This document summarizes substance use disorders. It defines substances such as alcohol, opioids, cannabinoids, sedatives/hypnotics, cocaine, caffeine, hallucinogens, and tobacco. It describes how to identify substance use disorders through self-report data, analysis of bodily fluids, clinical signs and symptoms, and informant history. It then explains different classifications of substance use disorders including acute intoxication, harmful use, dependence syndrome, tolerance, withdrawal states, psychotic disorders, amnesic syndromes, and residual/late onset psychotic disorders. It provides examples of each classification.

1. SUBSTANCE USE
DISORDERS
Niharika Thakkar
Child Guidance Centre and
Department of Behavioural Sciences and Mental
Health,
Sahyadri Hospitals ltd, Pune

2. What are Substances??
•Alcohol
•Opioids
•Cannabinoids
•Sedatives/Hypnotics
•Cocaine
•Caffeine
•Hallucinogens http://learn.genetics.utah.edu/content/addiction/drugs/ab
•Tobacco
•Volatile solvents

3. How to identify?
 Self report data
 Analysis of blood, urine etc
 Presence of drug samples
 Clinical signs and symptoms (Disturbances in
levels of consciousness, perception, affect,
behavior, psycho-physiological functions and
responses)
 Informant history
 Comorbidity with other psychotic disorders

4. Acute
Intoxication
 Small doses of substance
produce disproportionately
severe intoxication effect
 Causes behavioural
disinhibition
►Recovery is usually
complete ..Funny Anti Smoking Commercial - EPIC
SPOOF.flv

5. Harmful Use
 Pattern of Use
 Abusing the Substance
 Binging

6. Dependence Syndrome
 Strong desire or compulsion
 Difficulty in controlling in terms of onset,
termination or levels of use
 Withdrawal state
 Evidence of tolerance
 Neglect of alternative pleasures
 Persistent use inspite of
consequences

7. Tolerance
 Increased
doses
required
- Alcohol and
opiate-
dependent
individuals
take daily
doses
sufficient to
incapacitate
or kill non-
tolerant
users

8. Withdrawal State
 Indicator of Dependence
Syndrome
 Repeated prolonged high dose
 Onset and Course is time
limited
 Physical symptoms
 Psychological disturbances:
Anxiety, Depression & Sleep
disorders

9. Withdrawal State with Delirium
 Delirium tremens:
 Short lived
 Occasionally life threatening
 Toxic-confusional state with accompanying
somatic disturbances: Insomnia,
tremulousness and fear
 Clouding of consciousness, vivid
hallucinations and illusions affecting any
sensory modality, delusions, agitation,
automatic over activity.
http://learn.genetics.utah.edu/content/addiction/drugs/abuse.html

10. Psychotic Disorder
 During or immediately after
psychoactive substance use
 Vivid hallucinations
 Misidentifications
 Delusions or ideas of reference
 Psychomotor disturbances
 Abnormal affect : Fear to ecstasy
 Immediately or in 48 hours (or late onset)
 Resolves within a month and fully within 6
months

11. Amnesic Syndrome
 Chronic impairment in memory
 Remote memory lost, immediate memory
preserved
 Disorientation
 Confabulation
 Personality changes
Korsakov’s syndrome ..Requiem for a Dream.flv

12. Residual and Late onset Psychotic
Disorder
 Beyond the period during which psychoactive
substance related effect might reasonably be
assumed to be operating
 Not always reversible: Dementia
 Not to be confused with Withdrawal state
 Negative history: Rule out acute and transient
psychotic disorders
 Flashbacks

14. Guess the Celebrity??

16. Articles
 SUBSTANCE ABUSE IN INDIA, Ahmad Nadeem, Bano
Rubeena, Agarwal V.K., Kalakoti Piyush
 Tobacco use in India: prevalence and predictors of
smoking
and chewing in a national cross sectional household survey
M Rani, S Bonu, P Jha, S N Nguyen, L Jamjoum