Substance related disorder

What is a drug?
Any substance when taken into the living
organism, may modify one or more of it’s
functions. (WHO)

Substance classes
• Alcohol
• Caffeine
• Cannabis
• Hallucinogens
– PCP(phencyclindine)
– others
• Inhalants
• Amphetamines
•Opioids
•Sedatives, hypnotics, and
anxiolytics
•cocaine
•Nicotine

Substance abuse
A maladaptive pattern of substance use
manifested by recurrent and significant
adverse consequences related to repeated
use of the substance; any use of substances
that poses significant hazards to health;
leads to clinically significant impairment or
distress occurring within a 12-month
period.

DSM-V diagnostic criteria for
substance abuse

• Recurrent use resulting failure to fulfil the major role
obligation at work, school or home . (poor work
performance, suspension from school)
• Recurrent use of substance in situation in which it is
physical hazardous (driving, operating machine)
• Recurrent substance use related legal problem
(substance induced misconduct)
• Continued substance use despite of having recurrent
or persistent social or interpersonal problem(physical
fights, argument with spouse) occurs by the effect of
substance.

Substance dependence
Physical psychological

Physical dependence
Is evidenced by cluster of cognitive
behavioural and physical symptom indicating
that the individual continuous use of
substance despite of having significant
substance related problems.(APA 2000)

Psychological dependence
• When there is overwhelming desire to use
of a particular drug in order to produce
pleasure or avoid discomfort.
• The desire is very powerful, intense craving
for substance.

Criteria for Substance Dependence
 Evidence of tolerance
 the need for markedly increased amounts of the substance
to achieve desired effects.
 markedly diminished effect with continued use of the
same amount of the substance
 Evidence of withdrawal symptoms
 the characteristic withdrawal syndrome for the substance
 the same/similar substance is taken to relieve or avoid
withdrawal symptoms

Criteria for Substance Dependence (cont’d)
 The substance is often taken in larger amounts or
over a longer period
 There is a persistent desire or unsuccessful efforts
to cut down or control substance use
 A great deal of time is spend in activities necessary
to obtain the substance, use the substance, or
recover from its effects
 Important social, occupation, or recreational
activities are given up or reduced because of
substance use

Substance intoxication?
Development of reversible substance
specific syndrome caused by recent
ingestion or exposure of substance.

Diagnostic criteria
• Development of reversible substance specific
syndrome caused by recent ingestion or
exposer to a substance.
• Clinically significant maladaptive behaviour
or psychological changes that occurs due to
the effect of substance on CNS.
• The symptoms not due to any general
medical condition or any mental disorder.

Substance withdrawal
Is a state which is characterised by a
cluster of symptoms often specific to the
drug used which develop on total or
partial withdrawal of drug, usually after
repeated or higher dose use.

Diagnostic criteria for withdrawal
• Development of a syndrome specific behaviour caused by
cessation or reduction in heavy and prolonged substance
use.
• Clinically significant distress in social, personal and
occupational and other important areas of functioning.
• Not due to any medical condition or any mental disorder.

F10 - F19
MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE
SUBSTANCE USE
F10. – Mental and behavioural disorders due to use of alcohol
F11. – Mental and behavioural disorders due to use of opioids
F12. – Mental and behavioural disorders due to use of cannabinoids
F13. – Mental and behavioural disorders due to use of sedative hypnotics
F14. – Mental and behavioural disorders due to use of cocaine
F15. – Mental and behavioural disorders due to use of other stimulants,
including caffeine
F16. – Mental and behavioural disorders due to use of hallucinogens
F17. – Mental and behavioural disorders due to use of tobacco
F18. – Mental and behavioural disorders due to use of volatile solvents
F19. – Mental and behavioural disorders due to multiple drug use and
use of other psychoactive substances

Predisposing factor
Biological
psychological
Socio cultural

Genetic vulnerability: family history of
substance use disorder, e.g. twin studies suggest that genetic
mechanisms might account for all The risk of alcohol use
disorder is higher for people who have a parent or other
close relative who has problems with alcohol. This may be
influenced by genetic factors.

