SUBSTANCE ABUSE

DISORDERS

ANASARIO|BAXINELA|ILANGA|NODERAMA|PAMINTO
Contents of This Report
 01 02
ALCOHOL- CAFFEINE-
RELATED RELATED
DISORDERS DISORDERS

03 04
HALLUCINOGEN- INHALANT-
RELATED RELATED
DISORDERS DISORDERS
 05 06
CANNABIS- OPIOID-RELATED
RELATED DISORDERS
DISORDERS

07 08
SEDATIVE-, STIMULANT-
HYPNOTIC-, OR RELATED
ANXIOLYTIC- DISORDERS
RELATED
DISORDERS
 09 10
TOBACCO-
RELATED ANABOLIC-
DISORDERS ANDROGENIC
STEROID ABUSE
Introduction

● As of 2012, it is
estimated that more
than 22 million persons
older than the age of
12 years were classified
as having a substance-
related disorder
 ETIOLOGY

PSYCHODYNAMIC LEARNING AND

FACTORS GENETIC FACTORS CONDITIONING

NEUROCHEMICAL
FACTORS
 COMORBIDITY

ANTISOCIAL
PERSONALITY
DISORDER About 1/3 to 1/2 of all those
Range of 35 to 60% of
patients with
substance abuse or
substance
dependence also
meets the diagnostic
criteria for antisocial
personality disorder
DEPRESSION SUICIDE
with opioid abuse or About 15% of persons
opioid dependence and with alcohol abuse or
about 40% of those alcohol dependence
with alcohol abuse or have been reported to
alcohol dependence
commit suicide
meet the criteria for
major depressive
disorder
Substance use Disorder
Treatment and Rehabilitation
 01
Alcohol-related disorders
Alcohol abuse can produce serious
temporary psychological
symptoms (anxiety, depression
and psychosis)

Long term alcohol consumption

can produce tolerance as well as
intense adaptation of the body
that cessation of use can
precipitate a withdrawal
syndrome (anxiety, hyperactivity
of ANS and insomnia)
COMORBIDITY
 ETIOLOGY

PSYCHOLOGICAL PSYCHODYNAMIC
THEORY THEORY BEHAVIORAL THEORY

SOCIOCULTURAL
THEORY GENETIC THEORY
 EFFECTS OF ALCOHOL
BEHAVIORAL EFFECTS SLEEP EFFECTS
● Functions as a depressant ►Increases the ease of falling asleep
►Decrease in REM and deep sleep and
ALCOHOL EFFECT more sleep fragmentation
LEVEL ► Hence, the idea that drinking alcohol
Thought, judgment, and helps persons fall asleep is a myth
0.05% restraint are loosened and
sometimes disrupted
Voluntary motor actions
0.1% usually become perceptibly
clumsy
0.1 to 0.15% Legal intoxication
0.2% Motor area is depressed
0.3% Confused or stuporous
0.4 to 0.5% Coma
>0.5 Death
ALCOHOL INTOXICATION
● Intoxication requires a blood
concentration of 80 to 100 mg
ethanol per deciliter of blood
ALCOHOL WITHDRAWAL

CLINICAL ONSET
MANIFESTATION
TREMULOUSNESS 6 – 8 hours
PSYCHOTIC AND
8 – 12 hours
PERCEPTUAL SYMPTOMS
SEIZURES 12 – 24 hours
DELIRIUM TREMENS during first 72 hours
 DELIRIUM
● Danger to themselves and to others because of the unpredictability of their behavior
● Essential feature of the syndrome is delirium occurring within 1 week after a person stops drinking
or reduces the intake of alcohol
● Features include autonomic hyperactivity such as tachycardia, diaphoresis, fever, anxiety, insomnia,
and hypertension
● Perceptual distortions, most frequently visual or tactile hallucinations; and fluctuating levels of
psychomotor activity, ranging from hyperexcitability to lethargy

