03 Apr 2018
Table of Contents
Detoxification is most successful when it takes place in a setting like a hospital. But it may also be done in an outpatient setting depending on the severity of the person's dependency and other medical problems. It usually includes mental health counseling with medical monitoring, supervision, and support. n.d.Detoxification. Retrieved November 13, 2014, from http://www.webmd.com/hw-popup/detoxification
Overdose occurss due to the increasing of amount consumed in order to overcome drug tolerance developed and achieve intoxication.
According to the UN Office on Drugs and Crime’s world drug report 2011, approximately 149 to 271 million people aged from 15 to 64 years had used an illegal drug at least once in 2009 (as cited in Degenhardt & Hall, 2012). Furthermore, in The United States of America alone, drug-induced deaths totalled at 39,147 in 2009, effectively overtaking traffic accidents as the number one external cause of death that year (Kochanek et al., 2011). Besides, causing direct health detriments to the user, substance abuse also causes an array of societal problems such as increasing crime rates, unemployment rates and contributing to family brokenness. Therefore, it is evident that due to its prevalence and the damage it does, drug related disorders are a major area of concern to psychologists and mental health professionals. As such research and, studies are consistently done to further advance knowledge and expertise in the subject so that individuals with drug-related disorders can be rehabilitated effectively.
The focus of this paper will on one such disorder known as, ‘Substance-Use Disorder’. In the first part of the paper, the characteristics of this condition, factors influencing it’s occurrence in individuals as well as treatment approaches are examined. After which, an analysis of the drug situation in Singapore is made, with presentations of secondary statistics and applications of the rehabilitation process in local context.
What is ‘Substance Use Disorder’?
There are several disorders under the main category of substance related disorders. For instance, substance-induced psychotic disorder, substance-induced anxiety disorder, substance-induced neurocognitive disorder and a couple of others in similar fashion. It is important to note however; that, as the names of the above mentioned disorders suggests, these disorders occur as a result of substance use disorder, substance intoxication or substance withdrawal which incidentally the latter two are closely linked to substance use disorder.
First and foremost, one needs to understand what is meant by substance as it is a rather generic term. In the context of psychopharmacology it refers psychoactive drugs which are basically chemical substances that when introduced into the body acts on the central nervous system and affects mental processes such cognition, mood, perception and consciousness (“Alcohol and Other Drugs – Overview”, 2002, Psychoactive drugs para. 1). Examples of psychoactive drugs are cocaine, inhalants, amphetamines and, even alcohol and caffeine.
In the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-V) published by the American Psychiatric Association (APA) in 2013, drug abuse and drug dependence – which were previously separate classifications of disorders – were subsumed into a single classification known as ‘Substance Use Disorder’.
Substance abuse can be defined as a pattern of substance use despite the fact that it results in harmful social, physiological and/or psychological consequences – for example, interpersonal conflicts, driving while intoxicated, failing to fulfil work or personal commitments and running into trouble with the law. Similarly, substance dependence involves continued substance use and the occurrence of the aforementioned negative consequences but the distinction lies in the fact that there is an added component of psychological dependence present, as well as a probability for physiological dependence depending on the class of drug being used; psychological dependence refers to the experience of reduced control and, compulsion over substance use whereas physiological dependence refers to tolerance and withdrawal symptoms brought about substance use (World Health Organization, 1994) .
Thus, substance-use disorder under the new manual can be briefly defined as the condition wherein psychoactive substance(s) are used frequently enough to produce clinically significant distress or impaired performance which results in particular maladaptive behavioural characteristics (Morrison, 2014). Additionally, the classification is also stratified according to specific drug classes and level of severity ranging from mild, moderate and to severe for greater accuracy of diagnosis. For example specific diagnoses of addicts might read ‘mild cannabis use disorder’ or ‘severe opioid use disorder’.
Characteristics of Substance Use Disorder
While it is mentioned above that the disorder is sub-classified according to drug type, the characteristics of each specific disorder is very similar with a few exceptions such as hallucinogens and inhalants which commonly do not cause withdrawal symptoms in users. Consequently, the following are five essential features when characterising substance use disorders in general:
Firstly, impacts to personal life and interpersonal relationships. This could show in the form of avoidance of family duties, arguments and fights with family or friends, even neglect in participating in leisurely activities and fulfilling personal needs in favour of drug use. They may be aware of the strain their drug use is causing but nonetheless, they continue its use.
Secondly, employment and education is affected as effort previously spent in engaging in these are instead spent procuring their drugs, consuming it experiencing intoxication and then sobering up. Obviously resulting in absenteeism and even dismissal from work or dropping out of school if the situation worsens.
Thirdly, loss of control. Drug users often end up taking more than they intended and for a longer time then intended due to cravings. Although, they might make attempts to stop or lessen their intake, it is often fruitless.
Fourthly, health and safety hazards. Users may engage in dangerous behaviours such as driving of operating machinery while intoxicated which could cause harm to themselves and also other and may also result in legal repercussions. Moreover, they continue usage disregarding health problems that could arise such as liver cirrhosis or hepatitis C and HIV if drug use is intravenous.
Lastly, physiological sequels develop, specifically drug tolerance and withdrawal symptoms upon abstinence. Tolerance is the condition wherein effect of a drug is increasingly diminished due to recurrent intake at a particular dosage, a drug user would then have to increase the dosage to experience the same level of intoxication.
Diagnosis of substance use disorder is carried out via a differential diagnosis methodology and the symptoms must have occurred within the past twelve months. There are eleven specific symptoms which can extracted from the five feature discussed earlier:
Severity of the disorder is determined by the number of symptoms exhibited with mild conditions having 2-3 displaying symptoms, moderate 4-5 and sever 6 or more.
Degenhardt, L., & Hall, W. (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet, 379(9810), 55-70.
Kochanek, K.D., S.L. Murphy, J. Xu, A. Minio, & H. Kung. (2011). Deaths: Final Data for 2009. National Vital Statistics Reports, 60(3)
Morrison, J. (2014). DSM-5(r) Made Easy, The Clinician's Guide to Diagnosis. New York: The Guildford Press.
World Health Organization. (1994). Lexicon of alcohol and drug terms. Geneva: World Health Organization.
Alcohol and Other Drugs - Overview. (2002). Retrieved November 19, 2014, from http://www.nt.gov.au/health/healthdev/health_promotion/bushbook/volume2/chap1/sect1.htm
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