Biochemical factor:-
 Dopamine is a crucial neurotransmitter
having vital functions in different pathways
in the brain. The levels of dopamine is
naturally controlled by the brain.
 For ex:- When a person engages in
pleasurable activities the brain will increase
the level of dopamine in the neucleus
accumben, however during addiction the
dopamine signaling in this area is changed.

 For any drug to have any pleasurable feeling to the
user then the level of dopamine must be increased &
this causes euphoric feelings that drug users will do
anything to achieve.
 Research studies shown that chinese, japannese &
koreans with a defficiency or absence of alcohol
dehydrogenase( a liver enzyme) tend to drink less &
are lower risk for alcoholism. because their livers do
not break down alcohol, these people experience
vomiting, & increased heart rate & don’t drink as
often.

• Sense of inferiority
• Poor impulse control
• Low self-esteem
• Inability to cope with the pressures of living and society
(poor stress management skills)
• Loneliness,
• Sexual immaturity

Having friends or a close partner who drinks regularly could increase
your risk of alcohol use disorder. The glamorous way that drinking is
sometimes portrayed in the media also may send the message that it's OK
to drink too much. For young people, the influence of parents, peers and
other role models can impact risk. Other social factors are:-
 Extended periods of education
• Unemployment
• Overcrowding
• Poor social support
• Effects of television and other mass media

Alcohol use disorder
What is alcohol? (C2 H5 OH)

Properties of alcohol
• Scientifically known as ethyl alcohol.
• Is a clear coloured liquid with burning taste.
• Absorption of alcohol into blood stream is more
rapid than its elimination.
• The absorption process is slow when the food is
present in stomach.
• Some amount of alcohol are excreted through urine
and small amount is exhaled

Contd…
• A concentration of 80to 100mg of alcohol per 100 ml of
blood is considered intoxication.
• A person with 200mg to 250mg will be toxic, sleepy,
confused and his thought process will be altered.
• If blood level is 300mg/100 ml of blood the person may lose
consciousness.
• A concentration of 500 mg /100 ml is fatal. All the symptoms
change according to tolerance.
Note: symptom depends on tolerance

Epidemiology
• The incidence of alcohol dependence is 2% In India.
• In India both in rural & urban areas with prevalence rates as per
various studies varying from 23%- 74% in male & 24%- 48% in
female
• 20 to 40% of subjects aged above 15years are current users of
alcohol, and nearly 10% of them are regular or excessive users.
• Nearly 15to 30% of patients are developing alcohol-related
problems and seeking admission in psychiatric hospitals.

Progress of alcohol drinking phase
Pre
alcoholic Early
alcoholic
crucial
chronic

Pre alcoholic phase
• This phase is characterised by use of alcohol to
reduce the every day stress and tension of life.
• A child learns from his parents or other adult drinking
alcohol and enjoying effects
• The child learns it as a acceptable method of coping
with stress.
• Tolerance develops to get desired effect and amount
increases steadily.

Early alcoholic phase
• Is a period begins with black out means period of
amnesia during or immediate after drinking.
• The individual does not need it for pleasure or
entertainment required it as a drug.
• The common behaviour are secret drinking ,
preoccupation with drinking, , maintaining the supply of
alcohol, rapid gulping of drinks results further black
out.
• The individual feels guilty and very much defensive
about his/her drinks.

Crucial phase
• The individual loss his control and there is physiological
dependence.
• Binge drinking present last for hours to several weeks.
• In this phase the individual is extremly ill, loss of
consciousness, degradation.
• Takes the risk to loose everything but give max. effort to
maintain drinking.
• The individual looses his job, family, marriage, friends
especially self worth.

Chronic phase.
• There is a physical and emotional disintegration
evidenced by profound helplessness, self pity,
anger and aggression is very common.
• May have hallucination, delusion, psychosis,
tremor, agitation, panic, depression and ideas of
suicide.

