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Substance Abuse

Substance Abuse. Drugs of abuse. Narcotic. Non narcotic. Opium alkoloids. Sedatives. Morphine. Benzodiazepines. barbiturates. Codeine. Stimulants. Synthetic opiods. Amphetamine. Cocaine. Heroin. Hallucinogen s. Methadone. LSD. Ecstasy. Cannabis. Causes of drug abuse.

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Substance Abuse

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  1. Substance Abuse

  2. Drugs of abuse Narcotic Non narcotic Opium alkoloids Sedatives Morphine Benzodiazepines barbiturates Codeine Stimulants Synthetic opiods Amphetamine Cocaine Heroin Hallucinogens Methadone LSD Ecstasy Cannabis

  3. Causes of drug abuse • Availability Prescribed Dx ‘Street’ Dx • Vulnerable personality • Social pressures

  4. Substance dependence • Strong desire or compulsion to take • Difficult to control intake • Withdrawal state when stopped /reduced • Persisting use despite harm • Neglect of alternate pleasures • Tolerance

  5. Substance Dependence • Physiological Fast – Opioids Slow – Anxiolytics None- Cannabis Hallucinogens • Psychological Craving, dysphoria Due to conditioning

  6. Harmful Consequences • Physical health Vein thrombosis , infection IV drug use - HIV, hepatitis, endocarditis In pregnancy - fetal defects, growth, dependence • Psychiatric -anxiety -mood -psychotic • Social

  7. Opioids • Extract of Papaver somniferum • Used for >3500 years (poppy) • Used as medication/pleasure • Heroin- • ‘chasing the dragon’ • Smoking • Intra venous (IV)

  8. Opioids Act through- 1. NAD cell firing on withdrawal NAD action 2. Act on endogenous opioid receptors • Effects – Euphoria, analgesia, drowsiness, constipation, LOA, libido • Dependence +Rapidtolerance & withdrawals – low mood, aches, Insomnia, pupils dilated, lacrimation

  9. Dried resin of cannabis sativa- has Tetrahydrocannabinol Effects – existing mood enhanced Psychomotor retardation (!!driving) slowed time sense, red conjunctiva, cough, dry mouth psychotic symptoms Psychological dependence only Withdrawal- LOA, insomnia, irritability

  10. Nicotine abuse • Most active chemical in tobacco • Smoking- ‘largest cause of preventable premature death’ – Kills 1 in 3 smokers • In SL used as – cigarettes, cigars, tobacco leaves • Diseases caused- -Cancers (Tar) – lung, GI renal, pharyngeal -Lung disease (irritants) -MI, Stroke ( CO, clotting) -Sexual -Impotence

  11. Action of nicotine- • Acts on Ach receptors (but these ) • Has stimulant and depressant actions • dopamine, Adrenaline, NAd, serotonin • Reduces insulin - hyperglycaemic Effects • Performance enhancement • Mood stabilizer (reduce anger) • Reduces appetite ; BMR Withdrawal Low mood, irritability, Low concentration, restlessness weight gain, impaired functioning

  12. Management of tobacco use

  13. Pharmacotherapies used

  14. Other substances • Stimulants – Amphetamines Psychosis, aggression Cocaine MDMA (ecstasy)- hallucinogenic too • Hallucinogens – LSD ‘Magic mushrooms’ • Hypnotics - benzodiazepines

  15. Management of substance abuse • Identify & Assess • Manage acute intoxication • Detoxification Withdrawals – Dx of same group – e.g. Methadone for heroin Longer acting bezodiazepine • Advice & education – Harm reduction • Rehabilitation houses & groups

  16. Thank you Dr Himalee Abeya

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