Drug Abuse and Addiction


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My neuropsychiatric assignment in Year 5 IUMP.

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Drug Abuse and Addiction

  2. 2. BY:ASIF AMRI BIN HUSSIN (07-5-11)
  3. 3. OVERVIEW <ul><li>Drugs have been part of our culture since the middle of the last century. Popularized in the 1960s by music and mass media, they invade all aspects of society. </li></ul><ul><li>An estimated 208 million people internationally consume illegal drugs </li></ul>
  4. 4. <ul><li>The most commonly used illegal drug is marijuana. According to the United Nations 2008 World Drug Report, about 3.9% of the world’s population between the ages of 15 and 64 abuse marijuana. </li></ul>
  5. 5. DEFINITION OF DRUG ABUSE <ul><li>There is several ways to define the term drug abuse but the main concept is about the non permissive consumption of certain substance i.e drug that can give certain effects to an individual in which the chronic use of that substance may lead to physical and psychological dependence. </li></ul>
  6. 6. <ul><li>This term can be define as the use of either licit or illicit drug outside or beyond the permitted medical practice or medical justification. </li></ul>
  7. 7. STATISTICS OF DRUG ABUSE IN MALAYSIA <ul><li>Drug abuse has been the most complex social problem faced by the country. </li></ul><ul><li>The community involvement with drugs was not bounded by age and involved all groups either poor, rich, professionals, labourers, public servants or students. </li></ul>
  8. 8. <ul><li>The National Drug Agency (ADK) has, through its efforts, registered more than 300,000 addicts in its drug fight. However, just like the iceberg, the numbers are only what is seen above the surface. </li></ul><ul><li>Some local studies have suggested there are an estimated three to four addicts who are not registered with the ADK for every one that is. </li></ul>
  9. 9. <ul><li>Hence the potential numbers of addicts in Malaysia is quite staggering, a possible one million addicts in our country of 25 million, or 4% of the populace! </li></ul>
  10. 10. <ul><li>The following graph and chart is obtained from the National Anti Drug Agency(NADA) from January to June 2011. </li></ul>
  11. 11. This map shows the Malaysia and it’s states.
  12. 12. The following table illustrates the number of drug abuse in Malaysia by states from January to June 2011 and the differences in the number for the same period during 2010.
  13. 13. This table shows the number of drug abuser in Malaysia from January to June 2011 and the differences of the numbers in the same months from the last year.
  14. 14. <ul><li>The table above clearly illustrates the number of drug abuser in Malaysia from January-June 2011 according to gender. </li></ul><ul><li>As we can see there is decrease in number of drug abuser in 2011 compared to the number of drug abuser in same period of the last year. </li></ul><ul><li>However,nearly 99% of the drug abuser are male while female contribute just nearly 2% of drug abuser in Malaysia. </li></ul>
  15. 15. <ul><li>The chart above shows the age of drug abuser when they were detected by the authority. </li></ul><ul><li>From this chart it is clear that most of the drug abuser came from the youth which comprise of about 79% of total drug abuser in Malaysia from January to June 2011. </li></ul>
  16. 16. The table above shows the number of drug abuser according to the job and the differences in number compared to 2010 statistics.
