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4.5 Substance Use and Abuse

4 min readLast Updated on June 24, 2024

Substance use disorders can profoundly impact lives, affecting brain chemistry and behavior. These disorders involve impaired control, social problems, risky use, and pharmacological effects like tolerance and withdrawal. Understanding the criteria helps identify and address these complex issues.

Different drugs interact uniquely with neurotransmitters, leading to varied effects on mood, cognition, and physical health. Stimulants boost dopamine, depressants enhance GABA, opioids activate specific receptors, and hallucinogens alter serotonin. Recognizing these mechanisms is crucial for effective treatment and prevention strategies.

Substance Use Disorders

Criteria for substance use disorders

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  • Impaired control
    • Using larger amounts or for longer than intended due to increased tolerance or compulsive use (binge drinking, chain smoking)
    • Persistent desire or unsuccessful efforts to cut down or control use despite negative consequences (failed attempts to quit, relapsing)
    • Spending a great deal of time obtaining, using, or recovering from the substance leading to neglect of responsibilities (skipping work to buy drugs, hangover affecting performance)
    • Craving or strong desire to use the substance triggered by environmental cues or withdrawal symptoms (seeing drug paraphernalia, feeling irritable without nicotine)
  • Social impairment
    • Failure to fulfill major role obligations at work, school, or home resulting in poor performance or absenteeism (missing deadlines, neglecting childcare)
    • Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance use (arguments with spouse, losing friends)
    • Giving up or reducing important social, occupational, or recreational activities in favor of substance use (skipping hobbies, isolating from family)
  • Risky use
    • Recurrent use in physically hazardous situations endangering self or others (driving under the influence, operating machinery while impaired)
    • Continued use despite knowledge of persistent or recurrent physical or psychological problems likely caused or worsened by the substance (smoking despite lung disease, drinking despite depression)
  • Pharmacological criteria
    • Tolerance: needing increased amounts to achieve the desired effect or diminished effect with the same amount due to brain adaptations (higher doses of opioids for pain relief, more alcohol to feel drunk)
    • Withdrawal: experiencing withdrawal symptoms or taking the substance to relieve or avoid withdrawal symptoms when blood levels decline (nausea and tremors without alcohol, using opioids to prevent flu-like symptoms)

Drug interactions with neurotransmitters

  • Stimulants (cocaine, amphetamines)
    • Increase dopamine levels in the brain's reward pathway leading to euphoria and addiction (dopamine hypothesis of reward)
    • Enhance norepinephrine and serotonin transmission affecting mood, attention, and impulsivity (elevated heart rate, increased focus)
  • Depressants (alcohol, benzodiazepines, barbiturates)
    • Enhance the effects of GABA, the primary inhibitory neurotransmitter resulting in sedation and anxiolysis (feeling calm and sleepy)
    • Reduce glutamate, the primary excitatory neurotransmitter leading to impaired memory and coordination (blackouts, stumbling)
  • Opioids (heroin, prescription painkillers)
    • Activate opioid receptors, particularly mu-opioid receptors involved in pain relief and reward (morphine binding to receptors)
    • Increase dopamine release in the brain's reward pathway contributing to euphoria and addiction (heroin rush)
  • Hallucinogens (LSD, psilocybin)
    • Act on serotonin receptors, particularly 5-HT2A receptors involved in perception and cognition (visual hallucinations, altered thinking)
    • Alter glutamate transmission in the prefrontal cortex affecting mood and insight (feelings of connectedness, ego dissolution)
  • Cannabinoids (marijuana)
    • Activate cannabinoid receptors (CB1 and CB2) involved in appetite, pain, and memory (munchies, pain relief)
    • Modulate the release of various neurotransmitters, including dopamine, GABA, and glutamate affecting reward, inhibition, and excitation (feeling high, impaired memory)

Effects of drug categories

  • Stimulants
    • Increased alertness, energy, and confidence due to norepinephrine and dopamine release (feeling "wired", sociable)
    • Decreased appetite and sleep due to elevated metabolism and arousal (weight loss, insomnia)
    • Potential for anxiety, paranoia, and psychosis at high doses due to excessive dopamine (stimulant-induced psychosis)
  • Depressants
    • Sedation, relaxation, and anxiety reduction due to enhanced GABA activity (feeling calm, less worried)
    • Impaired coordination, judgment, and memory due to reduced glutamate and increased GABA (slurred speech, poor decision making)
    • Potential for respiratory depression and overdose due to suppressed brain stem function (shallow breathing, coma)
  • Opioids
    • Pain relief, euphoria, and sedation due to mu-opioid receptor activation (feeling no pain, intense pleasure, nodding off)
    • Slowed breathing, constipation, and itching due to effects on respiratory, digestive, and sensory systems (respiratory depression, opioid-induced bowel dysfunction)
    • High potential for dependence and overdose due to rapid tolerance and respiratory suppression (needing higher doses, risk of fatal overdose)
  • Hallucinogens
    • Altered perceptions, thoughts, and emotions due to 5-HT2A receptor activation (seeing colors and patterns, feeling profound insights)
    • Increased sensory experiences and feelings of detachment due to changes in sensory processing and self-awareness (heightened senses, out-of-body experiences)
    • Potential for intense emotional reactions and impaired judgment due to altered cognition and perception (bad trips, risky behavior)
  • Cannabinoids
    • Relaxation, altered perception of time, and increased appetite due to CB1 receptor activation (feeling chilled out, time dilation, munchies)
    • Impaired memory, learning, and coordination due to effects on hippocampus and cerebellum (forgetting things, clumsy movements)
    • Potential for anxiety, paranoia, and psychosis in some individuals due to individual differences in endocannabinoid system (cannabis-induced psychosis)

Addiction and Treatment

  • Addiction: A chronic, relapsing disorder characterized by compulsive drug seeking and use despite harmful consequences
  • Dependence: A state of physical or psychological reliance on a substance, often accompanied by tolerance and withdrawal symptoms
  • Overdose: Consumption of a drug in quantities greater than recommended or typically tolerated, potentially leading to severe adverse effects or death
  • Rehabilitation: A structured program aimed at helping individuals overcome substance use disorders and regain control of their lives
  • Harm reduction: Strategies and interventions designed to minimize the negative health, social, and legal impacts associated with drug use, drug policies, and drug laws

Term 1 of 37

5-HT2A Receptors
See definition

5-HT2A receptors are a subtype of serotonin receptors that are widely distributed in the central nervous system and play a crucial role in various physiological and behavioral processes. These receptors are known to be involved in the modulation of substance use and abuse, making them an important target of study in the context of psychology.

Key Terms to Review (37)

Term 1 of 37

5-HT2A Receptors
See definition

5-HT2A receptors are a subtype of serotonin receptors that are widely distributed in the central nervous system and play a crucial role in various physiological and behavioral processes. These receptors are known to be involved in the modulation of substance use and abuse, making them an important target of study in the context of psychology.

© 2025 Fiveable Inc. All rights reserved.
AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.

Term 1 of 37

5-HT2A Receptors
See definition

5-HT2A receptors are a subtype of serotonin receptors that are widely distributed in the central nervous system and play a crucial role in various physiological and behavioral processes. These receptors are known to be involved in the modulation of substance use and abuse, making them an important target of study in the context of psychology.



© 2025 Fiveable Inc. All rights reserved.
AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.

© 2025 Fiveable Inc. All rights reserved.
AP® and SAT® are trademarks registered by the College Board, which is not affiliated with, and does not endorse this website.
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