Substance abuse is a very common problem in the current scenario. lets discuss few types of Substance related disorders.

1. Dynamics of substance related
disorders
Sayani samanta
M.Sc. Nursing 2nd year

2. TERMS USED IN SUBSTANCE RELATED
DISORDER
• Dependence: The repeated use of a drug or chemical substance,
with or without physical dependence. Physical dependence indicates
an altered physiologic state caused by repeated administration of a
drug, the cessation of which results in a specific syndrome.
• Abuse: Use of any drug, usually by self-administration, in a manner
that deviates from approved social or medical patterns.
• Misuse: Similar to abuse, but usually applies to drugs prescribed by
physicians that are not used properly.

3. Cont..
• Addiction: The repeated and increased use of a substance,
the deprivation of which gives rise to symptoms of distress
and an irresistible urge to use the agent again and which
leads also to physical and mental deterioration.
• Intoxication: A reversible syndrome caused by a specific
substance (e.g., alcohol) that affects one or more of the
following mental functions: memory, orientation, mood,
judgment, and behavioral, social, or occupational
functioning.

4. Cont..
• Withdrawal: A substance-specific syndrome that
occurs after stopping or reducing the amount of the
drug or substance that has been used regularly over
a prolonged period. The syndrome is characterized
by physiological signs and symptoms in addition to
psychological changes, such as disturbances in
thinking, feeling, and behavior. Also called
abstinence syndrome or discontinuation syndrome.

5. Cont..
• Tolerance: Phenomenon in which, after repeated
administration, a given dose of drug produces a
decreased effect or increasingly larger doses
must be administered to obtain the effect
observed with the original dose. Behavioral
tolerance reflects the ability of the person to
perform tasks despite the effects of the drug.

6. Predisposing Factors

7. • Genetics
• Biochemical aspects: alcohol may produce morphine-like
substances in the brain that are responsible for alcohol
addiction. These substances are formed by the reaction of
biologically active amines (e.g., dopamine, serotonin) with
products of alcohol metabolism, such as acetaldehyde.
Biological factors

8. Psychological factors
• Developmental influences: The psychodynamic approach to
the etiology of substance abuse focuses on a punitive
superego and fixation at the oral stage of psychosexual
development.
• Personality factors: Some clinicians believe low self-esteem,
frequent depression, passivity, the inability to relax or to
defer gratification, and the inability to communicate
effectively are common in individuals who abuse substances.

9. Socio cultural factors
• Social learning: The effects of modeling, imitation, and
identification on behavior can be observed from early
childhood onward.
• Conditioning: Many substances create a pleasurable
experience that encourages the user to repeat it.
• Cultural and ethnic influencing: Incidence of alcohol
dependence among Asians is relatively low. This may be a
result of a possible genetic intolerance of the substance.

10. Alcohol abuse and dependence
• Alcohol is a natural substance formed by the reaction of
fermenting sugar with yeast spores.
• The alcohol content varies by type of beverage. For
example, most American beers contain 3 to 6 percent
alcohol, wines average 10 to 20 percent, and distilled
beverages range from 40 to 50 percent alcohol.

11. Why do people drink?

12. Effects on the body
• Peripheral neuropathy: Peripheral neuropathy,
characterized by peripheral nerve damage, results in
pain, burning, tingling, or prickly sensations of the
extremities.

13. • Alcohol Myopathy: Alcoholic myopathy may occur as
an acute or chronic condition. In the acute condition,
the individual experiences a sudden onset of muscle
pain, swelling, and weakness; a reddish tinge in the
urine caused by myoglobin, a breakdown product of
muscle excreted in the urine; and a rapid rise in
muscle enzymes in the blood.
• The symptoms of chronic alcoholic myopathy include
a gradual wasting and weakness in skeletal muscles.

14. • Wernicke’s Encephalopathy
It represents the most serious form of thiamine
deficiency in alcoholics. Symptoms include paralysis
of the ocular muscles, diplopia, ataxia, somnolence,
and stupor. If thiamine replacement therapy is not
undertaken quickly, death will ensue.

15. • Korsakoff’s psychosis: It is identified by a syndrome of
confusion, loss of recent memory, and confabulation in
alcoholics.
• Treatment is with parenteral or oral thiamine
replacement.
• Alcohol cardiomyopathy: The effect of alcohol on the
heart is an accumulation of lipids in the myocardial
cells, resulting in enlargement and a weakened
condition.

