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Hasham Masood
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At the end of this presentation you
will know :• What is Substance Abuse ?
• Terms associated with a Substance Abuser.
• Risk Factors/Etiology.
• Approach to a patient with substance abuse.
• Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder.
Terms to get familiar with :
• Substance Intoxication :Reversible, maladaptive use of a substance that leads to changes, ie Behavioral or physiological.
• Substance Withdrawal : Condition experienced when the drug is stopped or the dosage is decreased, on which the person is dependent.
• Substance Dependence :An adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of the drug.
• Substance Tolerance : When an increased dosage is required to get the desired effect.
Substances that are abused :
• Alcohol
• Cannabis
• Heroine
• Ecstasy
• Cocaine
• Amphetamines
• Bath salts
• Anabolic Steroids
• Benzodiazepines
• Hallucinogens
• Inhalants
• Opiates
• Phencyclidine (PCP)
Etiology/Risk Factors
• Family History
• Physiology :Individual who are innately tolerant to alcohol.
• Developmental History: Poor Parenting, permissive attitude towards drug use.
• Environmental risk factors:Exposure to drugs through peers, certain occupation, social isolation.
• Psychiatric disturbances: Depression, conduct disorder, low self-esteem.
• Self-Medication hypothesis: e.g., a person suffering from anxiety disorder uses alcohol to decrease it.
How to approach a patient with
Substance abuse Disorder ?
• History
• Examination
• Diagnosis
• Treatment
History :
• Substance Abuse History :
I. Substance Used
II. Dosage
III. Effects
IV.Duration
V. Where did he use it ?
• Medical History : Any complications of
substance abuse, eg: Liver cirrhosis, lung
cancer etc.
• Psychiatric History
Examination :
• Mental status examination
I. Anxiety
II. Depression
III. Emotional Terminal
• Physical examination : Signs of drug abuse, eg: needle marks, burns, skin Infections etc.
• Evidence of self inflicted injuries or accidents.
Should also look for :
• Poor hygiene
• Poor nutrition
• Cough
Diagnosis :
• CAGE
I. Have you ever felt that you should Cut down your drinking ?
II. Have you ever felt Annoyed by others who have criticized your drinking ?
III. Have you ever felt Guilty about your drinking ?
IV. Have you ever had a morning drink(Eye opener) to steady your nerves or alleviate a hangover ?
• Urine drug screen :Amphetamines,
barbiturates, benzodiazepines, cannabinoids,
cocaine, methodone, methaqualone, opiates,
phencyclidine .
For shortest time : 2-3 days (Cocaine)
For longest time : up to 30 days (Marijuana)
• Breath test : For Alcohol
• Blood : AST, ALT, GGT, LDH
• Hair testing (Not a routine test) : Cocaine,
amphetamines, methamphetamines, opiates,
PCP, marijuana
Types of Treatment :
• Pharmacotherapy : Medications that work on reward centre, such as naltrexone, varenicline, and buropion
• Psychotherapy : Group Therapy, ie Alcoholic Anonymous, Narcotics Anonymous
• Behavioral Modification : techniques: disulfram(aversive conditioning), patch, gum.
• Detoxification units
• Rehabilitation programs
Source of Information :
CH:11, USMLE Step 2 CK, Psychiatry.
Webmd.
• Thank you !
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