Transcript II. Substance-induced disorders

Disclosure Statement
Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA
University of the East Medical Center
Veterans memorial Medical Center
Past President, PPA
Advisory Board
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Abbott Laboratories- mood stabilizer
Eli Lilly
- antidepressant
Astra Zeneca
- antipsychotic
Medichem
GSK
Speaker’s Bureau
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Abbott Laboratories
Medichem
GSK
Astra Zeneca
Researches/GrantSupport
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Eli Lilly
Les Servier
Janssen Pharmaceutica
Otsuka
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Novartis
Astra Zeneca
Lundbeck
Pfizer
. . . “ An enemy more insidious than those
that offer overt threats to national
security; for it strikes deep at the
physical condition and moral fiber of our
national strength; and lays to waste our
most valuable assets, namely, the
people”. . .
The Late PRES. CORY C. AQUINO
SUBSTANCES of ABUSE: its
Related Disorders
Felicitas Artiaga- Soriano, M.D., FPPA
Objectives:
• To know the drugs of abuse and its psychological
and physical effects.
• To learn the substance-related disorders.
• What is drug abuse/dependence?
• Signs and Symptoms.
• How can one become a drug abuser/dependent?
(neurobiology of addiction).
• The Philippine drug scene
Joaquin Phoenix
Eva Mendes
•Heather Locklear
•Edgar Allan Poe
•Mel Gibson
• He went into rehab for six weeks in 2005, admits he was
‘close to dying‘. The acclaimed actor was quoted as saying
“I was drunk or high since I was 14.” •Collin Farrell
Addiction, is not merely the chronic use of drugs, it is
characterized by compulsive, craving, seeking, and use/practice that
persists even in the face of negative consequences
DRUG ADDICTION IS A COMPLEX ILLNESS
“loss of control”
Drug Addiction is also known as:
A.) Drug Abuse
B.) Drug Dependence
C.) Both
D.) None of the Above
Drug Addiction is also known as:
A.) Drug Abuse
B.) Drug Dependence
C.) Both
D.) None of the Above
Common Underlying Neurobiological
Factors Can Be:
Neurochemical (imbalance of
neurotransmitters)
Structural/anatomical (same regions
and pathways)
Genetic (inherited factors that
compromise function)
Factors Affecting Vulnerability
•
Presence of a psychiatric disorder
•
Physical abuse
•
Poor social skills
People With Comorbid
Mental and Addictive Disorders
Have a Double
DoubleBrain Disease
Mental
Disorder
Comorbid
Disorders
Addictive
Disorder
Why do people use drugs?
A.) To experiment/curiosity
B.) Recreational use/casual users-for fun and
thrill
C.) Peer pressure
D.) Iatrogenic
E.) Help deal with social interactions
F.) Self medication-to decrease anxiety,
depression, fears, pain or fight insomnia, etc
Anxiety
DRUG USE
(Self-Medication)
What
Role
Does
Stress
Play
CRF
In Initiating Drug Use?
STRESS
CRF
Anxiety
% in each age group who develop
first time dependence
ADDICTION IS A DEVELOPMENTAL
DISEASE
starts in adolescence and childhood
1.8%
TOBACCO
THC
ALCOHOL
1.6%
1.4%
1.2%
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
5 10 15
21 25 30 35 40 45 50 55 60 65
Age
Age at tobacco, at alcohol and at cannabis dependence as per DSM IV
NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.
HOW DOES ADDICTION
OCCUR?
www.drugabuse.gov
Important neurotransmitters in
the reward pathway
• Norepinephrine – chemical messenger to cause us to protect
ourselves when we are angry or afraid, the flight-or fight
responses.( modulate reward dependence)
• Dopamine – chemical messenger for exploratory behavior and
pleasure. (well-being, arousal, reward)
• Endorphins – chemical messengers for relieving pain and stress
• Gamma-aminobutyric Acid (GABA)- inhibition of stimulation
• Serotonin- modulate harm avoidance (tendency to respond
intensely to aversive stimuli and their conditional signals)
• Glutamate- excitatory
 Opioid
rewarding and reinforcing
Different Drugs, Same Ultimate Effect
Source: Nestler, EJ and Malenka, RC, Scientific American, pp. 78-85, March 2004.
