Drug Addiction (Updated) PDF

Drug addiction (Updated) Professor Dr Hussain Habil Head of School and Addiction medicine consultant and psychiatrist (delivered by Mdm Sharon L How) Head of Department – Psychiatry  Learning outcomes Students should be able to: Describe the various types of stimulant drugs State...

Drug addiction (Updated) Professor Dr Hussain Habil Head of School and Addiction medicine consultant and psychiatrist (delivered by Mdm Sharon L How) Head of Department – Psychiatry  Learning outcomes Students should be able to: Describe the various types of stimulant drugs State some of the criteria for drug dependence DEFINITION OF DRUGS & DRUG ABUSE Drugs - Chemical substances used in treatment, cure, prevention or diagnosis of diseased or used to otherwise enhance physical or mental well-being Drug abuse - Use of any drug, usually by self-administration, in a manner that deviates from approved social or medical patterns OR - Maladaptive use that lead to biological, psychological and social impairments CRITERIA FOR DRUGS DEPENDENCE Based on ICD-10 classification of mental and behavioural disorders:- Based on DSM-5 classifications:-  Commonly used drugs in Malaysia Methamphetamine (syabu) Alcohol Cannabis Heroin CLASSIFICATION FOR DRUGS DEPENDENCE CNS Depressants -Alcohol, benzodiazepin es, barbiturates Volatile Opioids substance (solvents, - heroin, inhalants) morphine, codeine Classification of drugs abuse/dependen ce CNS Cannabis Stimulants- amphetamine s, cocaine Hallucinoge ns - LSD, PCP, psilocybin, ketamine  ALCOHOL Alcohol is a central nervous system depressant and most common abuse substance across the world There are many forms of alcohol, including:- - Beer - Wine - Liquor ALCOHOL INTOXICATION The DSM-5 diagnostic criteria for alcohol intoxication/simple drunkenness are based on evidence of recent ingestion of ethanol, maladaptive behavior, and at least one of several possible physiological correlates of intoxication:- ALCOHOL WITHDRAWAL Alcohol-Induced Psychotic Disorder Approximately 3% of alcoholic persons experience auditory hallucinations or paranoid delusions. The voices heard are characteristically maligning, reproachful, or threatening, although some patients report that the voices are pleasant and non-disruptive. The hallucinations usually last less than a week. Alcohol-Induced Mood Disorder 80% of people with alcoholism report histories of intense depression. Alcohol-Induced Anxiety Disorder Anxiety symptoms fulfilling the diagnostic criteria for alcohol­induced anxiety disorder are also common in the context of acute and protracted alcohol withdrawal. Alcohol-Induced Persisting Dementia Global decreases in intellectual functioning, cognitive abilities, and memory are observed, but recent memory difficulties are consistent with the global cognitive impairment Alcohol-Induced Persisting Amnestic Disturbance in short-term memory Disorder caused by prolonged heavy use of alcohol. Rare in persons younger than age 35.  OPIOIDS Have powerful analgesic action, produce euphoria and anxiolytic effects Epidemiology:- Heroin is the opioid drug that most associated with abuse in developed countries Estimated 1000,000 users reported in United States Male: female = 3:1 with heroin dependence Age: 30s to 40s Heroin is most commonly used by patients of lower socioeconomic status who often engaged in criminal activities to pay for drugs Example:- - Morphine - Codeine - Heroin - Synthetic analgesics – pethidine, methadone  Routes of administration:- - Intravenous route - Subcutaneous - Inhaled nasally (sniffed/snorted) Clinical effects:- - Respiratory depression - Constipation - Reduce appetite - Low libido Withdrawal symptoms:- - Intense craving for the drug - Restlessness and insomnia - Pain in muscles and joints - Running nose and eyes - Abdominal cramps, vomiting and diarrhea - Sweating, dilated pupils and raised pulse rate - Disturbance of temperature control  Begin about 6 hours after last dose, reach peak after 36-48 hours  CANNABIS Cannabis is derived from the plant Cannabis sativa Common names for cannabis are