SUBSTANCE USE DISORDER

Salami Ibrahim Ayobami - 180814065

Erinle Olawale Joseph - 190904001

Aseperi Oluwagbemisoke Ruth - 190904002

Atiku Oluwabusayo Basirat - 190904003

Falade Olufunmilola Rachael - 190904004

Oyeyipo Ireyemi Peculiar - 190904005

Department of Psychology, University of Lagos.

Course Title: PSY 322 - Clinical Psychology

Dr Aroyewun Afolabi

June
 ABSTRACT

Substance use disorder is characterized by a psychological dependence on a substance or a drug that

is beyond voluntary control and that can cause serious harm to the individual when used repetitively.

This paper aims at explaining the neurobiology of drug addiction and investigating the effects of

substances such as psychostimulants, opioids, nicotine and alcohol on an individual’s health.

Moreover, this paper gives an overview of the neurotransmitters and brains structures that are altered

following the excessive use of drugs, and illustrates some of the neurobiological changes that occur

during drug addiction. At the molecular level, drug abuse induces functional and morphological

changes of specific brain structures, which generally lead to adverse consequences such as drug

relapse. Although previous studies have significantly improved our understanding of the

neurobiological mechanisms of substance use disorder in humans, more work need to be done to

identify potential therapeutic targets and develop new treatment strategies. A doctor may suggest

individual counseling with a psychologist, psychiatrist, or addiction counselor depending upon the

condition of the individual. In this paper, we would briefly look at substance use disorder and

treatment modalities available for its management.

Keywords: substance use disorder; alcohol; cannabis; opioids; psychostimulant

 INTRODUCTION

Substance use disorder is a chronic disorder characterized by a compulsive need to use a substance in

order to function normally. It is associated with severe problems for the individual, and often shows

a high comorbidity with other psychiatric disorders and symptoms, such as depression, obsessive-

compulsive disorder, anxiety, aggression and suicide.

According to the previous diagnosis manual DSM-IV, substance use disorders were classified as

substance abuse or substance dependence, whereas in the DSM-5, the terminology of these diagnoses

is replaced by ‘substance use disorder’. Substance use disorders are a major public health concern

everywhere, and responding to the burden they cause is a challenge for health systems in both

developed and developing regions. Addictive behaviors usually begin with a period of

experimentation with a particular drug or substance, which most often escalates over repeated

exposures associated with the appearance of tolerance. Drug dependence produces significant and

lasting changes in brain chemistry and function. At some point, increasing amounts of the substance

are needed to reach the same level of pleasure and reward produced by earlier lower quantities, and

the individual is often in a negative emotional state when access to the substance is prevented.

As an individual heads towards dependence, there is an increase in the motivation to obtain

and continue consuming the drug or substance. There is a growing awareness of the emotional

consequences associated with drug use and a link to environments associated with accessing or

taking the drug. Drugs known to cause addiction can be legal or illegal, and can also be prescribed

for medical use. Substances known to cause addiction include stimulants, such as cocaine, caffeine,

and sedatives including barbiturates, benzodiazepines and methaqualone, and so on. Drugs of abuse

also include opiate and opioid analgesics. Several medications have shown to be effective in treating

opioid addiction, but there is still no maintenance medication that has been approved for the
treatment of psychostimulants addiction. Effective medications are available for treating nicotine,

alcohol, and opiate dependence but not stimulant or marijuana dependence.

The main priority of the neurobiological research is to understand the pharmacological and

neuroadaptive mechanisms within specific brain circuits that translate to chronic addiction.

Enormous progress has been made in brain imaging technology that eventually provides accurate

quantitative approaches and enhanced the understanding of the role that neurology plays in

psychiatric disorders. Modern imaging techniques has enabled researchers to observe drug actions as

they occur in the brains of addicted individuals, which can help in better understand the

pathophysiology of substance use disorder.

This paper discusses the clinical effects of substance-use disorders such as; psychostimulants,

opioids, alcohol and tobacco, and also describes the functional and structural changes that occur in

the brain in addicted individuals. For this analysis, studies were identified using predefined search

criteria that included the following keywords: drug abuse, addiction, alcohol, opioid and

psychostimulant, in the PubMed and Medline databases. The studies discussed in this paper are

primary peer-reviewed articles that were published in high-quality journals.

TREATMENTS:

In order to treat people with substance use disorders, a thorough psychiatric evaluation (assessment)

must be performed, intoxication and withdrawal symptoms must be addressed as soon as they arise,

co-occurring mental and general medical conditions must be addressed, and a treatment plan must be

created. For treatment to result in long-lasting behavioral changes, it must be prolonged. During

therapy, the drug user is trained to break old thought and behavior patterns and pick up new abilities
for abstaining from drugs and illegal activity. People who suffer from serious substance addiction

together with co-occurring disorders usually require more extensive treatments and longer treatment

periods (such as three months or longer). The drug addict starts a therapeutic process of change early

on in treatment. Later on, he or she learns how to handle other drug-related issues and addresses

them (NIDA, 2023).

1. Assessment

This refers to a comprehensive psychiatric evaluation which is essential to guide the treatment of a

patient with a substance use disorder.

