Substance abuse

Substance abuse, dependence, withdrawal, Substance abuse, dependence, withdrawal, tolerance, and demographicstolerance, and demographics

DefinitionsDefinitions Substance abuse is a pattern of abnormal Substance abuse is a pattern of abnormal

substance use that leads to impairment of substance use that leads to impairment of occupational, physical, or social occupational, physical, or social functioning.functioning.

Substance dependance is substance abuse Substance dependance is substance abuse plus withdrawal symptoms, tolerance, or a plus withdrawal symptoms, tolerance, or a pattern of repetitive use.pattern of repetitive use.

Withdrawal is the development of physical Withdrawal is the development of physical or psychological symptoms after the or psychological symptoms after the reduction or cessation of intake of a reduction or cessation of intake of a substance.substance.

Tolerance is the need for increased amounts of the Tolerance is the need for increased amounts of the substance to achieve the same positive substance to achieve the same positive psychological effect.psychological effect.

Cross tolerance is the development of tolerance to Cross tolerance is the development of tolerance to one substance as the result of using another one substance as the result of using another substance.substance.

Epidemiology and demographicsEpidemiology and demographics -caffeine, alcohol, nicotine, marijuana and to a -caffeine, alcohol, nicotine, marijuana and to a

lesser extent, cocaine, amphetamines, and heroin, lesser extent, cocaine, amphetamines, and heroin, are the most commonly used.---are the most commonly used.---

The use of illegal substance is more The use of illegal substance is more common among young adults and is three common among young adults and is three times more common in males.times more common in males.

Classes of abused substance includes Classes of abused substance includes stimulants, sedatives, opiods, and stimulants, sedatives, opiods, and hallucinogens.hallucinogens.

StimulantsStimulants --overview --overview Stimulants are central nervous system Stimulants are central nervous system

activators that include caffeine, nicotine, activators that include caffeine, nicotine, amphetamines and cocaine.---amphetamines and cocaine.---

Caffeine is found in coffee(125mg per cup), Caffeine is found in coffee(125mg per cup), tea (65mg\cup), cola(40mg\cup), tea (65mg\cup), cola(40mg\cup), nonprescription stimulants, and diet agents.nonprescription stimulants, and diet agents.

Nicotine is a toxic substance present in Nicotine is a toxic substance present in tobacco. Cigarette smoking decreases life tobacco. Cigarette smoking decreases life expectancy more than any other substance., expectancy more than any other substance.,

Amphetamines are used clinically and are also Amphetamines are used clinically and are also drugs of abuse. drugs of abuse.

They are medically indicated in the treatment of They are medically indicated in the treatment of attention- deficit hyperactivity disorder (adhd )attention- deficit hyperactivity disorder (adhd )

And narcolepsy. They are sometimes used to treat And narcolepsy. They are sometimes used to treat depression in the elderly and terminally ill, depression in the elderly and terminally ill, depression and obesity in patients who do not depression and obesity in patients who do not respond to other treatments.respond to other treatments.

The most common clinically used amphetamines The most common clinically used amphetamines are dextroamphetamine, methamphetamine, and a are dextroamphetamine, methamphetamine, and a related compound, methylphenidate.related compound, methylphenidate.

-speed, ice and ecstacy { methylene dioxy- -speed, ice and ecstacy { methylene dioxy- methamphetamine are street names for methamphetamine are street names for amphetamine compounds.amphetamine compounds.

CocaineCocaine -crack and freebase are smokable forms of -crack and freebase are smokable forms of

cocaine: in pure form cocaine is sniffed into the cocaine: in pure form cocaine is sniffed into the nostrilsnostrils

-hyperactivity and growth retardation -hyperactivity and growth retardation are seen in newborns of mothers who are seen in newborns of mothers who used cocaine during pregnancy.used cocaine during pregnancy.

Tactile hallucinations of bugs crawling Tactile hallucinations of bugs crawling on the skin (fornication) is seen with on the skin (fornication) is seen with use of cocaine (cocaine bugs)use of cocaine (cocaine bugs)

Neurotransmitter associationsNeurotransmitter associations --stimulant drugs work primarily by --stimulant drugs work primarily by

increasing the availability of dopamine.increasing the availability of dopamine. Amphetamine use causes the release of Amphetamine use causes the release of

dopamine.dopamine. -both the release of dopamine and the block -both the release of dopamine and the block

of dopamine reuptake result in increased of dopamine reuptake result in increased availability of this neurotransmitter in the availability of this neurotransmitter in the synapse.synapse.

Increased availability of dopamine in the synapse Increased availability of dopamine in the synapse is apparently involved in the euphoric effects of is apparently involved in the euphoric effects of stimulates and opiates. as in stimulates and opiates. as in schizophrenia ,increased dopamine availability schizophrenia ,increased dopamine availability may also result in psychotic symptoms.may also result in psychotic symptoms.

