3. Amphetamine Related disorders
Introduction
Amphetamine and amphetamine like drugs are
the most widely used illicit substances
Second only to cannabis, in the United States,
Asia, Great Britain, Australia, and several other
western European countries.
5. At this time, medical professionals recommended
amphetamine as a cure for a range of ailments—alcohol
hangover, narcolepsy, depression, weight reduction,
hyperactivity in children, and vomiting associated with
pregnancy.
6. During World War II, the military in the
United States, Great Britain, Germany, and
Japan used amphetamines to increase
alertness and endurance and to improve mood.
7. PREPARATIONS
The major amphetamines currently
available and used in the United States are
dextroamphetamine (Dexedrine),
methamphetamine (Desoxyn) and
amphetamine like compound
methylphenidate (Ritalin).
These drugs go by street names as ice,
crystal, crystal meth, and speed.
8. The typical amphetamines are used to
increase performance and to induce euphoric
feeling, for example, by students studying
for examinations, by long- distance truck
drivers on trips, by business people with
important deadlines, by athletes in
competition, and by soldiers during war time.
9. Epidemiology
The National Household Survey on Drug Abuse
(NHDSA) conducted in 2001 found that 7.1% of
persons (12 years of age and older) reported
lifetime non medical use of stimulants.
Age: 18-25 year olds, followed by 12-17 year olds.
10. Amphetamine’s Effects on the Brain
Neurotransmitter
dopamine and
norepinephrine
are released in
the brain and
their reuptake is
inhibited
When nerve
cells in the brain
and spinal cord
are activated by
amphetamine
the mental
focus, the
ability to stay
awake, and the
ability to
concentrate is
improved
11. The effects of amphetamines can last several hours whereas the effects
of cocaine generally last less than one hour
The onset of effects from injecting methamphetamines occurs
immediately
When this drug is snorted, effects occur within 3 to 5 minutes
When ingested orally, effects occur within 15 to 20 minutes
12. DIAGNOSIS
DSM-IV-TR Diagnostic Criteria for amphetamine
intoxication
Recent use of amphetamine or a related substance (e.g.,
methylphenidate)
Clinically significant maladaptive behavioural or
psychological changes (e.g., euphoria or affective blunting;
changes in sociability; hypervigilance; interpersonal
sensitivity; anxiety, tension, or anger; stereotyped
behaviors; impaired judgement; or impaired social or
occupational functioning) that developed during, or shortly
after, use of amphetamine or a related substance
13. Two ( or more) of the following,
developing during, or shortly after,
use of amphetamine or a related
substance:
• Tachycardia or bradycardia
• Pupillary dilation
• Elevated or lowered blood pressure
14. Perspiration or chills
Nausea or vomiting
Evidence of weight loss
Psychomotor agitation or retardation
Muscular weakness, respiratory depression, chest pain, or
cardiac arrhythmias
Confusion, seizures, dyskinesia’s, dystonia’s, or coma
15. The symptoms are not due to a general medical condition
and are not better accounted for by another mental
disorder.
16. DSM-IV-TR Diagnostic Criteria for amphetamine
withdrawal
Cessation of amphetamine use that has been heavy
and prolonged
17.
18. The symptoms in criterion B cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
The symptoms are not due to a general medical
condition and are not better accounted for by
another mental disorder.
19. Amphetamine dependence and Amphetamine
abuse
Amphetamine dependence can result in a rapid downward
spiral of a person’s abilities to cope with work- and family-
related obligations and stresses.
A person who abuses amphetamines requires increasingly high
doses of amphetamine to obtain the usual high, and physical
signs of amphetamine abuse almost always develop with
continuous abuse
21. Adverse effects
Physical
Cerebrovascular, cardiac and gastrointestinal effects are
myocardial infarction, severe hypertension,
cerebrovascular disease and ischemic colitis.
Neurological symptoms like twitching to tetany to
seizures to coma and death.
Nonlife threatening adverse effects are flushing, pallor,
cyanosis, fever, headache, tachycardia, palpitations,
nausea, vomiting, bruxism (teeth grinding), shortness of
breath, tremor, and ataxia.
22. Psychological
Restlessness, dysphoria, insomnia, irritability, hostility,
and confusion.
Amphetamine use can also induce symptoms of anxiety
disorders, such as GAD and panic disorder, as well as
ideas of reference, paranoid delusions, and
hallucinations.
24. CAFFEINE
Caffeine is the most commonly used mood-altering. Caffeine is
found in numerous plants, the most widely consumed being coffee,
tea, cola nut, cocao pod, guarana, and maté.
It is estimated that in North America between 80 and 90 percent
of adults and children habitually consume caffeine.