1. Acute intoxication
2. Withdrawal syndrome
3. Alcohol induced amnestic disorders
4. Alcohol induced psychiatric disorders

 Acute intoxication develops during or shortly after
excessive alcohol ingestion.
 It is characterized by clinically significant maladaptive
behavior or psychological changes, e.g.
 inappropriate sexual or aggressive behavior
 impaired judgment,
 slurred speech,
 incoordination,
 unsteady gait,
 nystagmus,
 impaired attention and memory finally resulting in
stupor or coma.

In persons who have been drinking heavily over a
prolonged period of time, any rapid decrease in the
amount of alcohol in the body is likely to produce
withdrawal symptoms. These are: Mild tremor, nausea,
vomiting, weakness, irritability, insomnia and anxiety.
Others: Delirium Tremens, alcoholic seizures and
alcoholic hallucinosis

 Delirium tremens:
It occurs usually within 2-4 days of
complete or significant abstinence from
heavy alcohol drinking. The course is short,
with recovery occurring within 3-7 days.
 It is characterized by:
 A dramatic and rapidly changing picture
of disordered mental activity, with
clouding of Consciousness and
disorientation in time and place.
 Poor attention span.

 Vivid hallucinations which are usually visual; tactile
hallucinations can also occur.
 Grossly tremulous hands with truncal ataxia & the
characteristics of tremor is an intention tremor(at rest
there is no tremor, but when you ask the patient to
extend their hands or arms you will observe tremor.
 Autonomic disturbances such as sweating, fever,
tachycardia, raised blood pressure, pupillary dilatation
 Dehydration with electrolyte imbalances
 Insomnia
 Blood tests reveal leukocytosis and impaired liver
function.

 Generalized tonic- clonic seizure occurs.
 Dependence individual usually develops 12-
48 hours after a heavy bout drinking.
Alcoholic Hallucinosis
Auditory hallucination during partial or
complete abstinence.

 Chronic alcohol abuse associated with
thiamine (vitamin 'B') deficiency is the most
frequent cause of amnestic disorders. This
condition is divided into:
a) Wernicke's syndrome: Wernicke’s
encephalopathy 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 occur.

b) Korsakoff' s syndrome:
 Korsakoff’s psychosis is identified by a syndrome of
confusion, loss of recent memory, Impairment of insight in
alcoholics.
 In the United States, the two disorders are usually
considered together and are called Wernicke-Korsakoff
syndrome.
 Treatment is with parenteral or oral thiamine replacement.

a) Alcohol-induced dementia: It is a long term
complication of alcohol abuse, characterized by
global decrease in cognitive functioning (decreased
intellectual functioning and memory). This disorder
tends to improve with abstinence, but most of the
patients may have permanent disabilities.
b) Alcohol-induced mood disorders: Excess
drinking may induce persistent depression or anxiety.

c) Suicidal behavior:
 Suicidal rates are higher in alcoholics when compared
to non-alcoholics of the same age.
 The risk factors for suicidal behavior are :-continued
drinking, co-morbid major depression, serious medical
illness, unemployment and poor social support.
d) Alcohol-induced anxiety disorder: Alcohol persons
report panic attacks during acute withdrawal, similarly
during the first 4 to 6 weeks of abstinence.

e) Impaired psychosexual function: Erectile dysfunction and
delayed ejaculation are common in chronic alcoholics.
f) Pathological jealousy: Excessive drinkers may develop an
overvalued idea or delusion that the partner is being unfaithful.
g) Alcoholic seizures (rum fits): Generalized tonic clonic seizures
occur usually within 12- 48 hours after a heavy bout of drinking.
Sometimes, status epilepticus may be precipitated.
h)Alcoholic hallucinosis: This is characterized by the presence of
hallucinations (auditory) during abstinence, following regular alcohol
intake. Recovery occurs within one month.

