1. Substance abuse

2. Definition It’s a mental disorder that shows symptoms and maladaptive behavioral changes with the use of substances that affect the CNS. 2

3. Addiction: The habitual use of substances, such as alcohol, psychoactive drugs, and nicotine, and also compulsive behaviors, such as overeating, use of diet pills

4. Substance Use Terminology Use – Drinks alcohol, swallows, smokes, sniffs or injects Drug misuse: The occasionally inappropriate or unintentional use of a medication. Abuse – Use for purposes of intoxication or for Rx beyond intended use Dependence – Use despite adverse consequences 4

5. Substance Use Terminology Two types of dependence: – Physical dependency: Physiological changes that occur following prolonged substance use (the normal functioning of the person is not maintained until he takes a dose of the drug). Dependency is evidence of tolerance – Psychological dependence: It’s craving for a substance that the person over use it over a prolonged period of time.. 5

6. Substance Use Terminology Tolerance – A need for increased dose of substance in order to achieve the same effect originally brought about by smaller doses of the same substance. – More substance is needed to achieve the same effect; or the same amount of the substance is not producing the same effectt Cross tolerance – Tolerance to several drugs from the same classification (a person tolerant to heroin or alcohol will be tolerant to several other CNS depressant) 6

7. Substance Use Terminology Substance Withdrawal – It is a maladaptive behavioral, cognitive, and physiological changes due to the reduction of heavy substance use ( symptoms are substance specific). Detoxification – Process of safely and effectively withdrawing a person from an addictive substance Relapse – Recurrence of alcohol- or drug-dependent behavior in person who had previously been abstinent. 7

8. 8 Drug interaction Addictive Synergistic Antagonistic Potentiating

9. Drug interaction Addiction (abuse) – Is the loss of control over substance intake to the extent that the person increases the dose to the point of dependency. – It’s loss of control of alcohol ingestion; drinking despite alcohol related problems, and a tendency to relapse. Potentiating – To make the effect of the drug more powerful and stronger 9

10. Drug interaction Synergistic effects: – Taking some drugs together that helps to intensify or prolong the effects of either or both drugs (combination of alcohol and barbiturate). Antagonistic effect: – Is taking a combination of drugs to weaken or inhibit the effect of another drug (algat and barbiturate) 10

11. Substance Use Terminology Co-dependence – Are constellation of maladaptive behaviors that are exhibited by the person who lives with a substance dependent person. These behaviors protect the dependent and enable him/her to continuo their dependency 11

12. Commonly Misused Over-The-Counter (OTC) Drug Aspirin Nonsteroidal Anti-Inflammatory Drugs Ibuprofen Nasal sprays Laxatives Diet pills Eye drops Sleep aids Cough syrup 12

13. Warning Signs Of A Substance Use Disorder An Abrupt Change In Attitude Mood Swings A Decline In Performance Increased Sensitivity Secrecy Physical Changes Money Problems Changes in Appearance Defiance of Restrictions Changes in Relationships 13

14. DSM-5 Substance Abuse Disorders  Alcohol  Amphetamines  Cannabis (marijuana)  Cocaine  Hallucinogens  Inhalants  Nicotine  Opioids  Phencyclidine  Sedative- hypnotics  Anxiolytics  Caffeine

15. DSM division Substance related disorders are divided into 2 groups: – Substance use disorders (substance dependence & substance abuse) – Substance induced disorders (intoxication, withdrawal, substance induced delirium or dementia, or amnestic disorders …etc.) 15

16. Substance dependence disorder It replaces the term addiction and habituation, Refers to the reliance on or the acquired need for a substance. At least 3 of the following criteria must be present within the last 12 months. – Evidence of tolerance as defined Need for increased amount of drug to achieve intoxication or desired effect Decrease in the effect of the same dose over time – The substance is taken in large amount over a long period of time than intended 16

17. Substance dependence disorder – Evidence of withdrawal symptoms (substance specific signs & symptoms) The signs & symptoms of withdrawal syndrome for the substance Intake of a closely related substance to avoid the withdrawal signs & symptoms – Unsuccessful attempts to cut down on substance. – Spending big effort and time to obtain the substance. – Reduced social and occupational interaction due to substance use. 17

18. Substance dependence disorder – Persistent taking of drug despite its effect on health (peptic ulcer, depression) – The same or related substance is taken to relieve or avoid withdrawal symptoms 18

19. Substance abuse disorder Is a maladaptive pattern of substance use leading to clinically significant impairment, manifested by one or more of the following within 12 months – Impairment in role functioning (school, work, house keeping). – Use of substance while in hazardous situations (driving). – Recurrent legal problems due to substance use. – Continued substance use despite interpersonal problems caused by the effects of the substance 19

20. Substance intoxication disorder – The development of reversible substance specific syndrome after ingestion of a substance (different substances may cause similar or different signs & symptoms) – Clinically significant maladaptive behaviour affecting CNS such as: Belligerance Mood lability Cognitive impairment Impaired judgment Impaired social & occupational functioning – Exclude any medical or mental disorders 20

21. Substance withdrawal disorder A substance specific withdrawal syndrome develops caused by the decrease of substance in the body after a heavy over a long time Significant distress or impairment in social or occupational functioning Exclude any medical conditions or mental disorders 21

22. 22 Methods of administration

23. 23 Routes drug abuse