1. Substance Abuse

2. Drugs of abuse Narcotic Non narcotic Ecstasy Opium alkoloids
Synthetic opiods
Morphine
Codeine
Heroin
Methadone
Sedatives
Stimulants
Hallucinogens
Cannabis
Benzodiazepines
Amphetamine
Cocaine
LSD
barbiturates
Ecstasy

3. Causes of drug abuse Availability Prescribed Dx Vulnerable personality
‘Street’ Dx
Vulnerable personality
Social pressures

4. Substance dependence Strong desire or compulsion to take
Difficult to control intake
Withdrawal state when stopped /reduced
Persisting use despite harm
Neglect of alternate pleasures
Tolerance

5. Substance Dependence Physiological Psychological Fast – Opioids
Slow – Anxiolytics
None- Cannabis
Hallucinogens
Psychological
Craving, dysphoria
Due to conditioning

6. Harmful Consequences Physical health Vein thrombosis , infection
IV drug use HIV, hepatitis, endocarditis
In pregnancy - fetal defects, growth, dependence
Psychiatric
-anxiety
-mood
-psychotic
Social

7. Opioids Extract of Papaver somniferum Used for >3500 years (poppy)
Used as medication/pleasure
Heroin-
‘chasing the dragon’
Smoking
Intra venous (IV)

8. on withdrawal NAD action 2. Act on endogenous opioid receptors
Opioids Act through-
NAD cell firing
on withdrawal NAD action
2. Act on endogenous opioid receptors
Effects – Euphoria, analgesia, drowsiness, constipation, LOA, libido
Dependence Rapid tolerance
& withdrawals – low mood, aches,
Insomnia, pupils dilated, lacrimation

9. Effects – existing mood enhanced
Dried resin of cannabis sativa-
has Tetrahydrocannabinol
Effects – existing mood enhanced
Psychomotor retardation (!!driving)
slowed time sense, red conjunctiva, cough, dry mouth
psychotic symptoms
Psychological dependence only
Withdrawal- LOA, insomnia,
irritability

10. Nicotine abuse Most active chemical in tobacco
Smoking- ‘largest cause of
preventable premature death’ – Kills 1 in 3 smokers
In SL used as – cigarettes, cigars, tobacco leaves
Diseases caused-
-Cancers (Tar) – lung, GI
renal, pharyngeal
-Lung disease (irritants)
-MI, Stroke ( CO, clotting)
-Sexual -Impotence

11. Action of nicotine- Effects Acts on Ach receptors (but these )
Has stimulant and depressant actions
dopamine, Adrenaline, NAd, serotonin
Reduces insulin - hyperglycaemic
Effects
Performance enhancement
Mood stabilizer (reduce anger)
Reduces appetite ; BMR
Withdrawal
Low mood, irritability, Low concentration, restlessness weight gain, impaired functioning

12. Management of tobacco use

13. Pharmacotherapies used

14. Other substances Stimulants – Amphetamines Psychosis, aggression
Cocaine
MDMA (ecstasy)- hallucinogenic too
Hallucinogens – LSD
‘Magic mushrooms’
Hypnotics - benzodiazepines

15. Management of substance abuse
Identify & Assess
Manage acute intoxication
Detoxification
Withdrawals – Dx of same group –
e.g. Methadone for heroin
Longer acting bezodiazepine
Advice & education – Harm reduction
Rehabilitation houses & groups

16. Thank you
Dr Himalee Abeya