25. In the United States the average per capita daily
intake among adult caffeine consumers is 280
milligrams. Studies show that 30 milligrams or less
of caffeine can alter self-reports of mood and
affect behavior and 100 mg per day can lead to
physical dependence and withdrawal symptoms
upon abstinence.
26. Coffee is the leading dietary source of caffeine
among adults in the United States, while soft
drinks represent the largest source of caffeine
for children. Caffeine consumption from soft
drinks has dramatically increased over the last
few decades and 70% of all soft drinks contain
caffeine.
27. DEFINITION
Caffeine is a white, bitter crystalline alkaloid derived
from coffee or tea.
It belongs to a class of compounds called xanthines,
its chemical formula being 1,3,7- trimethylxanthine.
Caffeine is classified together with cocaine and
amphetamines as an analeptic, or central nervous
system stimulant.
28. Pharmacological aspects of caffeine
When a person drinks a beverage containing
caffeine, the caffeine is absorbed from the
digestive tract without being broken down.
It is rapidly distributed throughout the tissues of
the.
If a pregnant woman drinks caffeine in the drink
will cross the placental barrier and enter the
baby's bloodstream.
29. When the caffeine reaches the brain, it increases the
secretion of norepinephrine, a neurotransmitter that is
associated with the so-called fight or flight stress
response.
The rise in norepinephrine levels and the increased activity
of the neurons, or nerve cells, caffeine intoxication
resemble the symptoms of a panic attack.
30. Caffeine content of food items and
OTC preparations
The caffeine content of various food items and
medications is as follows:
Oz means ounce (1oz = 29.57ml)
Brewed coffee, 8-oz cup: 135–150 mg
Instant coffee, 8-oz cup: 95 mg
Powdered cappuccino beverage, 8-oz cup: 45–60 mg
33. CAFFEINE AND HEALTH
Caffeine use can be associated with several distinct psychiatric
syndromes: caffeine intoxication, caffeine withdrawal, caffeine
dependence, caffeine-induced sleep disorder, and caffeine-induced
anxiety disorder.
With regard to cardiovascular health, caffeine produces modest
increases in blood pressure.
Studies suggest that there may be an association between high
daily caffeine consumption and delayed conception and lower birth
weight.
35. Mood Altering Effects
In caffeine nonusers or intermittent users, low
dietary doses of caffeine (20-200 mg) generally
produce positive mood effects such as increased
well-being, happiness, energetic arousal, alertness,
and sociability.
Large caffeine doses (200 mg or greater) may
produce negative mood effects, these effects
include increased anxiety, nervousness, jitteriness,
and upset stomach.
36. Reinforcing Effects
Drug reinforcement refers to the ability of a drug to
sustain regular self-administration
As the most widely consumed mood altering drug in the
world, it is clear that caffeine is a rein forcer.
Contemporary research has shown that caffeine functions
as a rein forcer when it is delivered in coffee, soft drinks,
tea, or capsules.
For regular caffeine users, the avoidance of low grade
withdrawal symptoms, such as drowsiness after overnight
abstinence, has been identified as a central mechanism
underlying the reinforcing effects of caffeine
37. Anxiety and Caffeine
Studies have shown that high dietary doses of
caffeine (200 mg or more) increase anxiety
ratings and induce panic attacks in the general
population.
Individuals with panic and anxiety disorders are
especially sensitive to the effects of caffeine.
38. Sleep and Caffeine
Studies have demonstrated that caffeine disrupts sleep.
When caffeine is consumed immediately before bedtime or
continuously throughout the day, sleep onset may be
delayed, total sleep time reduced, normal stages of sleep
altered, and the quality of sleep decreased.
Because of its ability to cause insomnia, sleep researchers
have used caffeine as a challenge agent in order to study
insomnia in healthy volunteers.
Caffeine-induced sleep disturbance is greatest among
individuals who are not regular caffeine users.
40. Diuresis (increased urinary output)
Gastrointestinal disturbance
Muscle twitching
Talking or thinking in a rambling manner
Tachycardia (speeded-up heartbeat) or disturbances of heart
rhythm
Periods of inexhaustibility
Psychomotor agitation
41. CAFFEINE WITHDRAWAL
The caffeine withdrawal syndrome has been well-
characterized in double-blind studies. The potential for
caffeine withdrawal to cause distress or impairment in
functioning is reflected by the inclusion of caffeine
withdrawal as an official diagnosis in ICD-10 and DSM-IV.
Although most research on withdrawal has been
performed with adults, there is also evidence that
children experience withdrawal effects during caffeine
abstinence.
