Substance use disorders

1. Substance use disorders Dr. Andrea Bodrogi Awakenings Foundation Blue point Drug Consulting Centre

2. Addiction is a Brain Disease Beyond a Reasonable Doubt

3. Addiction Medical Medical Neurotoxicity AIDS, Cancer Mental illness NEUROTOXICITY AIDS CANCERMENTAL ILLNESS DRUGS Economic Social Health care Productivity Accidents Homelessness Crime Violence

4. However…advances in science have revolutionized our fundamental views of drug abuse and addiction, showing us that: ► abuse is a preventable behavior ► addiction is a chronic, relapsing brain disease

5. Whyaddictbrain is notableto stop? NOT ADDICTED BRAIN ADDICTED BRAIN CONTROL EXIST CONTROL DOESN’T EXIST DELIBERATION OF STIMULI AND NO DELIBERATION RESPONSE INHIBITORY POWER FUNCTIONS INHIBITORY POWER DOESN’T FUNCTION

6. Biology/genes Biology/ Environment Interactions Environment

7. Rewardsystem

8. Why Do People Take Drugs ? To feel good Most abused drugs produce intense feelingsof pleasure This initial sensation of euphoria is followed by other effects which differ with the type of drug used To feel better To lessen: anxiety worries fears depression hopelessness

9. Basic conceptions • Psychoactive substance: compound that can alter one’s state of mind • Reinforcer: that causes pleasant or stops unpleasant conditions

10. Abuse Maladaptive use of the substance /It interferes with the person’s life, causes harm in social functioning, in family life, health, etc./

11. Addiction Compulsive behavioural pattern of seeking drugs consumption of drugs Characterized by strong dsesire towards the drugs, and strong tendency to the relapse after the withdrawal

12. Tolerance The dose of the drug has to be increased in order to reach the desired effect effect of drug develops Level of tolerance ------------------------- effect of drug doesn’t develop

13. Dependence Two types - physical dependence psychological dependence

14. psychologicaldependence • Drug use is needed for keeping well • Craving in the absence of drug

15. PhysicalDependence When the substance use is reduced or ceased withdrawal symptoms develop lack of withdrawal symptoms Level of dependence ----------------------------- withdrawal symptoms

16. Categories of drugs CNS Depressants Alcohol Sedatives, hypnotics, and anxiolytics OpiatesStimulants Heroin Amphetamines Meperidine Methylphenidate Codeine Cocaine Hydromorphone Cannabis HallucinogensDesigner Drugs Inhalants

17. Alcohol vs. Other Drugs We know that alcohol impairs the brain and results in addiction with repeated use in the same way as other drugs Psysical and psychological dependence First sign of psysical dependence: Predelirium: trembling, sweating

18. Neuropsychiatricdisordersduetoalcoholconsumption Delirium tremens Alcoholic hallucinosis Alkoholic delusive disorder Alcoholic personality changes Alcohol-induced Persisting Dementia Wernicke’s encephalopathy Korsakoff syndrome

19. Delírium tremens Most severe form of alcohol withdrawal At 15 % of Alcoholic persons Untreated delirium has a mortality rate of 20 % Occurs after prolonged and heavy alcohol consumption at cease or reduction of alcohol use Provoking factors can often be seen (fever, internal disturbance)

20. Symptoms of delirium Psychic, vegetative, somatic symptoms Dsiturbance of consciousness, Desorientation Hallucinations (visual, tactile etc.) Psychomotor agitation Trembling, sweating Hypertension, fever Increased pulse rate, inversion of sleeping Epileptic attacs

21. Treatment of delirium Prevention Benzodiazepines Ensure fluid and electrolite ballance High calorie, high-carbohydrate diet suplemented by multivitamins Treatment of Brain oedema Cardial support Treatment of internal disorders, infections, etc.

22. AlcoholichallucinOSIS After prolonged and heavy drinking After alcohol-abuse, or cease of alcohol consumption

23. Alcoholichallucinosis Symptoms: Hallucinations Clear consciousness, kept orientation Severe anxiety Persecutory delusions Delusions of reference Altered behaviour by the Psyichotic contents Suicadial danger

24. Alkoholic delusive disorder Delusions of jealousy (most often) Persecutory Reference

25. Alcoholic personality changes Slowly progressing chronic psychic distrubance involving all parts of personality after prolonged alcohol consumption

26. Symptoms • Changeable mood, Superficial emotions, Bursts of anger • Superficial attachment to the family • Lack of inhibitions, Lack of ethic • Decreased critical sense, confused consciousness • Irritability, Agressivity • Decreased adapting to the society • Decreased judgement • Deterioration of intellectual functions