REWARD SYSTEM
Medial Forebrain
Bundle
Dopamine
c c
Positive
reinforcement
J Pleasure
WITHDRAWAL SYSTEM
Abstinence
Dopamine
Noradrenaline
G-proteins
Adenylate Cyclase
CAMP Kinase
Locus Ceruleus
c c
Negative
reinforcement
L Discomfort
What Happens When A Person
Stops Taking A Drug?
Anxiety
Prolonged
DRUG
USE
CRF
Abstinence
RELAPSE
Drugs
& its
Psychological and Physical Effects
Substance
• A substance is any natural or synthesized
product that has psychoactive effects—it
changes perceptions, thoughts, emotions,
and behaviors.
• It may be:
–
–
–
–
–
Legal but controlled or taxed
Legal prescribed with restrictions
Illegal
Naturally occurring
synthetic
Felicitas I. Artiaga-Soriano, M.D., FPPA
The Commonly abused
drugs/substances
1. Opioids and opiates- opium,
morphine, methadone, codeine,
meperidine (Demerol)
2. Sedatives/Hypnotics- barbiturates,
benzodiazepines, chloral hydrate and
others
3. Hallucinogens- LSD, phencyclidine
(PCP), cannabis (marijuana)
Felicitas I. Artiaga-Soriano, M.D., FPPA
The Commonly abused
drugs/substances:cont……
4. Stimulants- amphetamines,
metamphetamine (Shabu) and cocaine
5. Alcohol- beer, gin, wine
6. Caffeine- coffee, softdrinks
7. Nicotine- cigarettes, chewing tobacco
8. Inhalants and Solvents- (volatile
hydrocarbons)- rugby, kerosene, gasoline,
thinner
Felicitas I. Artiaga-Soriano, M.D., FPPA
Categories of Drugs
Felicitas I. Artiaga-Soriano, M.D., FPPA
Categories of Drugs
Stimulants - “uppers”
- stimulate the central nervous system
- amphetamines, amyl nitrite, cocaine, crack, ecstasy
Depressants - “downers”
- depress the central nervous system
- alcohol, barbiturates, benzodiazepines
Analgesics - powerful painkillers
- from opium poppy or synthetically produced
Hallucinogens- “psychedelics”
- dramatically alter perception
- LSD, psilocyn, psilocybin, cannabis, ecstasy
Views of the Seriousness of Health Problems
% saying “very serious problem”
(Top Ten of Thirty-Six Problems)
Drug abuse
Cancer
Drunk driving
Heart disease
HIV/AIDS
Violence
Child abuse
Smoking
Alcohol abuse
Stress
82%
Drug Abuse and
Addiction
are Among the Most
Serious
Public
HealthProblems
Facing
Our Society
78%
75%
74%
73%
71%
69%
68%
65%
65%
Harvard School of Public Health/Robert Wood Johnson Foundation/ICR, August 2000
Worldwide
• Estimated 190 million addicts around the world
• About 3-4% of the total world population
regularly abuse drugs
• 140 million marijuana addicts
• 30 million amphetamine-type stimulants addicts
• 13 million heroin addicts
• 8 million cocaine addicts
• Int’l drug cartel earn $400B/year=8% of the world
trade
The Philippine Drug Scene
Philippines
• 2.0 million drug users
• 1.2 million Filipino Youth using drugs (National
Youth Commission)- 15 – 17 years old
• Monthly consumption of 5-10 grams
• At 5 gms=8.5 million grams total consumption per
month=17B pesos monthly=204 B pesos annually
expected to hit 300B (50% national budget in
2002)
The Philippine Drug Scene
• RA 9165 – Comprehensive Dangerous Act of 2002
• signed June 7, 2002
• stiffer penalties for illegal drug possession and
pushing
• RA 7624 – Integrated Drug Prevention Control in the
Intermediate & Secondary Curricula
• signed July 22, 1991
• Drug users:  300% annually
• Growing number of executives – hooked on drugs
• Growing problem: production of shabu in the country
• Philippines: serves as a transit point – strategic
location
Profile of a Filipino Drug User:
Age:
26 years old (24-29 years old)
Sex:
male (11:1)
Civil Status:
single 55.78%
Birth order:
eldest
Family size:three (3 )-four (4) siblings
Educational Attainment: High School level
27.77%
IQ:
Average
Felicitas I. Artiaga-Soriano, M.D., FPPA
Profile of the Filipino Drug
Abusers, cont…..
