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Know the diagnostic criteria for SUD from p. 263 – for example, I might ask something like “Which of the following is NOT a criterion…” or I may ask you to list a few of them in a short answer

1) The quantity of the substance used or the amount of time spent using is often greater than intended; 2) Efforts to control the use of the substance are unsuccessful due to a persistent desire for the substance; 3) Considerable time is spent using the substance, recovering from its effects, or attempting to obtain the substance; 4) A strong desire, craving, or urge to use the substance is present; 5) Substance use interferes with major role obligations at work, school, or home; 6) Use of the substance continues despite harmful social or interpersonal effects caused or made worse by substance use; 7) Participation in social, work, or leisure activities is avoided or reduced due to substance use; 8) Substance use occurs in situations where substance use may be physically hazardous;
9) Continued substance use occurs even when the substance is causing physical or psychological problems or making these problems worse;
10) Tolerance for the substance develops, including a need for increasing quantities of the substance to achieve intoxication or desired effects or a noticeable decrease in effects when using the same amount of the substance;
11) After heavy or sustained use of a substance, reduction in or abstinence from the substance results in withdrawal symptoms or precipitates resumption of use of the substance or similar substances to relieve or avoid withdrawal symptoms.


What drugs are considered by your authors to be “gateway” drugs?

Prescription opioids, Cannabis (Experimentation with inhalants does not appear to be a gateway to more serious drug use, although those who chronically abuse inhalants often initiate marijuana and cocaine use)


Depressants (Broad Category)

Alcohol, Opioids, Sedatives, Hypnotics, and Anxiolytics


Alcohol (Specific Examples)

One drink is defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of hard liquor


Opiates (Specific Examples)

aka opioids or narcotics; Heroin, Opium, (including the medications morphine, codeine, and hydro/oxycodone)


Sedatives, Hypnotics, and Anxiolytics (Specific Examples)

The drug classes of barbiturates, such as Seconal and phenobarbital, and benzodiazepines, such as Valium, Ativan, and Xanax, provide rapid anxiety-reducing effects when used in moderate doses; higher doses are prescribed to produce hypnotic, or sleep-inducing, effects


Stimulants (Broad Category)

Caffeine, Amphetamines, Cocaine


Caffeine (Specific Examples)

Energy drinks, coffee, chocolate, tea, and soft drinks.


Amphetamines (Specific Examples)

Ritalin, Adderall, and Dexedrine, Methamphetamine


Cocaine (Specific Examples)



Hallucinogens (Broad Category)

LSD, Psilocybin, Mescaline, Salvia


Dissociative Anesthetics (Broad Category)

Phencyclidine (PCP), Ketamine, Methoxetamine (MXE), Dextromethorphan (DXM)


Substances with Mixed Chemical Properties (Broad Category)

Nicotine, Cannabis, Inhalants, Designer Drugs (ecstasy)


Nicotine (Specific Examples)

Cigarette Smoking, Electronic cigarettes


Cannabis (Specific Examples)



Inhalants (Specific Examples)

Chemical vapors found in a variety of common household products, including solvents (paint removers, gasoline, lighter fluid), office supplies (marker pens, correction fluids), aerosol sprays (spray paints, hair spray), and compressed air products (computer and electronics duster sprays).


Designer drugs (Specific Examples)

Ecstasy (methylenedioxymethamphetamine, or MDMA), Synthetic marijuana, made from a combination of herbs and chemicals, MDPV marketed as “bath salts” or “plant food”, DOM, known as STP or Serenity, Tranquility, and Peace, Bromo-Dragonfly or B-fly, with persistent hallucinogenic effects, Methoxetamine or MXE, with effects similar to PCP and ketamine


What are the “mixed properties” of nicotine, cannabis, and ecstacy? (In other words, what are the multiple effects that each of these drugs can have?)

Stimulant, depressant, and hallucinogenic effects


What percentage of marijuana users become dependent on it?

Approximately 10 percent of those who use marijuana become dependent on the drug


What four categories of life stressors mostly likely lead to substance use disorders?

