Addiction and Substance Use Disorder Mnemonics (Memorable Psychiatry Lecture)

Summary

The video script delves into the prevalence of psychoactive substance use, detailing intoxication, withdrawal, and addiction as separate yet interconnected issues. It outlines the DSM-5 criteria for substance use disorders and introduces the 'three reapers' model for diagnosing addiction. The script also addresses the variability in addiction, its societal impact, and the importance of individualized treatment, including detoxification, rehabilitation, and motivational interviewing. It emphasizes the significance of social support and community in overcoming addiction.

Takeaways

• 🌟 **Commonality of Substance Use**: Over 90% of people in the United States use psychoactive substances regularly.
• 🚫 **Problems from Substance Use**: While many can use substances without harm, a minority develop issues such as intoxication, withdrawal, and addiction.
• 🔑 **Understanding Intoxication**: Intoxication is an acute state of being under the influence of a substance, with specific signs and symptoms known as a toxodrome.
• 🔄 **Withdrawal Symptoms**: Withdrawal occurs when stopping a substance, leading to physiological and psychological effects, often opposite to those seen in intoxication.
• 🔗 **Addiction as a Chronic Condition**: Unlike intoxication and withdrawal, addiction is a chronic condition marked by repeated use despite negative consequences, known as substance use disorder.
• 📋 **DSM-5 Criteria for Substance Use Disorders**: The DSM-5 lists 11 criteria for diagnosing substance use disorders, with two or more required for diagnosis.
• 🔑 **The Three Reapers of Addiction**: Addiction can be recognized by repeated use, positive reinforcement, and negative repercussions.
• 🚫 **Distinguishing Addiction from Compulsion**: Addiction involves positive reinforcement, while compulsions are driven by negative reinforcement, requiring different treatment approaches.
• 👨‍⚕️ **Clinical Tools for Diagnosis**: Clinicians can use mnemonics like 'TRAPPED' for substance history and 'THIS GUY' for major classes of addictions to aid in diagnosis.
• 🌐 **Societal Impact of Addiction**: Addiction is a leading cause of death and societal costs, with less than 20% of those affected receiving quality treatment.

Q & A

What is the prevalence of psychoactive substance use in the United States?

Over 90% of people in the United States take at least one psychoactive substance on a regular basis.

How are intoxication, withdrawal, and addiction different from each other?

Intoxication is an acute state of being under the influence of a substance with specific signs and symptoms. Withdrawal involves physiological and psychological effects of stopping a substance, often opposite to intoxication. Addiction is a chronic condition characterized by repeated use despite negative consequences.

What are the 11 criteria for substance use disorders according to the DSM-5?

The DSM-5 lists 11 criteria for substance use disorders, which can be remembered using the phrase 'Time to Cut Down, Pal', indicating that two or more of these criteria are required for diagnosis. The criteria include spending a lot of time using or obtaining the substance, experiencing cravings, inability to cut down, tolerance, dangerous use, social and interpersonal problems, withdrawal, neglecting responsibilities, and giving up activities due to substance use.

What are the 'three reapers' that characterize addiction?

The 'three reapers' that characterize addiction are repeated use, positive reinforcers, and negative repercussions. All three components must be present for a diagnosis of addiction.

What is the significance of the mnemonic 'TRAPPED' in gathering a substance history?

The mnemonic 'TRAPPED' stands for Treatment history, Route of administration, Amount used, Pattern of use, Prior abstinence, Effects of use (both positive and negative), and Duration of use. It is a tool to help clinicians gather a comprehensive substance history.

What does the phrase 'This guy's having trouble, but can his dog behave' represent in the context of addiction?

The phrase 'This guy's having trouble, but can his dog behave' is a mnemonic to remember the major classes of addictions: Tobacco, Hallucinogens, Alcohol, Nicotine, Inhalants, Stimulants, Depressants, Opioids, Gambling, and other Behavioral addictions.

What is the lifetime prevalence of addiction in the United States?

The lifetime prevalence of addiction in the United States is around 10%, making it one of the most common psychiatric conditions.

Why are men treated for addictive disorders more often than women, despite similar vulnerability?

Men are treated for addictive disorders more often than women because they tend to use illegal substances more frequently, which are more likely to come to legal or clinical attention.

How does the presence of a dual diagnosis affect the prognosis for addiction and mental disorders?

The presence of both an addiction and a mental disorder, known as dual diagnosis, worsens the prognosis for both types of disorders considerably.

What is the role of social support in the treatment of addiction?

Social support is considered one of the most important, if not the most important, predictors of successful treatment for addiction. The opposite of addiction is not just sobriety but connection in community.

What is the significance of motivational interviewing in addiction treatment?

Motivational interviewing is a counseling technique used to increase a patient's motivation to treat their addiction by matching interventions to the patient's stage of change, which has been found to be very effective with large effects compared to treatment as usual.