Substance Abuse PowerPoint Presentation PDF

Substance ABUSE  In This Presentation 1. Substance Abuse 2. Common Drugs:Adverse Effects & Treatment Alcohol Cannabis Opioids TERMS TO KNOW TOLERANCE: Tolerance occurs when the person no longer responds to the drug in the way that person initially responded. It takes a hi...

Substance ABUSE  In This Presentation 1. Substance Abuse 2. Common Drugs:Adverse Effects & Treatment Alcohol Cannabis Opioids TERMS TO KNOW TOLERANCE: Tolerance occurs when the person no longer responds to the drug in the way that person initially responded. It takes a higher dose of the drug to achieve the same level of response achieved initially DEPENDANCE: Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. WITHDRAWAL: Physical symptoms occur when the drug intake is suddenly stopped.  SUBSTANCE MISUSE Substance abuse or misuse is formally defined as the continued misuse of any mind-altering substance that severely affects person's physical and mental health, social situation and responsibilities Mental Health Foundation  Routes of Drug Administration 1. Smoking 2. Orally 3. Snorting 4. Injecting Subcutaneous Injections Intravenous Injections Intramuscular Injections The Fastest Way to The BRAIN The fastest way to get a drug to the brain is by smoking it. This fast delivery is one reason smoking cigarettes is so addicting. Injecting a drug directly into a blood vessel is the second fastest way to get a drug to the brain, followed by snorting or sniffing it through the nose. A slow mode of delivery is ingestion, such as drinking alcohol. The effects of alcohol take  DEPENDENCE SYNDROME According to ICD 10: “Dependence Syndrome is a cluster of physiological, behavioural and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value.” Presence of At least 3: Craving Tolerance Difficulty in controlling substance taking behavior Withdrawal symptoms Neglect of alternative interests Continuous use despite harm  REWARD PATHWAY The Ventral Tegmental Area is connected to both the nucleus- accumbens and the prefrontal cortex via this pathway and it sends information to these structures via its neurons. The neurons of the VTA contain the neurotransmitter dopamine, which is released in the nucleus-accumbens and in the prefrontal cortex  DOPAMINE LEVEL INCREASE All addictive drugs affect brain pathways involving reward—that is, the dopamine system in the reward pathway. Within seconds to minutes of entering the body, drugs cause dramatic changes to synapses in the brain. By activating the brain's reward circuitry, drugs deliver a jolt of intense pleasure  ALCOHOL Definition Effects Withdrawal syndrome Withdrawal symptoms DT’s Mech of action Management Treatment  Alcohol has been widely consumed for centuries for numerous reasons: part of a standard diet, for therapeutic reasons, for its relaxant and euphoric effects, or for recreational purposes. Ethanol is a psychoactive drug with a depressant effects. Ethyl alcohol is generally consumed in one of a few different types of alcoholic beverage  LONG SHORT TERM TERM EFFEC TS EFFECTS Slurred speech Heart-related Drowsiness diseases Vomiting Liver disease Upset stomach Nerve damage Headaches Sexual Anemia problems Unconsciousness Domestic Blackouts Problems Breathing Social difficulties Problems Distorted vision Occupational and hearing Problems Impaired Academic judgment Problems Decreased Financial  Alcohol Withdrawal Syndrome Neuroadaptation – Adjustment of CNS to constant presence of alcohol in body Lower Blood alcohol concentration results in withdrawal syndrome Symptoms can range from mild to severe: insomnia to Delirium tremens (DT’s) First symptoms occur within hours of the last drink and may peak within 24-48 hours. Mild to moderate symptoms disappear with in a week, in severe cases (5%) DT’s may develop These symptoms include: (RSTANVLTSGD) Restlessness Tremor Sweating Anxiety Nausea Vomiting Loss of appetite and insomnia Tachycardia Systolic hypertension Generalized seizures (rarely-24hrs) Delirium Tremens (DT’s) Delirium Tremens (DT’s)  Toxic confusional state, occurs in severe withdrawal  Life threatening condition  Symptoms: peak 72 – 96 hours (CVMPAA) Clouding of consciousness and confusion Vivid hallucination affecting all senses Marked tremor Paranoid delusions Agitation Autonomic hyperactivity MECHANISM OF ACTION  MANAGEMENT OF ALCOHOL WITHDRAWAL Most patients can safely undergo withdrawal at home under supervision. Whereas some may need pharmacological treatment. Patients need supervised medically assisted treatment if: Severe dependence Poor social support and homelessness History of epilepsy or DT’s seizures Polydrug use Psychiatric comorbidity Poor physical health 1. Withdrawal Assessment: CIWA-Revised SAWS 2. Management in Community Social support Treatment plan Check on the supply of medication Give contact details for any emergencies or problems Stop detoxification if drinking is resumed  Pharmacological Treatment Benzodiazepines are first choice treatment. They have anticonvulsant properties and are cross- tolerant with alcohol. Typically given for 7 days. Depends on circumstances Chlordiazepoxide for uncomplicated cases as it has low dependence-forming potential. Oxazepam-( short acting) used for patients with alcohol liver disease. Longer acting benzodiazepines are effective for seizures and delirium but have a risk of accumulation in elderly patients and liver disease.  MOTIVATIONAL INTERVIEWING "Motivational interviewing is a directive, client- centred counselling style of eliciting behavior change by helping clients to explore and resolve ambivalence.” Miller (1995) Focuses on: 1.the theory that most people move through a series of steps prior to changing their behavior; 2.change comes from within rather than from without; 3.confrontation and negative messages are ineffective; 4.knowledge alone is not helpful; 5.reducing ambivalence is the key to change. CANNABIS ABUSE Cannabis Mechanism Symptoms Adverse effects Withdrawal Pharmacological Induced Treatment  Cannabis is a generic term used to denote the several psychoactive preparations of the plant Cannabis sativa. The major psychoactive constituent in cannabis is tetrahydrocannabinol (THC). Compounds which are structurally similar to THC are referred to as The plant is used as: 1)The resin – a brown/black lump, - known as bhang, ganja, hashish and resin. 