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addictions:home [on April 30, 2020]
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-====== ​Addiction Medicine ​======+====== ​Substance Use and Addictive Disorders ​======
 {{INLINETOC}} {{INLINETOC}}
  
-<WRAP group> 
-<WRAP half column> 
 ===== Primer ===== ===== Primer =====
-**Addiction** is a brain and mental ​disorder characterized by compulsive engagement ​in rewarding stimuli despite adverse consequences. However, in many ways, the nature and etiology ​of addiction remains a controversial topic;​[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​30332573|Lewis, M. (2018). Brain Change in Addiction ​as Learning, Not Disease. New England Journal of Medicine, 379(16), 1551-1560.]])] addictions can also be viewed through a social and political lens as well.[([[https://​www.nature.com/​articles/​s41562-017-0055|Hart, C. L. (2017). Viewing addiction as a brain disease promotes social injustice. Nature Human Behaviour, 1, 0055.]])]+**Substance Use Disorders and Addictive Disorders** are mental ​disorders ​in the DSM-5 broadly divided into 10 classes ​of drugs for which substance-related disorders can apply: alcohol, caffeine, cannabis, hallucinogens,​ inhalants, opioids, "​sedatives,​ hypnotics, and anxiolytics,"​ stimulants, tobacco, and other (or unknown) substances. 
 +===== Addiction Medicine ​===== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​ 
 +See main article: **[[addictions:1-introduction:​home|]]** 
 +</​alert>​
  
-===== Diagnostic Criteria ===== +**Addiction Medicine** ​is a branch ​of medicine involved ​in the diagnosis, treatment, and prevention ​of substance use disorders. See the main article above for an introduction ​to the basic concepts and approach ​to addictions.
-A substance use disorder is diagnosed when there is a problematic pattern ​of substance use leading to clinically significant impairment or distress, as manifested by at least ''​2''​ of the following, occurring within a 12-month period: +
-  - The substance is often taken in larger amounts or over a longer period than was intended. +
-  - There is a persistent desire or unsuccessful efforts to cut down or control ​the substance use. +
-  - A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. +
-  - Craving, or a strong desire or urge to use the substance. +
-  - Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. +
-  - Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects ​of the substance. +
-  - Important social, occupational,​ or recreational activities are given up or reduced because of the substance use. +
-  - Recurrent substance use in situations in which it is physically hazardous. +
-  - Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. +
-  - Tolerance, as defined by either of the following:  +
-    * (A) a need for markedly increased amounts of the substance ​to achieve intoxication or desired effect, or +
-    * (B) a markedly diminished effect with continued use of the same amount of the substance. +
-  - Withdrawal, as manifested by either of the following:​ +
-    * (A) the characteristic withdrawal syndrome for the substance, or +
-    * (B) the substance is taken to relieve or avoid withdrawal symptoms.+
  
-</​WRAP>​ +===== Substance and Addictive Disorders ​===== 
-<WRAP half column>​ +  * **Depressant** use generally causes mood elevation, anxiety, sedation, behavioural disinhibition,​ and respiratory depression during intoxication. Withdrawal symptoms generally speaking cause anxiety, tremor, seizures, insomnia. 
-===== Addiction Medicine Topics ​===== +  * **Stimulant** use generally causes mood elevation, decreased appetite or anorexia, psychomotor agitation, insomnia, cardiac arrhythmias,​ tachycardia,​ and anxiety. Withdrawal symptoms typically include a "​post-use crash" that includes symptoms such as depression, fatigue/​lethargy,​ increased appetite, insomnia, and vivid nightmares. 
-<catlist addictions: -columns:1 -noHead -noAddPageButton ​-sortAscending ​-noNSInBold>​+  * **Hallucinogens** are substances that can cause mind and body separation (“dissociative”) effects and visual and/or auditory hallucinations. Of note, hallucinogens such as PCP and LSD do not cause withdrawal symptoms, and hence do not have a DSM-5 diagnosis for withdrawal. Other hallucinogens however, like [[meds:stimulants:​mdma|MDMA]] (which is officially designated as a hallucinogen in the DSM-5, but in fact has strong stimulant properties) and cannabis, can trigger withdrawal symptoms. 
 +  * Finally, [[addictions:non-substance:​gambling|gambling disorder]] is the only non-substance DSM-5 addictive disorder.
  