 Cardiopulmonary complications:-
 Arrhythmias
 Cardiomyopathy
 Pneumonia
 Increased risk of TB
 Neurologic complications:-
 Alcohol dementia
 Korsakoff’s syndrome
 Seizure disorders
 Alcohol withdrawal delirium
 GI complications:-
 Gastric ulser
 Gastritis
 Pancriatitis
 Chronic diarrhea
 Esophagitis
 Esophageal varices
 Psychiatric complications:-
 Depression
 Impaired social & occupational
functioning
 Suicide
 Multiple substance abuse
 Other complications:-
 Hypoglycemia
 Fetal alcohol syndrome

 Blood alcohol level to indicate intoxication
(200mg/dl).
 Urine toxicology to reveal use of other drugs
 Serum electrolyte analysis revealing electrolyte
abnormalities associated with alcohol abuse.
 Liver functioning studies demonstrating alcohol
related liver damage.

1. A full assessment
2. Goal setting
3. Treatment for withdrawal symptoms
4. Alcohol deterrent therapy
5. Psychological treatment

1. A full assessment, including an appraisal of current medical,
psychological and social problems.
2. Goal setting:
 Setting up of short-term goals that deal with any
accompanying problems in health, marriage, job and social
adjustments;
 long-term goals can be set as treatment progresses, which are
concerned with trying to change factors that precipitate or
maintain excessive drinking, such as tensions in the family.

Deterrent agents are those which are given to desensitize
the individual to the effects of alcohol and maintain
abstinence. The most commonly used drug is disulfiram
(tetraethyl thiuram disulfide).

 Disulfiram is used to ensure abstinence in the
treatment of alcohol dependence.
 Its main effect is to produce a rapid and violently
unpleasant reaction in a person who ingests even a
small amount of alcohol while taking disulfiram.
 Mechanism of action Disulfiram is an aldehyde
dehydrogenase inhibitor that interferes with the
metabolism of alcohol and produces a marked
increase in blood acetaldehyde levels.

 The accumulation of acetaldehyde (to a level of 10times more
than that which occurs in the normal metabolism of alcohol)
produces unpleasant reactions called the disulfiram-ethanol
reaction (DER).
 It is characterized by nausea, throbbing headache, vomiting,
hypotension, sweating, thirst, dyspnea, tachycardia, chest
pain, vertigo, blurred vision and a sense of life-threatening
crisis may lead people to feel they may die with severe
anxiety.
 The reaction occurs almost immediately after the ingestion of
even one alcoholic drink and may last up to 30minutes.

Indications of disulfiram:- The primary indication for disulfiram use
is as an aversive conditioning treatment for alcohol dependence.
Side-effects:-
 The adverse effects of disulfiram in the absence of alcohol
consumption include fatigue, dermatitis, impotence, optic neuritis,
mental changes, and hepatic damage.
 With alcohol consumption the intensity of the disulfiram-alcohol
reactions varies with each patient. In extreme cases it is marked by
convulsions, respiratory depression, cardiovascular collapse,
myocardial infarction and death.

Contraindications:-
 Pulmonary and cardiovascular disease.
 Disulfiram should be used with caution in patients with nephritis,
brain damage, hypothyroidism, diabetes, hepatic disease etc.
 Patients at high risk of alcohol ingestion.
Dosage Disulfiram:-
It is supplied in tablets of 250and 500mg. The usual initial dose is
500 mg/ day orally for the first 2 weeks, followed by a maintenance
dosage of250mg/ day. The dosage should not exceed 500mg/ day.

 An informed consent should be taken before starting
treatment.
 Ensure that at least 12hours have elapsed since the last
ingestion of alcohol before administering the drug.
 Patient must be instructed that ingestion of even the
smallest amount of alcohol brings on a disulfiram-
ethanol reaction with all its unpleasant effects ; he
should therefore be strictly warned not to take any
alcohol whatever.

 The patient should also be warned against ingestion of any
alcohol-containing preparations such as cough syrups, drops
of any kind, and alcohol-containing foods and sauces. Advise
not to use alcohol based aftershave lotions etc., containing
alcohol. Any topical applications containing alcohol should
also be avoided.

 Instruct patient to avoid driving.
 Patients should be warned that the disulfiram-alcohol
reaction may continue for as long as 1 to 2 weeks after
the last dose of disulfiram.
 Emphasize the importance of follow-up visits to the
physician to monitor progress in long-term therapy.

