Occurs when the recurrent use of a substance, such
as alcohol or drugs, causes clinically significant
Substance Use Disorder impairment, including health problems, disability, or
failure to meet responsibilities at home, work, or
school.
When does drug use Adolescence
typically begin?
Anxiety disorders
depression
Common Comorbidities
bipolar disorder
of substance use
psychotic illness
disorder
borderline personality disorder
antisocial personality disorder
40-60% of a client's vulnerability to substance use
disorders may be attributed to genetic factors
Vulnerability involves complex interactions between
Neurological basis:
multiple genetic factors/.
Genetic factors of SUD
Genetic involvement may impact an individual's
experience of a drug as pleasurable or not or how
long a drug remains in the body.
Epigenetic factors in influence whether genes associated with substance
SUD` use disorder are activated
Brain circuits that mediate reward, impulse control,
Neurological Basis:
decision making, learning, and emotions play a role
Neuroanatomy in SUD
in substance use disorder.
has been identified as the key pathway that
mediates reward.
Mesolimbic Dopamine Connects the ventral tegmental area of the midbrain
pathway in SUD to the ventral striatum of the basal ganglia.
The pathway begins in the ventral tegmental area
(VTA) and connects to the ventral striatum/nucleus
Mesolimbic pathway is most associated with reward.
Drugs and alcohol act directly on brain receptors
leading to a release of dopamine.
Neurobiological Basis:
Neural Networks As substance use increases, brain circuits adapt by
reducing sensitivity to dopamine, leading to
tolerance and the need to increase use of a
substance to achieve the same high.
Dopamine is responsible for regulating the brain's
motivation, pleasure, and reward center.
Dopamine is release in response to natural
pleasurable activities or situations such as achieving
Neurological Basis: an accomplishment, enjoying a good meal. or
Neural Signaling participating in an athletic activity. Addictive drugs
cause a surge of dopamine in the ventral striatum or
nucleus accumbens.
Repeated use can lead to changes in brain circuitry
leading to craving, addiction, dependence,
withdrawal.
What neurotransmitter is Dopamine.
the target when treating
SUD?
With repeated ingestion of a drug, the drug shows
decreased effect. Increasing doses are required to
Tolerance
achieve the effects noted with the original
administration
State of adaption produced with repeated
administration of certain drugs so that physical
Dependence
symptoms occur when the drug is discontinued
abruptly.
A change in behavior caused by biochemical
changes in the brain after continued substance use
Addiction
characterized by preoccupation with and repeated
use of a substance despite negative outcomes.
Physiological and psychological reactions that
Withdrawal occur when the use of a substance is stopped
abruptly.
Condition following the ingestion of a substance
Intoxication resulting in changes in level of consciousness,
cognition, perception, judgement, and behavior.
The PMHNP must ascertain what substance the
client is using, how much and how often the
substance is used, and when the substance was last
ingested to determine the most appropriate course
of treatment.
Treatment Treatment is different when a client is actively using
vs during withdrawal, following detoxification, and
abstinence.
Tolerance and dependence impact treatment
decisions, sometimes necessitating increased
medication dosing.
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