Specific Symptom Sets: Clinical Phenomenology

R. Andrew Chambers; Kevin G. Masterson

doi:10.1017/9781009501439.003

2 - Specific Symptom Sets: Clinical Phenomenology

Published online by Cambridge University Press: 03 April 2025

R. Andrew Chambers and

Kevin G. Masterson

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R. Andrew Chambers: Affiliation:
Indiana University School of Medicine, Indianapolis
Kevin G. Masterson: Affiliation:
Linden Oaks Hospital, Naperville

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Summary

The addiction syndrome is quite similar across different addictive drug types, reflecting a shared pathway of pathological changes within motivational circuits that increasingly prioritize drug acquisition and use. This neurobiology, and drug addiction symptomatology, overlaps considerably with behavioral addictions (e.g., gambling disorder). However, addiction is distinct from symptoms and mechanisms underpinning intoxication and withdrawal, which are diverse and unique to each drug class. The intoxication phase is followed by some degree of withdrawal, manifesting clinically as opposite to intoxication, reflecting a homeostatic response to it. Withdrawal has a quality, duration, and dangerousness that depends on the individual, the drug type, and drug use history. Heavy/chronic patterns of use in addiction can produce longer, more severe withdrawal phases, but addiction and withdrawal can exist separately. How a drug acts upon different receptors and other downstream brain systems (pharmacodynamics) impacts the strength of its psychoactive (intoxicating) and motivational (addictive effects). Meanwhile, the route and rate of drug intake and its breakdown and elimination (pharmacokinetics) can also impact intoxication, withdrawal, and addiction risk. With addiction, the patient becomes tolerant (insensitive) to the intoxicating profiles of drugs they like, whereas their motivation, craving, and wanting to use the drug sensitizes (grows pathologically).

Keywords

Intoxication Withdrawal Tolerance Sensitization Homeostasis Disinhibition Pharmacodynamics Pharmacokinetics Hyperalgesia Substance use disorder

Type: Chapter
Information: Introduction to Addiction Psychiatry , pp. 36 - 78

DOI: https://doi.org/10.1017/9781009501439.003 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2025

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References

American Psychiatric Association, DSM-5 Task Force. 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (American Psychiatric Association: Washington, DC).Google Scholar

Banerjee, N. 2014. Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian J Hum Genet, 20: 20–31.CrossRef Google Scholar PubMed

Bruehl, A. M., Lende, D. H., Schwartz, M., Sterk, C. E., and Elifson, K.. 2006. Craving and control: Methamphetamine users’ narratives. J Psychoactive Drugs, Suppl 3: 385–92.Google Scholar PubMed

Burkett, J., and Young, L.. 2012. Love and addiction: An uneasy marriage? A response to “The devil is in the differences.” Psychopharmacology, 224: 31–32.Google Scholar

Burma, N. E., Kwok, C. H., and Trang, T.. 2017. Therapies and mechanisms of opioid withdrawal. Pain Manag, 7: 455–59.Google Scholar PubMed

Chambers, R. A. 2009. A nicotine challenge to the self-medication hypothesis in a neurodevelopmental animal model of schizophrenia. J Dual Diagn, 5: 139–48.CrossRef Google Scholar

Chambers, R. A. 2010. Dazed and confused by self-medication. Am J Psychiatry, 167: 600; author reply 600–01.Google Scholar PubMed

Chambers, R. A., and Greene, M. S.. 2016. Physician understanding and treatment of addiction: Have “pseudoaddiction” and “self-medication” led us astray? J Addiction Depend, 2: 1–4.Google Scholar

Christie, M. J. 2008. Cellular neuroadaptations to chronic opioids: Tolerance, withdrawal and addiction. Br J Pharmacol, 154: 384–96.CrossRef Google Scholar PubMed

Colrain, I. M., Nicholas, C. L., and Baker, F. C.. 2014. Alcohol and the sleeping brain. Handb Clin Neurol, 125: 415–31.Google Scholar PubMed

Davies, M. 2003. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci, 28: 263–74.Google Scholar PubMed

de Wit, H., Uhlenhuth, E. H., Hedeker, D., McCracken, S. G., and Johanson, C. E.. 1986. Lack of preference for diazepam in anxious volunteers. Arch Gen Psychiatry, 43: 533–41.Google Scholar PubMed

Fischman, M. W. 1989. Relationship between self-reported drug effects and their reinforcing effects: Studies with stimulant drugs. NIDA Res Monogr, 92: 211–30.Google Scholar PubMed

Fischman, M. W., and Foltin, R. W.. 1992. Self-administration of cocaine by humans: A laboratory perspective. Ciba Found Symp, 166: 165–73; discussion 73–80.Google Scholar PubMed

