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Substance use disorders

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Arshya Vahabzadeh.

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  • marcimus pink style avatar for user nik.svitlica
    At the end of the video he mentions that we can not develop a substance use disorder for caffeine. I am curious why that is the case because people can display withdrawal symptoms? Does it it depend on the duration of the symptoms?
    (32 votes)
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    • piceratops seedling style avatar for user Usama Malik
      I believe he was mentioning that Diagnostic and Statistical Manual of Mental Disorders (DSM) book does not include caffeine as a possible drug for substance use disorder. However, this does not mean that it might not be considered that in the future. From the way the DSM adds to disorders in every update, there might be a disorder for everyone in the future :)
      (27 votes)
  • male robot hal style avatar for user Wudaifu
    Who else feels that when discussing the "intoxication" effects of substance use that the presentation should have listed PHYSICAL effects in addition to "psychological" and "behavioral" effects? The physical effects of substance use are enormous and go far beyond the effects on the brain that were mentioned later in the video. There can be profound effects on the heart, lungs, liver, kidneys, gastrointestinal system, muscles, nerves, reproductive organs and virtually every organ system, depending on the substance being used.
    (14 votes)
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  • piceratops ultimate style avatar for user Giulia Comerio
    You mentioned that non every substance user becomes a substance addict: but at what percentage does that happen? Is the step to becoming an addict, when you're a casual user, fairly easy or is it not?
    (2 votes)
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  • leafers seed style avatar for user allykettering1
    What other websites help with substance use disorders?
    (3 votes)
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  • ohnoes default style avatar for user a.m.ahkee
    Has there been research done on addiction and withdrawal effects by energy drinks components?
    (2 votes)
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  • leafers ultimate style avatar for user ff142
    Caffeine use disorder has recently been added to the DSM
    (1 vote)
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  • hopper cool style avatar for user HawkeHPP
    What is the difference between "substance use" and "substance abuse" ?
    (3 votes)
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  • blobby green style avatar for user DRO93
    Could someone elaborate on how withdrawal can be dangerous? Like in the case of an alcoholic It makes sense the body has become accustomed to the alcohol but what happens to your body that can kill you if you abruptly stop drinking?
    (2 votes)
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  • purple pi purple style avatar for user Priya
    which drugs have dangerous withdrawal symptoms? what are they?
    (2 votes)
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  • leaf green style avatar for user Karl Kramer
    personally, I have never associated the term withdrawal with the effects of toxins leaving the body (at least not in the same way I associate the term intoxication with toxins entering the body). Is there another, more specific, term that can be used to signify the relatively immediate exiting (expulsion / excretion) of toxins from the human body? The only terms that come to mind are "to come down" or "to sober up."
    - many thanks
    (1 vote)
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    • orange juice squid orange style avatar for user Paul Norwood
      withdrawal isn't a direct effect of toxins leaving the body so if the video said that it's an error (I don't remember hearing that, but I may well have missed it). Whether or not you take another dose, your body is busy excreting the toxin (say, the caffeine in coffee, of which I drink a lot). So when I drink my third cup of coffee at eleven AM and when I finally reach the state of no caffeine at eleven PM, my body has been excreting the whole time at possibly the same rate, but I wouldn't actually get withdrawal symptoms until the substance is gone. The only direct effect of caffeine leaving the body is peeing more, and possible dehydration as a result. :)
      (1 vote)