  17. 18. <ul><li>The previous slide is the number of drug abuser according to the type of drugs abused by them. </li></ul><ul><li>As we can see the most commonly abuse drug in Malaysia is of the opiate group of drug. </li></ul><ul><li>It comprises about 67% from the total drug abused in Malaysia. </li></ul>
  18. 19. <ul><li>Then it is followed by marijuana which also known as ganja in Malaysia. </li></ul><ul><li>It is abused by nearly 17% of the drug abuser in Malaysia. </li></ul>
  20. 21. INTRODUCTION <ul><li>Drug abuse is not just the problem of the individual. </li></ul><ul><li>Factors that contribute to drug abuse come from all levels. </li></ul><ul><li>From the individual's predisposition to addiction to the economy of their environment </li></ul>
  21. 24. genetic <ul><li>Susceptibility does not mean inevitability </li></ul><ul><li>Biological differences </li></ul><ul><li>It may be harder for people with certain genes to quit once they start.  </li></ul><ul><li>Factors that make it harder to become addicted also may be genetic. </li></ul><ul><li>Example: an individual may feel sick from a drug that makes other people feel good. </li></ul>
  22. 25. <ul><li>There is no single addiction gene </li></ul><ul><li>Scientists will never find just one single addiction gene. </li></ul><ul><li>Susceptibility to addiction is the result of many interacting genes. </li></ul><ul><li>Social and environmental factor contribute to risk of addiction </li></ul>
  23. 26. <ul><li>When addiction runs in family </li></ul><ul><li>Researchers construct pedigrees of large families with addiction as a first step to understanding the disease </li></ul><ul><li>Not every addict will carry the same gene, and not everyone who carries an addiction gene will exhibit the trait </li></ul>
  24. 27. The A1 allele of the dopamine receptor gene  DRD2  is more common in people addicted to alcohol or cocaine Increased expression of the  Mpdz  gene results in mice experiencing less severe withdrawal symptoms from sedative-hypnotic drugs such as barbiturates Mice bred to lack the cannabinoid receptor gene  Cnr1  have a reduced reward response to morphine . Mice bred to lack the serotonin receptor gene Htr1b  are more attracted to cocaine and alcohol Mice bred to lack the β2 subunit of nicotinic cholinergic receptors have a reduced reward response to cocaine Mice with low levels of neuropeptide Y drink more alcohol, whereas those with higher levels tend to abstain Fruit flies mutated to be unable to synthesize tyramine remain sedate even after repeated doses of cocaine Mice mutated with a defective Per2  gene drink three times more alcohol than normal Non-smokers are more likely than smokers to carry a protective gene,  CYP2A6 , which causes them to feel more nausea and dizziness from smoking Alcoholism is rare in people with two copies of the  ALDH*2  gene variation Mice with the  Creb  gene &quot;knocked-out&quot; are less likely to develop morphine dependence.
  25. 28. OTHER FACTORS <ul><li>SEX </li></ul><ul><li>Men are twice as likely to have problems with drugs. </li></ul><ul><li>DRUG </li></ul><ul><li>Cause temporary,pleasurable feelings </li></ul><ul><li>Dependent </li></ul><ul><li>Mental condition </li></ul><ul><li>Anxiety,depression and other mental conditions </li></ul>
  26. 29. <ul><li>Environment </li></ul><ul><li>Peer pressure </li></ul><ul><li>Lack of parental guidance and supervision </li></ul><ul><li>Economy </li></ul><ul><li>Unemployed </li></ul><ul><li>Laid off to CEOs in big corporations </li></ul>
  27. 31. conclusion <ul><li>Just because you are prone to addiction doesn't mean you're going to become addicted. It just means you've got to be careful. </li></ul><ul><li>There are many ways that genes could cause one person to be more vulnerable to addiction than another. </li></ul>
  29. 33. Cannabinoids and hallucinogens By: Ahmad Asyraf bin Mohamed (3)
  30. 34. Cannabinoids <ul><li>Any chemical that activates the body’s cannabinoid receptors. </li></ul><ul><li>Most commonly understood through the use of the Cannabis plant, marijuana (a dry, shredded green and brown mix of flowers, stems, seeds, and leaves) </li></ul><ul><li>Arguably the most controversial and commonly abused drug. </li></ul>
  31. 36. Mechanism of action <ul><li>The main active chemical in marijuana is delta-9-tetrahydrocannabinol (THC), a cannabinoid. </li></ul><ul><li>It acts on the cannabinoid receptors, namely the: </li></ul><ul><ul><li>CB 1 (Primarily found in CNS neurons) </li></ul></ul><ul><ul><li>CB 2 (Primarily found in PNS immune cells) </li></ul></ul>
