Substance abuse can involve the misuse of legal substances, such as alcohol or prescription medications, as well as the use of illegal drugs. Some common substances of abuse include alcohol, nicotine, marijuana, cocaine, opioids (such as heroin and prescription painkillers), methamphetamines, and hallucinogens.

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SUBSTANCE USE DISORDER
Dr.Shrinivasa Bhat Undaru M.D.
Asst.Professor,
Dept. Of Psychiatry
KSHEMA, Mangalore

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CLASSES OF SUBSTANCES
• ALCOHOL
• OPIODS
• CANNABINOIDS
• SEDATIVES OR
HYPNOTICS
• COCAINE
• HALLUCINOGENS
• TOBACCO
• VOLATILE
SOLVENTS
• CAFFEINE

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CLINICAL CONDITIONS
• DRUG ABUSE
• DEPENDENCE SYNDROME

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CLINICAL CONDITIONS
• Intoxication
• Withdrawal state
• Withdrawal state with delirium
• Psychotic disorders
• Amnestic state

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SUBSTANCE ABUSE
• FAILURE TO FULFIL MAJOR SOCIAL
ROLE OBLIGATIONS
• USE IN PHYSICALLY HAZARDOUS
SITUATIONS
• LEGAL PROBLEMS
• PERSISTENT IP AND SOCIAL
PROBLEMS

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Substance Dependence
• TOLERANCE
• WITHDRAWAL
• TAKEN IN LARGE AMOUNT/FOR A
LONG PERIOD
• PERSISTENT DESIRE/
UNSUCCESSFULL ATTEMPT TO
CUT DOWN

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• GREAT DEAL OF TIME SPENT ON
OBTAINING THE SUBSTANCE
• SOCIAL, OCCUPTIONAL AND
RECREATIONAL DYSFUNCTION
• CONTINUED DISPITE KNOWLEDGE
OF HAVING PHYSICAL OR
PSYCHOLOGICAL PROBLEMS

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DRUG -USE HISTORY
• AGE OF STARTING DRUG USE
• TYPES AND QUANTITIES OF DRUGS TAKEN
• FREQUENCY OF MISUSE AND ROUTES OF
ADMINISTRATION
• OVERDOSE
• ABSTINENCE AND RELAPSE TRIGGERS
• WITHDRAWAL SYMPTOMSS
• MEDICAL COMPLICATIONS
• PSYCHIATRIC COMPLICATIONS
• LEGAL COMPLICATIONS

15. • Nearly 200 MILLION PEOPLE ARE USING
THESE DRUGS WORLDWIDE.
• Cannabis -marihuana, hashish, thc- leads by
far with 162 million users.
• Ats -amphetamine, methamphetamine,
ecstasy, methcathinone- follow with 35
million users.
• Globally, an estimated 16 million people use
opiates -opium, morphine, heroin, synthetic
opiates-
• Some 13 million people use cocaine.

16. • Nearly 200 million people are using these
drugs worldwide. Cannabis -marihuana,
hashish, THC- leads by far with 162 million
users. ATS -amphetamine,
methamphetamine, ecstasy, methcathinone-
follow with 35 million users. Globally, an
estimated 16 million people use opiates -
opium, morphine, heroin, synthetic opiates-
and some 13 million people use cocaine.

17. Illegal drug use at the global level

19. Trafficking in cannabis herb, 2005 (countries
reporting seizures of more than 100 kg)

20. ALCOHOL RELATED
DISORDERS

21. Epidemiology:
Prevalence of drinking-
Most persons begin alcohol intake in
early to mid-teen years
Current drinker-
- anyone who has used alcohol in
preceding 1 to 3 months
Temporary problems-
- blackouts, drunk driving, missing school
due to hangover or desire to party with
alcohol rather than work

22. CONDITION % POPULATION
Ever had a drink 90
Current drinker 60 - 70
Temporary problems 40+
Abuse M - 10
F - 5
Dependence M – 10
F – 3to5

23. Etiology:
Psychological theories
- use of alcohol to reduce tension, increase
feelings of power, decrease psycologic
pain
Psycodynamic theory
- dis-inhibition and anxiety-lowering effects

24. Etiology:
Behavioural theory
- expectations of rewarding effects of
drinking & subsequent actual
reinforcement after alcohol intake
contribute to decision to drink again after
one experience with alcohol

25. Etiology:
Sociocultural theory
- social groups with high or low rate of
alcoholism
Biological theory
- Genetic theory
--close fmly members have fourfold ↑risk
--identical twin of alcoholic person ↑risk
--adopted away child of alcoholic person