The assessment includes:

● A thorough history of the patient's past and current substance use, as well as the impact of

substance use on cognitive, psychological, behavioral, and physiological functioning

● a general medical and psychiatric examination,

● a history of psychiatric treatments and their results

● a family and social history

● testing for drugs in the blood, breath, or urine

● additional laboratory testing to verify the existence or lack of diseases that commonly co-occur

with substance use problems

● getting in touch with a significant other for more details. (Performed with consent from the

patient).

2. Psychiatric management

This serves as the cornerstone of patients' treatment for substance use disorders.

It's objectives include:

● motivating the patient to change,

 ● forming and sustaining a therapeutic alliance with the patient,

● evaluating the patient's safety and clinical status

● managing the patient's states of intoxication and withdrawal

● Creating and facilitating the patient’s adherence to a treatment plan,

● preventing the patient from relapsing

● educating the patient about substance use disorders,

● lowering the morbidity and consequences of substance use disorders

● reducing the morbidity and sequelae of substance use disorders.

Psychiatric management, however, is typically paired with certain treatments. In a number of

settings, such as community-based organizations, clinics, hospitals, detoxification programs, and

residential treatment facilities, this is done cooperatively with experts from different fields. Everyone

contributes to the patient's improvement.

Research indicates that a significant number of patients derive advantages from participation in self-

help group sessions; hence, psychiatric management strategies may promote such involvement.

3. Specific treatments

The specific treatments could be pharmacological and psychosocial interventions, alone or in

combinations. pharmacological and psychosocial treatments discussed here are typically used in

conjunction with multimodal treatment programs.

● Pharmacological treatments:

Pharmacological treatments are helpful for certain patients with particular substance use disorders.

The categories of pharmacological treatments are:

- medications to treat intoxication and withdrawal states,

- medications to lessen the reinforcement of substance abuse,

- agonist maintenance therapies,

- antagonist therapies,

- abstinence-promoting and relapse prevention therapies

- medications to treat comorbid psychiatric conditions.

● Psychosocial treatments: Evidence-based psychosocial treatments include:

- cognitive-behavioral therapies (CBTs, e.g. relapse prevention, social skills training),

- motivational enhancement therapy (MET),

- behavioral therapies (e.g., community reinforcement, contingency management),

- 12-step facilitation(TSF),

- psychodynamic therapy/interpersonal therapy (IPT), self-help manuals,

- behavioral selfcontrol,

- brief interventions,

- case management, and

- group, marital, and family therapies.

psychosocial interventions

There is proof that integrated treatment, which combines psychosocial therapies for treating

particular substance use disorders with psychosocial treatment approaches for other psychiatric

diagnoses (such as cognitive behavioral therapy for depression), is effective for patients with co-

occurring psychiatric disorders and substance use.

4. Formulation and implementation of a treatment plan

Patients usually need long-term therapy since many substance-use disorders are chronic; however,

the precise therapies used to accomplish these goals and their level of intensity may vary over time.

As a matter of fact, individuals may need distinct therapy depending on the stage of their sickness.

The treatment plan includes measures to improve ongoing adherence to the program, prevent relapse,

and improve functioning; it also includes any additional treatments needed for patients with co-

occurring mental illness or general medical condition. These include strategies for achieving

abstinence or minimizing the effects or use of substances of abuse. Several months to several years

may pass between treatments, depending on the needs of the individual patient.

It is critical to increase drug use monitoring when a patient is at high risk of relapsing, such as during

the early stages of treatment, throughout the transition to less intensive levels of care, or in the first

year after stopping active treatment.

5. Treatment settings

The settings for therapy are determined by several factors. Availability of certain treatment

modalities, degree of access restriction to substances that are likely to be abused, availability of

general medical and psychiatric care, and general environment and treatment philosophy are a few of

these factors. In order to maximize safety and effectiveness, patients should get care in the least

restrictive environment possible. Hospitals, residential treatment centers, programs for partial

hospitalization, and outpatient clinics are examples of therapeutic venues that are frequently

accessible.

The patient's capacity to comply with and benefit from the treatment provided, abstain from drug

abuse, stay away from high-risk behaviors, and require structure and support or specific treatments

that might only be available in specific settings should all be taken into consideration when choosing
the patient's place of care. Based on these variables and an evaluation of their capacity to gain safely

from a higher degree of care, patients are moved from one level of care to another.

Hospitalization is appropriate for patients who:

- have a substance overdose that cannot be safely treated in an emergency room or outpatient

setting,

- are at risk for severe or medically complicated withdrawal syndromes (such as a history of

delirium tremens or a history of very heavy alcohol use and high tolerance),

- Have co-occurring general medical conditions that make ambulatory detoxification unsafe,

- have a history of not engaging in or benefiting from treatment in a less intensive setting (such as

residential or outpatient), or

- have a level of psychiatric comorbidity that would significantly impair their ability to participate

in, adhere to, or benefit from treatment

- display drug use or other behaviors that put them or others in immediate danger;

- have not responded to or were unable to follow less intensive treatment programs.

Patients who don't fit the clinical criteria for hospitalization but whose lives and social interactions

are primarily focused on substance use, lack the necessary social and vocational skills, or don't have

substance-free social supports to sustain sobriety in an outpatient setting should consider residential

treatment. For these patients, residential treatment lasting longer than or equivalent to three months is

linked to improved long-term results.

