities being
neglected in pursuit of pleasure received from gambling activities.

Prevalence
According to the UNODC in 2018, 14.4% (14.3 million) of Nigerian individuals
between the ages 15-64 years abuse drugs. The most commonly abused drugs are
cannabis (also known as marijuana, dope, weed, ganja), alcohol, cigarettes,
codeine, and tramadol.
Also, according to the UNODC in the same year, 1 in 5 high risk drug users
administer their doses via injection; 47% of the Nigerian population has used
opioids like tramadol, codeine, and morphine for non-medical purposes. 376,000
people are estimated to be high risk users, most of them using opioids.
Substance use is prevalent in all six geo-political zones, but southern states (Lagos,
Oyo [Ibadan], etc.) have the highest prevalence rate according to Olanrewaju,
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Hamzat, Enya, et al., (2022). Substance use has a high prevalence among
university and secondary school students, youths generally, commercial bus
drivers, farmers, and sex workers (Jatau, Sha’aban, Gilma, et al. 2021).
Access to care is most difficult in Yobe, Imo, Bayelsa, Rivers, and Lagos.
A recent study of the Nigerian general population found that 36% of adult
respondents had gambled and 53% of these people were daily gamblers. It is more
common in men than in women
Classification of Substance-Related and Addictive Disorders
Substance-Related Disorders
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text
Revision (DSM-V), categorizes substance use disorders as follows:
Substance-related disorders are categorized into 10 classes based on use of the
following substances: alcohol, caffeine, cannabis, hallucinogens, inhalants,
opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, and other (or
unknown) substances. There are two categories of substance-related disorders: (a)
substance use disorders and (b) substance-induced disorders.
A. Criteria for Diagnosis with a Substance Use Disorder:
There are 11 symptoms for each substance class (except for caffeine) that are used
to make a substance use disorder diagnosis. The diagnosis is made along a
continuum - mild, moderate, or severe - based on the number and severity of the
symptoms.
Substances used can further be categorised into:
 CNS depressants: alcohol, cannabis, inhalants, opioids, sedatives,
hypnotics or anxiolytics.
 CNS stimulants: tobacco, caffeine, stimulants
 Hallucinogens, empathogens and dissociative drugs.
B. Substance-Induced Disorders
Substance-induced disorders include intoxication, withdrawal, and other
substance/medication-induced disorders. The DSM-V provides a complete
description of criteria for each category.
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The following conditions may be classified as substance-induced disorders:

 Intoxication - Refers to a reversible set of symptoms occurring after the use
or exposure to a drug. Symptoms may vary based on substance used, and
may occur in those not suffering from substance use disorders. Symptoms
are not attributable to another medical condition or mental disorder.
 Withdrawal - Diagnosed based on the behavioral, physical, and cognitive
symptoms that occur due to the abrupt reduction or discontinuation of heavy
and prolonged substance use, and symptoms are not attributable to another
medical condition or mental disorder. Not all drugs cause a withdrawal
syndrome on discontinuation.
 Other substance/medication-induced mental disorders - This category
includes: Psychotic disorders, bipolar and related disorders, depressive
disorders, anxiety disorders, obsessive-compulsive and related disorders,
sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders.

Addictive Disorders
Although some behavioral conditions that do not involve ingestion of substances
have similarities to substance-related disorders, only one disorder - gambling
disorder - has sufficient data to be included in this section.