2) Herbal cannabis – made up of the dried flowering tops and variable amounts of dried leaves -known as grass, marijuana, and weed. MECHANISM OF ACTION Cannabis Intake makes a person feel: some people may feel chilled out, relaxed and happy others get the giggles or become more talkative hunger pangs People may become more aware of their senses – colours may look more intense and music may sound better it’s common to feel as though time is slowing down AACIDIPP altered senses (for example, seeing brighter colors) altered sense of time changes in mood impaired body movement difficulty with thinking and problem- solving impaired memory-especially short term Paranoia Problems with child development during  CANNABIS WITHDRAWAL SYNDROME Three or more to be present in the course of one week Psychological Physical (ASHFCH) (IADRCC) Abdominal pain Irritability Sweatiness Anxiety Shakiness Depressed mood Fever Restlessness Chills Changes in sleeping Headache (e.g., insomnia, fatigue) Changes in eating (e.g., reduced appetite/weight loss).  Pharmacological Intervention Agonist Approach One strategy to treat drug dependence is long-term treatment with the same agonist drug or with a cross-tolerant drug to suppress withdrawal and drug craving. Antagonist Approach The antagonist approach uses long-term treatment with a antagonist to prevent patients from experiencing the pleasurable reinforcing effects of cannabis use, resulting in extinction of drug-seeking and drug-taking  CANNABIS INDUCED PSYCHOSIS Use of Cannabis can cause a condition called cannabis-induced psychosis. Research has found that THC can induce symptoms of psychosis in healthy people and worsen psychotic symptoms in people already experiencing them. However, if someone has a predisposition to a psychotic illness such as schizophrenia, cannabis may trigger the first episode of an ongoing condition. Cannabis generally makes psychotic symptoms worse and lowers the chances of recovery from a psychotic episode SYMPTOMS Presence of prominent hallucinations or delusions. Hallucinations and/or delusions develop during, or within one month of, intoxication or withdrawal from a substance or medication known to cause psychotic symptoms. Psychotic symptoms are not actually part of another psychotic disorder Psychotic symptoms do not only occur during delirium Treatment Treatment for psychosis is usually a combination of psychosocial interventions (such as counselling) and antipsychotic medication. Antipsychotics (clozapine, olanzapine, and aripiprazole) to be most useful in treating such patients. MOTIVATIONAL INTERVIEWING  OPIOIDS Opioids Mech Dependence Adverse Effects Withdrawal Pharmacological Substitute  An opioid is any chemical such that resembles opiates in its pharmacological effects. Although the term opiate is often used as a synonym for opioid, the term opiate is properly limited to the natural alkaloids opium poppy, while opioid refers to both opiates and synthetic substances. Opioids work by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract.  The abuse of opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies It is estimated that between 26.4 million and 36 million people abuse opioids worldwide MECHANISM OF ACTION  Opioid Dependence Opioid dependence or opioid use disorder is a medical condition of opioid addiction, and is characterized by a compulsive use of opioids in spite of consequences of continued use. MHCOH morphine heroin codeine oxycodone hydrocodone  ADVERSE EFFECTS (DDSMMCPRCNS) Nausea and vomiting Drowsiness or sedation Skin changes Miosis: excessive constriction of pupil. Constipation Respiratory depression Psychological effects (hallucinations, delirium, dizziness and confusion. memory loss and headache. Changes in heart rate Spasms Myoclonus: sudden jerks  OPIOID WITHDRAWAL SYNDROME Untreated symptoms reach their peak in 32-72 hours after the last dose and subside substantially after 5 days. (MAHRLY) Low energy, Irritability, Anxiety, Agitation, Insomnia. Runny nose, Teary eyes. Hot and cold sweats, Goose bumps. Yawning. Muscle aches and pains and twitching. Abdominal cramping, Nausea, Vomiting, Diarrhea  PHARMACOLOGICAL TREATMENT TREATMENT AIM To reduce or prevent withdrawal symptoms To reduce or eliminate non-prescribed drug use To stabilize drug intake and lifestyle To reduce drug related harm (injecting) Working alliance TREATMENT pharmacotherapies or other interventions available Previous history of drug use and treatment Substitute Prescribing It is preferable to use longer-acting opioid agonist or partial agonist (methadone or buprenorphine respectively) For less severe dependence, maintaining/detoxifying using similar preparation on which the patient is dependent is preferred. According to NICE (2007) oral methadone and buprenorphine are recommended. Based on patient’s preference with respect to several factors. Methadone is first choice treatment generally. Considerations while choosing medication Withdrawal syndrome Side Effects Chronic Pain Effectiveness Combining with other medication Pregnancy Diversion  MOTIVATIONAL INTERVIEWING Research proven counselling technique used for opioids and other substance abuse. COMPARISON  REFERENCE Prescribing Guideline in Psychiatry 11th edition, David Taylor DSM 5 http://www.drugwarfacts.org/cms/Addictive_Properties#st hash.wEvwzN3k.dpbs https://www.nice.org.uk/guidance/ta114 https://ncpic.org.au/media/1602/management-of-cannabis -withdrawal.pdf http://psychcentral.com/disorders/cannabis-marijuana-wit hdrawal/ http://www.drugs.com/illicit/cannabis.html THANK YOU DISCUSSI ON