Therapeutic communities have been demonstrated to be beneficial for patients with opioid use

disorders. Patients who require acute care but have a fair chance of abstaining from illicit substance

use outside of a restricted setting may benefit from partial hospitalization. Patients who are at high
risk of relapsing after leaving hospitals or home settings are often placed in partial hospitalization

settings. Patients with severe psychiatric comorbidity, a history of substance use relapse in the

immediate post-hospitalization or post-residential period, low motivation to continue treatment,

returning to a high-risk environment, and insufficient psychosocial supports for abstaining from

substance use are among these.

Patients who are at high risk of relapsing after leaving hospitals or home settings are often placed in

partial hospitalization settings. Patients with severe psychiatric comorbidity, a history of substance

use relapse in the immediate post-hospitalization or post-residential period, low motivation to

continue treatment, returning to a high-risk environment, and insufficient psychosocial supports for

abstaining from substance use are among these. Programs for partial hospitalization are also

recommended for patients who are not improving even after receiving intense outpatient care.

Patients with substance use disorders who do not require more intense care should be treated as

outpatients if their clinical condition or environmental factors do not warrant it. Similar to other

treatment environments, a comprehensive strategy that combines behavioral monitoring with a range

of psychotherapy and pharmaceutical therapies when appropriate is ideal. Although patients with

alcohol withdrawal must be detoxified in a setting that offers frequent clinical assessment and any

necessary treatments, the majority of treatment for patients with alcohol dependence or abuse can be

successfully carried out outside the hospital (e.g., in outpatient or partial hospitalization settings).

Clinical and scientific experience indicate that intensive outpatient treatment—which focuses on

maintaining abstinence while utilizing multiple treatment modalities—is beneficial for many people

with cocaine use disorders. Unless they require hospitalization for other reasons, people with

marijuana use disorders or nicotine addictions are treated as outpatients.

 6. Clinical features influencing treatment

A clinician should take into account a number of factors when planning and carrying out treatment

for a patient, including co-occurring mental and physical health conditions, gender-related issues,

age, the patient's social and living environment, cultural background, and family dynamics. The

diagnostic differentiation between drug use and other disorders' symptoms, as well as the specific

treatment of comorbid illnesses, should be given special attention due to the high frequency of

comorbidity between substance use disorders and other psychiatric disorders. When a patient has co-

occurring psychiatric disorders, psychosocial stressors, or other life circumstances that exacerbate

the substance use disorder or impede treatment, different psychotherapies may also be indicated in

addition to pharmacotherapies tailored to the patient's specific needs.

When a patient stops using drugs, there may be changes in their mental health or how their

prescriptions are metabolized (such as when they stop smoking and have altered antipsychotic

metabolism via cytochrome P450 1A2). In these cases, the dosage of psychotropic medications may

need to be adjusted. It is important for women who are of childbearing age to take pregnancy into

account. Since all of the drugs covered in this practice guideline have the potential to harm the fetus,

it is advised that pregnant women receive psychosocial treatment to support their decision to abstain

from drugs. Continuous substance use may not be preferable to concurrent agonist treatment when it

comes to some substances. Treatment with nicotine replacement therapy (NRT) may be beneficial

for pregnant smokers. Treatment with methadone or buprenorphine can be a helpful addition to

psychosocial treatment for pregnant women with opioid use disorders.

A. NICOTINE USE DISORDERS: TREATMENT PRINCIPLES AND ALTERNATIVES

● Pharmacological treatments
 For those who want to quit but have not been successful without pharmaceutical help or who would

rather use them, pharmacological treatment is advised. The U.S. Food and Drug Administration

(FDA) has approved six drugs for the treatment of nicotine dependence. These include bupropion

and five NRTs (patch, gum, spray, lozenge, and inhaler). All of these first-line medications work just

as well to lessen withdrawal symptoms and stop smoking. Depending on the patient's preference, the

mode of administration, and the profile of adverse effects, any of these could be employed.

Dependency is one of the rare major side effects of NRTs. These drugs work even in the absence of

psychosocial treatment, even though combination psychosocial and pharmacological treatment yields

the best results in treating nicotine use disorders.

Combining these first-line therapies could potentially enhance the results. As second-line

medications, nortriptyline and clonidine are useful, but they seem to have higher adverse effects. The

efficacy of acupuncture and other drugs has not been established. Bupropion, Varenicline, and

nicotine replacement therapy (available as a patch, inhaler, or gum) are common drugs used for

diseases related to nicotine dependence. (NIDA, 2023).

● Psychosocial treatments

The psychosocial treatments of cognitive behavioral therapy (CBTs), behavioral therapies, short

interventions, and MET are also beneficial in treating nicotine dependence. These treatments can be

given in telephone, group, or individual settings, as well as through self-help books and online

resources.The quantity of psychological treatment received has an impact on treatment efficacy.

Hypnosis, inpatient therapy, and 12-step programs have not been shown to be successful.

B. ALCOHOL USE DISORDERS: TREATMENT PRINCIPLES AND ALTERNATIVES

● Management of intoxication and withdrawal

 Controlling alcohol use and withdrawal, the patient who is severely drunk should be kept under

observation and in a secure setting. The onset of alcohol withdrawal symptoms usually happens 4–12

hours after cutting back on alcohol consumption, peaks on the second day of abstinence, and goes

away in 4–5 days on average. Seizures, delusions, and delirium are examples of serious side effects.