SedativesSedatives --overview--overview --sedatives are central nervous system depressants --sedatives are central nervous system depressants

that include alcohol , barbiturates, and that include alcohol , barbiturates, and benzodiazepines. benzodiazepines.

Sedative agents work primarily increasing Sedative agents work primarily increasing gaba.gaba.

Hospitalization of patients for withdrawal Hospitalization of patients for withdrawal from sedatives is prudent.from sedatives is prudent.

The withdrawal syndrome may include The withdrawal syndrome may include seizures and cardiovascular symptoms.seizures and cardiovascular symptoms.

AlcoholAlcohol Acute associated problemsAcute associated problems --traffic accidents, homicide, suicide, and --traffic accidents, homicide, suicide, and

rape, are correlated with the concurrent use of rape, are correlated with the concurrent use of alcohol.alcohol.

Child physical sexual abuse, spouse abuse, Child physical sexual abuse, spouse abuse, and elder abuse are also associated with and elder abuse are also associated with alcohol use. alcohol use.

Chronic problemsChronic problems

Thiamine deficiency resulting in wernicke Thiamine deficiency resulting in wernicke and korsakoff syndromes is associated with and korsakoff syndromes is associated with long term use of alcohol. long term use of alcohol.

Liver dysfunction, gastrointestinal problems Liver dysfunction, gastrointestinal problems and reduced life expectancy are also seen .and reduced life expectancy are also seen .

Fetal alcohol syndrome (including facial Fetal alcohol syndrome (including facial abnormalities, reduced height and weight, abnormalities, reduced height and weight, and mental retardation) is seen in the and mental retardation) is seen in the

Offspring of women who drink during Offspring of women who drink during pregnancy.pregnancy.

A childhood history of problems such as A childhood history of problems such as attention-deficit hyperactive disorder and attention-deficit hyperactive disorder and conduct disorder.conduct disorder.

IntoxicationIntoxication Legal intoxication is defined as 0.08-0.15 Legal intoxication is defined as 0.08-0.15

percentage blood alcohol concentration, percentage blood alcohol concentration, depending on individual state laws.---depending on individual state laws.---

Coma occurs at a blood alcohol concentration Coma occurs at a blood alcohol concentration of 0.40-0.50 percentage in non alcoholics.of 0.40-0.50 percentage in non alcoholics.

Delirium tremens (dts) Delirium tremens (dts) Alcohol withdrawal delirium may occur Alcohol withdrawal delirium may occur

during first week of withdrawal from alcoholduring first week of withdrawal from alcohol Delirium tremens is life threatening: the Delirium tremens is life threatening: the

mortality rate is about 20 percentage.mortality rate is about 20 percentage.

BarbituratesBarbiturates -used medically as sleeping pills, -used medically as sleeping pills,

tranquilizers, anticonvulsants and tranquilizers, anticonvulsants and anesthetics.anesthetics.

Frequently used/abused barbiturates include Frequently used/abused barbiturates include amobarbital, pento barbital & secobarbital.amobarbital, pento barbital & secobarbital.

Cause respiratory depression. most Cause respiratory depression. most commonly used for suicide commonly used for suicide

BenzodiazepinesBenzodiazepines --sedatives, anticonvulsants,& anesthetics. to --sedatives, anticonvulsants,& anesthetics. to

treat alcohol withdrawal.treat alcohol withdrawal. Safety margin high.Safety margin high. Opiods Opiods -agents used medically as analgesics—-agents used medically as analgesics—

morphine and as drugs of abuse—heroinmorphine and as drugs of abuse—heroin heroin more potentheroin more potent

MethadoneMethadone Synthetic opiod used treat heroin addiction it can Synthetic opiod used treat heroin addiction it can

be taken orally be taken orally Has longer duration of action Has longer duration of action Causes less euphoria and drowsinessCauses less euphoria and drowsiness HallucinogensHallucinogens --include lsd, pcp, canabis and mescaline.--include lsd, pcp, canabis and mescaline. Promote altered states of consciousnessPromote altered states of consciousness Increased availability of serotonin Increased availability of serotonin

MarijuanaMarijuana --tetrahydrocannabinol (thc) is the primarily --tetrahydrocannabinol (thc) is the primarily

active compound active compound Marijuana increases appetite and causes Marijuana increases appetite and causes

relaxationrelaxation Chronic use causes lung problems and Chronic use causes lung problems and

amotivational syndromesamotivational syndromes

Lsd and pcpLsd and pcp Lsd is ingested and is pcp is smokedLsd is ingested and is pcp is smoked They cause altered perceptionThey cause altered perception Er findings for pcp include hyperthermia Er findings for pcp include hyperthermia

and nystagmusand nystagmus Consumption of more than 20mg of pcp Consumption of more than 20mg of pcp

may cause convulsions, coma & death may cause convulsions, coma & death