16. CONT..
• Symptoms include decreased exercise tolerance,
tachycardia, dyspnea, edema, palpitations, and cough.
Laboratory studies may show elevation of the enzymes
CPK, AST, alanine aminotransferase (ALT), and LDH.
Changes may be observed by electrocardiogram, and
congestive heart failure may be evident on chest X-ray
films.
• The treatment is total permanent abstinence from alcohol.

17. • Esophagitis: inflammation and pain in the esophagus—
occurs because of the toxic effects of alcohol on the
esophageal mucosal. It also occurs because of frequent
vomiting associated with alcohol abuse.
• Gastritis: effects of alcohol on the stomach include
inflammation of the stomach lining characterized by
epigastric distress, nausea, vomiting, and distention.
• Alcohol breaks down the stomach’s protective mucosal
barrier, allowing hydrochloric acid to erode the stomach
wall. Damage to blood vessels may result in hemorrhage.

18. • Pancreatitis: Acute pancreatitis usually occurs 1 or 2
days after a binge of excessive alcohol consumption.
Symptoms include constant, severe epigastric pain,
nausea and vomiting, and abdominal distention. The
chronic condition leads to pancreatic insufficiency
resulting in steatorrhea, malnutrition, weight loss, and
diabetes mellitus.

19. • Alcohol Hepatitis: Alcoholic hepatitis is inflammation of
the liver caused by long-term heavy alcohol use. Clinical
manifestations include an enlarged and tender liver,
nausea and vomiting, lethargy, anorexia, elevated white
blood cell count, fever, and jaundice. Ascites and weight
loss may be evident in more severe cases.
• With treatment—which includes strict abstinence from
alcohol, proper nutrition, and rest—the individual can
experience complete recovery.

20. Chirrhosis of Liver
• There is widespread destruction of liver cells, which are
replaced by fibrous (scar) tissue.
• Portal Hypotention
• Ascites
• Esophageal varices
• Hepatic encephalopathy
• Treatment requires complete abstention from alcohol,
temporary elimination of protein from the diet, and reduction
of intestinal ammonia using neomycin or lactulose.

21. • Leukopenia: Production, function, and movement of
the white blood cells are impaired in chronic alcoholics.
• Thrombocytopenia: Platelet production and survival are
impaired as a result of the toxic effects of alcohol.
• Sexual Dysfunction: For women, this can mean changes
in the menstrual cycles and a decreased or loss of ability
to become pregnant. For men, the decreased hormone
levels result in a diminished libido, decreased sexual
performance, and impaired fertility.

22. Fetal Alcohol Syndrome
• Prenatal exposure to alcohol can result in a broad range of disorders
to the fetus, known as fetal alcohol spectrum disorders (FASDs), the
most common of which is fetal alcohol syndrome (FAS).
• Children with FAS may have the following characteristics or exhibit
the following behaviors: Small size for gestational age, Facial
abnormalities, Poor coordination or delays in psychomotor
development, Hyperactive behavior, Learning disabilities, Mental
retardation, Problems with daily living, Vision or hearing problems,
poor judgement skill, sleep and sucking disturbances, heart &
kidney defects.

23. Alcohol intoxication
• Symptoms of alcohol intoxication include disinhibition of
sexual or aggressive impulses, mood lability, impaired
judgment, impaired social or occupational functioning,
slurred speech, incoordination, unsteady gait, nystagmus,
and flushed face.
• Intoxication usually occurs at blood alcohol levels
between 100 and 200 mg/dL. Death has been reported at
levels ranging from 400 to 700 mg/dL.

24. Alcohol withdrawal
• Within 4 to 12 hours of cessation of or reduction in heavy
and prolonged (several days or longer) alcohol use, the
following symptoms may appear: coarse tremor of hands,
tongue, or eyelids; nausea or vomiting; malaise or
weakness; tachycardia; sweating; elevated blood pressure;
anxiety; depressed mood or irritability; transient
hallucinations or illusions; headache; and insomnia

25. Sedative, Hypnotics or Anxiolytic
Abuse and Dependence

26. Effects on the body
• Effects on sleep and dreaming
• Respiratory depression
• Cardiovascular effects
• Renal function
• Hepatic effect
• Body temperature
• Sexual functioning

27. Sedative, Hypnotics or Anxiolytic
Intoxication
• Maladaptive changes may include inappropriate sexual or
aggressive behavior, mood lability, impaired judgment, or
impaired social or occupational functioning. Other
symptoms that may develop with excessive use of
sedatives, hypnotics, or anxiolytics include slurred speech,
incoordination, unsteady gait, nystagmus, impairment in
attention or memory, and stupor or coma.

