1. DRUG ADDICTION AND ALCOHOLISM
Yard. Doç. Dr. N. Berfu Akbaş
Yeditepe Üniversitesi
Psikiyatri Anabilim Dalı

2. DEPENDENCE:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, manifested by TOLERANCE, WITHDRAWAL, PERSISTANT DESIRE, a great time and activity spent, social activities given up, use is continued despite knowledge of harms.
ABUSE: recurrent substance use in a failure to fulfill major role obligations, use in situations physically hazardous, recurrent legal problems, continued use despite social and interpersonal problems
INTOXICATION: the development of a reversible substance-specific syndrome due to recent exposure ( clinicaly significant maladaptive behavioral or psychological changes on central nervous system )
WITHDRAWAL: the development of a reversible substance-specific syndrome due to the cessation of substance

3. ALCOHOL RELATED DISORDERS
%0.05 in blood: thought, judgment, restraint loosened
% 0.1 : voluntary motor actions clumsy
% : confusion and stupor
0.5 promil: 0.5gr alcohol in 1lt blood: %0.063 alcohol
Intoxication: inappropriate behaviour, mood lability, impaired judgement, slurred speech, incoordination, nystagmus, impaired attention amd memory, coma
Withdrawal: autonomic hyperactivity, hand tremor, insomnia, nausea-vomitting, hallusinations, illusions, psychomotor agitation, anxiety, grand mal seizures
Delirium Tremens: Alcohol ıntoxication delirium, mortal %20. ın 1 week after alcohol cessation. Hallusinations, delusions, tachycardia, diaphoresis, fever, hypertension, hyperexcitability or lethargy

4. Wernicke-Korsakoff Sydrome: alcohol-induced persisting amnestic disorder. Thiamine deficiency.
Wernicke’s Encephalopaty: alcoholic encephalopaty, ataxia, confusion, nystagmus, gaze palsy, anisocoria. Reversible if treated, if not→ Korsakoff’s Sydrome: chronic amnestic sydrome.
Marciafava-Bignami Syndr: demyelination of corpus callosum, optic tracts, cerebellar peduncles.
Medical complications of alcohol use:
Liver damage, peptic ulcer, pancreatitis
Peripheral neuropathies, myopathy, hepatocerebral degeneration, cerebellar degeneration,
HT, stroke cardiomyopathy, anemia, electrolyte imbalances
Ca of mouth, pharynx, liver, breast

5. Idiosyncratic alcohol intoxication: small amounts, agression
Pathological jealosy
Alcoholic hallusinosis: auditory

6. AMPHETAMINE-RELATED DISORDERS
Ice, crystal, speed, XTC, adam, eve...psychostimulants.
Metamphetamine, ephedrine, pseudoephedrine
A single dose ( 5mg): ıncrease the sense of well-being, elation, euphoria, friendliness, improve attention, increase performance, anorexia
Severe hypertension, myocardial infarction, cerebrovascular infarction, ischemic colitis, seizures, coma.

7. CAFFEINE RELATED DISORDERS
A cup of coffee: mg. Caffeine ( methylxanthine)
Low doses: + reinforcer, doses > 300mg: increased anxiety and mild dysphoria.
Global cerebral vasoconstriction
Intoxication:restlessness,nervousness, excitement, muscle twitching, cardiac arrhytmia
Withdrawal: fatique, drowsiness, anxiety and depression, nausea and vomitting

8. CANNABIS-RELATED DISORDERS
Hashish ( flower), marijuana ( leaves)
Red eye, tachycardia, increased appetite, hypotension, long term use; cerebral atrophy, seizures, chromosomal damage, decreased testesterone, amotivational syndrome

9. COCAINE-RELATED DISORDERS
Produces euphoria→personality changes, impulsive behaviour, weight loss, insomnia,nasal congestion, cerebrovascular, cardiological disorders ( arritymia, MI, CMP )seizures, death crash syndrome ( post intoxication depression) formication ( cocaine bugs)

10. Hallucinogen Related Disorders: mushrooms( psilocybin), mescaline ( cactus),LSD
“hallucinogen persisting perception disorder”- “flashbacks”
Inhalant Related Dısorders: solvents, glues, thinners, paints
Maladaptive behavioral and psychological changes
Nicotine related disorders:improved attention,learning, reaction time, skeletal muscle relaxation→long term use decrease CBF
Toxication.: nausea, vomit, abdominal cramps, confusion, HT, tremors

11. Opioid Related Disorders: morphine, heroin, fentanyl, codeine.
Euphoric high ( rush )→ sedation, respiratory depression, pinpoint pupils, smooth muscle contraction, anaphylactic shock, arrithmia, constipation,HT...
Sedative-hypnotic Related Disorders:benzodiazepines, barbiturates
Anabolic Steroid abuse: testesterone analogs
İnitially induce euphoria and hyperactivity→ anger, irritability, hostility, anxiety, depression, manic states