 Motivational interviewing: This involves providing
feedback to the patient on the personal risks that alcohol
poses, together with a number of options for change.
 Group therapy: Group therapy enables the patients to
observe their own problems mirrored in others and to work
out better ways of coping with them.
 Aversive conditioning: This therapy is based on classical
conditioning. In alcoholism the behavior patterns are self-
reinforcing and pleasurable, but are maladaptive for reasons
outside the control of the client. In this technique the client is
exposed to chemically induced vomiting or shock when he
takes alcohol.

 Cognitive therapy: This involves reduction in alcohol
intake by identifying and modifying maladaptive
thinking patterns.
 Cue exposure technique: This technique aims through
repeated exposure to desensitize drug abusers to drug
effects, and thus improve their ability to remain
abstinent.
 Other therapies include
 assertiveness training,
 Behavior counseling,

Nursing Assessment
 Recognition of alcohol abuse: The CAGE questionnaire may be
adopted for this purpose:
C: Have you ever felt you ought to CUT down on your drinking?
A: Have people ANNOYED you by criticizing your drinking?
G: Have you ever felt GUILTY about your drinking?
E: Have you ever had a drink first thing in the morning (an EYE-
OPENER)to steady your nerves or get rid of a hangover?

(a) Place the client in a room near the nurse's station or
where the staff can observe the client closely.
(b) Monitor the client's sleep pattern; he may need to be
restrained at night if confused
(c) Decrease environmental stimuli (bright lights,
television, visitors) when the client is restless, irritable.
Too many stimuli in the environment may increase
misperceptions and restlessness.

(d) Institute seizure precautions (padded tongue blade
and airway at bedside, raised side-rails, etc.) Seizures
can occur during withdrawal, precautions can
minimize chances of injury.
(e) Reorient the client to person, time, place and
situation as needed.
(f) Talk to the client in simple, direct language.

To improve health status of alcoholics:-
(a) Monitor the client's health status. Administer
medications as prescribed by physician. Observe the
client for any behavioral changes and inform physician
when necessary.
(b) Maintain fluid and electrolyte balance: Patients with
alcohol abuse problems are at high risk for fluid and
electrolyte, imbalances.

(c) Provide food or nourishing fluids as soon as the client
can tolerate eating(bland food usually is tolerated best at
first). Many patients who use alcohol heavily experience
gastritis, anorexia and so forth. Therefore bland foods are
tolerated most easily. It is important to re-establish
nutritional intake as soon as possible.

(d) Ensure that amount of protein in the diet is correct for
individual patient condition. Diseased liver may be
incapable of properly metabolizing proteins.
(e) Assist the client in self-care activities; it may be
necessary to provide complete physical care, depending
on the severity of the client's withdrawal.

 Develop trust, convey an attitude of acceptance. Ensure that
patient understands it is not him but his behavior that is
unacceptable.
 Identify recent maladaptive behaviors or situations that have
occurred in the patient's life and discuss how use of
drugs/alcohol may be a contributing factor.
 Provide positive reinforcement when the client shows insight
into his behavior. Enhances repetition of desirable behavior. ·

 Encourage client to explore options available to deal with stress,
rather than resorting to substance use. Practice these techniques.
To develop desirable ways of coping with stress.
 Give positive reinforcement for respond to stress with adaptive
coping strategies. Because of weak ego, patient needs a lot of
positive feedback to enhance self-esteem.
 Maintain frequent contact with the client, even if it is only by a
brief telephone call. Patient will not feel left alone to deal with
his problems.

NURSING DIAGNOSIS
1.Risk for injury related to hallucinosis, acute intoxication evidenced by
confusion, disorientation.
Interventions:-
 Monitor and document seizure activity. Maintain patent airway. Provide
environmental safety (padded side rails, bed in low position).
 Assist with ambulation and self-care activities as needed.
 Provide for environmental safety when indicated.
 Administer medications as indicated (Benzodiazepines).