marijuana, grass, pot, weed, tea, and Mary Jane The cannabis plant is usually cut, dried, chopped, and rolled into cigarettes which are then smoked Cannabidiol (CBD) is the compound used to treat some medical condition like epilepsy, anxiety, pain, and muscle disorder Delta-9-tetrahydrocannabinol (THC) is the cannabinoid that is found in the cannabis which primarily responsible for the psychoactive effects of cannabis  Epidemiology - Cannabis is the most widely used illegal drug in the world, with an estimate 19 million users in 2012 - Age 12 years and older is 7% while 57% before age 18 years - More common in men than women - Cannabis is the fourth most commonly used psychoactive drug among adults in the United States, after caffeine, alcohol, and nicotine Clinical features after taking it - Euphoric effect - Reddening of eyes - Dry mouth - Tachycardia - Irritation of respiratory tract - Coughing Adverse effects:- Chronic respiratory disease and lung cancer Cerebral atrophy Seizure susceptibility Chromosomal damage Birth defects Impaired immune reactivity Alterations in testosterone concentrations Dysregulation of menstrual cycles  CANNABIS USE DISORDER People who use cannabis daily over weeks to months are most likely to become dependent The risk of developing dependence is around 1 in 10 for anyone who uses cannabis The earlier the age of first use, the more often and the longer it has been used, the higher the risk of dependence CANNABIS INTOXICATION Euphoric effects appear within minutes, peak in about 30 minutes, and last 2 to 4 hours. Some motor and cognitive effects last 5 to 12 hours Sensitive to external stimuli, makes colors seem brighter and richer, and subjectively slows the appreciation of time In high doses, users may experience depersonalization and derealization Motor skills are impaired CANNABIS WITHDRAWAL Cessation of use in daily cannabis users results in withdrawal symptoms within 1 to 2 weeks Withdrawal symptoms (high doses):- - Irritability - Weight loss - Cannabis cravings - Depressed - Nervousness mood - Anxiety - Restlessness - Insomnia - Headache - Chills - Disturbed or vivid dreaming - GI upset - Decreased appetite - Sweating - Tremors  STIMULANT Drugs associated in this group:- - Amphetamine - Cocaine  AMPHETAMINES Ability to release and block reuptake of dopamine and noradrenaline Has pharmacological treatment for attention deficit hyperactivity disorder (ADHD) and narcolepsy Most amphetamines are now illegally synthesized and used as a street drug, known as ‘speed’ or ‘whizz’ Can be taken orally, intravenously or inhaled nasally (snorted)  Withdrawal symptoms Withdrawal symptoms:- - Low mood (mild cases) - Depression - Anxiety - Tremulousness - Lethargy - Fatigue - Nightmares - Craving for the drugs - Suicidal ideation  COCAINE Central nervous stimulants with effects similar to amphetamines Derived from the densely-leafed coca plant native to South America Can be administered by injection, smoking and sniffing into the nostrils Clinical effects:- - Excitement - Increased energy - Euphoria - Grandiose thinking - Impaired judgement - Sexual disinhibition - Visual and auditory hallucinations - Formication (cocaine bugs) - Paranoid psychosis with violent behaviour (high doses)  HALLUCINOGENS Hallucinogens include lysergic acid diethylamide (LSD), phencyclidine (PCP), psilocybin (from some mushrooms), and mescaline (from peyote cactus) Synthetic hallucinogens are easily made, easily distributed, sold cheaply – LSD and PCP Most hallucinogens are well absorbed after oral ingestion. Some are ingested by inhalation, smoking, or intravenous injection  Also called psychedelics or psychotomimetics because in addition to inducing hallucinations, they produce a loss of contact with reality and an experience of expanded and heightened consciousness Phencyclidine and ketamine also included in this category due to their hallucinogenic effects (DSM-5) Hallucinogen use is most common among young (15 to 35 years of age) white men Hallucinogen use is associated with less morbidity and less mortality than use of some other substances