650 



182 Psychoactive Substance Use Disorders 



presence or other smokers and the widespread availability of cigarettes. When efforts 

 to give up smoking are made. Nicotine Withdrawal may develop. 



Impairment. Since nicotine, unlike alcohol, rarely causes any clinically significant 

 state of intoxication, there is no impairment in social or occupational functioning as an 

 immediate and direct consequence of its use. 



Complications. The most common complications are bronchitis, emphysema, cor- 

 onary artery disease, penpheral vascular disease, and a variety of cancers. 



Prevalence and sex ratio. A large proportion of the adult population of the United 

 States has Nicotine Dependence, the prevalence among males being greater than that 

 among females. Among teen-age smokers, males are affected approximately as often as 

 females. .. 



Familial pattern. Cigarette smoking among first-degree biologic relatives of people 

 with Nicotine Dependence is more common than among the general population. 

 Evidence for a genetic faaor has been documented, but the effect is modest. 



304.00 Opioid Dependence 

 305.50 Opioid Abuse 



See Opioid-induced Organic Mental Disorders (p. 151) for a description of Opioid 

 Intoxication and Withdrawal. 



This group includes natural opioids, such as heroin and morphine, and synthetics 

 with morphinelike action, which act on opiate receptors. These compounds are pre- 

 scribed as analgesics, anesthetics, or cough-suppressants. They include codeine, 

 hydromorphone, meperidine, methadone, oxycodone, and others. Several other com- 

 pounds that have both direct opiatelike agonist effects and antagonist effects are 

 included in this class of substances because they often produce the same physiologic 

 and behavioral effeas as pure opioids, e.g., pentazocine and buprenorphine. Prescrip- 

 tion opiates are typically taken orally in pill form, but can also be taken intravenously; 

 heroin is typically taken intravenously, but can also be taken by nasal inhalation or 

 smoking. Regular use of these substances leads to remarkably high levels of tolerance. 



Although methadone is included in this class, people properly supervised in a 

 methadone maintenance program should not develop any of the Opioid-induced 

 Organic Mental Disorders. When the criteria for one of these diagnoses are met, this 

 indicates that there has been nonmedical use of methadone, in which case the appro- 

 priate didgnusib shuuid be made. 



Patterns of use. There are two patterns of development of dependence and abuse. 

 In one, which is relatively infrequent, the person originally obtained an opioid by 

 prescription, from a physician, for the treatment of pain or cough-suppression, but has 

 gradually increased the dose and frequency of use on his or her own. The person 

 continues to justify the substance use on the basis of treatment of symptoms, but 

 substance-seeking behavior becomes prominent, and the person may go to several 

 physicians in order to obtain sufficient supplies of the substance. 



A second pattern that leads to dependence or abuse involves young people in 

 their teens or early 20s who, with a group of peers, use opioids obtained from illegal 

 sources. Some use an opioid alone to obtain a "high," or euphoria. Others use these 

 substances in combination with amphetamines, cannabis, hallucinogens, or sedatives 

 to enhance the euphoria or to counteract the depressant effect of the opioid. In this 