TREATMENT
► Prevention
► Withdrawing from alcohol – benzodiazepine(such as 25 to 50 mg of
chlordiazepoxide every 2 - 4 h)
► Delirium - 50 to 100 mg of chlordiazepoxide should be given every 4 hours orally,
or lorazepam should be given intravenously (IV)
 ALCOHOL-INDUCED
PERSISTING AMNESTIC
DISORDER
► Essential feature is a disturbance in short-term memory caused by prolonged heavy use of alcohol

► Thiamine deficiency, caused either by poor nutritional habits or by malabsorption problems

● WERNICKE'S ENCEPHALOPATHY
● KORSAKOFF'S SYNDROME
 ALCOHOL INDUCED
PSYCHOTIC DISORDER
● Approximately 3% of alcoholic
persons experience auditory
hallucinations or paranoid
delusions in the context of
heavy drinking or withdrawal
Treatment
 02
CAFFEINE-RELATED
DISORDERS
● Caffeine is not associated with any life-
threatening illnesses, but its use can result
in psychiatric symptoms and disorders

● Worldwide, estimates place the average

daily per capita caffeine consumption at
about 70 mg
● About two thirds of those who consume
large amounts of caffeine daily also use
sedative and hypnotic drugs
►Recent consumption of  Most common symptoms
caffeine, usually in excess of are headache and fatigue
250 mg  Onset 12 to 24 hours after
►Common symptoms include the last dose, peak in 24 to
anxiety, psychomotor 48 hours and resolve
agitation, restlessness, within 1 week
irritability, and
psychophysiological CAFFEINE
complaints WITHDRAWAL
CAFFEINE
INTOXICATION
CAFFEINE
CONSUMPTIO EFFECT
N
Rambling speech, confused
thinking, cardiac arrhythmias,
1g inexhaustibleness, marked
agitation, tinnitus, and mild visual
hallucinations
Generalized tonic-clonic seizures,
10 g
respiratory failure, and death
TREATMENT
 03
HALLUCINOGEN-
RELATED DISORDERS
Hallucinogens are intoxicants and is associated with panic attacks, hallucinogen persisting perception
disorder, psychosis, delirium, and mood and anxiety disorders

Natural and synthetic substances that are variously called psychedelics or psychotomimetics because, in
addition to inducing hallucinations, they produce a loss of contact with reality and an experience of
expanded and heightened consciousness

Persons 26 to 34 years of age show the highest use of hallucinogens, with 16% having
used a hallucinogen at least once

Men represent 62% of those who have used a hallucinogen at some time
 HALLUCINOGEN USE
DISORDER
► Characterized by dulled thinking,
decreased reflexes, loss of memory,
loss of impulse control, depression,
lethargy and impaired concentration
HALLUCINOGEN PERSISTING
PERCEPTION DISORDER
► Long after ingesting a hallucinogen,
a person can experience a flashback
of hallucinogenic symptoms
► Spontaneous, transitory recurrences
of the substance-induced experience
HALLUCINOGEN
INTOXICATION
► Intoxication with hallucinogens is
characterized by maladaptive
behavioral and perceptual changes
and by certain physiological signs
HALLUCINOGEN-INDUCED
PSYCHOTIC DISORDER
► If psychotic symptoms are present in
the absence of retained reality testing
► The most common adverse effect is a
"bad trip," an experience resembling
an acute panic reaction

HALLUCINOGEN
INTOXICATION
► A basic principle in
treatment is providing
reassurance and supportive
care
► More rapid relief of intense
anxiety is likely after oral
administration of 20 mg of
diazepam
Treatment
HALLUCINOGEN
PERSISTING
DISORDER
► Treatment for hallucinogen
persisting perception
disorder is palliative
► The first step in the process
is correct identification of
the disorder
(benzodiazepines,
anticonvulsant)
HALLUCINOGEN
INDUCED
PSYCHOSIS
► Goal: Treatment are the control of
symptoms, a minimal use of hospitals,
daily work, the development and
preservation of social relationships,
and the management of comorbid
illnesses
 04
INHALANT-RELATED
DISORDERS
Volatile hydrocarbons that vaporize to gaseous fumes at room temperature and are inhaled
through the nose or mouth to enter the bloodstream via the transpulmonary route