28. Sedative, Hypnotics or Anxiolytic
Withdrawal
• Withdrawal symptoms associated with sedatives,
hypnotics or anxiolytics include autonomic
hyperactivity (e.g., sweating or pulse rate greater
than 100), increased hand tremor, insomnia, nausea
or vomiting, hallucinations, illusions, psychomotor
agitation, anxiety, or grand mal seizures.

29. CNS Stimulant Abuse and Dependence

30. Effects on the body
• Central Nervous System
• Cardiovascular/ pulmonary effects
• Gastrointestinal and renal effect
• Sexual functioning

31. CNS Stimulant Intoxication
• Amphetamine and cocaine intoxication typically produces
euphoria or affective blunting; changes in sociability;
hypervigilance; interpersonal sensitivity; anxiety, tension, or
anger; stereotyped behaviors; or impaired judgment.
• Physical effects include tachycardia or bradycardia, pupillary
dilation, elevated or lowered blood pressure, perspiration or
chills, nausea or vomiting, weight loss, psychomotor agitation or
retardation, muscular weakness, respiratory depression, chest
pain, cardiac arrhythmias, confusion, seizures, dyskinesias,
dystonias, or coma.

32. CNS Stimulant Withdrawal
• Withdrawal from amphetamines and cocaine cause
dysphoria, fatigue, vivid unpleasant dreams, insomnia or
hypersomnia, increased appetite, and psychomotor
retardation or agitation.
• Caffeine withdrawal symptoms include: headache, fatigue,
anxiety, irritability, depression, impaired psychomotor
performance, nausea, vomiting, craving for caffeine, and
muscle pain and stiffness.

33. Inhalant Abuse and Dependence

34. Effects on the body
• Central nervous system
• Respiratory effects
• Gastrointestinal effects
• Renal system effects

35. Inhalant intoxication
• Dizziness, Nystagmus, Incoordination, Slurred
Speech, Unsteady gait, Lethargy, Depressed
reflexes, Psychomotor retardation, Tremor,
Generalised muscle weakness, Blurred vision
or diplopia, Stupor or coma, Euphoria.

36. Opioid Abuse and Dependence

37. Effects on the body
• Central Nervous System
• Gastrointestinal System
• Cardiovascular effect
• Sexual functioning

38. Opioid Intoxication
• Symptoms include initial euphoria followed by
apathy, dysphoria, psychomotor agitation or
retardation, and impaired judgment. Physical
symptoms include papillary constriction (or
dilation due to anoxia from severe overdose),
drowsiness, slurred speech, and impairment in
attention or memory. Severe opioid
intoxication can lead to respiratory
depression, coma, and even death.

39. Opioid Withdrawal
• Symptoms include dysphoric mood, nausea or
vomiting, muscle aches, lacrimation or
rhinorrhea, pupillary dilation, piloerection,
sweating, abdominal cramping, diarrhea,
yawning, fever, and insomnia.

40. Hallucinogen Abuse and Dependence

41. Effects on the body
• Physiological effects
• Psychological effects
• Toxic effects

42. Hallucinogen intoxication
• Maladaptive behavioral or psychological changes include
marked anxiety or depression, ideas of reference, fear of losing
one’s mind, paranoid ideation, and impaired judgment.
Perceptual changes occur in a state of full wakefulness and
alertness and include intensification of perceptions,
depersonalization, derealization, illusions, hallucinations, and
synesthesias. Physical symptoms include pupillary dilation,
tachycardia, sweating, palpitations, blurring of vision, tremors,
and incoordination.

43. Cannabis abuse and dependence

44. Effects on the body
• Cardiovascular system
• Respiratory system
• Reproductive effects
• Central nervous System effects
• Sexual functioning

45. Cannabis Intoxication
• clinically significant maladaptive behavioral or
psychological changes that develop during, or
shortly after, cannabis use. Symptoms include
impaired motor coordination, euphoria,
anxiety, a sensation of slowed time, and
impaired judgment. Physical symptoms
include conjunctiva infection, increased
appetite, dry mouth, and tachycardia.

46. Title: Intelligence and Fetal Alcohol Spectrum
Disorders: A Review.
• METHODS:
• Indexed articles of the last 10 years were selected for
an integrative literature review. After inclusion and
exclusion criteria were satisfied 37 articles were
selected.
• RESULTS:
• General intelligence, both verbal and non-verbal, is
impaired in people who are prenatally exposed to
alcohol. There is a tendency to a greater reduction in
the Freedom from Distractibility/Working Memory
Index of Wechsler Scales.