Procedures for Diagnosis

Substance Use Disorders
The DSM-5 gives eleven criteria under four categories for diagnostics use. They
are: impaired control over use, social impairment, risky use, and pharmacological
symptoms. At least two of these criteria must have been fulfilled for a period of 12
months before a person can be diagnosed with a substance use disorder.
The eleven criteria are as follows:
Impaired Control
 The person may take the substance in larger amounts or over a longer period
of time than initially intended
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 The person reports a desire to quit usage of the substance and records
unsuccessful attempts at doing so
 The person spends a lot of time doing activities involving taking the
substance
 The person has an intense desire (craving) to make use of the substance
Social Impairment
 As a result of continued substance use, the person fails to perform major
obligations at work, school, or home
 There is continued substance use despite recurrent social or interpersonal
problems caused or worsened by use of said substance
 Important occupational, social, or recreational activities may be forfeited
because of substance use
Risky Use
 There is recurrent substance use even in physically hazardous situations
 Persistent substance use despite having a physical or psychological problem
likely to have been caused or exacerbated by the substance
Pharmacological Symptoms
 Tolerance is observed when a highly increased dose is required to give a
desired effect or the usual dose provides a reduced effect
 Withdrawal symptoms are observed when blood or tissue concentrations of
the substance are reduced in an individual who has indulged in heavy doses
for an extended period of time
Severity of substance use disorders ranges from mild (2-3 criteria fulfilled over a
period of 12 months), moderate (4-5 criteria), to severe (6 criteria and more
observed).
Other clinical tools exist for the diagnosis of substance use disorders, and are used
in conjunction with observed criteria. They may be self-administered or
administered by a trained professional, and include:
 The Drug Use Disorders Identification Test (DUDIT) – an 11-item self-
administered screening instrument for drug-related problems, giving
information on the level of drug intake and selected criteria for substance
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abuse or harmful use and dependence according to the ICD10 and DSM-4
diagnostic systems (emcdda.europa.edu, document library, DUDIT)
 The Alcohol Use Disorders Identification Test (AUDIT) – a 10-item self-
administered test
 Alcohol, Smoking, and other Substance Involvement Screening Test
(ASSIST)
 Addiction Severity Index (ASI)
 Other blood and urine sample tests

Gambling Disorder
An essential feature of this disorder is persistent and recurrent maladaptive
gambling behavior that disrupts personal, family, and/or vocational pursuits (DSM-
V, pg. 586). The DSM-5 gives 9 criteria for diagnosis, at least 4 of which must
be fulfilled at any time during a 12-month period before a person is diagnosed
with gambling disorder. The nine criteria are:
 Needs to gamble with increasing amounts of money in order to achieve the
desired excitement
 Is restless or irritable when attempting to cut down on gambling
 Is preoccupied with (has persistent thoughts about) gambling
 Has tried unsuccessfully to reduce or stop gambling
 Often gambles when feeling distressed
 Lies to cover up degree of involvement in gambling
 After losing money gambling, often comes back the next day or shortly after
to attempt to win back what they’ve lost
 Has destroyed or lost significant relationships, opportunities, or employment
due to gambling activities
 Relies on another to provide money to relieve financial situations caused by
gambling activities
Severity ranges from mild (4-5 criteria observed), moderate (6-7 criteria), to
severe (8-9 criteria).
Associated features that support a positive diagnosis include the individual’s
exhibition of distorted thinking (overconfidence, sense of power and control over
outcomes of chance events, denial, etc.). Some are impulsive, competitive,
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energetic and easily bored, while others feel depressed and lonely, often gambling
when they feel helpless, guilty, or depressed. Up to half of people being treated for
gambling disorder have suicidal ideation (DSM-5, Pg. 621, 2013).
Other tools used in diagnosing gambling disorder include objective tests like:
 Brief Biosocial Gambling Screen (BBGS)
 NORC Diagnostic Screen for Gambling Problems – Self-Administered
(NODS-SA)

CNS Depressants
These are substances that slow down the activity of the central nervous system,
making them useful for treating panic, anxiety, and sleep disorders. They include
alcohol, cannabis, inhalants, opioids, sedatives, and benzodiazepines. Their
mechanism of action is to affect the neurotransmitter gamma-aminobutyric acid
(GABA), leading to side effects which include drowsiness, relaxation, and
decreased inhibition (AddictionCenter.com). They lower levels of awareness in the
brain.
Case Study
Presenting problem: Kunle is a 35-year-old male who presented with symptoms
indicative of substance disorder related to the intake of depressants.
History of Present illness: Kunle has been taking an excess of alcohol along with
cannabis to manage stress and anxiety. He reported a pattern of increasing use over
the past year, leading to negative consequences in his personal and professional
life. He had previously attempted to quit his habit but was unsuccessful; also, his
indulgence has caused him to lose his employment, his marriage has deteriorated,
and sometimes he has suicidal ideations.
Assessment: Kunle's physical examination revealed signs of intoxication as
confirmed by observed sedation, slurred speech, and impaired coordination.
Laboratory tests confirmed elevated levels of alcohol and cannabis in his blood and
urine. Additionally, the patient exhibited symptoms of tolerance and withdrawal,
indicating a physiological dependence on these substances.
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CNS Stimulants
Stimulants are a class of drugs that speed up messages travelling between the brain
and body. They can make a person feel more awake, alert, confident or energetic.
Stimulants include caffeine, nicotine, amphetamines and cocaine. The forms in
which stimulants are made available make them accessible and easy to abuse e.g.
caffeine in energy drinks, coffee, cigarettes (nicotine) etc.
Stimulant-related disorders are common among individuals between ages 16 and
25, and are of two types: Stimulant use disorders and Stimulant-induced disorders.

