Substance use disorder

DEFINITION OF PSYCHOACTIVE SUBSTANCES Alcohol, coffee, heroin, GHB, amphetamines, cocaine, and cannabis are all psychoactive substances, which means that they affect people’s mental processes. Psychoactive substances: Alter people’s perceptions, moods, thinking, behaviour, and various physical and psychological functions; using them exposes people to risks and health hazards and can have social consequences in their daily lives; it can also lead to dependence Also cause bodily reactions that vary widely with the properties of each substance, its effects, and how harmful it is.

DEFINITION OF PSYCHOACTIVE SUBSTANCE USE DISORDER Psychoactive substance use disorder refers to condition arising from the abuse of alcohol, psychoactive drugs and other chemicals such as volatile solvents.

TERMINOLOGIES Substance - Any drug, medication, or toxin that shares the potential for abuse. Addiction- Is a physiologic and psychologic dependence on alcohol or other drugs of abuse that affects the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued. Abuse- It refers to maladaptive pattern of substance use that impairs health in a board sense.

Dependence - It refers to certain physiological and psychological phenomena induced by the repeated taking of a substance. Tolerance - It is a state in which after repeated administration, a drug produces a decreased effect, or increasing doses are required to produce the same effect. Withdrawal state- A group of signs and symptoms recurring when a drug is reduced in amount or withdrawn, which last for a limited time. The nature of the withdrawal state is related to the class of substance used.

CLASSIFICATION (F10–F19) Mental and behavioural disorders due to psychoactive substance use F10.- Mental and behavioural disorders due to use of alcohol F11.- Mental and behavioural disorders due to use of opioids F12. –Mental and behavioural disorders due to use of cannabinoids F13. –Mental and behavioural disorders due to use of sedative hypnotics F14. –Mental and behavioural disorders due to use of cocaine F15. –Mental and behavioural disorders due to use of other stimulants, including caffeine F16. –Mental and behavioural disorders due to use of hallucinogens F17. –Mental and behavioural disorders due to use of tobacco F18. –Mental and behavioural disorders due to use of volatile solvents F19. –Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances

COMMONLY USED PSYCHOTROPIC SUBSTANCE Alcohol Opioids Cannabis Cocaine Amphetamines Hallucinogens Sedatives and hypnotics Inhalants Nicotine Other stimulants

ETIOLOGICAL FACTORS 1. BIOLOGICAL FACTORS- Genetic vulnerability Biochemical factors Neurobiological theories Withdrawal and reinforcing effect Co morbid medical disorder 2. BEHAVIOURAL THEORIES Behavioural theorists view drug abuse as the result of conditioning Drug use causes euphoric experience Stimuli and setting associated with drug use

3. PSYCHOLOGICAL FACTORS General rebelliousness Sense of inferiority Poor impulse control Low self- esteem Inability to cope up with the living and society. Loneliness, unmet needs Desire to escape from reality Desire to experiment , a sense of adventure Pleasure- seeking Sexual immaturity

4. SOCIAL FACTORS Religious reasons Peer pressure Urbanization Extended periods of education Unemployment Overcrowding Poor social support Effects of television and other mass media Occupation

5. EASY AVAILABILITY OF DRUGS Taking drugs prescribed by the doctors Taking drugs that can be bought legally without prescription Taking drugs that can obtained by illicit sources. 6. PSYCHIATRIC DISORDERS Depression Anxiety disorders Personality disorders Occasionally in organic brain disease and schizophrenia

CONSEQUENCES OF SUBSTANCE ABUSE Substance abuse leads to physical , psychological dependence or both. Causes unhealthy life styles and behaviour such as poor diet. Impairs social and occupational functioning Creates personal, professional , financial and legal problems. May leads to emotional and behavioural problems. Life threatening complications Develops maladaptive behaviours Toxic and allergic reactions.

ALCOHOL DEPENDENCE SYNDROME Alcoholism refers to the use of alcoholic beverages to the point of causing damage to the individual, society or both.

PROPERTIES OF ALCOHOL Alcohol is a clear colored liquid with a strong burning taste. The rate of absorption of alcohol into the bloodstream is more rapid than its elimination. Absorption of alcohol into the bloodstream is slower when food is present in the stomach. A small amount is excreted through urine and a small amount is exhaled.

A concentration of 80 – 100 mg of alcohol per 100ml of blood is considered intoxication. A person with 200-250 mg will be toxic, sleepy, confused and his thought process will be altered. If blood level is 300mg/100ml of blood the person may lose consciousness. A concentration of 500 mg/100 ml is fatal.

EPIDEMIOLOGY The incidence of alcohol dependence is 2 percent in India. While 20- 40% of subjects aged above 15 years are current users of alcohol and nearly 10 % of them are regular or excessive users. Nearly, 15- 30% of patients are developing alcohol related problems and seeking admission in psychiatric hospitals.

SIGNS AND SYMPTOMS OF ALCOHOL DEPENDENCE Minor complaints: malaise, dyspepsia, swings or depression, increased incidence of infection. Poor personal hygiene, untreated injuries (cigarette burns, fractures, bruises that cannot be fully explained.) Unusually high tolerance for sedatives and opioids. Nutritional deficiency (vitamins and minerals.)

Secretive behaviour (may attempt to hide disorder or alcohol supply) Consumption of alcohol containing products (mouthwash, aftershave, hair spray, lighter fluid) Denial of problem. Tendency to blame others and rationalize problems (possibly displacing anger, guilt or inadequacy onto others to avoid confronting illness.)

ICD- 10 CRITERIA FOR ALCOHOL DEPENDENCE A strong desire to take the substance. Difficulty in controlling substance taking behaviour. A physiological withdrawal state. Development of tolerance. Progressive neglect of alternative pleasure or interests. Persisting with substance use despite clear evidence of harmful consequences.

PSYCHIATRIC DISORDERS DUE TO ALCOHOL DEPENDENCE Acute intoxication Withdrawal syndrome Alcohol-induced amnestic disorders. Alcohol-induced psychiatric disorders.

ACUTE INTOXICATION Acute intoxication develops during or shortly after alcohol ingestion. It is characterised by clinically significant maladaptive behaviour of psychological changes for examples:- inappropriate sexual or aggressive behaviour, mood liability, impaired judgment, slurred speech, incoordination, unsteady gait, nystamus, impaired attention and memory finally resulting in stupor or coma.

WITHDRAWAL SYNDROME In persons who have been drinking heavily over a prolonged period of time any rapid decrease in the amount of alcohol in the body is likely to produce withdrawal symptoms. These are:- Simple withdrawal syndrome Delirium tremens

Simple Withdrawal Syndrome It is characterized by mild tremors, nausea, vomiting, weakness, irritability, insomnia and anxiety

Delirium tremens It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking. The course is short, with recovery occurring within 3-7 days. It is characterized by:- Clouding of consciousness Disorientation in time and place. Poor attention span. Vivid hallucination which are usually visual, tactile hallucinations can also occur. Severe psychomotor agitation, shouting and evident fear. Grossly tremulous hands

Autonomic disturbances such as sweating, fever, tachycardia, raised blood pressure, puplllary dilation. Dehydration with electrolyte imbalances Reversal of sleep- wake pattern or insomnia. Blood tests reveal leukocytes and impaired liver function Death may occur due to cardiovascular collapse, infection, hyperthermia or self inflicted injury.