SUBSTANCE AND ALCOHOL USE DISORDERS

At Agia Irini Psychiatric Clinic of Drama, we provide care with a profound sense of responsibility and genuine dedication to the wellbeing of our patients.

There are various substances of use and misuse that can lead to dependence, including alcohol, heroin, cocaine, benzodiazepines, amphetamines, and others.

The causes of substance and alcohol use disorders involve a complex interplay of factors, including:

Biological factors – such as individual sensitivities to the effects of certain substances, differences in substance metabolism, cellular adaptations within the central nervous system, chronic exposure to the substance, and increased vulnerability to medical and neuropsychiatric complications resulting from long-term use.

Psychological factors – including the presence of co-existing mental health conditions such as depression, anxiety, psychosis, eating disorders, or attention-deficit/hyperactivity disorder (ADHD). Other predisposing personality traits may include a strong need for sensory stimulation, poor impulse control, difficulty delaying gratification, antisocial tendencies, current or past exposure to severe stress, and the impact of physical health issues such as chronic pain. Substance use often begins as an attempt at self-medication.

Social factors – such as peer or friendship influence leading to recreational use, availability of substances at different stages of an individual’s development, and broader socio-economic or political challenges that may be associated with a lack of clear goals and values within society. 

Genetic factors – research has shown a hereditary component in alcohol dependence, where specific traits can be genetically transmitted, increasing vulnerability. Higher rates of such disorders are observed in the children of individuals with substance use problems.

Characteristics and Diagnostic Criteria for Substance Use Disorder
According to the American DSM-5 classification system, the main features and diagnostic criteria include:

Impaired control over substance use
  1. Using a substance in larger amounts or over a longer period than was initially intended.
  2. Persistent desire to cut down or regulate substance use, with repeated unsuccessful attempts to reduce or stop.
  3. Spending a significant amount of time obtaining, using, or recovering from the effects of the substance.

Experiencing craving — an intense desire or urge to use the substance — which may occur at any time, often in places where the substance was previously obtained or used.
Social impairment
  1. Recurrent substance use leading to a failure to fulfil major role obligations at work, school, or home.
  2. Continued substance use despite persistent or recurrent social or interpersonal problems caused or worsened by the effects of the substance.
  3. Giving up or reducing important social, occupational, or recreational activities because of substance use.
Risky use
  1. Recurrent substance use in situations where it is physically hazardous.
  2. Continuing to use the substance despite being aware of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
Pharmacological criteria
  1. Tolerance – needing markedly increased amounts of the substance to achieve the desired effect, or experiencing a markedly diminished effect with continued use of the same amount.
  2. Withdrawal – experiencing the substance’s withdrawal syndrome, or taking the substance to avoid or relieve withdrawal symptoms. (Note: neither tolerance nor withdrawal is required for a diagnosis of substance use disorder.)

Therapeutic Approach to Substance and Alcohol Use Disorders
Treatment includes the use of medication to manage withdrawal symptoms associated with each substance, as well as addressing co-occurring conditions such as anxiety, depression, or psychotic disorders. It also involves psychoeducation, supportive psychotherapy, and other evidence-based interventions aimed at achieving recovery and long-term stability.

Substance and Alcohol Use Disorders Treatment – Supporting the individual in overcoming dependence