Occupation: Workers/employees 42.51%
Unemployed
21.75%
Self-employed
12.58%
Students
12.16%
OSY
3.68%
Economic Status:
middle income
Place of Residence:
Urban esp. NCR 58.31%
Region IV 22.31%
Region III 5.37%
Region VII 4.57%
Region X
2.55%
Felicitas I. Artiaga-Soriano, M.D., FPPA
Profile of the Filipino Drug
Abusers, cont…..
• Nature of Drug Taking- Mono
drug-use
• Drugs of Use Shabu,
Marijuana
• Duration of Drug-Taking More
than two ( 2 ) years
Felicitas I. Artiaga-Soriano, M.D., FPPA
Use of Illegal Substances by Age Group
30
25
20
15
10
5
0
12-17 18-25 26-34 35-39 40-44 45-49 50-54 55-59 60-64
Age Group
65+
Copyright@2007 by the Mcgraw-Hill Co. Inc, All right reserved
Felicitas I. Artiaga-Soriano, M.D., FPPA
Terminology
Substance-related disorder
I. Substance use
disorder
Substance
abuse
Substance
dependence
II. Substance-induced disorder
Substance intoxication
Substance withdrawal
Substance-induced
Delirium, Dementia, Amnestic disorder
Psychotic disorder
Mood disorder
Anxiety disorder
Sexual dysfunction
Sleep disorder
Identification
of a
Drug User
Identification of a Drug User
• excitable, hostile, violent, destructive behavior, outbreaks of temper
• unsteadiness, clumsiness
• slurred speech, talking to oneself
• in a state of confusion
• dreamy, hallucinations
• lack of personal hygiene
• loss of concentration or attention
• loss of interest in personal care & appearance, food, family activity
• social withdrawal
• sudden decline in attendance or performance in school
• frequent job hopping
• frequents places like storage rooms, toilets, isolated corners
• sores on nose & mouth (glue sniffers), runny nose, bloodshot eyes
• smell solvents on breath, clothes, hair (glue sniffers)
• I’ve slept with too many women, done too many drugs and
been to too many parties. I loved acid (LSD) when I was at
college. It was an escape. I liked mushrooms (PCP). They
were like easy acid. I did like blow…Blow would dress
you up for a party, but never take you there. You’re always
like, This is going to be great! Then you’re just depressed.”
– George Clooney, in 1997
•The User
•The Abuse
•The
Dependence
I. Substance Abuse vs. Substance Dependence
• DRUG ABUSE; 1 of • Drug Dependence; 3 of
Recurrent substance use:
-failure to fulfill major obligations
at work, school, or home.
-physically hazardous
-related legal problems
- persistent or recurrent social or
interpersonal problems
---same
• Tolerance- markedly increased
amounts; markedly diminished effect
• taken in larger amounts or over a
longer period
• Withdrawal
• unsuccessful efforts to reduce/ cut
down
• great deal of time is to obtain or use
or recover
• Important activities are given up or
reduced
• Use continues despite problems
•12-month period
Felicitas I. Artiaga-Soriano, M.D., FPPA
Examples of Drug Addiction:
People who could not quit
• actor Robert Downey, Jr.
• nominated for Academy Award
for his role in “Chaplin” (1992),
when he was 27 years old
• played a cocaine addict in “Less
Than Zero” (1987)
• own drug problems began at an
early age
• Served a 3-year prison term for
drug possession (released in
2000)
II. Substance-induced disorders:
• symptoms of the disorder are present,
having developed during or within a
month of substance intoxication or
withdrawal
• the symptoms are in excess of those
usually associated with the intoxication
and withdrawal syndrome and
sufficiently severe to warrant
independent clinical attention.
Felicitas I. Artiaga-Soriano, M.D., FPPA
II. Substance-Induced Disorders
• Substance intoxication: Experience reversible,
substance-specific, maladaptive behavioral or
psychological changes directly resulting from the
physiologic effects on the central nervous system
of recent ingestion of or exposure to a psychoactive
substance
• Substance withdrawal: Experience of clinical
significant distress in social, occupational, or other
areas of functioning due to the cessation or
reduction of substance use.