1) an individual decides to experiment with alcohol or drugs—perhaps to satisfy curiosity, enhance self-confidence, rebel against authorities, imitate others, or conform to social pressure.
2) the substance begins to serve an important purpose (such as reduce anxiety, produce feelings of pleasure, or enhance social relationships) and so consumption continues.
3) brain chemistry becomes altered from substance use. In many cases, physiological dependency develops, resulting in craving for the substance and withdrawal symptoms if use is discontinued; it also becomes difficult to experience pleasure without the substance.
4) lifestyle changes occur due to chronic substance use. These changes may include loss of interest in previous activities and social relationships and preoccupation with opportunities to use the substance. Consistent with the multipath model, in all four phases, biological, psychological, social, and sociocultural influences are involved


What are the links between behavioral undercontrol and substance use disorder?

Associated with rebelliousness, novelty seeking, risk taking, and impulsivity, increases risk of substance use and abuse. Individuals with these traits are more likely to experiment with substances and continue use because they find the effects rewarding and exciting


African Americans (What are the specific patterns of ethnic group membership and substance USE)

Show lower rates of using alcohol or illicit drugs than European Americans and Latino/Hispanic Americans at most age levels, although the gap is narrowing due to recent increases in marijuana use among younger African Americans.


Latino/Hispanic Americans (What are the specific patterns of ethnic group membership and substance USE)

Have the highest prevalence of illicit drug use, although European American adolescents have the highest rate of prescription drug misuse.


Asian American students (What are the specific patterns of ethnic group membership and substance USE)

The group least likely to engage in substance use, are less likely to have friends and siblings who use substances; they also are more likely to respect parental expectations that they not use drugs or alcohol


Treatment for Alcohol Use Disorder

Participation in AA; Controlled drinking; Medications: Antabuse and Acamprosate, Naltrexone, Nalmefene; Face-to-face interventions using motivational interviewing and providing information correcting misperceptions of social norms regarding drinking yielded the greatest reduction in alcohol- related problems
Opioid Use Disorder


Treatment for Opioid Use Disorder

Physicians often prescribe synthetic opioids such as methadone to reduce cravings without producing euphoria
buprenorphine is a less addic- tive synthetic opioid that can ease opioid withdrawal and prevent cravings and relapse.
Naltrexone (the medication designed to block pleasurable sensations in those who use alcohol) is sometimes used with opioid abuse, but appears to have limited effectiveness unless delivered in extended-release injections
Contingency management with incentives for abstinence and behaviorally oriented individual and family counseling have improved treatment outcomes.


Treatment for Stimulant Use Disorder

There are currently no effective pharmacological interventions for stimulant abuse; Working on vaccine


Treatment for Cannabis Use Disorder

Psychological approaches such as brief therapy, cognitive-behavioral therapy, and motivational enhancement have shown promise with cannabis-use disorder; using short, frequent therapy sessions and focusing on increased self-efficacy; The use of vouchers to reinforce negative urine toxicology has shown some promise; Contingency management combined with motivational enhancement and cognitive-behavioral therapy


Treatment for Tobacco Use Disorder

Three pharmaceutical products are used for smoking cessation—nicotine replacement, bupropion, and varenicline; Nicotine replacement therapy (NRT) involves delivering increasingly smaller doses of nicotine using a patch, inhaler, nasal spray, gum, or sublingual tablet; Bupropion (marketed under the name Zyban as an antismoking agent and Wellbutrin as an antidepressant) is frequently mentioned in the smoking cessation literature; Varenicline (marketed as Chantix), has shown success in reducing cue-activated cravings and withdrawal symptoms, as well as decreasing smoking satisfaction in healthy, adult smokers; Intervention to address anxiety issues is particularly important in smokers with anxiety disorders; they tend to have greater nicotine dependence and are less responsive to standard pharmacological interventions; Smoking quit- lines that include abstinence-related support and counseling have proven to be an effective intervention; Bupropion was used in combination with cognitive-behavioral therapy focused on the issue of weight control