Caffeine
Recurrent consumption of caffeine (typically a high dose well in excess of 250 mg)
is indicative of a caffeine use disorder. Five (or more) of the following signs or
symptoms develop during or shortly after caffeine use:
 Restlessness
 Nervousness
 Excitement
 Insomnia
 Flushed face
 Diuresis
 Gastrointestinal disturbance
 Muscle twitching
 Rambling flow of thought and speech
 Tachycardia or cardiac arrhythmia
 Periods of inexhaustibility
 Psychomotor agitation

The signs or symptoms above cause clinically significant distress or impairment

in social, occupational, or other important areas of functioning.
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The signs or symptoms are not attributable to another medical condition and are
not better explained by another mental disorder, including intoxication with
another substance.

Caffeine can be consumed from a number of different sources, including coffee,

tea, caffeinated soda, "energy" drinks, over-the-counter analgesics and cold
remedies, energy aids (e.g., drinks), weight-loss aids, and chocolate. Caffeine is
also increasingly being used as an additive to vitamins and to food products. The
various forms in which stimulants are made available makes it very easy to be
abused, as in some cases the individual is not conscious of his or her intake.

Prevalence
The prevalence of caffeine intoxication in the general population is unclear. In the
United States, approximately 7% of individuals in the population may experience
five or more symptoms along with functional impairment consistent with a
diagnosis of caffeine intoxication.

Cessation of (or reduction in) prolonged amphetamine-type

substance, cocaine, or other stimulant use
Dysphoric mood and two (or more) of the following physiological changes,
developing within a few hours to several days after cessation of stimulants
 Fatigue
 Vivid, unpleasant dreams
 Insomnia or hypersomnia
 Increased appetite
 Psychomotor retardation or agitation
The signs or symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The signs or symptoms are not attributable to another medical condition and are
not better explained by another mental disorder, including intoxication or
withdrawal from another substance.
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Diagnostic Criteria
Problematic pattern of stimulant use leading to clinically significant impairment or
distress, as manifested by at least two of the following, occurring within a 12-
month period:
 The stimulant is often taken or ingested in larger amounts or over a longer
period than was intended
 There is a persistent desire or unsuccessful efforts to cut down or control
stimulant use
 A great deal of time is spent in activities necessary to obtain or use stimulant
 Craving, or a strong desire or urge to use stimulant
 Recurrent stimulant use resulting in a failure to fulfill major role obligations
at work, school, or home (e.g., interference with work)
 Continued stimulant use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of stimulant
(e.g., arguments with others about tobacco use)
 Important social, occupational, or recreational activities are given up as
result of stimulant use
 Recurrent stimulant use in situations in which it is physically hazardous
(e.g., smoking at a gas station)
 Stimulant 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 stimulant
 Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of stimulants to achieve the
desired effect.
b. A markedly diminished effect with continued use of the same amount of
stimulants.
 Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for stimulants
b. Stimulant is taken to relieve or avoid withdrawal symptoms.
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Withdrawal
Abrupt cessation of stimulant use, or reduction in the amount of stimulant used is
followed within 24 hours by four (or more) of the following signs or symptoms:
 Irritability, frustration, or anger
 Anxiety
 Difficulty concentrating
 Increased appetite
 Restlessness
 Depressed mood
 Insomnia

Risks and Prognostic Factors

1. Temperamental - Comorbid bipolar disorder, schizophrenia, antisocial
personality disorder, and other substance use disorders are risk factors for
developing stimulant use disorder and for relapse to cocaine use in treatment
samples. Also, impulsivity and similar personality traits may affect
treatment outcomes. Childhood conduct disorder and adult antisocial
personality disorder are associated with the later development of stimulant-
related disorders.
2. Environmental - Predictors of cocaine use among teenagers include
prenatal cocaine exposure, postnatal cocaine use by parents, and exposure to
community violence during childhood. For youths, especially females, risk
factors include living in an unstable home environment, having a psychiatric
condition, and associating with dealers and users.