These compounds are commonly found in many household products and are divided into
four commercial classes (1) solvents for glues and adhesives, (2) propellants, (3) thinners
and (4) fuels

Inhalant substances are easily available, legal, and inexpensive

Accounts for 1% of all substance-related deaths and less than 0.5% of all substance-related
emergency room visits

White users of inhalants are more common than either black or Hispanic users

Most users (up to 80%) are males

 CLINICAL FEATURES
● Small initial doses - can be disinhibiting and produce feelings of euphoria and excitement as well
as pleasant floating sensations
● High doses - cause psychological symptoms of fearfulness, sensory illusions, auditory and visual
hallucinations, and distortions of body size
● Neurological symptoms can include slurred speech, decreased speed of talking, and ataxia
● Long-term use can be associated with irritability, emotional lability, and impaired memory
● Withdrawal syndrome when it occurs, can be characterized by sleep disturbances, irritability,
jitteriness, sweating, nausea, vomiting, tachycardia and sometimes delusions and hallucinations
 INHALANT USE DISORDER
►Most persons probably use inhalants for
a short time without developing a pattern
of long-term use
►Dependence and abuse of inhalants occur
INHALANT INTOXICATION
► Presence of maladaptive behavioral
changes and at least two physical
symptoms
► Characterized by apathy, diminished
social and occupational functioning,
impaired judgment, and impulsive or
aggressive behavior,

INHALANT INDUCED
PSYCHOTIC DISORDER
►Hallucinations or delusions are the
predominant symptoms
►Paranoid states are probably the most
common psychotic syndromes during
inhalant intoxication
 TREATMENT
INHALANT INTOXICATION
► Usually requires no medical attention and resolves spontaneously
► However, effects of the intoxication, such as coma, bronchospasm, laryngospasm, cardiac
arrhythmias, trauma, or burns, need treatment
► Otherwise, care primarily involves reassurance, quiet support, and attention to vital signs
and level of consciousness

INHALANT-INDUCED PSYCHOTIC DISORDER

► Appropriate is vigorous treatment of such life-threatening complications as respiratory or
cardiac arrest, together with conservative management of the intoxication itself
► Confusion, panic, and psychosis mandate special attention to patient safety
► Severe agitation may require cautious control with haloperidol
 05
CANNABIS-RELATED
DISORDERS
Cannabis

● Cannabis is the most widely used

illegal drug in the world
● Cannabis sativa - plant from which
cannabis preparations are
observed
● Delta-9-tetrahydrocannabinol
(delta- 9-THC) - cannabinoid,
primarily responsible for the
psychoactive effects of can­nabis.
● Common Names: marijuana, grass,
pot, weed, tea, and Mary Jane,
hemp, chasra, bhang, ganja, dagga,
and sinsemilla
 Epidemiology

● An estimated 22.2 million

Americans aged 12 or older in
2015 were current users of
marijuana
● 80.5 million European adults
have used marijuana at least
once
● most frequently used illicit
substance in Western
countries
 Neuropharmacology

● Delta-9- THC - principal component

● THC potently activates the G-protein–
coupled cannabinoid receptor CB1 and
modulates the cannabinoid receptor CB2
● Delta-9-THC is believed to exert all of its
effects on the brain via the CB1 receptor.
Cannabinoid receptor is found in highest
concentrations in the basal ganglia, the
hippocampus, and the cer­ebellum
● Euphoric effects appear within minutes, peak
in about 30 minutes, and last 2 to 4 hours.
Some motor and cognitive effects last 5 to 12
hours.
 Diagnosis and Clinical Features