  32. 37. <ul><li>When cannabinoids bind to receptors they inhibit adenylyl cyclase activity and activate the Mitogen-activated protein (MAP) kinase pathway in neurons and cells heterologously expressing CB 1 and CB 2 receptors. </li></ul>
  33. 38. Effects <ul><li>Psychoactive </li></ul><ul><ul><li>alteration of conscious perception, euphoria, feelings of well-being </li></ul></ul><ul><ul><li>20-30% users experiences panic attacks </li></ul></ul><ul><ul><li>marked distortions in the perception of time and space </li></ul></ul><ul><ul><li>  depersonalization and derealization </li></ul></ul>
  34. 39. More effects <ul><li>Somatic effects </li></ul><ul><li>  increase heart rate, dry mouth(cotton mouth), reddening of the eyes </li></ul><ul><li>reduction in intra-ocular pressure </li></ul><ul><li>  muscle relaxation </li></ul>
  35. 40. Withdrawal <ul><li>Occurs in long term abuser </li></ul><ul><li>Symptoms: </li></ul><ul><ul><li>irritability, sleeplessness, decreased appetite, anxiety, and drug craving </li></ul></ul><ul><li>It starts 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation. </li></ul>
  36. 41. Hallucinogens <ul><li>Hallucinogens are a diverse group of drugs that cause an alteration in perception, thought, or mood </li></ul><ul><li>most hallucinogens do not consistently cause hallucinations! </li></ul><ul><li>Examples: </li></ul><ul><ul><li>LSD (acid), MDMA(ecstasy), etc. </li></ul></ul>
  37. 42. Tablets of MDMA
  38. 43. Mechanism of action <ul><li>LSD binds to most serotonin receptor subtypes except for 5-HT 3  and 5-HT 4 </li></ul><ul><li>The psychedelic effects of LSD are attributed to its strong partial agonist effects at 5-HT 2A  receptors. </li></ul><ul><li>  MDMA inhibits the vesicular monoamine transporter, which results in increased concentrations of serotonin, norepinephrine, and dopamine in the cytoplasm, and induces their release by reversing their respective transporters through a process known as phosphorylation. </li></ul>
  39. 44. Effects of LSD <ul><li>Known as “trip” </li></ul><ul><li>  experience of radiant colors, eidetic imagery, altered sense of time. </li></ul><ul><li>Visual effects, as movement of static surface, after images, intensification of colours. </li></ul>
  40. 46. Effects of MDMA <ul><li>Diminished fear, anxiety </li></ul><ul><li>Mood lift with subsequent euphoria </li></ul><ul><li>Mild psychedelia </li></ul><ul><li>hyperactivity </li></ul><ul><li>Increased energy and endurance </li></ul><ul><li>Increased alertness </li></ul>
  41. 47. Adverse effects <ul><li>Anxiety and paranoia </li></ul><ul><li>Depression </li></ul><ul><li>Irritability </li></ul><ul><li>Fatigue </li></ul><ul><li>Impaired attention, focus, and concentration </li></ul>
  42. 48. Withdrawal symptoms <ul><li>depression  </li></ul><ul><li>anxiety  </li></ul><ul><li>schizophrenia  </li></ul><ul><li>impaired memory  </li></ul><ul><li>lessened attention span  </li></ul><ul><li>mental confusion   </li></ul><ul><li>psychological dependence  </li></ul><ul><li>suicidal thoughts </li></ul>
  43. 49. References <ul><li>http://drugabuse.gov/infofacts/hallucinogens.html </li></ul><ul><li>http://emedicine.medscape.com/article/293752-overview#a0104 </li></ul><ul><li>http://en.wikipedia.org/wiki/Hallucinogen </li></ul>
  45. 51. Introduction <ul><li>Amphetamines and amphetamine-related drugs are central nervous system stimulants. </li></ul><ul><li>The past decade has seen a marked increase in the popularity of amphetamines use, particularly methamphetamine in Malaysia. </li></ul><ul><li>Types : </li></ul><ul><li>Amphetamines – group substances including predominantly amphetamine and methamphetamine. </li></ul><ul><li>Ecstasy- group substances – including MDMA (3, 4-Methylenedioxymethamphetamine ) and its analogues. </li></ul>
  46. 52. Effects of abuse <ul><li>Short term </li></ul><ul><li>loss of appetite, rapid breathing and heartbeat, high blood pressure, and dilated pupils </li></ul><ul><li>fever, sweating, headache, blurred vision, and dizziness (high dose) </li></ul><ul><li>flushing, pallor, very rapid or irregular heartbeat, tremors, loss of coordination, and collapse (very high dose) </li></ul><ul><li>death </li></ul>
  47. 53. <ul><li>feeling of well-being, great alertness and energy. </li></ul><ul><li>talkative, restless, and excited, and sense of power and superiority </li></ul><ul><li>paradoxically, in children these drugs frequently produce a calming effect and were often prescribed for hyperactivity. </li></ul>