Cont…
2. Situational Low Self-Esteem related to Biochemical body change (e.g., withdrawal
from alcohol/other drugs) as evidenced by Self-negating verbalization, expressions of
shame/guilt.
Intervention:-
 Provide opportunity for and encourage verbalization and discussion of individual situation.
 Assess mental status. Note presence of other psychiatric disorders.
 Encourage expression of feelings of guilt, shame, and anger.
 Help the patient acknowledge that substance use is the problem and that problems can be
dealt with without the use of drugs. Confront the use of defenses (denial, projection,
rationalization).
 Involve patient in group therapy.

Cont…
3. Ineffective individual coping related to impairment of adaptive behavior and
problem solving abilities evidenced by use of substance as coping
mechanisms.
Interventions:-
 Encourage verbalization of feelings, fears, and anxiety.
 Be aware of staff attitudes, feelings, and enabling behaviors.
 Explore alternative coping strategies.
 Assist patient to learn and encourage use of relaxation skills, guided imagery.
 Encourage involvement in therapeutic writing. Have patient begin journaling or
writing autobiography.
 Discuss patient’s plans for living without drugs

Prevention of substance use disorder
• Primary
• Secondary
• Tertiary

Primary prevention
• Reduction of over prescribing by doctors specially
benzodiazepines.
• Identification and treatment of family members who may
be contributing to the drug abuse.
• Induction of social changes is likely to affect drinking
patterns in the population as a whole by controlling on
sales, increasing the price of alcohol, restricting
availability.

Cont…
• Health education to college students and the youth about the
dangerous effect of drug abuse through curriculum and mass
media.

Secondary prevention
• Early detection and counseling.
• Brief intervention in primary care.
• Motivational interviewing which involves providing
feedback to the patient .
• Full assessment including an appraisal of current medical,
psychological and social problems.
• Detoxification with benzodiazepines.

Tertiary prevention
• Alcohol deterrent therapy.
• Other therapies such as assertive training, teaching how to use
coping skills, behavior counseling, supportive psychotherapy.
Some methods for relapse prevention such as
 Motivational enhancement
 Craving management
 Drink refusal skills(assertive training)
 Anger control
 Stress management
 Recreation and spirituality

Patient and family teaching
• Teach the patient and family about the physical,
psychological and social complications of drug and alcohol
use.
• Inform the patient and family that psychoactive substance
may alter a person’s mood, perceptions, consciousness, or
person’s behavior.
• Explain to the family that the patient may use lies, denial or
manipulation to continue drug or alcohol use and to avoid
treatment.

• Make aware the patient that sharing dirty or used
needles can result in a life threatening disease such as
AIDS, hepatitis B.
• Provide the patient with a full range of treatment
during hospitalization such as medication, individual
therapy, group therapy etc.
• Emphasize to the patient the importance of changing
life style, friendship and habits that promote drug use
to remain sober.
Cont…

Other substance use disorder
Presented by:-
Archana Tripathy
Msc N Tutor

Opioid use disorder
The last few decades, the use of opioids has
increased markedly world over.
The most important dependence producing
derivatives are morphine and heroin.

Cont…
 The common abused opioids (narcotics) in our
country are heroine (brown sugar, smack) and
synthetic preparations like pethidine, fortwin
(pentazocine).
 Most opiate user those had began chasing heroin
they gradually shifted needle use.

Acute intoxication
• Apathy
• Bradycardia
• Hypotension
• Respiratory depression
• Subnormal temperature
• Pin point pupil
• Later delayed reflexes
• Thready pulse
• coma

Withdrawl syndrome
• Watery eyes and nose
• Yawning
• Loss of appetite, irritability and aggressive behavior
• Tremor
• Sweating
• cramps,
• Nausea and vomiting
• Insomnia
• Raised body temperature
• Piloerection

Treatment
• Narcotic antagonist (naloxone &naltrexone)
• Detoxificant : methadone, clonidine, naltrexone and
buprenorphine
• Maintainance therapy:
1. Methadone maintenance
2. Opioid antagonists
3. Psychotherapy like individual psychotherapy, behavior
therapy, group therapy and family therapy.