Patients experiencing moderate to severe withdrawal are treated with thiamine and fluids,

benzodiazepines, and, in certain cases, additional medications like antipsychotics, clonidine, or

anticonvulsants. The goal of treatment is to minimize CNS irritability and restore physiological

homeostasis.

Following the establishment of clinical stability, the patient should be monitored for the recurrence

of withdrawal symptoms as well as the appearance of signs and symptoms that could indicate the co-

occurring psychiatric illnesses. Benzodiazepines and other drugs should be tapered as needed.

● Pharmacological treatments

Certain pharmacotherapies for individuals with alcohol dependence have a proven track record of

success and are moderately effective. Although there is little information on naltrexone's long-term

effectiveness, it may lessen some of the reinforcing effects of alcohol. Long-acting injectable

naltrexone may help with adherence, although there hasn't been much study published on the subject,

and FDA approval is still pending.Acamprosate is a γ-aminobutyric acid (GABA) analog that has the

potential to reduce alcohol appetite in abstinent persons. It may also be a useful supplementary drug

for motivated patients undergoing psychosocial treatment concurrently.

Disulfiram is a useful supplement to a thorough treatment plan for consistent, driven people whose

drinking may be brought on by situations that cause an abrupt spike in alcohol demand. Commonly

prescribed drugs for alcohol consumption disorders include Acamprosate, Disulfiram, and

Naltrexone
● Psychosocial treatments

.psychosocial interventions Some patients with an alcohol use disorder have found success with

psychosocial treatments such as MET, CBT, behavioral therapies, TSF, family and marital therapies,

group therapies, and psychodynamic therapy/IPT.It is frequently beneficial to suggest that patients

join self-help organizations like Alcoholics Anonymous (AA).

C. MARIJUANA USE DISORDERS: TREATMENT PRINCIPLES AND ALTERNATIVES

There are few studies on the management of marijuana use problems. It is not possible to

recommend any particular pharmacotherapies for marijuana use or withdrawal, when it comes to

psychological therapy, treating marijuana dependence may benefit from an intensive relapse

prevention strategy that incorporates motivational interventions and the development of coping

skills, although more research on these strategies is required.

D. COCAINE USE DISORDERS: TREATMENT PRINCIPLES AND ALTERNATIVES

● Management of intoxication and withdrawal:

Most cases of cocaine intoxication are self-limiting and simply need supportive care. However,

cocaine intoxication can also result in hypertension, tachycardia, seizures, and persecutory delusions,

all of which may need special care. Patients who are extremely agitated could benefit from

benzodiazepine sedation.

● Pharmacological treatments

Pharmacological treatment is not ordinarily indicated as an initial treatment for patients with cocaine

dependence. In addition, no pharmacotherapies have FDA indications for the treatment of cocaine

dependence. However, for individuals who fail to respond to psychosocial treatment alone, some
 medications (topiramate, disulfiram, or modafinil) may be promising when integrated into

psychosocial treatments.

● Psychosocial treatments

For people with cocaine dependence, pharmacological treatment is typically not recommended as an

initial course of treatment. Furthermore, the FDA has not approved any pharmacotherapies to treat

cocaine dependence. When combined with psychosocial therapy, some drugs (such as topiramate,

disulfiram, or modafinil) may show promise for those who do not respond to psychosocial treatment

alone. Psychosocial therapies that emphasize abstinence are successful for a large number of people

with cocaine use disorders.

Particularly, 12-step-oriented individual drug counseling, behavioral therapies, and cognitive

behavioral therapy (CBT) can be helpful; however, the effectiveness of these therapies differs among

patient subgroups. In some cases, patients with cocaine use disorders may benefit from regular

involvement in a self-help group.

E. OPIOID USE DISORDERS: TREATMENT PRINCIPLES AND ALTERNATIVES

● Management of intoxication and withdrawal.

Treatment is typically not necessary for mild to moderate acute opioid intoxication. On the other

hand, a severe opioid overdose that results in respiratory depression can be lethal and needs to be

treated in an inpatient or emergency department. Respiratory depression and other symptoms of an

opioid overdose can be reversed with naloxone. The goal of treating opioid withdrawal is to help

patients enter a long-term treatment program for opioid use disorders while also safely reducing their

acute symptoms. Effective strategies include: abruptly stopping opioids and using clonidine to stifle

withdrawal symptoms; substituting methadone or buprenorphine for the opioid and gradually

weaning off; and clonidine-naltrexone detoxification.

 The treating physician must determine whether the patient is using any other drugs. In particular,

alcohol, benzodiazepines, or other sedatives or anxiolytics should be avoided as concurrent use of

other drugs or withdrawal from them can make treating opiate withdrawal more difficult. Anesthesia-

assisted rapid opioid detoxification (AROD) is not advised due to unfavorable risk-benefit ratios and

lack of shown efficacy. The following drugs are frequently used to treat opioid addiction and

withdrawal: methadone, buprenorphine, lofexidine, and extended-release naltrexone. (NIDA, 2023)

● Pharmacological treatments

Patients with a longer history (>1 year) of opioid dependency should receive maintenance treatment

with methadone or buprenorphine. Achieving a stable maintenance dose of an opioid agonist and

promoting participation in an extensive rehabilitation program are the two main objectives of

treatment.

