Transcript Substance Abuse - muhadharaty.com

Motivation &
Substance Abuse
Al Mustansiriya
5th and 6th Dec. 2015
Sami Adil
Motivation
• What energize and direct behavior
• Most are learned
• Arise from two sources: internal drives, and
external incentive factors
• Hunger, thirst, sex, aggression
Reward System …. mesolimbic
• Mesolimbic pathway disturbed in schizophrenia,
mania, and depression
• Antipsychotic drugs therapeutic effect
• Deep brain stimulation in depression and Nas
• Addiction
• Placebo
Homeostasis
• It is the tendency to preserve of a constant internal state and
it occurs in all organisms. Homeostasis motivates us
sometimes without us understanding it. (e.g.Addison’s ….
Develop preference to eat salty )
• Addiction and homeostasis (Tolerance and withdrawal).
• Set point of hunger, thirt… hypothalamus
• Complex drives…. Hypothalamus, signals from other body
parts, cultural factors (eating.. Anorexia nervosa)
•Most abused substances can be classified as
stimulants, sedatives, opioids, or
hallucinogens, and related agents.
•Substance abuse is a pattern of
abnormal substance use that leads to
impairment of occupational, physical, or
social functioning.
•Substance dependence is substance
abuse plus withdrawal symptoms,
tolerance, or a pattern of repetitive use.
•Withdrawal is the development of physical or
psychological symptoms after the reduction or
cessation of intake of a substance.
•Tolerance is the need for increased amounts of
the substance to achieve the same positive
psychological effect.
•Cross-tolerance is the development of
tolerance to one substance as the result of
using another substance.
•Epidemiology differs from a country to another
but usually it is more common among young
adult males.
•Any substance abuse life time prevalence
according to the IMHS is 0.9% (1.5% in males,
and 0.25 in females) in Iraq. More common in
young than older, urban than rural (1).
• In study 2014 all over Iraq lifetime prevalence of drug use:
Tobacco: (29.0%); Alcohol, (8.6%); Licit drug misuse (2.5%,)
and Illicit drug use (0.4%) (2) . This study also found that:
• Anabolic steroids are the most widely used licit drug in Iraq
followed by bnz & benzhexol. In the North of Iraq, there are
concerns of increasing misuse of tramadol.
• Cannabis is the most widely used illicit drug, but use of
stimulants (Amphitamines and Captagon) in the South of
Iraq is present. This finding is consistent with worldwide
data, but in Iraq, this gender difference is either particularly
great.
• Lifetime rates of licit and illicit drug use were higher among
younger participants (18-34 years), those with less education
(less than primary school) and those who were not working.
•
Stimulants
• Dopamine
• Psychosis with Cocaine -- bug
• Cigarette smoking
decreases life expectancy
more than the use of any
other substance.