Felicitas I. Artiaga-Soriano, M.D., FPPA
II. Substance-Induced Disorders
Narcotics- Opium, Morphine,Codeine,Heroin
Intoxication
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Judgment is impaired
Apathy
Dysphoria
Eye changes- constriction
Drowsiness
Psychomotor changes
Attention is impaired
Speech is slurred
Triad - of coma,
pinpoint pupils, and
respiratory depression
Withdrawal
• M ood is dysphoric
• A ches in muscles and
bones
• N ausea, vomiting
• Y awning
• P iloerection-gooseflesh
• A gonist removes
withdrawal symptoms
• I nsomnia
• N ot life threatening
• D iarrhea
• E levated
temperature,RR, BP
• A bdominal cramps
• L acrimation and
rhinorrhea
Felicitas I. Artiaga-Soriano, M.D., FPPA
•
“I hate heroin because I’ve been fascinated by it. I’m not immune, but I
won’t do it now, at all.” “I’ve done just about every drug possible. Coke,
heroin, ecstasy, LSD, everything. The worst effect, for me, was pot (MJ). I
felt silly and giggly, and I hate feeling like that,” before recalling, “I
remember taking LSD before I went to Disneyland. I started thinking
about Mickey Mouse being a short, middle-aged man in a costume who
hates his life. Those drugs can be dangerous if you don’t go into it
positively. I gave them up long ago.”
– Angelina Jolie, in 1998
•
“If someone wants to do drugs…as long as he or she isn’t corrupting minors
or driving under the influence or endangering others, shouldn’t a person
have that right?”
– Brad Pitt, in 2006
Opium
Opium pod & derivatives
oxycontin
Morphine
Codeine in various
forms
Methadone
Morphine in various forms
Heroin in plastic
Heroin in various forms
with balloons
Heroin in
off white powder form
II. Substance-Induced Disorders
CNS Depressants- Alcohol, Sedative/Hypnotic,
Intoxication
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Speech is slurrred
Incoordination, Ataxia
Nystagmus
Gait is unsteady
Inattention and memory deficits
Numb- pain threshold increases
Appears drunk with drowsiness
Pupil size is normal
Respiratory Depression
Anxiolytics
Withdrawal
•
• Perceptual disturbanceshallucinations or illusions
• Insomnia, Irritability
• Nausea, vomiting
• Tremor-usually seen in the
hands
Delirum tremens
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Confusion
Disorientation
Delusional thinking
• Onset is from hours to 3 days
after last consumption
• Flushing of the face
• Autonomic hyperactivity- heart
rate, BP, temperature
• Seizures- grand mal (tonicclonic)
• Agitation
• Death
Felicitas I. Artiaga-Soriano, M.D., FPPA
Depressant
Pills
Downers
(various)
Barbiturate Pills
Benzodiazepine
Pills
Alcohol Abuse and Alcoholism
Relaxation
Sociability
Cheap High
Brand / Generic Names
Beer, Wine, Brandy, Gin, Tequila,
Vodka, Whiskey.
Street Names
Booze, Brew, Cold One, Juice,
Sauce, Wahoo Juice
ALCOHOL
• Ethyl alcohol=ethanol=beverage alcohol
• 1 oz of alcohol/hour is metabolized by an
average, healthy person
• 30mg/dL=signs of intoxication in an in
experienced drinker
• 200mg/dL=everyone is intoxicated
• 500mg/dL=unconsciousness occurs
• 600-800mg/dL=death
Felicitas I. Artiaga-Soriano, M.D., FPPA
Alcoholism
•Alcohol is a depressant that decreases the responses of the central
nervous system.
•Excessive drinking can cause liver damage and psychotic
behavior.
•As little as two beers or drinks can impair coordination and
thinking.
•Alcohol is often used by substance abusers to enhance the effects
of other drugs.
•Alcohol continues to be the most frequently abused substance
among young adults.
‘Celebrity Alcoholics’
Betty Ford
Celebrity Alcoholics
Nick Nolte
Lindsay Lohan
David Hasselhoff
Kiefer Sutherland
Amy Winehouse
Ernest
Hemmingway
Alcoholism and Nicotine
Addiction
Heavy smokers
> 20 cigarettes / day
 70% of alcoholics
 10% of the general
population
Nicotine
Tobacco
Street Names
Butts, Coffin Nails, Fags, Snuff, Chew, Nicotine,
Chaw, Stogies, Skag, Gasper, Cig, Smoke, Pill,
Dog Turd
CIGARETTES
• Physical dependence and brain rewards without
intoxication
• Serious habit without impairment in everyday life.
