Mental Health Book

Hallucinogen Use Disorders



Addiction Pathophysiology

Aka: Addiction Pathophysiology, Chemical Dependency Pathophysiology, Substance Abuse Pathophysiology
  1. See Also
    1. Chemical Dependency
    2. Substance Abuse Evaluation
  2. Pathophysiology: Mechanisms of primary effects
    1. Intoxication via CNS G Protein-coupled receptors
      1. Marijuana
      2. Opioids
    2. Intoxication via direct Central Nervous System (CNS) toxicity
      1. Toxic inhalants and other highly lipophilic agents
    3. Psychostimulation (Agitated Delirium) mediated by multiple Neurotransmitters (Epinephrine, Norepinephrine, Serotonin, Dopamine)
      1. Cocaine
      2. Methamphetamine
    4. Hallucinogenic effects mediated by Serotonin release (mediated at 5-HT-2A receptor)
      1. Ecstasy (MDMA)
      2. LSD
    5. Dissociation ("out-of-body") mediated by NMDA Receptor mediated glutamate modulation
      1. Ketamine
      2. Phencyclidine (PCP)
      3. Dextromethorphan (DM)
    6. Sedation (with anxiolysis and Amnesia) via Gamm-aminobutyric acid (GABA)
      1. Benzodiazepines
      2. Alcohol Intoxication
      3. Gamma Hydroxybutyrate (GHB)
  3. Stages: Step 1 - Child of Substance Abuser (e.g. Alcoholic)
    1. Childhood rejection by Alcoholic parent
    2. Maladaptive Family response
      1. Co-dependent spouse overprotects child
      2. Child given premature responsibility
    3. Excessive Dependent Needs develop in child
    4. Rejection triggers worsening of above
    5. Anxiety reaction results in:
      1. Denial or
      2. Reactive grandiosity
        1. "I don't need anyone"
        2. False sense of well being
  4. Stages: Step 2 - Children of Alcoholics become Alcoholics
    1. Adaptive mechanisms fail
      1. Anger
      2. Depression
      3. Anxiety
      4. Guilt
    2. Genetic Predisposition to Alcoholism
    3. Permissive environment for drinking (e.g. Military)
  5. Stages: Step 3 - Substance Abusers
    1. Obsessive Thought
      1. Patient becomes more and more self centered
      2. Relationships become less important
      3. Patient becomes alienated from self
        1. Avoid guilt by avoiding self awareness
    2. Compulsive Behavior
      1. All work is centered at feeding addiction
  6. Stages: Step 3 - Substance Abuse Phases
    1. Contact with Substance
      1. Socially introduced
      2. Mind altering effect
        1. "The hook of addiction"
        2. Provides some benefit or relief
    2. Prodromal
    3. Acute Substance Abuse
    4. Chronic Substance Abuse
  7. Stages: Step 4 - Recovery
    1. Abstain from substance
    2. Attain serenity (12 step AA program)
      1. Spirituality
      2. Rebuild relationships
  8. Stages: Step 5 - Relapse
    1. Craving
      1. Similar to waves (wax and wane)
      2. Craving goes away if not responded to
    2. Maladaptive decision making
      1. Self Efficacy
        1. Comfort with high risk situations
      2. Outcome Expectation
        1. What will come of reusing substance
      3. Response to Trigger or environmental cues
        1. Prior associations with substance use
          1. Paycheck
          2. Sexual partner

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