  48. 54. <ul><li>2. Long term effects </li></ul><ul><li>short-term effects are exaggerated </li></ul><ul><li>various illnesses related to vitamin deficiencies and malnutrition </li></ul><ul><li>more prone to illness </li></ul><ul><li>amphetamine psychosis - a mental disturbance very similar to paranoid schizophrenia </li></ul><ul><li>kidney damage, lung problems, strokes, or other tissue injury may result </li></ul>
  49. 56. <ul><li>3. Effects of ecstasy </li></ul><ul><li>users feel happy, relaxed and loving that last for 3-5 hours </li></ul><ul><li>decreases appetite and the need for sleep </li></ul><ul><li>mood swings, short-term memory loss, inability to concentrate and significant reduction in mental abilities </li></ul><ul><li>poor health </li></ul>
  50. 58. Withdrawal symptoms <ul><li>due to tolerance to some effects </li></ul><ul><li>become psychologically or physically dependent </li></ul><ul><li>fatigue, long but troubled sleep, irritability, intense hunger, and moderate to severe depression, which may lead to suicidal behaviour </li></ul><ul><li>fits of violence may also occur </li></ul><ul><li>these disturbances can be temporarily reversed if the drug is taken again </li></ul>
  51. 59. Tobacco and Inhalants Ahmad Abid Abas 2
  52. 60. Tobacco <ul><li>Mechanism </li></ul><ul><li>1) Enter bloodstream -> Stimulates adrenal glands -> adrenaline -> Stimulates CNS -> ↑BP,Respiration,HR. </li></ul><ul><li>2) Lead to released of glucose -> Suppressed insulin excretion -> chronically elevated blood glucose. </li></ul><ul><li>3) Increase level of Dopamine. </li></ul><ul><li>4) Addiction results from long term brain changes. </li></ul>
  53. 61. Tobacco <ul><li>Withdrawal Symptoms from Addicted User </li></ul><ul><li>- Irritability </li></ul><ul><li>- Attention difficulties </li></ul><ul><li>- Sleep disturbances </li></ul><ul><li>- Increase appetite </li></ul><ul><li>- Powerful cravings for tobacco </li></ul>
  54. 62. Adverse Effects on Health
  55. 63. Tobacco Free Initiative (WHO)
  56. 64. WHO response <ul><li>In 2008, WHO introduced a package of tobacco control measures to further counter the tobacco epidemic and to help countries to implement the WHO Framework Convention. Known by their acronym MPOWER : </li></ul><ul><li>1) Monitor tobacco use and prevention policies </li></ul><ul><li>2) Protect people from tobacco use </li></ul><ul><li>3) Offer help to quit tobacco use </li></ul><ul><li>4) Warn about the dangers of tobacco </li></ul><ul><li>5) Enforce bans on tobacco advertising, promotion and sponsorship </li></ul><ul><li>6) Raise taxes on tobacco. </li></ul>
  57. 65. Malaysian Smoking Cessation Programme and Smoke-Free Air Laws
  58. 66. Inhalants –Who’s Huffing Now (glue and gums sniffing)-(whippets,poppers,snappers) <ul><li>Inhalants are volatile substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect. </li></ul><ul><li>Types : </li></ul><ul><ul><ul><li>Volatile Solvents ( paint thinners and removers, dry-cleaning fluids, degreasers, gasoline, glues) </li></ul></ul></ul><ul><ul><ul><li>Aerosols ( spray paints, deodorant and hair sprays) </li></ul></ul></ul><ul><ul><ul><li>Gases ( ether, chloroform, halothane, and nitrous oxide ) </li></ul></ul></ul><ul><ul><ul><li>Nitrites ( cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl (butyl) nitrite ) </li></ul></ul></ul>
  59. 68. Inhalants (Mechanism affect brain) <ul><li>Hypoxia -> damage cells throughout body -> e.g Brain hypoxia (hippocampus) -> inability to learn new things and carry simple conversations. </li></ul><ul><li>Long term used will break down myelin -> muscle spasm and tremors -> difficulty with basic action like walking,talking etc. </li></ul><ul><li>Acting like CNS depressant similar to alcohol-> initial excitation then disinhibition,agitation. </li></ul>
  60. 69. Inhalants (symptoms of intoxication) <ul><li>slurred speech, lack of coordination, euphoria, and dizziness. - > lightheadedness, hallucinations, and delusions. </li></ul><ul><li>lose the ability to learn new things </li></ul><ul><li>muscle spasms and tremors </li></ul><ul><li>Long term -> mood swings,anergic,severe brain damage, </li></ul>
  61. 70. Inhalants (withdrawal symptoms) <ul><li>Anxiety,depression,aggressiveness </li></ul><ul><li>Headache,tremors,nausea,loss of appetite </li></ul><ul><li>Hallucinations </li></ul>
