Types of Substance-Related Disorders

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Currently, there are three types of disorders caused by the use of psychoactive substances, let's talk about the first:

Drug-induced psychoses are non-specific and can be identified in the ICD-10 or DSM-5 as substance-induced psychotic disorders. However, the ability to provoke psychotic symptoms varies considerably from substance to substance.

For example, cocaine or amphetamine-type substances can unequivocally lead to various psychoses, and there is also clear evidence for cannabinoids. But, for example, opiates or benzodiazepines are the least likely to cause such conditions.

On the other hand, in the case of serotonergic hallucinogens, the assessment of the potential danger is currently much less clear. It is possible that LSD may contribute to the onset of schizophrenic psychosis in people vulnerable to this clinical picture. At the same time, in individual cases, it is not clear whether psychosis would have occurred in these people without taking the substance at a later point in time.

The available data on the occurrence of anxiety disorders are also mixed. In a survey of 4,745 people, regular or excessive use of hallucinogenic substances was found to be associated with an increased risk of panic disorder. In contrast, intermittent use has not shown an increased risk.

However, an association has been reported between the occurrence of anxiety disorders and users of substances such as heroin or benzodiazepines, substances that tend to have a sedative effect and are therefore etiologically unlikely to be the precipitating agent. Therefore, it can be assumed that in many cases the anxiety disorder was present even before the hallucinogens were taken and thus could be considered as a non-specific risk factor for overconsumption.

Definitions of the flashback phenomenon have varied considerably since its first description in 1954. Flashbacks are short-term visual pseudohallucinations that occur after a break in the use of psychoactive substances and are expressed as spontaneous, in most cases uncontrolled effects experienced under the influence of substances. These phenomena are also called "free trip". Flashbacks usually last from a few seconds to minutes (especially visual ones). They are usually not distressing to those affected and almost never lead to help-demanding behavior.

The term HPPD "Hallucinogen Persisting Perception Disorder" does not appear in the ICD-10.

It should be emphasized that the criteria for diagnosing HPPD almost never apply to flashbacks, since they usually do not cause psychological stress or other disturbances. Note that the term "retrospective" is used very differently. It is necessary to clearly separate this designation as a description of the phenomenon of perception, and not a state of memory or emotional experience. Some researchers believe that the use of the term "retrospective" or flashback is misleading. However, most of the literature distinguishes between flashbacks and HPPD, while other authors conceptualize both forms as subforms of HPPD (HPPD type I: transient type, and type II: chronically persistent type).

Accordingly, it has not been fully elucidated to what extent flashbacks and HPPD are etiologically distinct entities of the disorder.

  1. On the one hand, the similarity between the two phenomena is obvious in terms of symptoms;
  2. On the other hand, it can be assumed that there is a continuum of perceptual changes with varying degrees of severity.

It is most rational to consider flashbacks separately from HPPD. In turn, HPPD should be divided into types, depending on the severity of the impact of disorders on the patient's activity, thus: