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Substance Use Disorders (SUDS) and Addiction

1) Elaborate on etiology, stressors, problems of addiction, dependence, and relapse in the United States today.

Addiction is defined medically as a “chronic, relapsing illness marked by obsessive drug seeking, sustained use despite negative consequences, and long-lasting alterations in the brain.” (Fluyau & Charlton, 2022).  The emergence of addiction, alcoholism, and other drug use disorders is influenced “by a complex interplay of genetics, environment, and” neurobiology (Fluyau & Charlton, 2022).  The neurological basis of addiction is supported by the evidence of reward activity (Fluyau & Charlton, 2022).  Both pharmacological and behavioral forms of addiction share environmental risk factors such as impulsivity, poor parental supervision, and criminality. The start and progression of both drug addiction and non-drug addiction can be influenced by sociodemographic risk variables associated with poverty, geography, family, and peer groups (Fluyau & Charlton, 2022).  An individual with “substance use disorder (SUD) has trouble controlling their use of drugs, alcohol, or other substances, whether they are legal or illicit” (Kalin, 2020). “Stress plays a role in the development of substance use disorders and is closely related to other psychiatric illnesses” (Volkow & Boyle, 2018).  In 2016, over 63,300 Americans died as a result of a drug overdose, while excessive alcohol and cigarette use are thought to be responsible for 88,000 and 480,000 deaths, respectively (Volkow & Boyle, 2018). “Overdose deaths only account for a small portion of the negative health effects associated with substance use disorders, which affect more than 20 million people in the United States” (Volkow & Boyle, 2018).  “According to statistics from the 2018 National Survey on Drug Use and Health, alcohol use disorders may have affected 14.8 million of the 20.3 million people aged 12 or older who had them over the previous year” (Kalin, 2020).  Taking other substances into account, the poll found that “4.4 million people had a marijuana use disorder and 2 million people had an opiate use problem” (Kalin, 2020).

2) Identify potential physical and mental findings when examining a client with a substance use disorder. Note your rationales.

When examining a client with a substance use disorder, a psychiatric mental health nurse practitioner (PMHNP) may notice unsteady gait, inability to coordinate speech, nausea or vomiting, and blackouts. The physical symptoms of acute intoxication include slurred speech, cognitive decline, impaired coordination, and unsteady gait (Jahan & Burgess, 2022). Potential mental findings when examining a client with a substance use disorder include behavioral changes such as a lack of irritation, motivation, agitation, stress, or worry.  Alcoholism frequently results in the manifestation of symptoms of mood disorders, such as irritability, aggressiveness, or aggression (Boland et al., 2021, pg. 677). It is evident that drinking or using other drugs is connected to the onset of some psychiatric illnesses. “Substance use disorders are common among people with serious mental illnesses” (Kassew et al., 2021). Alcohol use disorders are the substance that these patients utilize the most frequently.  â€œIndividuals with alcohol use disorders are more likely to have co-occurring mental disorders” (Kassew et al., 2021). “There is a high rate of co-occurrence between substance use disorders and mental illnesses such as depression, bipolar disorder, ADHD, psychotic illness, borderline personality disorder, and antisocial personality disorder” (NIDA, 2021). “Schizophrenia patients had higher rates of drug, alcohol, and tobacco use than the general population” (NIDA, 2021).

3) Describe possible triggers to compulsive substance use or behavioral addiction.

Possible triggers to compulsive substance use or behavioral addiction include the desire to use or try new drugs based on peer pressure, impulsive control, and excessive desire to have possessions (Alavi et al., 2012).  â€œBehavior-specific phenomena and diagnostic criteria such as craving, excessive behavior, psychological and physical withdrawal symptoms, loss of control, development tolerance (increased behavior range), and inducing and perceiving anticipated psychotropic effects are described by patients with behavioral addiction or compulsive substance use” (Alavi et al., 2012).

4) Discuss the neurobiological mechanisms that underlie addictive behavior.

“In the mesolimbic reward system, the nucleus accumbens and dorsal striatum release massive bursts of dopamine while a person is high. This reinforces drug usage (bingeing) and strengthens conditioned associations, which link cues that precede drug use with the expectation of reward” (Volkow & Boyle, 2018).  Contrary to widespread thinking, drug addiction paradoxically results in lower dopamine increases. Animal models and test subjects who were humans have both experienced this impact (Volkow & Boyle, 2018). Under the effect of the substance, humans experience a reduced subjective sensation of reward due to the drug’s slower dopamine response. “Opioids, cannabinoids, GABA, and serotonin—to a greater or lesser extent, depending on the pharmacological characteristics of the drug—contribute to the pleasurable or euphorigenic responses to drugs and to the neuroadaptations that result in addiction, even though the dopaminergic system has received significant attention in the explanation of the rewarding and reinforcing effects of drugs” (Volkow & Boyle, 2018).

5) What medication-assisted treatments (MATs) and psychotherapeutic interventions for monitoring (for alcohol and for opioid abuse) are available?

There are many medication-assisted treatments (MATs) for alcohol and opioid abuse. MAT is the administration of a drug that has received FDA approval along with a psychosocial intervention. Methadone, buprenorphine, and naltrexone are the three drugs that are now recognized for use in MAT (SAMHSA, 2019). Interventions that are structured in either the social or psychological domains are known as psychosocial interventions. Examples include motivational interviewing, sometimes known as “a dialogue about change,” is a technique used to help drug users recognize their desire for change (EMCDDA, 2016). Since this is thought to be the greatest impediment to change, it aims to address a person’s ambivalence regarding their drug problems (EMCDDA, 2016). Cognitive behavioral therapy helps patients in developing self-assurance and addressing the thoughts that are assumed to be the cause of their issues as part of drug treatment. Patients receive assistance in identifying the factors that lead to substance use and in learning coping mechanisms. These therapies can be used to diagnose the issue, address it, and support social reintegration at various points during the course of treatment (EMCDDA, 2016). In the treatment of opioid-related issues, these therapies are also used, occasionally in conjunction with pharmacological therapy. Additionally, they can improve therapy retention and assist clients keep their behavioral goals. During the phase of drug treatment known as social reintegration, psychosocial therapies may also engage the family and the community (EMCDDA, 2016)
Alavi, S. S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. International journal of preventive medicine, 3(4), 290–294.
Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2016). The roe of psychosocial interventions in drug treatment (Perspectives on drugs).
Fluyau, D., & Charlton, T. E. (2022). Drug Addiction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

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