● pharmaceutical interventions

An alternate approach is maintenance treatment with naltrexone; however, this strategy's usefulness

is frequently restricted by low treatment retention and non-adherence by patients.

● Psychosocial treatments

A thorough treatment strategy for people with an opioid use disorder should include psychosocial

therapies. For certain patients with an opioid use disorder, behavioral therapies (such as contingency

management), cognitive behavioral therapy (CBTs), psychodynamic psychotherapy, group, and

family therapies have been reported to be beneficial. Encouraging consistent attendance at self-help

groups could be beneficial as well.

FUNCTIONAL AND MORPHOLOGICAL CHANGES IN THE BRAIN

The human brain is a made up of interconnected neurons firing in precise patterns to

make everything from our thoughts and emotions to movement happen. Substances can

however disrupte the delicate balance of this system. This disruption has serious

consequences, which includes; cognitive decline, and even long-term brain damage.

Neurons are the fundamental units of the brain,and they ommunicate with each other

using chemical messengers called neurotransmitters. These neurotransmitters travel

across a tiny space between the neurons called the synapse, they then bind to receptors on

the receiving neuron.

Drugs can interfere with the delicate composition of neurotransmitters in several ways,

some of which includes;

1. Blocking Reuptake: Some drugs, like cocaine with dopamine, act like a closed

exit ramp. This prevents the reuptake of spent neurotransmitters back into the

presynaptic neuron, leading to an increase of neurotransmitter in the synapse. This

overstimulation of the neuron disorganizes the normal flow of information,

resulting in the intense feeling of being high associated with the use of cocaine.

2. Inhibiting Breakdown: Certain substances, like some antidepressants, inhibit

these enzymes. This keeps the neurotransmitters in the synapse, leading to

 prolonged and excessive stimulation.

3. Mimicking Neurotransmitters: Certain drugs can mimic the structure of natural

neurotransmitters, essentially acting as imposters. Opioids, for example, mimic

endorphins, the body's natural pain relievers. These imposters bind to the same

receptors as the natural neurotransmitters, triggering similar effects like pain relief

and pleasure. However, this can lead to dependence and addiction as the brain

prioritizes the drug-induced effects over the natural ones.

4. Blocking Receptors: Opposing the mimics, some drugs act like roadblocks,

preventing natural neurotransmitters from binding to their receptors.

Antidepressants like Prozac work in this way by blocking the reuptake of

serotonin, leading to an increase in available serotonin at the synapse. However,

some drugs can completely block these receptors, effectively shutting down a

particular communication pathway in the brain. This can lead to a variety of side

effects depending on the neurotransmitter and brain circuit involved.

By interfering with neurotransmission, drugs alter the firing patterns of neurons. This

usually has an effect on how brain circuits functions. Some of these effects includes;
 1. Increased Excitability: Drugs can make neurons more excitable, meaning they

fire more readily. This can lead to hyperactivity in certain brain circuits, causing

effects like tremors, seizures, or anxiety. It's like lowering the threshold for a

traffic light to turn green, leading to a chaotic flow of information in the brain

circuit. Stimulants like cocaine and amphetamines work in this way, causing an

overstimulation of the dopamine system.

2. Decreased Excitability: On the other hand, some drugs can reduce neuronal

firing, leading to sluggishness, impaired coordination, and cognitive decline. This

is often seen with alcohol use, which disrupts the activity of the GABA system,

leading to a generalized slowing down of brain activity.

3. Disrupted Synchronization: Healthy brain function relies on the coordinated

firing of neurons in specific networks. Drugs can disrupt this synchronization,

leading to problems with communication and information processing.

Brain circuits are specialized groups of interconnected neurons that perform specific

functions. The reward system, for instance, is involved in motivation and pleasure

seeking, while the memory circuit consolidates new experiences and information. When
drug use disrupts these circuits, it can lead to a cascade of effects depending on the circuit

involved:

1. Reward System: Drugs like cocaine and heroin hijack the reward system, flooding

the brain with dopamine and creating an intense feeling of euphoria. This can lead

to compulsive drug use as the brain prioritizes the drug-induced reward over

natural rewards like food and social interaction. Chronic drug use can also damage

the reward system, making it harder to experience pleasure from anything other

than the drug.

2. Memory Circuit: Drugs like marijuana can disrupt the activity of the

hippocampus, a critical region for memory formation. This can lead to difficulty

forming new memories, problems with learning, and impaired decision-making.

Chronic alcohol use can also have a devastating impact on memory, leading to

conditions like Korsakoff's syndrome, characterized by severe memory loss and

confabulation (fabricating memories).

3. Prefrontal Cortex: The prefrontal cortex is responsible for higher-order cognitive

functions like planning, decision-making, and impulse control. Drugs like

 methamphetamine can damage the prefrontal cortex, leading to poor judgment,

risky behavior, and difficulty regulating emotions.

4. Motor Cortex: Drugs that disrupt the motor cortex, responsible for movement

control, can lead to tremors, incoordination, and difficulty with balance. Alcohol

intoxication, for example, impairs the motor cortex, leading to slurred speech and

unsteady gait.

In some cases, the changes in neuronal activity caused by drug use can be permanent.

Excessive use of certain drugs can lead to neurodegeneration, the death of neurons in

specific brain regions. This can have a devastating impact on brain function, leading to

mental decline, dementia, and even Parkinson’s.

