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Substance use disorder

TERMINOLOGY

TERMINOLOGY

SUBSTANCE – It refers to any drug, medication or toxin that shares the potential for abuse.

1

ABUSE- it refers to maladaptive pattern of substance use that impairs the health in broad terms.

2

TOLERANCE- Reduction in drug effect requiring an increase in dosage to maintain the same response

cont....

DEPENDENCE

The state of response to a drug whereby removal of the drug evokes unpleasant, possibly life-threatening symptoms, often the opposite of the drug's effects.

cont....

ADDICTION

cont....

A physiological and psychological dependance on alcohol and other drugs of abuse that affects the central nervous system in such a way that withdrawal symptoms are experienced when substance is discontinued

WITHDRAWAL STATE

cont...

It is a group of sign and symptoms recurring when a drug is reduced in amount or withdrawn,which last for limited time.दवा

Risk Factors

Male sex (for alcohol)

Female sex (for prescription drugs)

Risk factors

Chronic pain

Chronic physical illness

cont...

Physical disabilities

Psychiatric risk factors

History of current psychiatric illness

Previous substance use

cont...

Social risk factors

Lower economic status

Living alone

Forced or unexpected retirement

cont...

Broken or dysfunctional families

Family history of drug use or mental illness

cont...

ICD – 10 CLASSIFICATION

F10 – F19 Mental &Behavior Disorders due to Psychoactive Substance Use.

F10 - Mental &Behavior Disorders due to use of Alcohol.

F11 - Mental &Behavior Disorders due to use of Opioids.

F12 - Mental &Behavior Disorders due to use of Cannabinoids.

F13 - Mental &Behavior Disorders due to use of Sedatives & Hypnotics.

F14 - Mental &Behavior Disorders due to use of Cocaine.

F16 - Mental &Behavior Disorders due to use of Hallucinogens.

ICD CLASSIFICATION

BIOLOGICAL FACTORS

Etiological factors

Genetic vulnerability

1

Biochemical factors

2

Neurobiological theories

3

Co-morbid Medical Disorder

4

BEHAVIORAL THEORIES

cont...

PSYCHOLOGICAL FACTORS

cont...

SOCIAL FACTORS

CONT...

EASY AVAILABILITY OF DRUGS

cont..

PSYCHIATRIC DISORDER

CONT...

HOW TO RECOGNIZE SUBSTANCE ABUSE / DEPENDENCE/ ADDICTION

6 Criteria have been given by the World Health Organization

CRITERIA

A strong desire to take the substance.

Difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use.

A physiological withdrawal state when substance use has ceased or been reduced.

cont...

Evidence of tolerance, such that increased doses of the substance are required in order to achieve the same effects.

Progressive neglect of alternative pleasures or interests.

Persisting with substance use despite harmful consequences.

For a Diagnosis 3 or more of these should have been present together at some time during the previous year.

cont...

Types

ALCOHOL

types

OPIOIDS

CANNABIS

COCCAINE

Cont..

AMPHETAMINES

HALLUCINOGENS

CONT...

SEDATIVES AND HYPNOTICS

INHALANTS

CONT...

NICOTINE

stages

SUBSTANCE ABUSE SIGNS AND SYMPTOMS

sign and symptoms

Loss of interest in activities and hobbies and in personal appearance.

Red eyes, slurred speech,

problems with coordination and memory lapses.

Difficulties or changes in relationships with friends, such as joining a new crowd.

Declining grades and problems in school.

Frequent mood changes and aggressive/ defensive behavior.

Change in personal grooming habits.

Pictures

Unusual smells on breath, body or clothes.

Cold, sweaty palms; shaking hands.

cont...

Red, watery eyes; pupils larger or smaller than usual

SUBSTANCE ABUSE COMPLICATIONS

Personal

complications

Physical

Familly

Social

Clinical

PREVENTIVE MEASURES

Assessment

Prevention

Motivational Assessment

What are treatments for drug addiction?

Treatment modalities

• Detoxification

• Medication-assisted therapies

• Behavioral therapies

Is treatment for drug addiction inpatient or outpatient?

cont...

Acute Pharmacological treatment with a Psychiatrist to address:-

cont..

1. Intoxication/ Withdrawal :

2. Detoxification

3. Methods of detoxification in withdrawal state

 Gradual reduction of substance dependence in decreasing amounts.

 Abrupt cessation with specific medication which have cross tolerance.

Benzodiazepines

Carbamazepine

Treatment Modalities:-

1. Medicine - antagonist, agonist, Deterrents and others.

2. Reversal of acute effects, overdose & toxicity.

3. Detoxification.

4. Decline of craving.

5. Prevent relapse.

6. Restoration of health damage.

7. Psychological and social therapies and counselling.

8. Therapeutic alliance.

9. Enhancement of Motivation.

10. Improved treatment compliance.

cont...

PSYCHOSOCIAL TREATMENT IN SUBSTANCE USE DISORDER

An Individual Psychotherapy/ Counselling Session

cont..

Cognitive Behavior Therapy

cont...

Group Therapy

cont...

Motivational Interviewing (MI)

cont...

Motivational Enhancement (MET)

cont...

12 STEP FACILITATION FOR SUBSTANCE ABUSE

cont...

The programme uses techniques to help an individual:-

1. Accept the addiction.

2. Realise our mind, body, and loved ones have paid a price for our addiction.

3. Work on our motivation to sustain abstinence from all substance.

4. Prevent relapse.

Self Help Approach

cont...

Exercise

Eat Well

cont...

Connect With Others

cont...

Relapse prevention strategies (for the individual, or the family member):-

Help the individual identify their high risk relapse factors and develop coping skills to deal with them.

Help the individual understand relapse as a process and as an event.

cont...

Understand and deal with cues related to drug and alcohol use and craving.

Encourage the individual to be open to seeking professional help, and facilitate treatment, if needed.

Develop and enhance a supportive social network.

Develop methods of coping with negative emotional states.

cont...

Learn methods to cope with cognitive distortion.

Work towards a balanced lifestyle.

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