27. Alcohol-induced Persisting Dementia • Reason: Direct neurotoxic effect of alcohol and thiamine deficiency Symptoms: • Deterioration of intellectual functions • Impaired memory, Impaired ability of abstraction • Impaired judgement, Impaired problemsolving thinking • Impaired orientation

28. Wernicke’sencephalopathy Prolonged and heavy drinking Acute illness Usually starts before the Korsakoff syndrome At 2-6% of alcoholic patients Reason of the illness: Thiamine (vitamine B1) deficiency

29. Symtpoms of Wernicke’ encephalopathy Ocular motility abnormalities Lateral rectal palsy, gaze palsy Disturbance of consciousness Ataxia

30. Korsakoff syndrome Prolonged and heavy drinking Chronic illness, slowly progressing Starts after Wernicke encephalopathy, or without it

31. Symptoms of Korsakoffsyndrome Memory disturbance Impaired short term memory, impaired ability of learning (Immediate recall, and long term memory are relatively kept) Patient is not able to memorize even simple informations Reason of the illness: Thiamine (vitamine B1) deficiency

32. Thiamine Reason of thiamine deficiency: • Poor nutrition • Malabsorption • Thiamine is a cofactor for several important enzymes • It’s involved in the conduction of the axon potential along the axon and in synaptic transmission

33. Neuropathological leasions in Wernicke – Korsakoff Syndrome • Leasons are simmetrical, Paraventricular • Mamillry bodies, Thalamus, Hypothalamus • Midbrain, Pons, Medulla • Fornix, Cerebellum

34. Effects and consequences of illegal drug use

35. Effects of opiate use -flushing - orgasmsensation in theabdomen - euphoria - calmness

36. Withdrawalsymptoms of opiates lacrimation rhinorrhea sweating yawning hot and cold flashes insomnia muscle and joint pain nausea abdominal cramps vomiting sever anxiety irritability

37. Effects of stimulants elevated mood increasd energy increased alertness transient psychosis decreased appetite autonomic hyperarousal: - tachicardia - elevated blood pressure

38. Effects of cocain euphoria disinhibition enhanced sens of mastery sexual alartness improved self esteem rush (rapid onset of euphoria) tactile hallucinations (coke bugs)

39. Stimulantwithdrawal fatigue depression nightmares headache sweating muscle cramps hunger

40. Hallucinogens Agents, that induce psychotic-like experiences, hallucinations, perceptual disturbances, feeling of unreality Hallucinogens LSD (lysergic acid diethylamide) peyotle mescaline MDMA

41. Effects of Hallucinogens Changes in perception: hallucinations, illusions synthesias (e.g. colors are brighter and more intense or colors may be heared and sounds seen) Emotions become intense and labile Introspection Depersonalisation, Derealization

42. Badtrips Patient develop marked anxiety and paranoia Flashback: a brief reoccurrence of a drug induced experience that occurs in situations unrelated to taking the drug

43. Cannabis • Cannabis derivatives are produced from the hemp Cannabis sativa • The active ingredient is the THC (delta-9-tetrahydrocannabinol) • The illicit psychoactive compound (marijuana) is probably the most widely used drug

44. Effects - euphoria - drowsiness • feeling of calm • feeling that time has slowed - improved self coinfidence - perceptual distortions • paranoia (suspiciosness) • decreased motor coordinaton

45. Consequences Amotivational syndrome Memory disturbance Marijuana impairs the transfer of material from mediate to long term memory

46. DesignerDrugs Synthetic drugs produced by underground chemists Inchemicalstructuretheyaresimilartothewellknownillicitdrugs They are technically legal by chemical formulation The sequestered and tested drugsbecomeillegal Not controlled by the United Nations drug control treaties Reported in: Africa, Asia, Australia, Europe, New Zealand, North America

47. New Psychoactivedrugs • Similar effects of the illegal counterpart • Easily obtain instructions of mixing, making, dosing and ingesting synthetic drugs in line (Erowid.org) • Easily obtained as internet is flourushing marketplace • Dangerous and unperdictable side effects because: • More potent, Last longer • Never tested on Humans • No regulatory oversight or quality control • More addictive potential

48. (United Nations Office onDrug and Crime) Ketamine Pheniletilamine Synthetic Cathinones (Mefedrone) Piperazi- nes New Psychoactivesubstances Mimiceffecttoillicitstimulants Plantbased substances Kartom Synthetic cannabinoids

49. Characteristics of New PsychoactiveDrugs Easy to obtain (At several places the only drug to be obtained) Continuously changing drugs New effects Unpredictable consequences Risk taking behaviour

50. Therapy of addictivedisorders Connected therapeutic chain from detixification to resocialisation and rehabilitation Aim of treatment: Improve ability to community and social functioning