Substance use disorders

Dependence a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and typically include: a strong desire to take the drug difficulties in controlling its use persisting in its use despite harmful consequences a higher priority given to drug use than to other activities and obligations increased tolerance physical withdrawal state.

Substance Abuse

A maladaptive pattern of substance use leading to clinically significant impairment or distress failure to fulfill major role obligations at work, school, or home physically hazardous legal problems social or interpersonal problems

Substance Withdrawal

Characterized by a cluster of symptoms often specific to the drug used Develop on total or partial withdrawal of drug Usually after repeated or high dose use Relieved by further substance use.

Dependent producing drugs

Alcohol Opioids Cannabinoids Cocaine Amphetamine Sedatives Inhalants Nicotine

Etiology-biological

Genetic Psychiatric disorder Medical disorder Reinforcing effects Withdrawal and craving Biochemical factors

Etiology-psychological

Curiosity Poor impulse control Sensation seeking Low self esteem Stress management Escape from reality

Etiology-social

Peer pressure Modelling Ease of availability Permissive social attitudes Religious reasons

Alcohol

Blood level 25-100mg% 80 % 100-200 % 200-300 % 300-350 % 350-400 % >400 %

Behaviour Excitement Legal limit for driving Slurred speech Dangerous Cold sweats Coma, breathing difficulty Death

Acute Effects
CNS Depressant Depression of inhibitory control Vasodilation, warm, flushed, reddish skin Emotional outbursts Decreased memory & concentration Poor judgment Decreased reflexes Decreased sexual response

Withdrawal (hangover)

Tremors Vomiting Insomnia Weakness Irritability Anxiety Seizure Hallucination Delirium

"Binge" drinking means having 5 or more drinks on one occasion. "blackouts"--forgetting what you did while drinking

Complications

Medical problems:liver failure Peptic ulcer Pancreatitis malabsorption Psychiatric problems:delerium tremens Rum fits Alcoholic hallucinosis Pathological intoxication Blackouts Depression,delusional disorder

Neurological problems:peripheral neuropathy wernickes encephalopathy Alcoholic dementia Cerebellar degeneration Headinjury and fractures

Metabolism I
H H H H OH
ADH

C
H

C
H

C
H

C =O
H

Ethanol

Acetaldehyde

(ADH Alcohol Dehydrogenase)

Metabolism II
H
H C H C =O H
ALDH

H
H C H C =O OH

Acetaldehyde

Acetate

(ALDH Acetaldehyde Dehydrogenase)

Treatment

Detoxification Behavioral therapy Group therapy Deterrent drugs Anticraving drugs Treatment of complications

Opioids

Morphine Brown sugar Codiene Heroin Spasmoproxyvon Cough syrups

Complications

Intoxication Withdrawal Parkinsonism,neuropathy AIDS,hepatitis,infections Legal issues

Cannabinoids

Derived from cannabis sativa Hashish/charas Ganja Bhang Hash oil

Physical Effects of use: Dry mouth, nausea, headache, decreased coordination, increased heart rate, reduced muscle strength, increased appetite and eating Mental Effects of use: Anxiety, paranoia, confusion, anger, hallucinations, tiredness, possible suicidal thoughts

Complications

Psychiatric disorders Amotivational syndrome Cannabis psychosis Relapse of schizophrenia

Sedatives

Benzodiazepines(sleeping pills) Both physical and psychological dependence Withdrawal as anxiety,irritability,insomnia Treatment by gradual withdrawal in stepwise manner

Inhalants-petrol,spray paints etc.

Chemicals that are huffed or sniffed like paint thinners, gasoline, glue, butane lighters, propane tanks, aerosol sprays, nail polish remover, etc.

Effects of Use: Slows down the bodys functioning, loss of body control, passing-out, permanent hearing loss, permanent muscle spasms and twitches, cancer, brain damage, bone damage, liver & kidney damage, heart failure and possible death.

Hallucinogens

LSD, Acid, PCP, Angel Dust, Mushrooms or Shrooms are all hallucinogens that alter the time, reality and environment around you. Long term effects can include flashbacks, schizophrenia and severe depression.

Methamphetamine

Meth, Speed or Chalk is taken by mouth, by snorting the powder, by needle injection, and by smoking. Effects of Use: Brain damage, confusion, anxiety, paranoia, anger, stroke, high body temperature, and convulsions which can lead to death.

Nicotine
Nicotine in a cigarette 8 to 10 mg Smoking delivers about 1 mg to the smoker Technique of smoker can increase nicotine (time smoke is in lungs, rapid puffing) Lung (nicotine enters brain in 7 seconds)

withdrawal
Restlessness Anxiety, hostility Irritability, impatience Difficulty concentrating Increased appetite (weight gain) Depression