1. 2. Drug Misuse and Dependency
April 2016

2. What is substance misuse/dependency
What is substance misuse/dependency? Can one become dependent on legal highs?

3. Substance Use Disorders -Classification diagnostic statistical manual DSM V (USA) or International Classification of Diseases and Health Problems (ICD-10) ICD10 (Europe):
Recurrent use resulting in a failure to fulfil major obligations at work, school, or home
Legal problems resulting from recurrent use
Continued use despite significant social or interpersonal problems caused by the substance use
Recurrent use in situations which are physically hazardous (e.g. driving while intoxicated)

4. DSM IV Substance Dependence:
Substance abuse
Increase in tolerance
Withdrawal symptoms
Compulsion to use

5. Withdrawal
Abrupt discontinuation or decrease in intake of medications or recreational drugs Common withdrawal problems with some antidepressants, psychostimulants, benzodiazepines and alcohol

6. Withdrawal effects Anxiety Irritability Drug craving Cramps
Hypo-locomotion
Anhedonia
Depression?

7. Cognitive deficits While under the influence After chronic use
Loss of concentration
Dissociation
Psychoses
After chronic use
Memory loss
Executive function

8. Evidence for legal highs showing addictive and/or withdrawal effects?

9. Literature
Erik W. Gunderson, et al (2012)“Spice” and “K2” Herbal Highs: A Case Series and Systematic Review of the Clinical Effects and Biopsychosocial Implications of Synthetic Cannabinoid Use in Humans The American Journal on Addictions 21 (4) DOI: /j x
Lally J, Hallaghan B et al. Prevalence study of head shop drug usage in mental health. B J Psych doi: /pb.bp
The rise and rise of legal highs
Turnbull A ( 2015) Independent Nurse, The low profile of legal highs

10. Literature
Psychiatria Danubina, 2011; Vol. 23, Suppl. 1, pp 32– Conference paper UNUSUAL PRESENTATION OF A PATIENT WITH GBL WITHDRAWL: A CASE REPORT
Gursharan Lal Kashyap & Ashok G. Patel
South Essex Partnership University Foundation Trust Calnwood Court Luton Bedfordshire, UK
Royal College of Psychiatrists (2014)One new drug a week Why novel psychoactive substances and club drugs need a different response from UK treatment providers p8 table listing effects
Winder ,G.S. et al (2103)Are “Bath Salts” the next generation of stimulant abuse? Journal of Substance Abuse Treatment
44(1) p 42–45 doi: /j.jsat