Video transcript

- [Voiceover] Let's consider drugs. I'm also going to call them substances. And as you know, there's a whole bunch of different drugs and substances that people use. Some of the most common ones include alcohol and tobacco. But also there's a range of other ones including cannabis, opioids. That includes things like heroin. Also things like stimulants. And that includes things like cocaine and amphetamines. And a whole bunch of other things including hallucinogens. And that includes things like LSD, inhalants, hypnotics, sedatives and other things. And let us not also forget one of the most commonly used substances, which is caffeine. Commonly found in your mug of coffee or tea. So when we look at drugs; when we consider drugs there's several things that we have to also kind of look at. So we have to consider what happens when drugs enter the body and also what happens when they exit. And these are two different processes. The first process when the drug actually goes into a human body, we can actually call this "intoxication." And that's when the drug exerts its effect on somebody. When it goes into their body. And if it exits after a period of prolonged use, we may experience something called "withdrawal." So what are we talking about when we mention intoxication? We're talking about both the behavioral and psychological effects of the drug on the person. And these can be very much drug specific. So can we think of some examples of intoxication? Well, let me give you a couple examples. When we're "drunk," that's an example of intoxication with alcohol. Or when we describe somebody as being "high" that again is a lay, colloquial way of describing what someone is intoxicated with another substance. Which may be something like cocaine or heroin, for example. So what about when a substance actually exits a person? Well withdrawal happens when we stop a substance. Stop taking a substance after having taken it for a prolonged period of time. And what happens there is that we get withdrawal symptoms. Symptoms of stopping the drug. And these symptoms can make us feel quite sick or ill. And in some cases can be quite dangerous or potentially fatal depending on the drug. And when I say "drug" I should also say "substance" here. That's a more formal way of referring to it. And both intoxication and withdrawal, the effects really vary on the precise drug or substance that we're using. But let us also think about drugs, or the substances, in a different way. Let us think about them on their effects on the human brain. Well we know these substances can actually result in a whole heap of other conditions. Because they can result in something called "substance-induced disorders." So these are conditions that are actually caused by substances. And these are conditions that could be substance-induced mood disorders. Disorders of mood, either experiencing moods that are too high, like mania, or moods that are low like depression. Disorders related to anxiety, sleep, sexual function. We may also get problems with something called "psychosis;" which is a loss of contact with reality. And that's where people can hear voices, or see things, or become very paranoid. Now when these drugs affect the brain, something completely different may also happen. We can actually have the development of a "substance use disorder." Now, not everyone that uses a substance develops a substance use disorder. Which basically implies that when they use this drug, the way that they're using the substance or the drug, is causing them a real degree of impairment. It's really affecting the way that they function in their life. Whether that's at school, work, or home, their drug use is really impairing. Now let us talk about substance use disorder a little further. Because when we talk about substance use disorder, the main issue that we are looking at is that there is a problem here. There is a problem with their substance use. And, again, not everybody that drinks alcohol or smokes cigarettes, or uses other substances, not everybody has a substance use disorder. But, some people do. So let's have a closer look at this. So how do we know they have a substance use disorder? One of the ways that we can find out is by looking at their use. And it's really important factors that we need to consider here. Are they using increasingly large amounts? Are they experiencing increasing craving or strong desires to use? Are they spending more and more of their time recovering from or trying to get the substances? Are they failing to try in cut back or cut down? And also feeding into this use issue, are they experiencing problems related to their obligations at work? At school? At home? If these things are appearing that really does suggest that maybe there's a problem, and maybe they have a substance use disorder. A second factor that we look at apart from use is the presence of something we talked about earlier and that was the presence of withdrawal. Now this is something that happens after you stop using the drug after prolonged or sustained use and you get-- you can feel pretty sick or unwell, with different symptoms depending on whatever drug that you're using after having stopped the drug. And this really also suggests that physiologically that you're dependent on the drug. Your body's dependent on the drug. And withdrawal can be dangerous. For example, alcohol withdrawal. You can get seizures potentially and die. And withdrawal symptoms are specific to their substance. So again, the presence of withdrawal suggests that you have a problem. Finally, the last thing I want to mention is the presence of something called "tolerance." And what tolerance is, let me graph it out for you. If this is the effect and this is the dose, the effect, the effect of the drug decreases with subsequent doses. Your body adapts to or builds a tolerance to the substance. So what people do in order to overcome this tolerance is they tend to keep increasing the dose, or the amount, of the substance that they use in order to achieve the same level of intoxication. So as we can see, the way that people are using and the problems that they're encountering with the substance, development of withdrawal symptoms and the development of tolerance all suggest that we have a problem. And actually just having a couple of these such as craving, or withdrawal, or having using increasing amounts, not being able to cut down, is enough for us to be able to diagnose a substance use disorder. And there's different severities of substance use disorder, from mild, moderate to severe. The one caveat I would say is that caffeine, of all the drugs that I've mentioned, with caffeine we cannot develop a substance use disorder according to the current criteria. Now that may be an arbitrary thing but I just want you to know that.