Hallucinogens
Hallucinogens are a class of drugs that alter perception, thoughts, and feelings.
They can cause hallucinations, sensory distortions, and intense emotional
experiences.
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Hallucinogens fall under two categories: Classical hallucinogens and Dissociative

hallucinogens.
Classical Hallucinogens (Serotonergic) – They include:
 LSD (Lysergic Acid Diethylamide) - Synthesised from a fungus; alters
perception of time and space.
 Psilocybin (Magic Mushrooms) - Found in certain mushrooms, and causes
visual and sensory hallucinations.
Dissociative Hallucinogens – They include:
 PCP (Phencyclidine) - Originally developed as an anesthetic; causes
dissociation from reality.
 Ketamine - Used as an anesthetic in medical settings, produces
hallucinations and dissociation.

Effects of Classical and Dissociative Hallucinogens

Classical Hallucinogens (Serotonergic):
Positive effects: Altered perceptions, intense sensory experiences.
Risks: Unpredictable reactions, anxiety, and flashbacks.
Dissociative Hallucinogens:
Positive effects: Dissociation, altered perception.
Risks: Loss of coordination, cognitive impairment.

Hallucinogen Intoxication
Symptoms:
 Distorted perception of reality.
 Hallucinations and vivid sensory experiences.
 Altered sense of time and space.
 Duration:
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Variable, depending on the substance and dosage.

Significant Psychological and Behavioral Changes

Psychological Changes:
 Altered mood and emotions.
 Intensified thoughts and perceptions.
 Potential for anxiety or panic attacks.
Behavioral Changes:
 Impaired judgments and decision-making.
 Altered motor coordination.
 Social withdrawal or, conversely, increased sociability.
Treatment Options:
 Medical Monitoring
 Therapeutic Support
 Supportive Environment

Case Study - Mark's Experience

Background: Mark, a 22-year-old male college student, experimented with drug
use when he ingested a small amount of LSD at a party. Initially he enjoyed the
perception of vibrant colours and enhanced senses, but shortly after began to
experience extreme anxiety, and his perceptions became distorted.
His friends sought medical help for him, and Mark was presented to the emergency
room after experiencing a bad trip on LSD. He was having intense visual
hallucinations, feeling paranoid and anxious, and was unable to control his
thoughts. He was admitted to the psychiatric ward and diagnosed with acute
psychosis. He was treated with antipsychotic medication and his symptoms
gradually improved.

Conclusion
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Classical hallucinogens and Dissociative hallucinogens have distinct effects.

Case studies highlight the importance of responsible drug use in both categories.

Addictive Disorders
Gambling Disorder
Gambling disorder is characterized by an uncontrollable urge to participate in
gambling activities despite harmful consequences. It is a chronic relapsing disorder
that can significantly impact individuals' lives.

Case Study
Mr. Gambil Tetelaye, a 25-year-old man, presents to the clinic seeking help for his
gambling problem. He reports that he has been gambling for over 10 years, and his
gambling has increased in frequency and intensity over the past few years. He
describes himself as a "chasing" gambler, meaning that he continues to gamble
even when he is losing money in an attempt to recoup his losses. He has maxed out
his credit cards, taken out loans, and even borrowed money from friends and
family to fund his gambling habit. He has also neglected his work and personal
relationships as a result of his gambling.

Symptoms and Diagnosis

Individuals with gambling disorder meet DSM-V criteria, exhibiting at least four
of the following symptoms:
● Preoccupation with gambling
● Tolerance
● Repeated attempts to control gambling
● Restlessness or irritability when unable to gamble
● Chasing losses
● Lying to conceal gambling
● Loss of control

Prevalence
Gambling disorder is prevalent, affecting many who perceive gambling as a
harmless pastime. It is more common in men, lower-educated individuals, and
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those with mental health comorbidities. A recent study of the Nigerian general
population found that 36% of adult respondents had gambled and 53% of these
people were daily gamblers. It is more common in men than in women, and it is
more common in people with lower levels of education and income.

Co-morbidity
Mr. Tetelaye also has a history of depression and anxiety. These co-morbid
conditions can make gambling disorder more difficult to treat.

