Hasham Masood

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At the end of this presentation you

will know :• What is Substance Abuse ?

• Terms associated with a Substance Abuser.

• Risk Factors/Etiology.

• Approach to a patient with substance abuse.

• Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods which are harmful to themselves or others, and is a form of substance-related disorder.

Terms to get familiar with :

• Substance Intoxication :Reversible, maladaptive use of a substance that leads to changes, ie Behavioral or physiological.

• Substance Withdrawal : Condition experienced when the drug is stopped or the dosage is decreased, on which the person is dependent.

• Substance Dependence :An adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of the drug.

• Substance Tolerance : When an increased dosage is required to get the desired effect.

Substances that are abused :

• Alcohol

• Cannabis

• Heroine

• Ecstasy

• Cocaine

• Amphetamines

• Bath salts

• Anabolic Steroids

• Benzodiazepines

• Hallucinogens

• Inhalants

• Opiates

• Phencyclidine (PCP)

Etiology/Risk Factors

• Family History

• Physiology :Individual who are innately tolerant to alcohol.

• Developmental History: Poor Parenting, permissive attitude towards drug use.

• Environmental risk factors:Exposure to drugs through peers, certain occupation, social isolation.

• Psychiatric disturbances: Depression, conduct disorder, low self-esteem.

• Self-Medication hypothesis: e.g., a person suffering from anxiety disorder uses alcohol to decrease it.

How to approach a patient with

Substance abuse Disorder ?

• History

• Examination

• Diagnosis

• Treatment

History :

• Substance Abuse History :

I. Substance Used

II. Dosage

III. Effects

IV.Duration

V. Where did he use it ?

• Medical History : Any complications of

substance abuse, eg: Liver cirrhosis, lung

cancer etc.

• Psychiatric History

Examination :

• Mental status examination

I. Anxiety

II. Depression

III. Emotional Terminal

• Physical examination : Signs of drug abuse, eg: needle marks, burns, skin Infections etc.

• Evidence of self inflicted injuries or accidents.

Should also look for :

• Poor hygiene

• Poor nutrition

• Cough

Diagnosis :

• CAGE

I. Have you ever felt that you should Cut down your drinking ?

II. Have you ever felt Annoyed by others who have criticized your drinking ?

III. Have you ever felt Guilty about your drinking ?

IV. Have you ever had a morning drink(Eye opener) to steady your nerves or alleviate a hangover ?

• Urine drug screen :Amphetamines,

barbiturates, benzodiazepines, cannabinoids,

cocaine, methodone, methaqualone, opiates,

phencyclidine .

For shortest time : 2-3 days (Cocaine)

For longest time : up to 30 days (Marijuana)

• Breath test : For Alcohol

• Blood : AST, ALT, GGT, LDH

• Hair testing (Not a routine test) : Cocaine,

amphetamines, methamphetamines, opiates,

PCP, marijuana

Types of Treatment :

• Pharmacotherapy : Medications that work on reward centre, such as naltrexone, varenicline, and buropion

• Psychotherapy : Group Therapy, ie Alcoholic Anonymous, Narcotics Anonymous

• Behavioral Modification : techniques: disulfram(aversive conditioning), patch, gum.

• Detoxification units

• Rehabilitation programs

Source of Information :

CH:11, USMLE Step 2 CK, Psychiatry.

Webmd.

• Thank you !