● Dilation of the conjunctival blood

vessels (red eye) and mild tachycardia.
● Orthostatic hypotension
● Increased appetite & dry mouth
● Chronic respiratory disease and lung
cancer.
● Cerebral atro­phy, seizure susceptibility,
chromosomal damage, birth defects,
impaired immune reactivity, alterations
in testosterone concen­trations, and
dysregulation of menstrual cycles
 DSM-5: 5 Cannabis-Associated
Disorders
Cannabis use disorder is
associated with substances
derived from the cannabis
plant and chemically similar
syn­thetic compounds
Cannabis Use
Disorder
• Heightens users'
sensitivities to external
stimuli
• makes colors seem brighter
and richer
• motor skills are impaired
• Cannabis intoxication
delirium
Cannabis Intoxication
 DSM-5: 5 Cannabis-Associated
Disorders

withdrawal symptoms short-lived anxiety

within 1 to 2 weeks states often
of cessation provoked by
paranoid thoughts

Cannabis Withdrawal Cannabis-Induced

Anxiety Disorder
 DSM-5: 5 Cannabis-Associated
Disorders

transient paranoid • cannot be classified as the

other categories
ideation • Flashbacks
- "hemp insanity" • Cognitive Impairment
- "bad-trip“ • Amotivational Syndrome

Cannabis-Induced Unspecified
Psychotic Disorder Cannabis-Related
Disorders
 Treatment and Rehabilitation

● Abstinence and support

● Education should be a cornerstone for
both abstinence and support programs.
● Antianxiety drug - short-term relief of
withdrawal symptoms

MEDICINAL USE OF CANNABIS

● Treat various disorders, such as the
nausea sec­ondary to chemotherapy,
multiple sclerosis (MS) chronic pain,
acquired immune deficiency syndrome
(AIDS), epilepsy, and glaucoma.
 06
OPIOID-RELATED
DISORDERS
 Opioids
● Analgesic and other medicinal purposes
● Cause disturbances in mood, behavior,
and cognition that can mimic other
psychiatric disorders
● Heroin - most frequently associated
with abuse and dependence
● Opiate and opioid come from the word
opium, the juice of the opium poppy,
Papaver somniferum
 Epidemiology

● People estimated to have

used heroin at any time in
their lives is ~3 million
● Male-to-female ratio of
persons with heroin depen­
dence is about 3:1
● Most per­sons with opioid
dependence are in their 30s
and 40s
Neuropharmacology
● Opioid receptors
● μ-receptors – regulation and
mediation of analgesia,
respiratory depression,
constipation and drug
dependence
● κ-receptors – analgesia,
diuresis and sedation
● Δ-receptors — analgesia
About 90 percent of Psychosocial Factors
persons with opioid Biological
dependence have an Genetic Factors
additional psychiatric
disorder.
Comorbidity Etiology
 Clinical Features
● Euphoric high (the rush)
● Feeling of warmth, heaviness of the
extremities, dry mouth, itchy face, and
facial flushing
● Respiratory depression, pupillary
constriction, smooth muscle contraction,
constipation, and changes in VS.
Adverse Effects Opioid Overdose

● Hepatitis and HIV ● Respiratory arrest

transmission, allergic
reactions, drug interaction
w/ MAOIs
 Diagnosis
1. Opioid Use Disorder
2. Opioid Intoxication
3. Opioid Withdrawal
4. Opioid Intoxication Delirium
5. Opioid-Induced Psychotic Disorder
6. Opioid-Induced Mood Disorder
7. Opioid-Induced Sleep Disorder and Opioid­Induced Sexual
Dysfunction
8. Unspecified Opioid-Related Disorder
 07
SEDATIVE-, HYPNOTIC-, OR
ANXIOLYTIC-RELATED
DISORDERS
 Have sedative or calming effects are on
a continuum with their hypnotic or
sleep-inducing effects

