1. Substance use disorder

2. 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.

3. 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.

4. 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.

5. 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A group of signs and symptoms recurring when a drug is reduced in amount or withdrawn, which last for a limited time.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.

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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.

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

14. 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.

15. A concentration of 80 – 100 mg of alcohol per 100ml of blood is considered intoxication.
A person with 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.

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

17. 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.)

18. 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.)

19. 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.

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

21. 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.

22. 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

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

24. 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

25. 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.