  62. 71. Adverse Effect on Health <ul><li>‘ Sudden Sniffing Death’ </li></ul><ul><li>Disturbed consciousness and apnea </li></ul><ul><li>Hearing loss </li></ul><ul><li>Peripheral Neuropathies or limb spasm </li></ul>
  63. 75. From to <ul><li>Depressant </li></ul><ul><li>Relaxation, </li></ul><ul><li>Lowered inhibitions, </li></ul><ul><li>Reduced intensity of physical sensations </li></ul><ul><li>digestive upsets, </li></ul><ul><li>Body heat loss, </li></ul><ul><li>reduced muscular coordination </li></ul><ul><li>Passing out, </li></ul><ul><li>loss of body control, </li></ul><ul><li>stupor, </li></ul><ul><li>Severe depression of respiration </li></ul><ul><li>possible death. </li></ul><ul><li>(Effects are exaggerated when used in combination with alcohol –synergistic effect). </li></ul>
  64. 76. <ul><li>Amnesia, </li></ul><ul><li>confusion, </li></ul><ul><li>drowsiness, </li></ul><ul><li>Personality changes </li></ul><ul><li>Development of Tolerance </li></ul><ul><li>Moderate </li></ul>
  65. 77. <ul><li>( DSM-IV ) requires 2 or more of the following characteristics to be present for diagnosis </li></ul><ul><li>autonomic hyperactivity </li></ul><ul><li>(eg, sweating, pulse rate >100); </li></ul><ul><li>increased hand tremor; </li></ul><ul><li>insomnia; </li></ul><ul><li>nausea or vomiting; </li></ul>
  66. 78. <ul><li>transient visual, tactile, or auditory hallucinations or illusions; </li></ul><ul><li>psychomotor agitation; </li></ul><ul><li>anxiety; </li></ul><ul><li>grand mal seizures. </li></ul>
  67. 80. Beer Hard Liquor Wine <ul><li>Development of Tolerance </li></ul><ul><li>Moderate </li></ul>
  68. 82. <ul><li>After a few drinks :     feel more relaxed, reduced concentration & slower reflexes. </li></ul><ul><li>  A few more drinks :     fewer inhibitions, more confidence, reduced coordination, slurred speech, intense moods </li></ul><ul><li>Still more drinks:      Confusion, blurred vision, poor muscle control.   </li></ul><ul><li>More still:      Nausea, vomiting, possible incontinence, poor respiration, a fall in blood pressure, sleep.  </li></ul><ul><li>Even More:      Possibly coma or death.  </li></ul>
  69. 84. <ul><li>The severity of alcohol withdrawal depends on various factors including </li></ul><ul><li>age, </li></ul><ul><li>genetics, </li></ul><ul><li>degree of alcohol intake </li></ul><ul><li>length of time the individual has been misusing alcohol </li></ul><ul><li>number of previous detoxifications. </li></ul>
  70. 85. <ul><li>Mild to moderate psychological symptoms : </li></ul><ul><li>Feeling of jumpiness or nervousness </li></ul><ul><li>Feeling of shakiness </li></ul><ul><li>Anxiety </li></ul><ul><li>Irritability  or easily excited </li></ul><ul><li>Emotional volatility, rapid emotional changes </li></ul><ul><li>Depression </li></ul><ul><li>Fatigue </li></ul><ul><li>Difficulty with thinking clearly </li></ul>
  71. 86. <ul><li>Mild to moderate physical symptoms : </li></ul><ul><li>headache  - general, pulsating </li></ul><ul><li>Sweating, especially the palms of the hands or the face </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Insomnia , sleeping difficulty </li></ul><ul><li>Paleness </li></ul><ul><li>Rapid heart rate ( palpitation ) </li></ul><ul><li>Eyes, pupils different size (enlarged, dilated pupils) </li></ul><ul><li>Skin,  clammy </li></ul><ul><li>Abnormal movements </li></ul><ul><li>Tremor  of the hands </li></ul><ul><li>Involuntary, abnormal movements of the eyelids </li></ul>
  72. 87. <ul><li>Severe symptoms : </li></ul><ul><li>A state of confusion and hallucinations (visual) -- known as  delirium tremens </li></ul><ul><li>Agitation </li></ul><ul><li>Fever </li></ul><ul><li>Convulsions (which may result in death) </li></ul><ul><li>“ Black outs &quot; -- when the person forgets what happened during the drinking episode </li></ul>
  73. 88. <ul><li>A toxicology screen refers to various tests to determine the type and approximate amount of legal and illegal drugs a person has taken. </li></ul><ul><li>How the Test Is Performed </li></ul><ul><li>blood or urine sample. </li></ul><ul><li>However, it may be done soon after swallowing the medication, using stomach contents that are obtained through gastric lavage  or after vomiting. </li></ul>
  74. 89. A blood toxicology screen can determine the presence and level (amount) of a drug in your body. Urine sample results are usually reported as positive (substance is found) or negative (no substance is found).