The good news is that the brain is a plastic organ. After stopping drug use, the brain can

begin to repair itself. The extent of this recovery depends on several factors, including the

type of drug used, the duration and frequency of use, and the individual's genetics. In

some cases, the brain can fully recover from the damage caused by drugs. However, in

other cases, some of the changes may be permanent.

The human brain is very complex it is a network of neurons working together in perfect

harmony. Drugs and substances can act like conductors, disrupting this delicate operation
and having a series of effects on behavior, cognition, and even brain structure. However,

the brain also possesses a remarkable capacity for healing. By understanding the impact

of drugs on neuronal activity and seeking help when needed, we can work towards

restoring the symphony of the mind and promoting a healthier future for ourselves and

our loved ones.

IMAGING TECHNIQUES USED ON INDIVIDUALS WITH SUBSTANCE USE DISORDER

Substance use disorder is characterized by addictive behaviors that results from dependency on

substances to function normally. The intake of these substances is known to have a physiological

effect in the brain, such as the executive function, reward and stress systems; (Murnane, et.al) and

these effects lead to the modifications/ changes in brain neural functions. Neuroimaging techniques

are used to visualize these changes in order to know the relationship between drug’s ability and areas

of the brain that are affected. The neuroimaging techniques include:

1. Magnetic Resonance imaging

2. Functional Magnetic Resonance Imaging

3. Positron Emission Tomography

4. Single Photon Emission Computerized Tomography

5. Proton Magnetic Resonance Spectroscopy

 MAGNETIC RESONANCE IMAGING

Structural MRI is a structural imaging technique that measures radiofrequency pulses that hydrogen

atoms emit due to their alignment with a powerful magnetic field and uses this to generate high-

resolution images of the brain. It generates information about different brain region, their sizes and
compositions. It provided clearer images than Computerized Tomography (CT) scan. In addition, it

produces in relatively higher spatial resolution and three-dimensional images.

In a study that investigated prefrontal cortex structural deficits in individuals with substance use

disorder. Findings showed that the prefrontal cortex total volume in the substance abuse group is

smaller compared to the control groups, and the deficits are associated with the gray matter but not of

the white matter. Hence, the indication that the atrophy of the prefrontal cortex is associated with

substance abuse and these structural deficits may explain the basis of neurological impairments in

substance abusers (Liu et al, 1998).

Its noninvasive nature makes it safe and suitable for repetitive use by pregnant women and children.

In addition, it is highly versatile and useful in detecting a wide range of neurological diseases.

 FUNCTIONAL MAGNETIC RESONANCE IMAGING

It is a noninvasive imaging technique that provides information about the brain activity by detecting

changes in blood flow and oxygenation in brain regions. When an individual is actively participating

in a task, the brain region responsible for managing this task is stimulated, that is, blood flow will be

increased in that region, for example, individuals who misuse stimulants such as Cocaine, develops

cognitive impairments in their prefrontal cortex and anterior cingulate due to the drug inducing

alterations of the stimulant, these brain regions are responsible for behavioral and cognitive control.

(Kaufman et al,2003; Wexler et al, 2001; & Paulus et al, 2002).

Blood Oxygenation Level-Dependent Functional Magnetic Resonance Imaging (BOLD fMRI)

BOLD fMRI measures neural activity through the blood circulation responses, when a particular

brain region is activated, there is an increased blood and oxygen supply to the brain region, it

measures neural activity by detecting changes in blood oxygenation levels. By interpreting BOLD

findings, researchers and Clinicians can identify the brain regions that are activated during the
consumption of a substance or drug. (Murnane et al, 2023). In a study that examined reactivity to

alcohol, marijuana, polydrug, and emotional picture cues in college students using fMRI BOLD

signals, results showed that alcohol, polydrug, and marijuana cues are responsible for the brain

activation in the left prefrontal cortex, left anterior cingulate, left caudate, and right insula. It was

concluded that the activation of Insula due to the cues may be an early sign of drug abuse

progression (Ray et al, 2010).

The fMRI has low spatial and temporal resolutions , also it cannot scan fast enough to take in

detailed brain activity. In addition, undergoing an fMRI involves the use of Gadolinium, a contrast

material, individuals might experience some side effects. However, this is rare, and if it does happen,

it will not last long.

 POSITRON EMISSION TOMOGRAPHY (PET)

The first neuroimaging technique to provide images of the brain activity and not images of the brain

structure. It uses a radioactive tracer to compute information from the tissues and organs in the body.

The tracer is injected into the body, most often the arm or hand, the tracer will then find its way to

that part of the body that has high level of metabolic activity, which can be viewed during the scan.

In the brain for example, fluorodeoxyglucose (FDg), a radioactive substance that is similar to

Glucose, the primary active substance used by the brain; is injected into the carotid artery. The active

cells in the brain cannot break down the radioactive substance quite easily, so it is accumulated in

active neurons. If this individual were to consume alcohol within this period, the radioactive

substance will move to the brain region affected by the alcohol. That is, if a PET scan were to be

taken after the consumption of alcohol, the prefrontal cerebral cortex will show high biochemical

activity. PET scans are used to quantify the processes of drug metabolism, absorption and

distribution. (Fakhoury,2015) PET studies have demonstrated the consequences of chronic substance

misuse by measuring oxygen usage, metabolism of glucose and blood flow in the brain. It also
demonstrates the capacity of the brain’s plasticity associated with substance misuse by examining

neural changes in neuroinflammation and binding at the receptors. (Murnane et al 2023)

PET is an invasive technique which that involve the injection of a radioactive substance in the body,

although the radiation exposure is low, it is not suitable for pregnant women as the fetus might be

exposed to radiation and also people with bad allergic reactions, as it might trigger an allergic

episode, however this is rare.