Friedman, L., Fleming, N. F., Roberts, D. H., and Hyman, S. E. (eds.). 1996. Source Book of Substance Abuse and Addiction (Williams & Wilkins: Baltimore, MD).Google Scholar

Gilpin, N. W., and Koob, G. F.. 2008. Neurobiology of alcohol dependence: Focus on motivational mechanisms. Alcohol Res Health, 31: 185–95.Google Scholar PubMed

Greene, M. S., and Chambers, R. A.. 2015. Pseudoaddiction: Fact or fiction? An investigation of the medical literature. Curr Addict Rep, 2: 310–17.CrossRef Google Scholar PubMed

Harris, R. A., Trudell, J. R., and Mihic, S. J.. 2008. Ethanol’s molecular targets. Sci Signal, 1: re7.Google Scholar PubMed

Jensen, E. L., Gerber, J., and Mosher, C.. 2004. Social consequences of the war on drugs: The legacy of failed policy. Crim Just Pol Rev, 15: 100–21.Google Scholar

Keegan, J., Parva, M, Finnegan, M., Gerson, A., and Belden, M.. 2010. Addiction in pregnancy. J Addict Dis, 29: 175–91.CrossRef Google Scholar PubMed

Kreek, M. J. 2011. Extreme marginalization: Addiction and other mental health disorders, stigma, and imprisonment. Ann N Y Acad Sci, 1231: 65–72.CrossRef Google Scholar PubMed

Kushner, M. G., Abrams, K., and Borchardt, C.. 2000. The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clin Psychol Rev, 20: 149–71.CrossRef Google Scholar PubMed

Lamb, R. J., Preston, K. L., Schindler, C. W., Meisch, R. A., Davis, F., Katz, J. L., Henningfield, J. E., and Goldberg, S. R.. 1991. The reinforcing and subjective effects of morphine in post-addicts: A dose–response study. J Pharmacol Exp Ther, 259: 1165–73.CrossRef Google Scholar PubMed

Lee, M., Silverman, S. M., Hansen, H., Patel, V. B., and Manchikanti, L.. 2011. A comprehensive review of opioid-induced hyperalgesia. Pain Physician, 14: 145–61.Google Scholar PubMed

Lembke, A. 2012. Time to abandon the self-medication hypothesis in patients with psychiatric disorders. Am J Drug Alcohol Abuse, 38: 524–29.CrossRef Google Scholar PubMed

Lembke, A. 2016. Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press: Baltimore, MD).Google Scholar

Littleton, J. 2001. Receptor regulation as a unitary mechanism for drug tolerance and physical dependence: Not quite as simple as it seemed! Addiction, 96: 87–101.CrossRef Google Scholar PubMed

McBride, W. J., Murphy, J. M., and Ikemoto, S.. 1999. Localization of brain reinforcement mechanisms: Intracranial self-administration and intracranial place-conditioning studies. Behav Brain Res, 101: 129–52.Google Scholar PubMed

Meldrum, D. R., Gambone, J. C., Morris, M. A., Meldrum, D. A., Esposito, K., and Ignarro, L. J.. 2011. The link between erectile and cardiovascular health: The canary in the coal mine. Am J Cardiol, 108: 599–606.CrossRef Google Scholar PubMed

Meredith, S. E., Juliano, L. M., Hughes, J. R., and Griffiths, R. R.. 2013. Caffeine use disorder: A comprehensive review and research agenda. J Caffeine Res, 3: 114–30.CrossRef Google Scholar PubMed

Moore, L. D., and Elkavich, A.. 2008. Who’s using and who’s doing time: Incarceration, the war on drugs, and public health. Am J Public Health, 98: 782–86.CrossRef Google Scholar PubMed

Petry, N. M., Bickel, W. K., and Arnett, M.. 1998. Shortened time horizons and insensitivity to future consequences in heroin addicts. Addiction, 93: 729–38.Google Scholar PubMed

Prochaska, J. J., Hall, S. M., and Bero, L. A.. 2008. Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? Schizophr Bull, 34: 555–67.Google Scholar PubMed

Robinson, T. E., and Berridge, K. C.. 1993. The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Res Rev, 18: 247–91.Google Scholar PubMed

SAMHSA. 2016. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health (SAMHSA: Rockville, MD).Google Scholar

Vaillant, G. E., and Keller, M.. 2023. Alcohol consumption. In Encyclopedia Britannica.Google Scholar

Weissman, D. E., and Haddox, J. D.. 1989. Opioid pseudoaddiction: An iatrogenic syndrome. Pain, 36: 363–66.CrossRef Google Scholar PubMed