 Intoxication short term psychological and physiological consequences   Abuse long term physical, mental and social problems  Hazardous use may cause damage to physical health  Harmful use already caused damage

 Tolerance higher dose for same effect  Withdrawal state  Craving  Dependence psychophysiological state accompany repeated administration

 Problem drinker  Is it a disease  Criteria of alcohol dependence  narrowing of repetoir of drinking  salience over other activities  tolerance  withdrawal  compulsion to drink  reinstatement after withdraw

Etiology  genetic  personality  behavioral theory  psychiatric  cultural  occupations

Complications  Consequences  social: marriage, work, offences, crimes,vagrancy

Complications psychiatric:  Depression, suicide  Delirium tremens  Hallucinosis  Amnesia  Cognitive impairment

physical  Liver damage  GIT  Anemia  Cancer  Heart  Infections  Fetal alcohol syndrome

neurological  Intoxication  Wernicke Korsakoff  Peripheral neuropathy  Convulsions  Myopathies 

Management 1-assessment CAGE  Psychiatric  Physical  2- detoxification 3- long term  Aversive therapy  Psychotherapy  self help groups

Prevention  Early detection  Control availability  Advertisement  Education

 Potent,short half life  Physical and psychological

 Heroin, pethidine  Physical dependence  Intoxication respiratory depression  Withdrawal anxiety  Management methadone, harm minimization

 MDMA cocaine amphetamines  No physical withdrawal syndrome  Euphoria increased sympathetic drive  Stopping depression, craving

 LSD psilocibine  Change reality  Bad trips  No physical dependence flash backs

Solvents  School boys  Disorientation vomiting  Risky, respiratory depression,  Irreversible neurotoxicity Anticholinergics  Benzhexol, procyclidine