• Nicotine
• Caffeine
• Amphetamine
• Cocaine
Substances
Effects of Use
Effects of Withdrawal
Psychological
Caffeine & Nicotine
Increased alertness and Lethargy
attention span
Mild depression of
Mild improvement in
mood
mood
Agitation and insomnia
Physical
Decreased appetite
Increased blood
pressure and heart rate
(tachycardia)
Increased GIT activity
Increased appetite with
slight weight gain
Fatigue
headache
Effects of use
Amphetamines
& Cocaine
Effects of withdrawal
Psychological
Significant elevation of mood
Significant depression of
(lasting only 1 hour with cocaine)
mood
Increased alertness and attention
Strong psychological
span
Aggressiveness, impaired
craving (peaking a few
judgment
days after the last dose)
Psychotic symptoms (e.g.,
Irritability
paranoid delusions with
amphetamines and formication
with cocaine)
Agitation and insomnia
Physical
Loss of appetite and weight
Pupil dilatation
Increased energy
Tachycardia and other CVS
effects which can be lifethreatening
Seizures (particularly with
cocaine)
Reddening (erythema) of the
nose due to "snorting" cocaine
Hypersexuality
Hunger (particularly
with amphetamines)
Pupil constriction
Fatigue
SEDATIVES
• GABA
‫أبو الحاجب‪ ،‬أبو الصليب‪ ،‬الدموي•‬
•BNZ
•Barbiturates
•Alcohol
Substances
Alcohol,
Benzodiazepines, &
Barbiturates
Effects of use
Effects of withdrawal
Psychological
Mild elevation of mood
Decreased anxiety
Somnolence
Behavioral disinhibition
Mild dression of mood
Increased anxiety
Insomnia
Psychotic symptoms
(e.g. delusions and
formication)
Disorientation
Physical
Sedation
Poor coordination
Respiratory depression
Tremor
Seizures CVS symptoms,
such as tachycardia and
hypertension
•Wernicke and Korsakoff
•Delirium Tremens
Opioids
‫سيمو‪ ،‬توسيرام•‬
Substances
Heroin, Methadone,
and Other Opioids
Effects of use
Effects of withdrawal
Psychological
Elevation of mood
Depression of mood
Relaxation
Anxiety
Somnolence
Insomnia
Physical
Sedation
Sweating, muscle
Analgesia
aches, fever
Respiratory depression Rhinorrhea (running
(overdose maybe fatal) nose)
Constipation
Piloerection (goose
Pupil constriction
bumps)
(miosis)
Yawning
Stomach cramps and
diarrhea
Pupil dilatation
(mydriasis)
hallucinogens
LSD
Substance
Effects of use
Cannabis, LSD,
Psychological
PCP, Psilocybin, Altered perceptual state (auditory and visual
Mescaline
hallucinations, alterations of body image,
distortions of time and space)
Elevation of mood
Impairment of memory (maybe long-term)
Reduced attention span
"Bad Trips" (panic reactions that may include
psychotic symptoms)
"Flashbacks" (a re-experience of the sensations
associated with use in the absence of the drug
even months after the last dose)
Physical
Impairment of complex motor activity
CVS symptoms
Sweating
Tremor
Nystagmus (PCP)
Effects of
withdrawal
Few if any
psychological
withdrawal
symptoms
Few if any physical
withdrawal
symptoms
‫أبو الجمجمة‪ ،‬آرتان‪ ،‬باركيزول•‬
Category
Immediate treatment/detoxification
Extended treatment/maintenance
Caffeine and
nicotine
Eliminate or taper from diet
Analgesics to control headache due to
withdrawal
Substitute decaffeinated beverage
Nicotine-containing gum, patch or nasal spray
Antidepressants (particularly bupropion)
Support
Hypnosis to prevent smoking
Amphetamine Benzodiazepines to decrease agitation
s and cocaine Antipsychotics to tr. Psychosis
Medical and psychological support
Education for initiation and maintenance of
abstinence
Sedative
Hospitalization
(alcohol, BNZ, Flumazenil to reverse affects of BNZ
Barbiturates) Use of long acting BNZ in decreasing doses
(detoxification)
Specifically for alcohol: thiamine, restoration of
nutritional state.
Education
Specifically for alcohol: disulfiram, naloxone,
naltrexone, acamprosate, psychotherapy, and
Alcoholic Anonymous AA or other peer support
groups
Opioids
Methadone, LAAM or buprinorphine maintenance
program
Naloxone, naltrexone (or buprenorphine) used
prophylactically to block the effects of abused
opioids
Narcotic Anonymous or other peer support
groups
Hospitalization and naloxone for overdose
Clonidine to stabilize ANS during withdrawal
Substitution of long-acting opioids
(methadone) in decreasing doses to decrease
withdrawal symptoms (detoxification)
Hallucinogens Calming or "talking down" the patient
BNZ to decrease agitation
Antipsychotics to tr psychosis
Education for initiation and maintenance of
abstinence
THANK YOU