26. Pharmacology:
Pharmacokinetics:
Ethanol is well absorbed throughout mucosal
lining of GIT in mouth, esophagus,stomach
Most prominent area of absorption is
proximal part of small intestine
It rapidly enters blood stream & as a result of high
water solubility is distributed to almost every body
system

27. Pharmacology:
Metabolism:
After absorption into bloodstream
2-10% excreted rest is
Unchanged via metabolised in
Lungs,kidney,sweat liver

28. Pharmacology:
Metabolism:
In liver
alcohol
alcohol DH
acetaldehyde
aldehyde DH
acetate
CO2+ H2O

29. Tolerance
With repeated administration of alcohol, larger
doses are required to produce desired effect
Cross tolerance-
- once tolerance has developed for one brain
depressant person shows similar rxn to 2nd drug
of that group
Reverse tolerance-
- seen in older individuals

30. Alcohol withdrawal:
DSM-IV Diagnostic criteria
A.Cessation or reduction of alcohol use that has
been heavy & prolonged
B. Two or more of the following developing
several hrs to days of criterion A
1. autonomic hyperactivity
2. increased hand tremor
3. insomnia
4. nausea/ vomiting
5. transient visual,tactile,auditory hallucinations

31. Alcohol withdrawal:
DSM-IV Diagnostic criteria
6. psychomotar agitation
7. anxiety
8. Grand mal seizures
C. S/S of criterion B cause significant distress or
impairment in social,occupational & other areas
of functioning
D. Symptoms are not due to general medical
condition & not better accounted for by another
mental disorder

32. Effects on the body:
Central and peripheral nervous system
1. Blackout
2. Sleep impairment
3. Peripheral neuropathy
4. Cerebellar degeneration
5. Sad mood, Severe anxiety, Psychosis
Gastrointestinal problems
- Gastritis, esophagitis
- fatty liver     cirrhosis

33. Effects on the body…
Cardiovascular problems:
- ↑LDL ↑ TG
↑ blood pressure
- ↑ risk of MI, thrombosis
- alcoholic cardiomyopathy

34. Effects on the body…
Blood producing systems:
- ↓ WBC count
- affects functioning of stem cells
↓ MCV
- impairs production & efficiency of
platelets
Malignancies-
- risk of head, neck, esophagus stomach,
liver, lungs, colon

35. Effects on the body…
Fetal alcohol effect:
- alcohol & aldehyde cross placenta
fetal deaths, spontaneous abortions
surviving infants develop
- mental retardation
- microcephaly,microsomia,syndactyly
- facial abnormalities
- atrial septal defect

36. Management :
3 steps involved-
I. Intervention / Confrontation
II. Detoxification
III. Rehabilitation

37. Management :
INTERVENTION /CONFRONTATION
- pt is brought face-to-face with reality
of the disorder
- break through denial & help pt realise
adverse effects likely if not treated
- Aimed at inducing high levels of
motivation for treatment
continued abstinence

38. Management :
INTERVENTION /CONFRONTATION
- involves convincing the pt
- single intervention is rarely sufficient
- family role is significant

39. Management :
DETOXIFICATION
1. Physical examination to rule out
medical disorder
2. Rest, nutrition,
multiple vitamins (thiamine)

40. Management :
DETOXIFICATION
- mild to moderate withdrawal
giving enough of brain depressant on
day 1 to decrease symptoms & then
weaning the pt off the drug over next 5
days provides optimal relief &
decreases possibility that severe
withdrawal develops
Benzodiazepines- diazepam/lorazepam

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STAGES OF CHANGE
MODEL
• PRE-CONTEMPLATION
• CONTEMPLATION
• DECISION
• ACTION
• MAINTAINENCE
• RELAPSE

42. Management :
REHABILITATION
- Counseling- continued efforts to
increase & maintain high levels of
motivation for abstinence -
- work to help pt to re-adjust to a
life-style free of alcohol
- Relapse prevention

43. Management :
REHABILITATION
- initial months focus on day-to-day
activities to help maintain high level of
motivation for abstinence
- enhancing functioning levels
- discussion maintainance factors
future course of drinking
sober peer groups

44. Management :
REHABILITATION
- counseling is done initially thrice
a week for 1month then weekly for
next 6 months
- Relapse prevention
identifying situation where risk for
relapse is high
help to develop modes of coping when
craving for alcohol increases

45. Management :
REHABILITATION
- Medications:
-to place pt in a situation in which
drinking alcohol precipitates
uncomfortable physical reaction
drugs used:-
disulfiram
naltrexone (opiate antagonist)
acamprosate

46. Management :
REHABILITATION
- Self help groups
Alcohol Anonymous

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groups Self help
• ALCOHOLIC ANONYMOUS
• AL-ANONS
• NARCOTIC ANONYMOUS