Cannabis use disorder
Cannabis is derived from hemp plant ,
cannabis sativa.
The dried leaves and flowering tops
are often reffered to as ganja or
marijuana.
The resin of the plant is referred to as
hashis.
Bhang is a drink made from cannabis

Acute intoxicationMild intoxication
 mild impairment of consciousness
 orientation,
 tachycardia,
 a sense of floating in the air
 Euphoria
 Dream like state
 Flashback
 Alteration in psychomotor activities
 Tremor
 Photophobia
 Lacrimation
 Dry mouth & increased apetite

Withdrawal symptoms
• Occurs within 72-96 hours.
• Irritability, anger or aggression
• Nervousness or anxiety
• Sleep difficulties
• Decreased appetite or weight loss
• Restlessness
• Depressed mood
• Abdominal pain
• Tremor
• Fever, chills & headache

Complications
• Transient psychiatric disorders such as acute
anxiety, paranoid psychosis, hysterical fugue,
hypomania, schizophrenia like state.
• Amotivational syndrome:- It is a term that refers to
a lack of desire to complete tasks, a sense of apathy
about the future, poor concentration, and decreased
interest in social and other activities.
• Memory impairment

Treatment
• Supportive and symptomatic treatment.
• CBT: a form of psychotherapy that teaches people
strategies to identify and correct problematic
behaviors in order to enhance self control, stop drug
use.
• Contingency management:

Cocaine use disorder
Cocaine is a kind of drug that functions to
increase the availability of dopamine
neurotransmitter in the brain.
Dopamine is associated with genration of
euphoric emotion.
Common street name is crack.
Can be administered orally, intranasally
by smoking or parenterally.

ACUTE INTOXICATION
• Pupillary dialatation
• Tachy cardia
• Hypertension
• Sweating
• Nausea
• Hypomania
• Agitation
• Muscle tics:- spontaneous contraction or twitch in a
muscle.
• Hyperactivity

Withdrawal syndrome
• Agitation
• Depression
• Anorexia
• Fatigue
• Sleepiness

COMPLICATION
 Acute anxiety reaction
 Uncontrolled compulsive behavior
 Seizure
 Respiratory depression
 Cardiac arrythmias
 Cardiomyopathy
 Endocarditis

Treatment
For intoxication: Amyl nitrite acts as an antidot, diazepam
and propanolol can also be given
For withdrawal symptoms: anti depressant
Methylphenidate can also be given for dependence.
PSYCHO THERAPY:
 Behavioral therapy
 Cognitive behavioral therapy
 Contigency management

BARBITURATE USE DISORDER
Are group of drugs from the sedative-
hypnotic class of medications used to
induce sleep and reduce anxiety
symptoms.
The common street names are yellow
jackets, downers, goofballs and reds.
The commonly abused barbiturates are
secobarbital, phenobarbital and
amobarbital.

Intoxication
• Strained interpersonal relationship
• Irritability
• Memory loss
• Labile mood
• Slurred speech
• Disinhibited behavior
• Incoordination
• Impaired attention
• Decreased functioning

Withdrawal symptoms
• Agitation
• Delirium
• Convulsion
• Weakness
• Anxiety
• Nausea and vomiting
• Sleep disturbances
• Tremor
• Hallucination
• High grade fever
• seizures

Treatment
• Symptomatic treatment
• Psychotherapy and behavioral therapy

Inhalant use disorder
Anything which can be inhaled without burning
or heating.
The commonly used volatile solvents include
petrol, aerosol, thinners, varnish remover and
industrial solvent.

Types of inhalant
• Spray paints and glue
• Nitrous oxide (laughing gas)
• aerosol and medical gases
• Poppers:-chemical class called alkyl nitrites

Intoxication
• Euphoria
• Belligerence
• Slurring of speech
• Apathy
• Impaired judgement
• Neurological signs
• Jerky reaction
• Dialated pupils

Withdrawal symptoms
• Anxiety
• Depression

Complications
• Brain damage
• Irreversible damage to liver and kidney
• Muscle weakness
• Depression
• Severe nose bleed

Treatment
• For intoxication: diazepam
• rehabilitation

Substance related disorder

More Related Content

What's hot

Similar to Substance related disorder

More from Archana tripathy

Recently uploaded

Substance related disorder