Transcript (PPS, 830KB) - Psychiatrist in Sydney

Substance Abuse
Drugs of abuse
Narcotic
Non narcotic
Sedatives
Opium alkoloids
Morphine
Benzodiazepines
Codeine
Synthetic opiods
Stimulants
Amphetamine
Heroin
Methadone
barbiturates
Cocaine
Hallucinogens
Ecstasy
LSD
Cannabis
Causes of drug abuse
 Availability
Prescribed Dx
‘Street’ Dx
 Vulnerable
personality
 Social pressures
Substance dependence
1.
2.
3.
4.
5.
6.
Strong desire or compulsion to take
Difficult to control intake
Withdrawal state when stopped /reduced
Persisting use despite harm
Neglect of alternate pleasures
Tolerance
Substance Dependence

Physiological
Fast – Opioids
Slow – Anxiolytics
None- Cannabis
Hallucinogens

Psychological
Craving, dysphoria
Due to conditioning
Harmful Consequences

Physical health

Psychiatric
Vein thrombosis , infection
IV drug use HIV, hepatitis, endocarditis
In pregnancy - fetal defects, growth, dependence
-anxiety
-mood
-psychotic

Social
Opioids




1.
2.
3.
Extract of Papaver somniferum
Used for >3500 years
(poppy)
Used as medication/pleasure
Heroin‘chasing the dragon’
Smoking
Intra venous (IV)

Opioids Act through1.
NAD cell firing
on withdrawal NAD action
2. Act on endogenous opioid receptors

Effects – Euphoria, analgesia, drowsiness,
constipation, LOA, libido
Dependence +
Rapid tolerance
& withdrawals – low mood, aches,
Insomnia, pupils dilated, lacrimation

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
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

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

Management of tobacco use
Pharmacotherapies used
Other substances
Stimulants – Amphetamines Psychosis, aggression
Cocaine
MDMA (ecstasy)- hallucinogenic too
 Hallucinogens – LSD
‘Magic mushrooms’
 Hypnotics - benzodiazepines

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

Thank you
Dr Himalee Abeya