Substance-Related And Addictive Disorders Based On DSM-5

Substance-related and addictive disorders based on the DSM-5 and the scholarly articles found

Substance-related and addictive disorders, as outlined in the DSM-5 and supported by recent scholarly research, encompass a broad spectrum of conditions associated with the excessive activation of the brain's reward system by various substances. These include ten primary classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and other or unknown substances. The commonality among these drugs is their capacity to produce euphoric sensations or a "high," which often leads to neglect of personal and social responsibilities, and potential addiction (American Psychiatric Association, 2013).

Substance-related disorders are classified into two primary categories: substance use disorders and substance-induced disorders. Substance-induced disorders include intoxication, withdrawal syndromes, and other mental health conditions such as psychosis, mood disorders, anxiety disorders, sleep disturbances, sexual dysfunctions, delirium, and neurocognitive impairments (American Psychiatric Association, 2013). On the other hand, substance use disorders are characterized by a problematic pattern of use that persists despite significant adverse consequences. This disorder is diagnosed based on a range of behavioral, physiological, and cognitive symptoms, categorized by impaired control, social impairment, risky use, and pharmacological criteria including tolerance and withdrawal (American Psychiatric Association, 2013).

The neuropsychological impact of these disorders is profound, involving long-lasting changes in brain circuits, which can persist even after detoxification, especially in severe cases. These alterations contribute to a high risk of relapse and are often triggered by environmental cues, emphasizing the importance of long-term management strategies (McLellan et al., 2000). The DSM-5 criteria specify that impaired control involves behaviors such as taking larger amounts or over longer periods than intended and unsuccessful efforts to reduce intake. Social impairment involves neglecting obligations and continuing use despite interpersonal issues, while risky use involves hazardous consumption and continued use despite health problems. The severity of the disorder—ranging from mild to severe—is determined by the number of symptoms present (American Psychiatric Association, 2013).

Research by Chesire et al. (2023) highlights that the brain's functioning is primed for both pleasure and pain relief, and substances can disrupt these functions by stimulating specific neural pathways. For example, alcohol impairs reaction time and emotional regulation, while opioids produce analgesia and euphoria. Stimulants induce intense behavioral stimulation and addiction, whereas hallucinogens generate diverse sensory experiences. Despite their different mechanisms, all these substances influence brain chemistry and reward pathways similarly, reinforcing their addictive potential.

The epidemiological data underscore the widespread nature of substance use disorders, with Karim and Keysor (2024) reporting that approximately 14.8 million individuals misuse alcohol, and around 2 million suffer from opioid use disorder in the United States. These disorders impose substantial economic and societal burdens, with the annual cost of opioid misuse alone estimated at over $786 billion in 2018. Overdoses remain a leading cause of accidental death, highlighting the urgent need for effective intervention and prevention strategies (Karim & Keysor, 2024).

From a psychological perspective, theories addressing the etiology of substance use disorders include social, personality, and biological models. Social and personality theories suggest that individuals with poor coping mechanisms, low stress tolerance, or social deficits are more vulnerable to substance use as a means of relief or social integration. Environmental factors such as poverty, trauma, and high-stress environments further heighten risk. Biological theories emphasize genetic predispositions and neurochemical sensitivities that predispose some individuals to addiction. For example, genetic factors can influence dopamine regulation, affecting reward sensitivity and the propensity for substance use (Chesire et al., 2023).

Pain, both physical and psychological, significantly contributes to the development and maintenance of substance use disorders. Factors influencing pain perception include genetics, childhood trauma, environmental stressors, and developmental conditions. Pain management is a primary motivator for substance use, especially in those seeking relief from chronic pain or emotional distress, which increases susceptibility to addiction (Chesire et al., 2023).

The relationship between substance use and criminal behavior is well-documented. Substance abuse often leads to impaired judgment, increased impulsivity, and aggressive behavior, which can result in criminal acts ranging from property crimes to violence (Dalbir et al., 2024). Moreover, addiction-related financial strains and social marginalization may push individuals toward criminal activities to sustain their substance habits or fulfill socioeconomic needs. Co-occurring mental illnesses and substance use intensify these risks, with studies indicating higher recidivism rates among offenders with dual diagnoses (Dalbir et al., 2024).

In forensic contexts, substance-related and addictive disorders pose significant challenges in assessing criminal responsibility, competency, and risk of recidivism. Forensic psychologists evaluate the cognitive and behavioral impact of substance use to inform legal decisions and sentencing. They also assess whether an individual’s mental health and substance use impairments affect their culpability or capacity to stand trial (Belenko, 2019). Moreover, these professionals provide treatment recommendations and contribute to specialized courts, such as drug courts, that aim to reduce recidivism through therapy and accountability measures (Belenko, 2019).

Incarceration, while often used as a punitive measure for substance-related offenses, is increasingly recognized as suboptimal for addressing these disorders. Evidence suggests that prisons foster environments that may exacerbate addiction and mental health issues, increasing the likelihood of future criminal activity (Rose & Clear, 1998; Pager, 2007). As an alternative, community-based supervision, such as probation and parole, emphasizes rehabilitation and engagement with treatment services. Probation officers play a vital role in motivating offenders to abstain from substance use and develop social and recovery capital, facilitating reintegration into society (Belenko, 2019; Farrall, 2002).

In conclusion, substance-related and addictive disorders are complex conditions with significant implications for individual health, societal wellbeing, and the criminal justice system. Their neurobiological, psychological, and social dimensions necessitate integrated treatment approaches that extend beyond detoxification and abstinence. Forensic psychology plays a crucial role in evaluating, managing, and rehabilitating individuals with these disorders within the legal system, aiming to reduce recidivism and promote social recovery. Future strategies should prioritize community-based interventions, targeted treatment programs, and comprehensive policy efforts to address the multifaceted challenges posed by substance use disorders.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• 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.
• Chesire, R. M., & Piotrowski, N. A. (2023). Substance use disorders. Salem Press Encyclopedia of Health.
• 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, 9(2), 264–286.
• Farrall, S. (2002). Social capital and desistance from crime. European Journal of Criminology, 9(3), 315–336.
• Karim, R., & Keysor, J. (2024). Substance Use Disorder Education in Physical Therapy Curricula. Journal of Allied Health, 53(1), 32–37.
• McLellan, A. T., et al. (2000). Reinforcing abstinence: The importance of long-term treatment and the neurobiology of addiction. Neuropsychopharmacology, 23(2), 103–114.
• Pager, D. (2007). The mark of a criminal record. American Journal of Sociology, 108(5), 937–975.
• Radparvar, S. (2023). The clinical assessment and treatment of inhalant abuse. Permanente Journal, 27(2), 99–109.
• Western, B., et al. (2015). The growth and fragmentation of the US probation population. Journal of Contemporary Criminal Justice, 31(4), 445–463.