All are associated with withdrawal

symptoms

Benzodiazepines, barbiturates, and

barbiturate-like substances
 DIAGNOSIS

● Sedative, Hypnotic, or
Anxiolytic Use Disorder
● Sedative, Hypnotic, or
Anxiolytic Intoxication
● Sedative, Hypnotic, or
Anxiolytic Withdrawal
● Other Sedative-, Hypnotic-,
or Anxiolytic­lnduced
Disorders
 Clinical Features

Patterns of Abuse Intravenous Use

Oral Use Users are mainly young adults who are

● To achieve a time-limited specific intimately involved with illegal sub­
effect or regularly to obtain a stances
constant, usually mild, intoxication
state
● relaxation for an evening,
intensification of sexual activities,
and a short­lived period of mild
euphoria.
 Clinical Features
Overdose
● Benzodiazepines have a large
margin of safety when taken in
overdoses; minimal degree of
respiratory depression
● Barbiturates are lethal when taken
in over­dose because they induce
respiratory depression.
● The barbiturate-like sub­stances
vary in their lethality and are
usually intermediate between the
relative safety of the
benzodiazepines and the high
lethality of the barbiturates
 Treatment and Rehabilitation
Withdrawal
● Benzodiazepines: Clinicians should gradually reduce the dosage.
Carbamazepine (Tegretol) may be useful in the treatment of
benzodiazepine withdrawal
● Barbiturates: Clinicians must follow conservative clinical guide­
lines. A clinician should attempt to deter­mine a patient's usual
daily dose of barbiturates and then verify the dosage clinically.
● Overdose: involves gastric lavage, activated charcoal, and careful
monitoring of vital signs and central nervous system (CNS)
activity.
 08
STIMULANT-
RELATED DISORDERS
 Amphetamines

● Among the most widely used illicit

substances, second only to cannabis.
Methamphetamine, a congener of
amphetamine
● The current U.S. Food and Drug
Administra­tion (FDA}-approved
indications for amphetamine are limited
to attention-deficit/hyperactivity
disorder (ADHD) and narcolepsy
 Amphetamines

● Typical amphetamines are used to

increase performance and to induce a
euphoric feeling
● Methamphetamine is a potent form that
abusers of the substance inhale, smoke,
or inject intravenously.
● Street names as ice, crystal, crystal
meth, and speed.
 Epidemiology

● Second most widely used substance,

following marijuana
 Neuropharmacology
● Rapidly absorbed orally; taken
intravenously; inhaled ("snorting") —>
Tolerance
● Classical amphetamines: release
dopamine —> Dopaminergic neurons
projecting from the ventral tegmental
area to the cerebral cortex and the
limbic areas (Reward circuit pathway)
● Designer amphetamines: release
dopamine, NE, and serotonin —>
neurochemical pathway for
hallucinogens
 Cocaine

● Cocaine is an alkaloid derived from the

shrub Erythroxylum coca
● Used as a local anesthetic
● Classified as a narcotic
 Epidemiology

● Persons aged 18 to 25 had a higher rate

of cocaine use than persons aged 26 or
older
● Males were twice as likely as females
● Asians had the lowest rate compared
with other racial or ethnic groups.
 Neuropharmacology

● Competitive blockade of dopamine

reuptake by the dopamine transporter
● Blocks the reuptake of norepine­phrine
and serotonin
Diagnosis and Clinical Features
Diagnosis and Clinical Features
 Treatment and Rehabilitation

● Abstinence
● specific drugs (e.g., antipsychotic and
anxiolytics) may be necessary
● Bupropion: patients who have
withdrawn from amphetamine
● Detoxification
● Psychosocial Therapies
● Pharmacological Adjuncts
 09
TOBACCO-RELATED
DISORDERS
Among the most prevalent, deadly, and
costly of substance dependencies

