Substance Related DisordersSubstance Related Disorders

Dr. Y R BhattaraiTMU

What is a drug?What is a drug?A drug is a substance that

has an action on biological tissues when administered

Some drugs influence mood cognition and behavior◦ Psychoactive/

Psychotropic drugs are like alcohol, cocaine, diazepam etc.

Psychoactive DrugsPsychoactive DrugsSubstances active on CNS tissues when

administered thereby causing changes

in mood, cognition, behavior

Psychoactive SubstancePsychoactive Substance

Psychoactive (psychotropic) substance is any substance which after absorption has influence on mental processes both cognitive and affective.

Drug Action on the Nervous SystemDrug Action on the Nervous System

Most drugs that are abused have a common effect on a particular NT pathway. The basic addiction pathway in the brain is a dopamine pathway followed by serotonin.

Activation of this pathway accounts for the positive reinforcement, feeling and makes us want to repeat the action that triggered the feeling.

Action on NT systems

Agonist Antagonist

Drug Action on the Nervous Drug Action on the Nervous System – Reinforcement System – Reinforcement

Drug Action on the Nervous System on Drug Action on the Nervous System on Repeated Use Repeated Use Tolerance

◦Decreased response to repeated exposureDependence

◦System adapts to presence of drug. Drug necessary for homeostasis

Withdrawal◦Response to drug leaving the system

Addiction◦Compulsive engagement in reinforcing

behavior

The DSM-IV defines substance The DSM-IV defines substance abuse asabuse asA maladaptive pattern of substance

leading to clinically significant impairment or distress as manifestated by one or more of the following:

Failure to fulfill major role obligations at home, school, or work.

Recurrent substance use in situations in which it is physically hazardous.

Definition....Definition....Recurrent substance related legal

problems.Recurrent substance use despite

persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.

Classification of the substances that are Classification of the substances that are commonly abusedcommonly abused

ALCOHOLSEDATIVES, HYPNOTICS & ANXIOLYTICSOPIATES (morphine, heroin)HALLUCINOGENS (LSD, mescaline)STIMULANTS (amphetamine, cocaine)CANNABIS (marijuana, hashish)NICOTINECAFFEINE INHALANTS (glue, paint, thinner)PHENCYCLIDINE ( PCP, angel dust)

Mental and Behavioral Disorders Mental and Behavioral Disorders Due to Psychoactive Substance Due to Psychoactive Substance UseUse

Specific Clinical Conditions:Acute intoxicationsDependence syndromeWithdrawal statePsychotic disorderAmnesic syndromeResidual state, late-onset psychotic

disorder

Substance Dependence Substance Dependence (Addiction)(Addiction)Substance dependence is defined as

adaptive pattern of substance use leading to clinically significant impairment, as manifested by three or more of the following occuring at any time in a 12 months period.

Tolerance Withdrawal Repeated unintended , excessive

use Persistent failed efforts to cut down.

Substance Dependence Substance Dependence contd...contd... Excessive time spent trying to

obtain the substance Reduction in important

social,occupational or recreational activities.

Continued use despite awareness that substance is the cause of psychological or physical difficulties.

Physical dependencePsychic (psychological) dependence

Withdrawal StateWithdrawal StateSymptoms occurring on absolute or

relative withdrawal of a substance after repeated and prolonged use of the substance

◦Uncomplicated◦With convulsions

Influence causing Drug Influence causing Drug DisordersDisorders

Public Health Model

Agent – Drug Properties

Host – Person Characteristics

Environment

Access, Norms

Media

EpidemiologyEpidemiology37% of people report to having used an

illicit substanceAbou1/3rd of psychiatric disorders are

abuse disorders.Men outnumber women roughly 2.5times.15% of people over 28 have a serious

substance use problem◦ 2/3 alcohol◦ 1/3 other drugs

In USA 50% of emergency visits are substance

related.

Contd…Contd…

Male>FemaleAlcohol use : White=Hispanic>BlackMarijuana use: Black>WhiteAlcohol – 59.6%Nicotine – 27.6%Cannabis– 24.9%LSD – 7.6%Hallucinogens - 10.1%Stimulants – 6.6%Cocaine – 2.7%Heroin – 1.8%

EtiologyEtiologyPsychological: associated with

conduct disorder, ADHD, depressionCulturalGeneticNeurochemical

Individual-related Risk Individual-related Risk FactorsFactorsEarly age of onset

Presence of early childhood behavioral problems

Poor academic performanceRisk-taking behaviorsFavorable beliefs about substance useShorter attention spansIncreased impulsivitySelf medication hypothesis: alcohol

for anxietyInnately more tolerant to alcohol

Family-related Risk FactorsFamily-related Risk FactorsFavorable beliefs about substance

use in parentsParental tolerance of substance useLack of closeness and attachment

between adolescent and parentLack of discipline/supervision by

parentParental substance useChildhood physical or sexual abuse

Peer-related Risk FactorsPeer-related Risk FactorsPeer substance useFavorable peer attitudes to useGreater orientation of adolescents

to peers as opposed to parents

Community-related Risk Community-related Risk FactorsFactorsLow SE statusHigh population densityHigh crime rate

Natural HistoryNatural HistoryMost adolescents try ‘gateway’

drugs (such as cigarettes or alcohol) which are legal and more accessible

such ‘gateway’ drugs then can lead to illicit drug use

PHYSICAL AND PSYCHIATRIC PHYSICAL AND PSYCHIATRIC EXAMINATIONEXAMINATION

Denial is very commonTry to obtain history from significant

family members and friendsHistory should include questions about

family function, school and occupational performance, and interactions with friends.

Types of substance used, amounts, circumstances of use and drug reactions

Clinical indicators of a Clinical indicators of a substance use problemsubstance use problemPsychosocial/behavioral

◦Change in school performance◦Involvement in illegal activities◦Sexual acting (ie. Prostitution)◦Increased demands for money◦Change in peer group/involvement◦Driving under the influence

Contd… Contd…

Medical◦ Frequent injuries◦ Suicide attempts◦ Sudden weight changes◦ Chronic respiratory symptoms◦ Gastrointestinal complaints◦ Insomnia◦ Infections◦ Anxiety◦ Depression◦ Sexually transmitted diseases

Contd…Contd…

Historical◦Parental use◦Estrangement from family◦Poor quality relations in the family◦Abuse/neglect◦Psychiatric disorders◦Early age of first use of substances

PREVENTIONPREVENTIONPreventive programs: teach adolescents

how to resist social pressure to use drugs.

Detoxification: substance specificDrug rehabilitation: develop new coping

skillsSelf-help groups: alcoholics anonymousDisulfiramNaltrexonemethadone

THANKYOU !THANKYOU !