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Substance related disorders are defined in the DSM-IV as 'an individual uses and abuses a substance leading to maladaptive behaviours which have interfered with normal life functioning over a 12 month period'. It is common to see disruptions in medical, social and psychological functioning of those diagnosed with this disorder. Substance related disorders are subcategorised into Substance Use Disorders (SUD) and Substance Induced Disorders (SID), though according to the DSM-IV, SID’s are usually reported into the context of SUD’s. <

Substance related disorders are most commonly seen amongst 18-15 year olds, with a higher proportion of males compared to females. The top five substances that are reportedly abused are alcohol, marijuana, prescription opiates, non-prescription opiates (e.g. heroin), stimulants and cocaine. A high percentage of people diagnosed with substance related disorders are also diagnosed with another psychiatric illness such as major depression, personality disorders and anxiety disorders. Though a ‘dual diagnosis’ is not needed for a person to be given a diagnosis of substance related disorder.

Signs and Symptoms
Symptoms of substance related disorders are often reliant upon the substance that is being abused; however common symptoms affecting the ability to function adequately are:


 * Sudden unexplained behavioural changes – Often observed as the abuser engaging in secretive and suspicious behaviour that is out of character.
 * Mood changes – anger, paranoia, and little care for own appearance and future
 * Problems in work/school – Sudden lack of attendance when previously this had not been a problem
 * Unexplained changes in sleeping and eating habits
 * Changes in friendship groups
 * Problems with family relationships
 * Unexplained financial problems – The abuser needs a means to fund their substance and can resort to stealing or lying to get the money.

Classification
The DSM-IV subcategorises substance related disorders into Substance Use Disorders and Substance Induced Disorders. Substance Use Disorders are then further categorised into Substance abuse and Substance dependence.

Substance Use Disorders
Substance abuse and Substance dependence make up the category of ‘Substance use disorders’ as identified by the DSM-IV. Substance abuse can occur independently of Substance dependence, where the symptoms of abuse have never met the criteria for dependence. Substance dependence cannot occur independently of substance abuse.

Substance Abuse
The DSM-IV criteria for substance abuse state that a maladaptive pattern of substance use, leading to a significant impairment or distress to the user must be present. This must also be manifested by one (or more) of the following, occurring during the same 12 month time frame:
 * Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home
 * Using the substance in situations in which it could be physically hazardous
 * Substance-related legal problems
 * Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

Substance Dependence
The DSM-IV criterion for substance dependence requires the presence of the maladaptive use of a substance that has lead to significant life impairment caused by three (or more) of the following within the same 12 month time frame: 1. Need for markedly more substance to achieve desired effect 2. Diminished effect with the continued same amount of substance 1. Characteristic withdrawal symptoms associated with the substance 2. Taking the same (or closely related) substance to relieve unpleasant withdrawal symptoms.
 * Tolerance, as defined by either of the following:
 * Withdrawal, as defined by either of the following:
 * Substance is taken over longer periods of time in larger amounts than was originally intended
 * Persistent unsuccessful attempts to cut down or control use of the substance
 * Large amounts of time spent obtaining the substance, using the substance or recovering from the effects of the substance
 * Activities that were previously a source of enjoyment are avoided or reduced as a result of the substance use
 * Continued use of the substance despite signs of physical and psychological complications, which may be worsened with persistent use.

Substance Induced Disorders
Substance Induced Disorders refers to a number of medical conditions that arise from the use of a substance. This can include disorders such as:

However, the most commonly observed substance induced disorders are intoxication and withdrawal.
 * Substance induced delirium
 * Persisting Dementia
 * Amnesia
 * Mood disorders – such as anxiety and depression
 * Sexual Dysfunction
 * Sleep disorders

Intoxication
Intoxication is the reversible substance-specific syndrome which is directly related to the recent ingestion of a substance. Specific symptoms that show psychological and behavioural changes that occur shortly after ingesting the substance. Examples of these changes include: changes in perceptive ability, wakefulness, thinking, judgment and attentional abilities, though this list in not exclusive. Changes occur directly as a result of the substance affecting the central nervous system, and cannot be explained by another medical condition or mental health problem. Intoxication does not apply to tobacco use.

Withdrawal
Withdrawal is the observed behavioural change that occurs due to the reduction or cessation of substance use. Symptoms of this can include physiological and cognitive components that are substance specific. Occupational, social and psychological distresses are also common signs of withdrawal. However, some hallucinogenic substances do not cause withdrawal symptoms when use is stopped.

Potential Complications
Potential complications that can arise from the use of drugs involve physiological, psychological and social implications that can be detrimental to user’s lives. It has also been found that woman are more susceptible to the negative long-term effects of drugs than men, showing more incidences of substance induced disorders and organ damage.

Physiological Implications
Common physiological implications include:
 * Alcoholic Liver Disease
 * Cardiac problems, leading to increase risk of heart attack
 * Premature Ageing
 * Fertility problems, specifically in females
 * Brain damage and changes to chemical balances in the brain which may explain the increased risk of co-morbidity across psychiatric disorders.

Psychological Implications
Over 50% of patients diagnosed with substance related disorders are also diagnosed with another psychiatric disorder. Common psychological implications associated with substance use are: However, it is important to note that psychological problems may have been present before the onset of substance use.
 * Depression
 * Anxiety
 * Paranoia
 * Personality disorders, such as borderline personality disorder.

Social Implications
Common social implications that arise from substance use are:
 * Relationship problems with friends and family due to personality and behavioural changes
 * Higher probability of problems with employment or education which could lead to the loss of either
 * Higher chance of getting involved in anti-social or illegal activity to either fund or gain the desired substance which could lead to problems with the law
 * People who abuse certain substances are often viewed negatively which leads to social discrimination

Treatments
Treatment for substance related disorders can vary dependent upon the substance, the physiological problems and psychological implications that have occurred due to drug use. Most treatments focus on the desired behavioural change through the use of Sociocultural, Psychodynamic, Cognitive-Behavioural and Pharmaceutical therapies.

Sociocultural Treatments
This encourages family therapy to help build up a support network. Group therapy such as alcoholics anonymous also comes under this category, which again works on giving support. .

Psychodynamic Treatments
Psychodynamic treatments aim to find a root source of psychological and emotional mechanisms why someone would misuse substances.

Cognitive- Behavioural Treatments
Cognitive-behavioural therapy aims to identify faulty patterns of thinking which may influence behaviour. If the cognitions are changes, then it is likely this with elicit a behaviour change.

Pharmaceutical Treatments
Pharmaceutical treatments are often only used as a short-term solution, to keep the chemical balance in the brain consistent whilst other therapeutic strategies are used to elicit behaviour change. Often used to reduce the effect of withdrawal symptoms.