Substance Related Disorders

Substance-Related Disorders refer to not only the chemical upon which abuse or dependence has occurred, but also the nature of the impact of the substance use has had upon the individual. This can vary from abuse to dependence and from hallucinations to delusions to delirium. Substance abuse or dependence can result in mood, anxiety, sleep and sexual disorders as well as problems arising from withdrawal. Agents ranging from alcohol to cocaine to cannabis, hallucinogens, inhalants, opioids, phencyclidine, inhalants and sedatives can be of concern.

Alcohol: When considering substance related disorders like alcohol abuse or dependence, you need to think in terms of the moods and behaviors that arise from intoxication as well as the physical problems which arise from withdrawal from the substance. The morbidity and mortality from alcohol, the most frequently used brain depressant, with 60% of males and 30% of females having at least one alcohol related adverse life event. There are psychological disorders that arise from the dependence upon alcohol and its abuse. These include dementia, amnesia, delusions, hallucinations, mood disorder, sleep disorder, anxiety disorder and sexual disorder. Not surprisingly, alcohol, the most commonly abused substance, is often an attempt at self-medicating the very problems that it creates.

Opioid-Related Disorder (including synthetic opiates) can be associated with abuse and dependence. The discontinuation of the medication can be related to withdrawal and overuse can be associated with intoxication, and dependent upon patient and dosage, psychotic symptoms with hallucinations and/or delusions. The medications themselves can create their own clinical manifestation of mood disorder. Sleep disorder due to changes in sleep architecture and sexual dysfunction may occur.

Sedative-, Hypnotic-, or Anxiolytic-Related Disorders: There are several sedative, hypnotic and anxiolytic disorders. Hypnotics are used for treatment of sleep disorders, anxiolytics are used for the treatment of a range of anxiety disorders. All three groups of agents, if not properly regulated can result in dependence, and all three are open to abuse. In some cases intoxication, withdrawal, delirium, amnesia, mood, sleep, sexual and other symptom patterns may arise. In some cases hallucinations may occur even though the individual is aware that the hallucinations are caused by the medication (does not believe the hallucinations to be real). However, these medications, when dispensed and used appropriately, can be quite effective as an adjunct to the treatment of a range of disorders and should be taken according to guidelines and not avoided due to fear.