42. Signs and symptoms.
The most commonly reported withdrawal symptoms
are listed below:
Headache
Fatigue /drowsiness
Difficulty concentrating
43. Work difficulty -- (e.g., decreased motivation for
tasks/work)
Irritability
Depression
Anxiety
Flu-like symptoms -- (e.g., nausea/vomiting, muscle
aches/stiffness, hot and cold spells, heavy feelings in
arms or legs)
Impairment in psychomotor, vigilance and cognitive
performances
44. Dosing parameters
Significant caffeine withdrawal has been shown to occur
after abstinence from a dose as low as 100 mg/day
Caffeine withdrawal has also been shown to occur after
stopping regular once-a-day consumption of caffeine
(e.g. daily consumption of a single cup of coffee).
45. Severity of caffeine withdrawal
When signs or
symptoms of
caffeine
withdrawal occur,
the severity can
vary from mild to
extreme.
significant
distress or
impairment in daily
functioning
46. Time course of caffeine withdrawal
Onset usually occurs 12 to 24 hours after
terminating caffeine intake, although onset
as late as 36 hours has been documented.
Peak withdrawal intensity has generally
been described as occurring 20 to 48 hours
after abstinence.
49. Cannabis is produced in nearly every country worldwide,
The highest levels of cannabis herb production – approximately 25 in
Africa, particularly in Morocco, South Africa, Lesotho, Swaziland, Malawi,
Nigeria, Ghana, Senegal, Gambia, Kenya, and Tanzania.
North and South America follow, each responsible for 23% of worldwide
production of cannabis herb.
Afghanistan has recently emerged as a major producer of cannabis
50. History
The oldest known written record on cannabis use
comes from the Chinese Emperor Shen Nung in
2727 B.C.
In 1545 cannabis spread to the western
hemisphere
51. Cannabis is dioecious, meaning it
comes as separate male and female
plants.
Male plants are taller and thinner
and have flower like pods which
contain the fertilizing, pollen-
generating anthers.
The female plant is darker and
shorter and has short hairs
protruding at the end of the
bracteole pods
52. Marijuana Paraphernalia
Most users smoke marijuana in hand-rolled
cigarettes called joints. Other popular methods of
smoking marijuana include using bowls, pipes, and
bongs.
53. Cannabis in the Brain and Body
The active ingredient in cannabis,
delta‐9‐tetrahydrocannabinol (THC), THC stimulates
cannabinoid receptors (CBRs), located on the surface
of neurons, to produce psychoactive effects.
Animal studies have indicated that THC exposure
increases the release of noradrenaline, causing
anxiety‐like behavior in rodents.
54. A few minutes after smoking cannabis, heart rate increases
and in some cases doubles, the bronchial passages relax and
become enlarged, and the eyes become red as the blood
vessels expand.
As those effects subside, some users report feeling sleepy or
depressed, and others may feel anxious or panicked, or have
paranoid thoughts or experience acute psychosis
It has negative effects on memory, including the ability to
form new memories, and on attention and learning.
These effects can last up to 28 days after abstinence from
the drug.
55. Cannabis and the Respiratory and
Cardiovascular Systems
Burning and stinging of the mouth and throat, along
with a heavy cough, daily cough production, frequent
acute chest illness, and an increased risk of lung
infections and pneumonia.
Long‐term studies from the USA and New Zealand
have shown that regular cannabis smokers report
more symptoms of chronic bronchitis than
non‐smokers.
56. Cannabis may produce adverse effects on the
cardiovascular system; because cannabis and THC
cause a dose‐dependent increase in heart rate,
concern exists about adults with cardiovascular
disease.
Cannabis use can cause an increase in the risk of
myocardial infarction and provokes angina in
patients with heart disease.
57. Cannabis and Pregnancy
In women, cannabis smoking during pregnancy leads to
decreased birth weight, most likely due to the effects of
carbon monoxide on the developing fetus.
Additionally, infants exposed to cannabis in utero show
developmental delays in the visual system as well as tremors
shortly after birth.
Older children have some deficits in higher cognitive
processes, such as perceptual organization and planning.
59. Cannabis and Mental Illness:
Cannabis use is
associated with
psychotic
symptoms,
schizophrenia,
anxiety, and
depression.
When compared with
those who have never
used cannabis, young
adults who began using
the drug at age 15 or
younger are twice as
likely to develop a
psychotic disorder, and
four times as likely to
experience delusional
symptoms.
60. CBR activation in the amygdala can produce anxiety
and increase reactivity to stressful events;
These neurological deficits may also be responsible
for reduced motivation and poor capacity to cope
with stress
61. Reasons for Cannabis Use
Reasons were the most commonly reported reasons for the
use of cannabis, specifically “to have a good time”, “to
experiment”, and “to get high”.
