Carolyn Thomas
MondayJul 1 at 9:05pmManage Discussion Entry
Substance-related and addictive disorders based on the DSM-5 and the scholarly articles found in this week’s Learning Resources.
Substance-related disorders include ten classes of drugs: alcohol, caffeine, cannabis, hallucinogens (phencyclidine and other hallucinogens), inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants (amphetamine-type substances, cocaine, and other stimulants), tobacco, and other/unknown substances. These drugs share the common trait of excessively activating the brain’s reward system, which leads to intense feelings of pleasure or a “high,” often resulting in the neglect of everyday activities (American Psychiatric Association,2013). Substance-related disorders are divided into two categories: substance use disorders and substance-induced disorders. Substance-induced conditions include intoxication, withdrawal, and other mental disorders such as psychotic, bipolar, depressive, anxiety, obsessive-compulsive, sleep, sexual dysfunctions, delirium, and neurocognitive disorders(American Psychiatric Association,2013).
Substance use disorders are characterized by a range of cognitive, behavioral, and physiological symptoms, indicating that an individual continues using a substance despite significant problems caused by its use. This diagnosis applies to all substance classes listed in the DSM-5 except caffeine. Specific courses may have fewer or no symptoms specified, such as withdrawal from phencyclidine, other hallucinogens, and inhalants. A notable feature of substance use disorders is long-lasting changes in brain circuits, persisting beyond detoxification, especially in severe cases(American Psychiatric Association,2013). These changes often result in repeated relapses and intense drug cravings triggered by environmental cues, suggesting the need for long-term treatment approaches (McLellan et al., 2000, as cited by American Psychiatric Association,2013).
The diagnosis is based on a pathological pattern of behaviors related to substance use, grouped into four categories: impaired control, social impairment, risky use, and pharmacological criteria. According to the DSM-5, “Impaired control includes taking the substance in larger amounts or over a longer period than intended, unsuccessful attempts to cut down, spending significant time obtaining or recovering from the substance, and intense cravings. Social impairment involves failing to meet major obligations, continuing use despite social or interpersonal problems, and giving up important activities. Risky use includes using the substance in hazardous situations and continuing despite physical or psychological problems caused by the substance. For instance, Inhalant Use Disorder often begins in adolescence and can lead to serious health issues, including brain damage and cardiovascular problems. It is frequently associated with other substance use disorders and mental health conditions(Radparvar,2013). Pharmacological criteria include tolerance and withdrawal, though not all substances exhibit these symptoms.” Also, substance use disorders can vary in severity from mild to severe based on the number of symptoms present(American Psychiatric Association,2013,p.484&485). For instance, Chesire et al. (2023) also state that research has shown that the brain is primed for pleasure and pain relief, with specific areas providing strong euphoric feelings when stimulated. Substances can disrupt various behavioral functions, with effects varying by substance. For example, alcohol can impair reaction time and emotional stability, while heroin provides pain relief and euphoria. Stimulants can cause profound addiction and behavioral stimulation, and hallucinogens can produce diverse sensory experiences. There are similarities in the effects of different drugs on brain chemistry.
According to Karim and Keysor (2024), “Substance use disorders (SUDs) are widespread, with approximately 14.8 million people misusing alcohol and around 2 million people suffering from an opioid use disorder. These disorders impose a significant burden on both individuals and society. In 2018, the total annual cost of opioid use disorder in the United States was estimated at $786.8 billion. Additionally, drug overdoses have become the leading cause of unintentional injury deaths in the country”(p.32). Chesire et al. (2023) state that substance use is analyzed in psychology from personality, social, and biological perspectives. Social and personality theories suggest that people with substance use disorders might struggle with stress tolerance, delaying gratification, social skills, isolation, risk-taking, and behavior regulation. Environmental factors like poverty and high-stress levels also contribute to substance use issues. Biological theories propose that genetic and conditioned sensitivities to substances and their effects may predispose individuals to these disorders. Those seeking relief from pain or increased pleasure may be at higher risk. Pain and euphoria are significant factors in substance use disorders. Pain can be physical or perceived, influenced by genetics, developmental issues, trauma, environment, and learning(Chesire et al.,2023).
Some of the symptoms associated with substance-related and addictive disorders contribute to criminal behavior.