 SINGLE PHOTON EMISSION COMPUTERIZED TOMOGRAPHY

SPECT is a brain imaging technique employ the use of radiotracers like PET, However, unlike PET,

SPECT radiotracers emit Gamma rays that can be detected by the gamma detectors surrounding the

individual’s head. A SPECT scan provides a three-dimensional map of the brain activity using blood

flows in the brain. Although, it is a recent imaging technique, it has made significant contributions in

understanding neuronal changes in the brain that are associated with substance use disorder.

Volkow et al (2003) reported that in a neuroimaging study where PET and SPECT were employed in

accessing the neuronal alterations in MDMA users, heavy use of MDMA could results into

neurotoxic effects on the serotonergic neurons, highlighting the role of serotonin in addiction, and

that females are more susceptible to these effects than males. SPECT study on chronic solvent

abusers indicated that regional cerebral blood flow abnormalities in the prefrontal cortex is

associated with chronic solvents abuse, and may the physiological basis of amotivational syndrome,

a psychiatric condition characterized by changes in an individual’s emotion, mental functions, and

personality, it is associated with the misuse of psychoactive substance. ( Okada et al,1999).

 PROTON MAGNETIC RESONANCE SPECTROSCOPY

It is a non-invasive neuroimaging technique that allows the quantification of fast acting drug effects

on the living brain. This imaging technique do this by providing information on certain compounds
found in the brain such as the neurotransmitters, Glutamate and Gamma aminobutyric acid (GABA).

It plays a vital role in understanding disorders with high neuronal alterations, such as substance

abuse; 1H-MRS was used to detect rapid drug-induced effects on a living brain metabolic activity,

findings showed that it is highly useful for CNS drug development and also for understanding the

neural mechanism of drug-inducing effects on cognition, emotion, and behavior (White &

Gonsalves, 2020). In a study investigating the ability of the MRS in detecting long term metabolic

abnormalities in abstinent methamphetamine users, results provide evidence to support long term

neuronal damage in abstinent methamphetamine users (Ernst et al,2000).

Despite MRS strengths, it has low spatial resolution compared to structural Magnetic resonance

imaging and its lack of whole-brain coverage, it can only be used to examine a specific brain region.

Also, interpreting the MRS data signals can be time consuming.

CONCLUSION

In conclusion, substance use disorders (SUDs) affects millions of people globally and it represents a

significant amount of risk to public health. These chronic conditions, which are characterised by an

obsession with drug use despite it’s harmful repercussions, have a big influence on people's

relationships with their families and friends as well as the welfare of society as a whole. In this work,

we have examined the neurobiology of drug addiction, the effects of various substances on

individuals health, and the structural and functional changes that drug users and substance addicts
may experience in their brains. Furthermore, we have provided an extensive overview of the range of

available treatment choices, highlighting the need of tailored and multifaceted approaches in

supporting individuals as they progress towards recovery.

The neuronal underpinnings of substance use disorders are complicated, as our understanding of

them grows. Current neuroimaging methods have completely changed our capacity to see and

measure the alterations that take place in the brains of those suffering from SUDs. For example,

magnetic resonance imaging (MRI) has identified structural abnormalities in the prefrontal cortex of

substance abusers, and it offers concrete proof of the physical toll these illnesses can have on

individuals. These results, along with those of Liu et al. (1998) have implied that some of the

neurological deficits seen in individuals with substance use disorders may be explained by prefrontal

cortical atrophy.

More knowledge has been provided by functional magnetic resonance imaging (fMRI) on the

dynamic alterations in brain activity linked to substance use. Research employing this methodology

has revealed modifications in the prefrontal cortex and anterior cingulate of stimulant abusers, such

as cocaine users therefore underscoring the influence on areas accountable for behavioural and

cognitive regulation (Kaufman et al., 2003; Wexler et al., 2001; Paulus et al., 2002). These

discoveries offer vital new understandings of the brain processes behind the loss of control and

obsessive drug-seeking behaviours typical to SUDs.

Our understanding has further been enhanced by other imaging modalities like Single Photon

Emission Computerised Tomography (SPECT) and Positron Emission Tomography (PET).

According to Fakhoury (2015), PET studies have shown the effects of long-term drug abuse by

assessing blood flow, glucose metabolism, and oxygen consumption in the brain. Similarly, regional

cerebral blood flow anomalies in the prefrontal cortex have been associated to chronic solvent
misuse by SPECT investigations, such as that carried out by Okada et al. (1999). This finding

suggests a possible physiological basis for disorders such as amotivational syndrome.

These neurological discoveries have significant therapeutic implications and go beyond academic

research. Understanding the particular brain circuits and neurotransmitter systems that different

medications affect has allowed for more specialised pharmacological interventions. For example,

medications such as naltrexone for alcohol dependency and buprenorphine for opiate use disorders

work by changing the same neurotransmitter systems that are dysregulated by these substances.