-</WRAP>+<​WRAP ​group> 
 +<WRAP third column>​ 
 +==== Depressants ==== 
 +<catlist addictions:​alcohol:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>​ 
 +<catlist addictions:​sedative-hypnotics:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>​ 
 +<catlist addictions:​opioid:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>​ 
 +<catlist addictions:​inhalant:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>
 </​WRAP>​ </​WRAP>​
  
- +<WRAP third column> 
-===== Biology of Addiction ===== +==== Stimulants ​==== 
- +<catlist addictions:stimulants: -columns:1 -noAddPageButton -sortAscending -noNSInBold>​ 
-  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3099425/​|Casey,​ B. J., & Jones, R. M. (2010). Neurobiology of the adolescent brain and behavior: implications for substance use disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 49(12), 1189-1201.]] +<catlist addictions:caffeine: -columns:1 -noAddPageButton -sortAscending -noNSInBold> 
-===== Tolerance ===== +<catlist addictions:​nicotine-tobacco:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>
-==== Physiological Tolerance ==== +
- +
-Physiological tolerance is best understood using the example of opioids: +
- +
-  * When the brain is chronically exposed to elevated levels of opiates, two things develop: (1) opioid tolerance and (2) opioid dependence. Tolerance is the need to take more of the same substance to achieve the same effect, and dependence is being susceptible to opioid withdrawal symptoms. You can only develop withdrawal symptoms if you develop tolerance first.[(https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC2851054/#​__sec2title)] +
-  * When morphine binds to opiate receptors, it triggers the inhibition of adenylate cyclase, which triggers cytokines to fire impulses. With repeated activation of the opiate receptor by morphine, the enzyme adapts so that morphine no longer cause changes in cell firing. Thus, the effect of a given dose of morphine or heroin is diminished. +
- +
-==== Environmental (Learned) Tolerance ==== +
- +
-Tolerance can also be learned or developed through environmental exposure. This is much like Pavlovian conditioning (Pavlov'​s Dogs), where environmental stimuli can trigger innate physiological responses. For example, for a heroin user who frequently injects in his bathroom at home, his body will adapt to develop increased tolerance to opiates at that time. If, however, he decided to go rehab, and not use for several weeks, and then injected in a a foreign location, his body develop this same learned tolerance, and thus this makes him more susceptible to an overdose.[(http://​www.apa.org/​monitor/​mar04/​pavlovian.aspx)] Cases have been reported of patients overdosing due to Pavlovian conditioning.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC1196296/​|A case report: Pavlovian conditioning as a risk factor of heroin '​overdose'​ death]])] +
- +
- +
-===== Resources ===== +
- +
-<WRAP group> +
-<WRAP quarter column> +
-==== For Patients ==== +
 </​WRAP>​ </​WRAP>​
  
-<​WRAP ​quarter ​column>​ +<​WRAP ​third column>​ 
-==== For Providers ​==== +==== Hallucinogens ​==== 
-  * [[http://​www.bccsu.ca/​courses/​online-addiction-medicine-diploma-program/​|British Columbia Centre on Substance Use: Online Addiction Medicine Diploma Program]]+<catlist addictions:​hallucinogens: -columns:​1 ​-noAddPageButton ​-sortAscending ​-noNSInBold>​ 
 +<catlist addictions:cannabis: -columns:1 -noAddPageButton -sortAscending -noNSInBold>​
  
 +==== Other ====
 +<catlist addictions:​non-substance:​ -columns:1 -noAddPageButton -sortAscending -noNSInBold>​
 </​WRAP>​ </​WRAP>​
-<WRAP quarter column> 
-== Websites/​Articles == 
-  * [[http://​www.cbc.ca/​radio/​ondrugs|CBC Radio: On Drugs]] 
-  * [[http://​www.abc.net.au/​triplej/​programs/​hack/​iceland-teen-substance-abuse/​8208214|ABC News: Iceland knows how to stop teen substance abuse - but the rest of the world isn’t listening]] 
-  * [[https://​www.centerforhealthjournalism.org/​2017/​08/​22/​free-your-mind-will-associated-press-change-how-we-talk-about-drugs|Free Your Mind: Will the Associated Press change how we talk about drugs?]] 
-  * [[https://​www.vox.com/​policy-and-politics/​2017/​4/​20/​15328384/​opioid-epidemic-drug-legalization|Vox:​ I used to support legalizing all drugs. Then the opioid epidemic happened.]] 
-  * [[https://​www.nytimes.com/​2017/​10/​25/​nyregion/​coming-out-of-a-cloud-after-drug-abuse-and-mental-illness.html|NYT:​ ‘Coming Out of a Cloud’ After Drug Abuse and Mental Illness]] 
 </​WRAP>​ </​WRAP>​
-<WRAP quarter column> 
-== Research == 
  
-</​WRAP>​ +===== Comparison of Substance Use and Substance-Induced Disorders ===== 
-</WRAP>+{{page>addictions:​1-introduction:​home#​substance-induced-mental-disorders&​nouser&​noheader&​nodate&​nofooter}}