This document discusses substance use disorders, including prevalence, routes of administration, etiology, diagnostic criteria, and management. It notes that substance use disorders affect people from all walks of life, with prevalence of various substances ranging from 1.3-16.7% globally. Common substances abused include alcohol, cannabis, opioids, sedatives, and stimulants. Diagnosis involves patterns of compulsive use, tolerance, withdrawal, and continued use despite harm. Treatment involves pharmacological approaches like detoxification and substitution therapy as well as psychosocial methods like counseling, group therapy, and lifestyle changes to prevent relapse.

1. Substance use disorders
By-
Mr. Kishor Supet
MSc. (N), PSN (SMHS)
BSP C.G.

2. Substance Related
Disorders and Their
Management

4. Slum Dwellers
Transport
Workers
Youth of all Class

5. Prevalence of SUD
USA
Substance use disorder –
3.8 to 16.7%
Alcohol disorder –
2.8 to 13.5 %
Any other drug disorder –
1.3 to 6.1 %

6. Prevalence of SUD
India
S. N. Substance Prevalence in Gen.
Population
Prevalence
among
Students
1. Cannabis 1.9 – 33% 1.7 – 66%
2. Opiates 0.7 – 24.8% 4.5 – 12.7%
3. Alcohol 2.9 – 82.5% 5.2 – 58%
4. Sedatives 3.5 – 53.8% 3.5 – 61%
Overall substance
abuse
28.77% 5.0 – 56.21%

7. Routes of adminstration of
substances -
Oral – Alcohol, tobacco, cocaine etc.
Sniffing / Snorting – Tobacco, brown sugar
Injection – Heroin, Morphine
Smoking – tobacco, cannabis

8. Etiology
Behavioral conditioning factors
Psychodynamic factors –
Defense Mechanisms
Sociocultural factors – Peer
pressure
Family dynamics – Stressful
conditions

9. Basics
 Substance Abuse
 Dependence
 Craving
 Tolerance
 Withdrawal

10. What is Substance Abuse
 A pattern of use that is harmful to oneself or
others.
 Any one of the following:
– Repeated failure to fulfill significant role obligations
– Continued use despite related social/interpersonal
problems

11. Dependence
 Larger amounts/longer period than intended.
 Inability to, cut down or control or persistent desire.
 A great deal of time spent obtaining, using, or
recovering.
 Important activities given up or reduced.

12. Diagnostic Guidelines for
Dependence Syndrome -
Strong desire to take the substance
Difficulty in controlling intake
Physiological withdrawal state
Tolerance evidenced with increased
intake
Persistent substance use despite
physical and mental problems

13.  Tolerance
 Need for increased amounts of substance to
achieve desired effect
 Diminished effect with use of same amount
 Withdrawal
 Characteristic syndrome of a drug upon stopping
 Taking the substance or a similar one to avoid
withdrawal

14. ICD – 10 Nomenclature of
Substance Related
Disorders
Acute intoxication
Harmful use
Dependence Syndrome
Withdrawal State
Withdrawal state with delirium

15. Psychotic disorders –
Schizophrenia, delusional,
depressive, mania
Amnestic syndrome
Dementia
Late onset psychotic disorders
Unspecified mental and
behavioral disorder

16. Drugs of Abuse
Alcohol Nicotine Heroin Cocaine
Crystal Meth / Methamphetamine Marijuana

17. Nicotine
 Is a specific type of
stimulant
 Toxicity Includes:
 Tolerance/dependence
 Cardiovascular disease
 Pulmonary disease
 Multiple cancers

18. Narcotics
 Lower perception of
pain
 Include:
 Opium
 Morphine
 Codeine
 Oxycodone
 Heroin

19. Stimulants
 Speed the action of CNS
 Include:
 Cocaine - Methylphenidate
 Amphetamines - Methcathinone
 Methamphetamines
 Ephedrine

20. Depressants
 Relax and slow CNS
 Include:
 Alcohol
 Chloral Hydrates
 Barbituates

21. Hallucinogens
 Affect serotonin levels
 Include:
 Lysergic Acid diethylamide (LSD)
 Psilocybin
 Ketamine

22. Inhalants
 Chemicals taken by inhalation
 Three main categories:
 Nitrites (butyl or amyl)
 Anesthetics (nitrous oxide, halothane, ether)
 Solvents, paints, sprays and fuels

23. Cannabis
 Alters mood and perception of reality
 Includes:
 Marijuana
 Marinol
 Hashish/hash oil
 Charas

24. Alcohol
 Alcohol is a CNS depressant.
 In low doses, alcohol acts primarily on inhibitory
centers. Resultant disinhibition may lead to out-
of-character activities (eg, dancing, blurting out a
long-held confidence).
 At higher doses, alcohol inhibits excitatory
centers. People may show effects ranging from
impairment of rational thinking to absence of
motor coordination

25. Systemic Effects
• Gastrointestinal -
Cirrhosis, peptic ulcer
disease, gastritis,
pancreatitis, carcinoma
• Cardiovascular - HTN and
cardiomyopathy
• Neurological - Peripheral
neuropathy , ataxia,
Wernicke encephalopathy,
Korsakoff psychosis,
dementia

26. Systemic Effects
• Immunologic - Suppression of neutrophil function
and cell-mediated immunity
• Endocrine - In males, increase in estrogen and
decrease in testosterone, leading to impotence,
testicular atrophy.
• Obstetric - Fetal alcohol syndrome (ie, mental
retardation, facial deformity, other neurologic
problems)
• Psychiatric - Depression or anxiety disorders

27. Alcohol Withdrawal
Common withdrawal
symptoms—
• Headache,
• nausea,
• vomiting,
• sweating and
• tremor
• Generalised (grand mal)
convulsions may occur during
withdrawal

28. Investigations / Screening -
Through history
Mental status examination
Physical examination for needle pricks,
black spots etc.
Study of biological markers like –
Aspartate Amino transferase, Gamma
glutamyl transferase
Mean cospuscular volume etc.
Blood and urine samples for
Thin Layer Chromatography
Gas liquid chromatography
Radio immune assay

29. Management modalities -
Pharmacological treatment with
antabuse, antagonists and anti-
anxiety medications
Detoxification – 6 hours - 15
days
Psycho-education of the client
and families
Group therapy

30. Counseling
Relaxation Therapy and
techniques
Development of Problem-solving
skills
Nutrition therapy

31. Pharmacotherapy – De-addiction
and Substitution:
Alcohol – Disulfiram, Benzodiazepines,
anticonvulsants
Opioids – Naloxone, Naltrexone, Rest and
nutrition support
Depressants – Phenobarbital,
benzodiazepines
Stimulants – Tranquilizers, rest in quiet
atmosphere
Hallucinogens and cannabinols –
benzodiazepines , antipsychotics

32. Important Interventions -
Ensure privacy
Remain non-judgmental
Show non-possessive warmth and
concern
Express empathy and optimism
Be willing to listen
Be clear and firm

33. Psychosocial Treatment
Methods -
Required to enhance the
motivation to take prescribed
medicine
To impart the coping skills and
prevent relapses
To improve interpersonal
functioning and enhance social
support.

34. To enhance stable familial,
social and occupational
functioning.
To ensure healthy life style
changes.
Individual psychotherapy,
Group psychotherapy,
Family therapy