However, as this paper has demonstrated, there are other effective treatments for substance use

disorders than medication. The American Psychiatric Association's practice recommendation (Kleber

et al., 2007) highlights the importance of a comprehensive, tailored approach that integrates

pharmacological, psychosocial, and environmental therapy as necessary. This multimodal approach

recognises that SUDs are complex disorders influenced by a multitude of factors, such as the social

environment, co-occurring mental health conditions, past experiences, and genetic susceptibility.

The patient's particular needs, interests, and circumstances should be taken into consideration while

choosing a treatment modality. For example, a patient with a long history of opioid dependence may

benefit from both methadone or buprenorphine maintenance treatment as well as extensive

psychological care. On the other hand, a college student who is struggling with marijuana use would

benefit more from a relapse prevention programme that incorporates motivational therapies and the

development of coping mechanisms.

Furthermore, the significance of treating co-occurring diseases has been emphasised in our

work. Due to the high rate of comorbidity, specific therapy and thorough diagnostic distinction are

required for substance use disorders and other psychiatric diseases. For example, in addition to drugs
specific to each ailment, a patient with cocaine addiction and depression may require integrated

psychosocial therapy.

It's critical to keep in mind that treating substance use disorders cannot be approached in a one-size-

fits-all manner. It requires ongoing assessment and adjustment in response to the individual's

reaction and changing needs. According to the practice guideline, "Patients usually need long-term

therapy since many substance use disorders are chronic; however, the exact therapies used to

accomplish these goals and their intensity may vary over time."

This is further supported by our examination of several substance-specific treatments. The rate of

nicotine dependency cessation can be significantly increased by combining cognitive-behavioral

therapy with medication support such as bupropion or nicotine replacement therapy. On the other

hand, when paired with psychosocial therapies such as 12-step facilitation or motivational

enhancement therapy, drugs such as acamprosate may help abstinent persons experience a decrease

in cravings associated with alcohol use disorders. It's interesting to note that while specific drugs can

effectively treat nicotine addiction, opiate addiction, and alcoholism, this isn't always the case with

other substance abuse disorders.

According to this paper, "Although previous studies have significantly improved our understanding

of the neurobiological mechanisms of substance use disorder in humans, more work need to be done

to identify potential therapeutic targets and develop new treatment strategies." For instance, there is

presently no FDA-approved pharmaceutical available to treat cocaine dependence, despite the fact

that psychosocial therapies like cognitive-behavioral therapy are successful in treating cocaine

addiction.. The primary focus of treatment for alcohol use disorders is intoxication and withdrawal

management. Patients experiencing mild to severe withdrawal are managed with thiamine,

benzodiazepines, fluids, and sometimes other medications. As a result, medications including

naltrexone, acamprosate, and disulfiram that have demonstrated a moderate level of success have
been demonstrated. These are commonly combined with psychosocial therapies as behavioural

therapy, MET, CBT, and 12-step facilitation (TSF) (Kleber et al., 2007; NIDA, 2023).

Treatment for opioid use disorders must include managing intoxication and withdrawal. Treatment

with naloxone for severe opioid overdoses needs to start right away. Effective methods for managing

opioid withdrawal include clonidine combined with buprenorphine or methadone substitutes, or

clonidine-naltrexone detoxification. In addition to psychosocial therapies such group therapy,

cognitive behavioural therapy, and behavioural therapies, maintenance with methadone or

buprenorphine is advised for long-term treatment (Kleber et al., 2007; NIDA, 2023).

This deficiency in our toolbox of pharmacological tools emphasises the continuous necessity for this

kind of study. According to Murnane et al. (2023), neuroimaging methods keep advancing our

knowledge of the neurobiology of drug use problems, which can help with the creation of novel,

focused treatments. Proton magnetic resonance spectroscopy (1H-MRS) has demonstrated potential

in promptly identifying drug-induced modifications to the metabolic activity of living brains, hence

expediting the development of CNS drugs.

Additionally, we have stressed in this paper the significance of treating the patient as a whole.

Gender, age, cultural background, and family dynamics are a few examples of factors that can have a

big impact on how drug use disorders progress and turn out. When a pregnant woman has an opioid

use disorder, treatment with methadone or buprenorphine in conjunction with psychosocial support

may be effective because the hazards of ongoing substance use are frequently higher than the risks

that these medications represent to the developing foetus.

The field of treating substance use disorders has a great deal of promise for the future. Together, the

domains of neuroscience, digital technology, personalised medicine, and cultural competence are

yielding solutions that are more effective, accessible, and empowering. The core principles of
clinical psychology, have not changed despite all of these scientific and technological developments

of a strong regard for human dignity, a conviction that every person has the capacity to grow, and a

steadfast dedication to supporting people as they journey towards recovery and self-realization.

To summarise, the history of clinical psychology's approach to substance use disorders has been

marked by advancements, adaptability, and optimism. It is the story of dedicated experts who put in

endless hours to help people break free from the grip of addiction. Their knowledge and skills are

always growing. Moving forward, we will not waver from the fundamental principles that have

guided our industry: respect, empathy, and a strong conviction that the human spirit can triumph over

the most difficult obstacles. By doing this, we pay tribute to the many people who have battled drug

use disorders and those who have triumphed over their issues while also paving the path for those

who have not yet started their path to freedom.

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