  75. 90. <ul><li>HOW LONG AFTER USAGE CAN DRUGS BE DETECTED </li></ul><ul><li>There is no simple answer to this question, because it depends on </li></ul><ul><li>substance itself </li></ul><ul><li>dosage, </li></ul><ul><li>frequency of abuse </li></ul><ul><li>individual rates of drug metabolism and excretion </li></ul><ul><li>sensitivity of the particular test carried out </li></ul>
  76. 91. DRUGS DURATION OF DETECTION IN URINE: Alcohol up to 1 day Amphetamines (including MDMA, MDA) 1-3 days Barbiturates 1-3 days Benzodiazepines 1-3 days Cannabis up to 14 days Cocaine 1-3 days Codeine 1-2 days Cyclizine 1-2 days Dihydrocodeine 1-2 days Heroin (morphine) up to 1 day Methadone 1-3 days 6-MAM up to 1 day
  77. 92. <ul><li>http://emedicine.medscape.com/article/290585-clinical </li></ul><ul><li>http://www.kickoff.net.au/Alcohol.html </li></ul><ul><li>http://health.nytimes.com/health/guides/tes/toxicology-screen/overview.html </li></ul><ul><li>http://www.toxlab.co.uk/dasguide.htm#SENSITIVITIES </li></ul><ul><li>http://alcoholism.about.com/cs/withdraw/a/aa030307a.htm </li></ul>
  79. 94. PRINCIPLES OF EFFECTIVE TREATMENT <ul><li>Addiction is a complex but treatable disease. </li></ul><ul><li>No single treatment is appropriate for everyone. </li></ul><ul><li>Attends to multiple needs of the individual, not just his or her drug abuse. </li></ul><ul><li>Treatment for an adequate period of time is critical. </li></ul><ul><li>Counseling and other behavioral therapies are the most commonly used. </li></ul><ul><li>Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. </li></ul>
  80. 95. <ul><li>Treatment plan must be modified as necessary to ensure that it meets patients changing needs. </li></ul><ul><li>Many drug–addicted individuals also have other mental disorders. </li></ul><ul><li>Medication by itself does little to change long–term drug abuse. </li></ul><ul><li>Treatment does not need to be voluntary to be effective. </li></ul><ul><li>Drug use during treatment must be monitored continuously, as lapses during treatment do occur. </li></ul><ul><li>Assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases. </li></ul><ul><li>Provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases. </li></ul>
  81. 96. <ul><li>There are 3 major areas in the rehabilitation program: </li></ul><ul><li>1. Detection and detoxification </li></ul><ul><li>2. Rehabilitation in an institution </li></ul><ul><li>3. Supervision in the community and follow-up care </li></ul>
  82. 98. DETOXIFICATION <ul><li>Detoxification is the process by which the body clears itself of drugs and is often accompanied by unpleasant and sometimes even fatal side effects caused by withdrawal. </li></ul><ul><li>The process of detoxification often is managed with medications that are administered by a physician therefore, it is referred to as &quot; medically managed withdrawal .&quot; </li></ul><ul><li>Generally considered a precursor to or a first stage of treatment because it is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. </li></ul>
  83. 99. Outpatient Drug Rehabs and Drug Treatment Centers <ul><li>Use a wide range of treatment modalities including: </li></ul><ul><li>problem-solving group or talk therapy, </li></ul><ul><li>insight-oriented psychotherapy </li></ul><ul><li>cognitive-behavioral therapy , and </li></ul><ul><li>12-step programs. </li></ul><ul><li>*more loosely structured </li></ul><ul><li>*depending on the individual patient's characteristics and needs. </li></ul>