Risk Factors
Gambling disorder is more common in men, lower-educated individuals, and those
with mental health comorbidities.

Prognosis
The prognosis for gambling disorder is generally positive with appropriate
treatment, which may include cognitive-behavioral therapy (CBT), medication,
support groups, and self-help strategies.

Treatment Approaches
After a precise diagnosis has been made, a treatment plan which depends on the
severity of the effect of the substance used or type of disorder as outlined in the
DSM-V is curated by the clinical physician. Typically, it involves a combination of
behavioral therapies, counseling, support and medication.
 Individual Counseling - One-on-one counseling sessions with a qualified
professional can help individuals explore and address the root causes of their
substance use, contributing to long-term recovery. In the case of a gambling
disorder, sessions should include financial counseling which would address
the financial consequences of gambling. Financial counseling helps
individuals manage debts, create budgets, and develop responsible financial
habits.

 Family Therapy - Involving family members in the treatment process can

enhance support and understanding, addressing family dynamics that may
contribute to substance use.
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 Behavioral Therapy - Cognitive-behavioral therapy (CBT) is effective in

addressing the psychological aspects of addiction, helping individuals
modify their behaviors and develop healthier coping mechanisms. It is also
often used to help individuals recognize and change unhealthy patterns of
thinking and behavior associated with substance use.

 Support Groups - Participation in support groups like Narcotics

Anonymous (NA) or SMART Recovery can provide a valuable network of
understanding peers and ongoing support. Incorporating sharing experiences
with others who are facing similar challenges can be a valuable part of the
recovery process. As regards gambling disorder, participating in support
groups like Gamblers Anonymous can provide a sense of community and
understanding.

 Holistic Approaches - Mindfulness-based interventions, meditation, and

other holistic approaches may complement traditional therapies, promoting
overall well-being including self-help strategies such as encouraging
individuals to use self-help strategies, such as keeping diaries, setting limits,
and avoiding triggers, can be beneficial. All enhances the withdrawal
method.

 Relapse Prevention - Developing strategies to prevent relapse is a crucial

aspect of treatment. This may involve identifying triggers, learning coping
mechanisms, and establishing a relapse prevention plan.

 Motivational Enhancement Therapy (MET) and Contingency

Management - This approach focuses on increasing an individual's
motivation to change and can be particularly useful in the early stages of
treatment. Contingency management approach involves providing incentives
or rewards for positive behaviors such as abstinence or adherence to the
treatment plan.

As the individual cases become more severe with the effect of the substance(s)
used or gambling disorder, there is a need for a medication treatment plan
alongside the above listed treatment schedules. This includes:
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 Medical Detoxification - In cases of severe dependence, a medically

supervised detoxification may be necessary to manage withdrawal
symptoms and ensure safety.

 Medication-Assisted Treatment (MAT) - In some cases, medication may

be used to assist in the recovery process. For example, medications like
naltrexone or acamprosate may be used for alcohol dependence.

However, some medications may be used to manage co-occurring conditions

like depression or ADHD. In cases of gambling disorder, medications used
for co-occurring conditions like depression or anxiety may be prescribed if
needed.
It's crucial for individuals to seek professional help tailored to their specific needs
and circumstances. Consulting with a healthcare provider or addiction specialist is
essential for developing an effective treatment plan.

Conclusion
Individuals suffering from substance-related and/or addictive disorders have a
reduced quality of life, and hence are many times unable to function as productive
members of society, causing there to be a reduction in the economy’s labour
market. Also, children of parents suffering from these disorders are more likely to
develop mental health issues later in life due to negative experiences they would
most probably be exposed to as a result of the effects of the disorders on their
guardians. Children and relatives of individuals with a history of these disorders
are also at a higher risk of suffering from the same disorders.
Inhabitants of urban locales and demanding industries are also at higher risk of
developing these disorders as a result of endeavouring to cope with stress, anxiety,
fear, loss, frustration, and other negative emotions and situations.
Prevention here is much easier than cure, and awareness of the dangers of
excessive indulgence in aforementioned substances and behaviours would help
individuals make more informed decisions.
Relapses will occur on the journey to conquering disorders, but social support and
constant motivation along with a consistent and effective treatment plan will help
individuals eventually take back their lives.