Substance-related and addictive disorders significantly contribute to criminal behavior through various avenues. Substance abuse often leads to cognitive impairments, increased impulsivity, financial strain, withdrawal symptoms, altered perceptions, and lower inhibitions from substances like alcohol, which can lead to erratic or aggressive actions. The compulsive nature of addiction drives drug-seeking behaviors involving criminal activities. When some seek out substances that are not available at home, such as illegal substances, that could lead them to associate with criminal networks to obtain illicit substances, exposing users to more criminal opportunities, neglect of responsibilities due to addiction can lead to crimes of omission, such as child neglect. When someone becomes addicted to drugs, they often become socially and economically marginalized, which can push individuals towards crime for survival. Also, if substance abuse disorder is co-morbid with other mental disorders and other risk factors, it can increase their chances of criminal recidivism. For instance, In a study by Dalbir et al. (2024), they addressed the prevalence of mental illness, substance use, and co-occurring disorders (CODs) among jail inmates,” finding that 20% had mental illness, 78% had substance use issues, and 17% had both. Only 19% of inmates had no problems with either. Mental illness predominantly co-occurred with substance use, affecting just 3% of inmates alone, whereas 61% had only substance use problems without mental illness. Also, regarding the impact on recidivism, inmates with mental illness were significantly more likely to return to jail, increasing the odds by 129%” (276-277).
Forensic psychological implications of substance-related and addictive disorders.
Substance-related and addictive disorders have significant forensic psychological implications, influencing various aspects of the criminal justice system and legal proceedings. These implications span a wide range of areas, including assessments of criminal responsibility and guilt, evaluations of competency to stand trial, considerations for mitigation in sentencing, and risk assessments for recidivism.
The forensic psychological implications of substance-related and addictive disorders are huge because forensic professionals are tasked with balancing the need for justice with an understanding of the underlying issues of addiction, often influencing decisions about appropriate interventions, sentencing, and rehabilitation options for individuals with substance-related disorders involved in the criminal justice system Forensic psychologists do this by providing treatment recommendations, conducting capacity evaluations, and addressing issues in child custody and family court matters related to substance use Also, it evaluates workplace misconduct, assesses intoxication defenses, and contributes to specialized courts and pretrial intervention programs Their expertise is valuable in providing testimony on addiction and behavior, helping legal professionals and jurors understand the complexities of substance use disorders Additionally, forensic psychologists assess for fake illnesses, ensuring the authenticity of reported substance use problems in legal contexts.
Also, the forensic psychologist’s job is to promote social change in every aspect of crime. Belenko (2019) emphasizes that treatment for substance use disorders in prisons and jails is generally not considered an optimal approach due to two main factors. First, incarceration has been shown to have adverse effects on individuals (Rose and Clear, 1998; Pager, 2007; Western et al., 2015). Second, imprisonment can increase the likelihood of future criminal behavior, a phenomenon known as the criminogenic impact of incarceration (Spohn and Halloran, 2002). Blenko (2019) suggests an ideal alternative is a community supervision system. Probation and parole officers should be crucial in encouraging and facilitating engagement with treatment services. Their responsibilities would include motivating offenders to abstain from drug use and criminal activities while also supporting the development of social connections and resources that aid in recovery, often referred to as social and recovery capital (Farrall, 2002; McNeill, 2006; Taxman, 2008; McNeill and Weaver, 2010).
References
Chesire, R. M., & Piotrowski, N. A. (2023). Substance use disorders. Salem Press Encyclopedia of Health.
Belenko, S. (2019). The role of drug courts in promoting desistance and recovery: A merging of therapy and accountability. Addiction Research & Theory, 27(1), 3–15. https://doi.org/10.1080/16066359.2018.1524882
Dalbir, N., Wright, E. M., & Steiner, B. (2024). Mental Illness, Substance Use, and Co-Occurring Disorders among Jail Inmates: Prevalence, Recidivism, and Gender Differences Corrections (2377-4657), 9(2), 264–286 https://doi.org/10.1080/23774657.2022.2090028
Karim, R., & Keysor, J. (2024). Substance Use Disorder Education in Physical Therapy Curricula. Journal of Allied Health, 53(1), 32–37.
Radparvar, S. (2023) The Clinical Assessment and Treatment of Inhalant Abuse. Permanente Journal, 27(2), 99–109. https://doi.org/10.7812/TPP/22.164