Young adult men are more likely to use cannabis to increase
or decrease the effects of other drugs, to seek deeper
insights, to have a good time, and because they are
addicted.
Reasons for cannabis use for both men and women include
fitting in socially, using it to cope, to conform to social
norms, for mind expansion, and to alter perceptions.
63. Risk and Protective Factors
Both risk and protective factors affect youth at different
life stages, from pregnancy through young adulthood, as well
as well as in various domains including individual, peer, family,
school and community.
When not properly identified and dealt with early on
negative behavior can further a child’s risks for drug use and
other problems.
Effective preventative interventions reduce risk and
increase protection at each developmental stage, as well as
within each domain.
64. Media Messages
In the past ten years, the internet has
revolutionized media.
Social networking sites, inexpensive mobile
technology, and the increase of internet reach
and speed have meant that young people are
routinely exposed to various kinds of messaging
and advertising.
66. Prevention Cannabis
efforts are critical because cannabis is often the first
illegal drug used by youth.
Preventing substance use before it begins not only makes
common sense, it is also cost‐effective.
In addition, there is also a need to focus specifically on
the community risk and protective factors explicitly
related to the initiation and use of, illegal drugs which
include, social norms, access, availability and perceptions
of harm.
67. Treatment
Since it is established that 1 in 10 cannabis users
will become dependent
as a one‐time intervention for short consultation and
literature, brief interventions – such as one to
twelve sessions of substance use intervention, and,
finally, (if necessary), referral to treatment for
dependent users to receive specialized services,
case management, and follow‐up support in the
community.
68. Cognitive‐behavioral therapy comprises a combination of
approaches meant to increase self‐control.
Specific techniques include exploring the positive and
negative consequences of ongoing use, self‐monitoring to
recognize drug cravings early on and to identify high risk
situations for use, and developing strategies for coping with
and avoiding high‐risk situations and the desire to use.
In several studies, most people receiving a
cognitive‐behavioral approach maintained the gains they
made in treatment throughout the following year.
69. The Cannabis Treatment Project Research Group
found, through a multisite trial, that Motivational
Enhancement Therapy (MET) has proven effective
for stopping cannabis dependence.
In the first treatment session, the therapist
provides feedback to the initial assessment,
eliciting discussion about personal drug use and
provoking self‐motivational statements.
70. Coping strategies for high‐risk situations are suggested
and discussed with the patient. In further sessions, the
therapist monitors change, reviews cessation
strategies being used, and continues to encourage
commitment to change or sustained abstinence.
MET has also been used successfully with adult
cannabis‐dependent individuals in combination with
cognitive‐behavioral therapy, comprising a more
comprehensive treatment approach.
71. There has also been some work done on finding a
medication to treat cannabis dependence, similar to
methadone or buprenorphine for opiate addiction.
These are in the early stages of development but
oral THC combined with lofexidine has been shown
to curb withdrawal symptoms.
73. A high-priced way of getting high
Called "the caviar of street drugs," Cocaine is seen as the status-
heavy drug of celebrities, fashion models, and Wall Street traders.
Cocaine has powerful negative effects on the heart, brain, and
emotions.
Many cocaine users fall prey to addiction, with long-term and life
threatening consequences. Even occasional users run the risk of
sudden death with cocaine use.
74. Signs and Symptoms of Cocaine Use
If a person is abusing powdered cocaine and they don’t want
you to know, they may disappear to use the drug and then
return in a very different mood.
They may seem excited and act more confident and exhibit a
greater sense of well-being.
They may be more excited sexually and talkative.
Their energy will be pumped up and they probably will not have
very much appetite for food and will not have a normal sleep
pattern.
75. Traces of white powder around a person’s nose are
also a sign of cocaine use.
While many people snort the drug (thus leaving the
powder), some will dissolve and inject it.
A few will ingest it, which can lead to severe
intestinal damage.
76. Dilated pupils
Runny noses and after long use, nosebleeds and damage
to the inside of the nose.
A cocaine user may also dissolve and inject the drug, in
which case you might find needle marks on arms, legs,
hands, feet or neck and discarded syringes left around the
place cocaine is consumed.
As powder cocaine’s effects only last an hour or less, the
user may leave periodically so he or she can use more of the
drug.
81. Cocaine withdrawal occurs when a heavy cocaine
user cuts down or quits taking the drug.
Complete abstinence and a serum drug level of
zero are not required.
82. Causes
Cocaine produces a sense of extreme joy by causing
the brain to release higher than normal amounts of
some biochemical.
