1. SUBSTANCE ABUSE AND ADDICTION

2. Substances:
Are chemicals like alcohol, drugs or food.

4. Substance abuse:
It is intermittent impaired control of substance use and represents a stage in the spectrum of substance use disorders

5. Tolerance:
It is a diminished biological or behavioral response to repeated administration of the same amount of a drug; or the need for an increased amount of the drug to achieve the same desired level of effect
Tolerance reflects the body’s homeostatic adaptations to counter the effects of a drug, there are two types of adaptations:

7. Cross-tolerance:
Is the decreased pharmacological or behavioral effects of a drug secondary to the use or abuse of a second drug e.g.: alcohol abuse cause cross-tolerance to sedative hypnotics.

8. Withdrawal (abstinence) syndrome:
It is a syndrome of physical and/or psychological disturbances that follows the abrupt discontinuation of a drug or pharmacological blockage of the actions of a drug

9. CNS depressants, such as alcohol, barbiturates and opiates have physical withdrawal symptoms such as muscle cramps, nausea, convulsions, and sweating that reflects the compensatory hyperexcitability of the CNS.
CNS stimulants, such as cocaine, amphetamine, and nicotine involve a general hypoexcitability of the CNS secondary to withdrawal.

10. Dependence:
It is persistent drug intake to prevent or diminish the physical or psychological disturbances of withdrawal. Dependence has two components:

11. Physical dependence: Refers to the physical withdrawal symptoms that occur upon termination of drug use such as, tremor, diarrhea, convulsion, hypnosis, … etc., so persistent drug intake to prevent these symptoms is physical dependence
Psychological dependence: Refers to the “ non-physical ” symptoms that occur upon termination of drug use, including: craving, agitation, anxiety, depression …etc.

12. Addiction:
It is the compulsive use and impaired control of intake of a drug despite its adverse consequences; the most addictive drugs are:
Opioids, cocaine, amphetamine, alcohol, and nicotine.

13. Risk factors of substance abuse:
Genetic vulnerability
Environmental factors
Pain and self-medications
Psychiatric disorders
Sociocultural factors

14. Classification of substances with abuse potential

15. 1- CNS depressants
2- CNS stimulants
3- Hallucinogens
4- Centrally acting anticholinergic drugs
5- Inhalants

16. CNS depressants Opioids morphine (natural opiate)
heroin (semisynthetic)
pethidine (synthetic)

17. opium poppy (Papaver somniferum)

18. opium poppy

19. heroin

20. CNS depressants
Alcohol ( ethanol)
wine
vodka
whisky
beer

21. Alcohol

22. CNS depressants Sedative - Hypnotic drugs
Barbiturates (Phenobarbital, secobarbital)
Benzodiazepines (diazepam, lorazepam, alprazolam)
others (chloral hydrate, meprobamate)

23. CNS stimulants Cocaine (coca leaves)
Amphetamines (amphetamine, methamphetamine)
Nicotine (tobacco)
Caffeine (coffee, tea)
Cathine (khat)

24. Coca leaves

25. Cocaine hydrochloride

26. Crack cocaine

27. Hallucinogens Cannabinoids (marijuana, hashish)
Lysergic acid diethylamide (LSD)
phencyclidine (PCP)
Psilocybin (magic mushroom)
Mescaline (hallucinogenic alkaloids)

28. Cannabis sativa

29. Cannabis sativa

30. marijuana

31. hashish

32. Centrally acting anticholinergic drugs
Procyclidine (kemadrin)
Biperiden (akineton)
Benzhexol (artein)

33. Inhalants (volatile organic compounds)
Aromatic hydrocarbons:
Benzene
Toluene (methyl benzene
Xylene (dimethyl benzene)
adhesives, glues, paints, paint thinners

34. volatile organic compounds
Aliphatic hydrocarbons:
- ethane, propane (cigarette lighters)
Halogenated hydrocarbons
Ethers
Ketones:
- acetone (nail polish remover)

35. General effects of substance abuse:
CNS stimulants
Mental stimulation, euphoria
Hyperactivity, increased sense of energy, increased self-confidence
Increased anxiety and easy irritability
Decreased appetite (anorexia)
Decreased need for sleep (insomnia)
Mydriasis , Hyperthermia, Dry mouth, Diaphoresis, Fine tremor, Tachycardia and high blood pressure

36. CNS depressants Sedation, euphoria Drowsiness and confusion
Decreased anxiety
Hypnosis, amnesia, and reduced reflex activity (in higher doses)
Pupil vary in size (miosis with opioids)
Respiratory depression (more obvious with opioids)
Weak pulse, bradycardia or tachycardia

37. Hallucinogens Relaxation, euphoria Confusion, slurred speech
Dilated pupils, congested conjunctivae (marked with cannabis}
Impairment of skilled motor activity
Hallucinations, illusions, depersonalization
Time seems to pass slowly, short term memory loss

38. Inhalants (VOCs) Euphoria, dizziness, disorientation
Confusion and impaired judgment (in high doses)
Congested conjunctivae, lacrimation
Nasotrachial irritation, wheezing
Hypotension and tachycardia

39. Generally the withdrawal signs and symptoms will be opposite to the effects produced by the substance or drug, but also each agent have a characteristic withdrawal syndrome

40. Consequences and complications of substance abuse:

41. Acute complications: Acute overdose Drug interactions
Idiosyncratic reaction (mostly with heroin)
Body packer syndrome ( rupture of balloons or condoms filled with drugs inside the GIT, occurred in drug smugglers)

42. Chronic medical consequences
depend on the specific substance and the method of administration

43. Infections
AIDS & Hepatitis (B&C) in IV drug abusers, due to sharing needles

44. Psychiatric and behavioral changes
Chronic anxiety
Depression
Violent behavior,
Sleep disorders

45. Neurological complications
CVA (CNS stimulants)
dysarthria
ataxia
impaired motor skills

46. Skin
(mostly manifestation of parenteral drug administration)
Injection marks
Multiple abscesses and ulcers due to infected needles
Granulomatous lesions “popper lesions” in subcutaneous tissue due to injection of insoluble adulterants like starch and talc that acts as foreign bodies

47. Skin
Hyperpigmentation over veins “turkey skin” which is bluish-black tattooing resulted from carbon deposition by needles sterilized over naked flame
Cord-like thickening of superficial veins “heroin tracks” due to repeated thrombophlebitis
Thermal burns in the hands due to repeated lighting or holding hot pipes

48. Respiratory
(mostly due to smoking and inhalation of substances like tobacco, marijuana, crack cocaine, VOCs ……etc)
URTI, LRTI, COPD, lung cancer

49. ENT Eye CVS Perforation of the nasal septum ( cocaine sniffing)
Rhinitis, sinusitis, pharyngitis, laryngitis, cancer
Eye
Keratitis (crack smoking)
Conjunctival ingection (marijuana)
CVS
HTN, IHD and arrhythmia ( CNS stimulants)

50. GIT
Chronic gastritis, peptic ulcer , liver cirrhosis (alcohol)
Genitourinary
Impotence and infertility (common with marijuana)
STD (sexually transmitted disease), common with cocaine

58. Thank you