  84. 100. Inpatient Short-Term   Drug Rehabs and Drug Treatment Centers <ul><li>Keep patients up to 30 days in treatment center. </li></ul><ul><li>Most of these treatment programs focus on: </li></ul><ul><li>*medical stabilization </li></ul><ul><li>*abstinence </li></ul><ul><li>*lifestyle changes </li></ul><ul><li>Staff members are primarily medical professionals and counselors trained in drug and alcohol addiction.  </li></ul><ul><li>Tends to be less effective in long-term recovery. </li></ul><ul><li>Intensive but relatively brief residential treatment based on a modified 12-step approach, talk and group therapy. </li></ul>
  85. 101. Inpatient Long-Term   Drug Rehabs and Drug Treatment Centers <ul><li>Around-the-clock, drug-free treatment in a residential community of counselors and fellow recovering addicts. </li></ul><ul><li>Patients generally stay in these programs several months or up to a year or more.   </li></ul><ul><li>Greater chance of success </li></ul><ul><li>provide care 24 hours per day, generally in non-clinical settings. </li></ul><ul><li>The best-known residential treatment model is the therapeutic community (TC) </li></ul>
  88. 106. <ul><li>usually conducted in specialized settings (e.g., methadone maintenance clinics). </li></ul><ul><li>long-acting synthetic opioid(opioid agonist). </li></ul><ul><li>80–125 mg/d, periodic dose adjustments as their clinical or subjective tolerance changes. Reduction by a slow taper to minimize discomfort. </li></ul><ul><li>prevent opioid withdrawal, block the effects of illicit opioid use, and decrease opioid craving. </li></ul>
  89. 107. <ul><li>semi-synthetic partial opioid agonist(agonist and binds more tightly at the mu-opioid receptor and blocks other opioid from binding to the receptor). </li></ul><ul><li>addition of Naloxone to Buprenorphine may further decrease abuse liability while increasing its safety. </li></ul><ul><li>eliminates withdrawal symptoms. </li></ul>
  90. 108. <ul><li>long-acting synthetic opioid antagonist. </li></ul><ul><li>to prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone. </li></ul><ul><li>noncompliance is a common problem. </li></ul><ul><li>best suited for highly motivated patients. </li></ul>
  91. 110. <ul><li>originally marketed as an antidepressant. </li></ul><ul><li>has mild stimulant effects through blockade of the reuptake of catecholamines, especially norepinephrine and dopamine. </li></ul><ul><li>suppressing tobacco craving, promoting cessation without concomitant weight gain. </li></ul>
  92. 111. <ul><li>partial agonist of nicotinic receptors (alpha-4 beta-2) which thought to be involved in the rewarding effects of nicotine. </li></ul><ul><li>blocks the ability of nicotine to activate dopamine. </li></ul><ul><li>interfering with the reinforcing effects of smoking, thereby reducing cravings and supporting abstinence from smoking. </li></ul>
  93. 113. <ul><li>blocks opioid receptors that are involved in the rewarding effects of drinking and the craving for alcohol. </li></ul><ul><li>reduces relapse to heavy drinking but less effective in helping patients maintain abstinence. </li></ul>
  94. 114. <ul><li>stabilize the chemical balance in the brain that was disrupted by alcoholism, possibly by blocking glutamatergic N-methyl-D-aspartate receptors, while GABA type A receptors are activated. </li></ul><ul><li>reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria. </li></ul><ul><li>help dependent drinkers maintain abstinence for weeks to months, and more effective in patients with severe dependence. </li></ul>
  95. 115. <ul><li>interferes with degradation of alcohol, resulting in the accumulation of acetaldehyde producing a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. </li></ul><ul><li>compliance is generally poor. </li></ul><ul><li>Effective in highly motivated patients. </li></ul>
  96. 116. <ul><li>THANK YOU </li></ul>