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ContentHistorical highlights. Terminology. Etiology, Level of
PAS use, Effects, Biomolecular aspects, Signs of possible PAS use , Diagnosis, Symptoms of usage,
Abstinence and Intoxication, Management , Prognosis
Referal
Kaplan HI., Sadock BJ., Comprehensive Textbook of Psychiaty vol. I, 7th. Ed., Lippincot, Williams & Wilkins, Baltimore, 2000.
Diagnosis and Statistical Manual of Mental Disorder , 4 th. Ed., American Psychiatric Association, Washington DC, 1994.
Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III , cetakan 1, DirJen YanDik DepKes RI, Jakarta.
Kaplan HI. Sadock BJ., Synopsis of Psychiatry , Behavioral Sciences / Clinical Psychiatry 8 th. Ed., Williams & Wilkins, Baltimore, 1998.
Undang-undang Narkotika & Psikotropika , cetakan kedua . Sinar Grafika , Jakarta 1999
Historical Hightlights
Used since ancient time rituals,
socialization, recreation .
INDONESIA
Opiate ordonance 1927
Import, distribution, usages
regular opiate distribution for personal consumption ( old Chinese people )
Brisbane ordonance
Terminology
Psychoactive substance (PAS) a substance when ingested acts on the mind
SUBSTANCES:
PPDGJ III , ICD 10
DSM IV
Dependence syndrome
Tolerance
Withdrawal syndrome
Inter-relation of PAS, the individual person and the enviroment
Characteristics
PAS : effect , accessibility
Person : high risk, curiousity ,peer solidarity , identity, escapism, misuse abuse
Environment : family disharmony, authority crisis, norm - value changes, morale & religiousities forced by peers, less facililities for youth activities, less employment and education facilities.
High rik individuals Potential user
Easily disappointed aggressive,
instant gratification ,
bored easily depresive
risk taking behaviour
psychosexual problems
personality disturbance
lower intelligence
• Physically and mentally healthy
• Socially well adjusted
• Honest
• Responsible
• Able to handle severe / acute stress
• Able to fulfill leisure time
• Rationale expextations
dependence
abuser
situational
Low risk
High risk
occational
experimental
Treatment & rehabilitation
intervention
promotion
Promotion & prevention
Level of PAS Use
user
Non user
Physical the substance, ingredients and method of usage
- pulmonary & respiratory system
- Cardiovascular - GI tract
- dermatologic - urinary tract
- haemopoetic - endocrine
- bone & muscle - nervous system
- other (AIDS)
HIV infection
Flulike syndrome after 3 -- 6 weeks becoming infected
Seroconversion 6 -- 12 weeks,
6 -- 12 month
(Elisa , Western blot ) HIV AIDS 8 -- 11 years
Psychological several kind of mental and behavioural problems due to PAS use
Social disturbance of produtivty and social live
Alcohol amphetamine halucinogen opiate cocaine cannabis sedatives / hypnotics designer amphetamines ( e.g. ecstasy )
Achievement ( work , academic ) irritable Socialization Dicipline No sense of responbility Stealing , cheating , dishonest Not well groomed Use to be alone in certain “special” places Use to wear sun glasses, longleeves shirt
Diagnosis
PPDGJ III / ICD 10
DSM IV
Dependence Syndrome
1. A strong desire or sense of compulsion to take the substance
2. Difficulties in controlling substance taking
3. A physiological withdrawal state
4. Evidence of tolerance
5. Progressive neglect of alternative pleasure or interests because of PAS use
6. Persisting with substance use despite clear evidence of overtly harmful consequences
Symptoms of Usage , Abstinence & Intoxication
1. Opiate
Symptoms of Usage , Abstinence & Intoxication
2. Cannabis
Symptoms of Usage , Abstinence & Intoxication
3. Sedative - hypnotic
Symptoms of Usage , Abstinence & Intoxication
4. Alcohol
Symptoms of Usage , Abstinence & Intoxication
5. Amphetamine
Symptoms of Usage , Abstinence & Intoxication
6. Cocaine
Symptoms of Usage , Abstinence & Intoxication
7. Inhalants
Symptoms of Usage , Abstinence & Intoxication
8. Hallucinogens
ManagementBasic principles
Supply
Needsabuse
Prosperity approachPromotion education prevention
Treatment rehabilitation
Security approach
NEEDS
2 major goals of treatment
Complete abstinence
Physical, psychiatric and psychosocial well - being
Adequate psychosocial supports are very important for changes of behaviour
urine drug screens
Treatment
1. By laws
UU no. 5 1997 (Psikotropika)
UU no. 22 1997 (Narkotika)
2.1. Potential users
2.2. Users
2. 1. Potential users Prevention (parent, families,teachers, tutors)
develop alternate activities
2. Users Physical, psychological, social.
Treatment & rehabilitation are not separate
Long - term
Need broad cooperation
Treatment phases
1. Initial, 1- 3 days (in patient)
2. Detoxification and treatment for medical complications , 1- 3 weeks (in patient)
3. Stabilization , 3 - 9 months
4. Preparation for reintegration to the community , 3 - 12 months
5. Resocialization , approx. 3 years.
treatment
Opiate
Education Methadone Naltrexone Psychotherapy
treatment
Cannabis
Amotivational syndrome Abstinence & suport education Psychotherapy, Antianxiety, antidepressant
treatment
Sedative - hypnotic
Withdrawal Overdose
treatment
Alcohol
Psychotherapy Behaviour therapy Pharmacotherapy
treatment
Amphetamine & cocaine
• Very difficult to remain abstinent powerfully reinforcing & induces craving
• Psychotherapy
• Antipsychotic
• Anticraving
treatment
Inhalant Short lived cease or change to
another substance Counselling, education about PAS DA antagonist
treatment
Hallucinogens
Talking down DA antagonist, bzd.
Referals
Early phases GPs Advance phase Psychiatric facilities Acute intoxication (emergency situation)
& medical complications General hospital : ER, ICU.
Psychiatric symptom Psychiatric facilities
Treatment facilities
Mental hospital, Psychiatric departements 10 % of bed capacities
RSKO ( Jakarta ) Police facilities ( Pamardi Siwi , Jakarta ) Religion - based facilities Social wellfare facilities (Lembang , Parung) Rehabilitation centers
PrognosisRemission specifiers Early partial remission Early full remission
1 month -- 12 months , no dependence Sustained partial remission Sustained full remission
12 months , no dependence
Alcohol
20 % spontaneous remission no antisocial personality no other PAS use general life stability joining full course of initial rehabilitation 60 % chance for 1 year abstinence
Amphetamine
25 % have unfavorable outcomes in daily living affairs (family, work, drug use)
Cannabis
Those who does not understand the intellectual reasons for addressing a
substance abuse problem has a little motivation to stop .
Hallucinogens
Lifetime character of hallucinogen abuse : bell curve
Inhalants
Low prevalence in adulthood , associated with increased risk for future diagnosis of
antisocial personality disorder and other PAS use disorder
Opiate
Relapse rate : high
relapse mostly at the first 3 month , 2 out of 3 patients relapse within
6 months.
33 % of those with 3 years abstinence , eventually relapsed
Death rate 1 - 3 % / year.
Sedative - hypnotics
10 months -- 6 years follow up ,
45 -- 70 % no longer taking bzd.