Cocaine's effects body can be very serious or even
deadly.
When cocaine use is stopped or when a binge ends, a
crash follows almost immediately.
83. This crash is accompanied by a strong craving for
more cocaine. Additional symptoms include fatigue,
lack of pleasure, anxiety, irritability, sleepiness,
and sometimes agitation or extreme suspicion or
paranoia.
Cocaine withdrawal often has no visible physical
symptoms like the vomiting and shaking that
accompanies the withdrawal from heroin or alcohol.
84. Cocaine is addictive when addiction is defined as a
desire for more of the drug, despite negative
consequences
The level of craving, irritability, delayed
depression, and other symptoms produced by
cocaine withdrawal rivals or exceeds that felt
with other withdrawal syndromes.
85. Symptoms
• Agitation and restless behavior
• Depressed mood
• Fatigue
• Generalized malaise
• Increased appetite
• Vivid and unpleasant dreams
• Slowing of activity
Primary
symptoms may
include:
86. The craving and depression can last for months
following cessation of long-term heavy use
(particularly daily) with suicidal thoughts in some
people.
Can produce fear and extreme suspicion rather than
joy (euphoria). Just the same, the cravings may
remain powerful.
87. Exams and Tests
A physical examination and history of cocaine use are
sufficient to diagnose this condition.
Blood chemistries and liver function tests
Cardiac enzymes (look for evidence of heart damage or heart
attack)
CBC (complete blood count, measures red and white blood
cells, and platelets, which help blood to clot)
Chest x-ray
Urinalysis
88. Treatment withdrawal
The withdrawal from cocaine may not be as unstable
as withdrawal from alcohol. There is a risk of suicide
or overdose.
People who have cocaine withdrawal will often use
alcohol, sedatives, hypnotics, or anti-anxiety
medications such as diazepam (Valium) or lorazepam
(Ativan) to treat their symptoms.
Use of these drugs is not recommended because it
simply shifts addiction from one substance to
another.
89. At least half of all people addicted to cocaine also
have a mental disorder (particularly depression and
attention-deficit disorder)
These conditions should be suspected and treated.
When diagnosed and treated, relapse rates are
dramatically reduced. All prescription drug use
should be monitored carefully in patients who abuse
substances
90. Treatment cocaine abuse
Several medications marketed for other diseases (e.g.,
vigabatrin, modafinil, tiagabine, disulfiram, and topiramate) show
promise and have been reported to reduce cocaine use in
controlled clinical trials.
Among these, disulfiram (used to treat alcoholism) has produced
the most consistent reductions in cocaine abuse.
Compounds that are currently being tested for addiction
treatment take advantage of underlying cocaine-induced
adaptations in the brain that disturb the balance between
excitatory (glutamate) and inhibitory (gamma-aminobutyric acid)
neurotransmission.
91. Behavioral Interventions
Many behavioral treatments for cocaine addiction
have proven to be effective in both residential and
outpatient settings. Indeed, behavioral therapies
are often the only available and effective
treatments for many drug problems, including
stimulant addictions.
92. One form of behavioral therapy that is showing positive
results in cocaine-addicted populations is contingency
management, or motivational incentives (MI).
MI may be particularly useful for helping patients achieve
initial abstinence from cocaine and for helping patients stay
in treatment.
Programs use a voucher or prize-based system that rewards
patients who abstain from cocaine and other drug use. On
the basis of drug-free urine tests, the patients earn points,
or chips, which can be exchanged for items that encourage
healthy living, such as a gym membership, movie tickets, or
dinner at a local restaurant.
93. Cognitive-behavioral therapy (CBT) is focused on helping
cocaine-addicted individuals abstain—and remain
abstinent—from cocaine and other substances.
The underlying assumption is that learning processes play
an important role in the development and continuation of
cocaine abuse and addiction.
This approach attempts to help patients recognize, avoid,
and cope; that is, they recognize the situations in which
they are most likely to use cocaine, avoid these situations
when appropriate, and cope more effectively with a range
of problems and problematic behaviors associated with
drug abuse.
94. Therapeutic communities (TCs), or residential programs, offer
another alternative to persons in need of treatment for
cocaine addiction.
TCs usually require a 6- or 12- month stay and use the
program's entire "community" as active components of
treatment.
They can include onsite vocational rehabilitation and other
supportive services and focus on successful reintegration of
the individual into society.
95. Community-based recovery groups—such as
Cocaine Anonymous—that use a 12-step
program, can also be helpful to people trying
to sustain abstinence. Participants may
benefit from supportive fellowship and from
sharing with those experiencing common
problems and issues.