One of the most ignored

Tobacco does not cause behavioral

problems

Dependence features appear to develop

quickly
 Epidemiology
● Tobacco kills more than 8 million people each year
● Over 80% of the 1.3 billion tobacco users live in low-middle income countries
● In terms of the diagnosis of tobacco use disorder, 20% develops tobacco
dependence
● 50% of all psychatric outpatients smoke
● 70 percent of outpatients with bipolar I disorder
● Almost 90 percent of outpatients with schizophrenia
● 70 percent of patients with substance use disorder
● Death is the primary adverse effect of cigarette smoking
 Neuropharmacology
● Nicotine affects the central nervous system (CNS) by acting as an ago­nist
at the nicotinic subtype of acetylcholine receptors
● Positive reinforcing and addictive properties by activating the
dopaminergic pathway projecting from the ventral tegmental area to the
cerebral cortex and the limbic system.
● increase in the concentrations of circulating norepinephrine and
epinephrine and an increase in the release of vasopressin, B-endorphin,
adrenocorticotropic hormone (ACTH), and cortisol.—> Stimulatory effect
 Diagnosis

Tobacco Use Disorder

● craving, persistent and

recurrent use, tolerance, and
withdrawal if tobacco is
stopped.
● Most persons who smoke
want to quit and have tried
many times to quit but have
been unsuccessful.
 Diagnosis
Tobacco Withdrawal

● Withdrawal symptoms can develop within 2

hours of smoking the last cigarette
● peak in the first 24 to 48 hours and can last for
weeks or months.
● intense craving for tobacco, tension, irritability,
difficulty concentrating, drowsiness and
paradoxical trouble sleeping, decreased heart
rate and blood pressure, increased appetite and
weight gain, decreased motor performance, and
increased muscle tension.
 Clinical Features
● Stimulatory Effects

○ produce improved attention, learning, reaction time, and problem-solv­ing ability.

○ lifts their mood, decreases tension, and lessens depressive feelings

○ skeletal muscle relaxant

● Adverse Effects

○ nausea, vomiting, salivation, pallor weakness, abdominal pai, diarrhea, dizziness,

headache, increased blood pressure, tachy­chardia, tremor, and cold sweats

○ inability to concentrate, confusion, and sensory disturbances

○ low birth weight babies

 Treatment
● Psychosocial Therapies

○ Hypnosis
● Pharmacological Therapies

○ Nicotine Replacement Therapies

○ Non-nicotine Medications
● Combined Pyschosocial and Pharmacological Therapies
● Smoke-Free Environment
 10
ANABOLIC-
ANDROGENIC
STEROID ABUSE
 Family of hor­mones that includes
testosterone, the natural male hormone, and
numerous synthetic analogs of testoster­one

Exhibit various degrees of anabolic (muscle

build­ing) and androgenic (masculinizing)
effects

are widely used illicitly

 Epidemiology and Pharmacology

● High rates of steroid use among younger

indi­viduals appear
● All steroid drugs--are synthesized in vivo
from cholesterol and resemble
cholesterol in their chemical structure.
● testosterone deficiency, hereditary
angioedema, and some uncommon
forms of anemia caused by bone marrow
or renal failure.
Adverse Reactions

● activate hemostasis and

increase blood pressure, acne
and male pattern baldness
● tes­ticular atrophy and
sterility, and gynecomastia
Etiology

● to enhance either ath­letic

performance or physical
appearance
 Diagnosis and Clinical Features

● Steroids may initially induce euphoria

and hyperactivity
● Associated with increased anger,
arousal, irritability, hostility, anxiety,
somatization, and depression
● Hypomanic or manic episodes, and a
smaller percentage may have clearly
psychotic symptoms.
 Treatment

● Abstinence is the treatment goal of

choice for patients manifest­ing AAS
abuse or dependence.
● Therapeutic alliance that is based on a
thorough and nonjudgmental
understanding of the patient's values
and motivations for using AAS.
THANK YOU FOR LISTENING!!
 References

● Kaplan Synopsis of Psychiatry (2015)

11th edition
● DSM V