• Most lethal of all dependencies, causing more
deaths than alcohol and all other drugs combined.
• Cigarette smoking is highly correlated with drug
and alcohol use
II. Substance-Induced Disorders
Nicotine-cigarettes, tobacco
Intoxication
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Highly toxic alkaloid
Doses of 60 mg are fatal
Nausea, vomiting
Pallor
Weakness
Diarrhea
Dizziness
Headache
Hypertension
Tachycardia
Tremor
Cold sweats
Confusion
Sensory disturbances
Withdrawal
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Depressed mood
Insomnia
Irritability, frustration or anger
Anxiety
Difficulty concentrating
Restlessness
Bradycardia
Increased appetite or weight gain
• Most lethal of all dependencies,
causing more deaths than
alcohol and all other drugs
combined
Felicitas I. Artiaga-Soriano, M.D., FPPA
II. Substance-Induced Disorders
Caffeine
Intoxication
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Insomnia
Flushed face
Arrythmia
Rambling-thought and speech
Muscle twitching
GI disturbances
Restlessness
Excitement
Nervousness
Agitation
Diuresis
Energy level increases
Several cups of coffee (250mg
or more of caffeine)-2-3 cups
of instant coffee
Withdrawal
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agitation
depression
irritability
insomnia
loss of appetite
severe trembling
shaking and
increase heart rate
330ml can of Coke -11mg
Cup of tea
- 30-60mg
Instant coffee -75-150mg
Felicitas I. Artiaga-Soriano, M.D., FPPA
Marijuana
Cannabis sativa
(Brand / Generic Names)
Hash Oil, Hashish, Marijuana, Marinol,
Dranabinol, Thai Stick.
You probably know why marijuana
is abused
• Relaxation
• Euphoria
“Pot-'Gateway'to
Harder Drugs”
Marijuana
• Called the “careless drug” because pot users
often lose the capacity to care. In the most
extreme form, this is called the
“amotivational syndrome,” meaning that
chronic pot smokers become listless and
apathetic, not just when using the drug but
all of the time.
II. Substance-Induced Disorders
Cannabis- Marijuana
Intoxication
 Mouth is dry
 Appetite increases- “the
munchies”
 Tachycardia
 Conjunctival injection
 Heightened sensitivity to
stimuli
 Drowsy
 Euphoric states
 Disturbance in perception
of time and space
 Hallucinations
Withdrawal
• No specific
withdrawal
symptoms
Felicitas I. Artiaga-Soriano, M.D., FPPA
seeds
Marijuana leaves
In joint rolling
In plastic bag
In block
Cannabis
Hashish oil
Coca leaves and powder
CNS Stimulants
Uppers
(Brand / Generic Names)
Cocaine, Amphetamine, Methamphetamine,
Methylphenidate, Phenmetrizine
II. Substance-Induced Disorders
CNS Stimulants- Cocaine, Amphetamine, Methamphetamine,
Methylphenidate
Intoxication
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Dilated pupils
Arrythmias
Respiratory depression
Nausea and vomiting
Blood pressure changesincrease or decrease,
CVA
Anorexia,insomnia
Psychomotor agitation or
retardation
Sweating- perspiration
or chills
Pulse changestachycardia or
bradycardia
Paranoid thoughts
Neurologic
abnormalitiesconfusion,seizures, death
Withdrawal
 Sleep problems-insomnia or
hypersomnia
 Psychomotor changesagitation or retardation
 Appetite increases
 Crusty mood-dysphoria
 Energy level decreasesfatigue
 Dreams-unpleasant and
vivid
 Suicidal depression
Felicitas I. Artiaga-Soriano, M.D., FPPA
• “My mind seemed to
have a huge neon sign
in it that blinked
nonstop: COKE. GET
COKE. So I did. It
was great for dieting,
partying and picking
up my mood.”
– Drew Barrymore
(who had gone
through rehab twice
by age 13), in 1996
You probably know why ice is
abused –
•
•
•
•
Temporary mood elevation
Exhilaration (high)
Increased mental alertness
Upper-increase wakefulness
Also known as:
Meth, Crystal, Crank, ICE
Methamphetamine
But did you know that –
• Ice is extremely addictive - sometimes with just one use!
• Ice can cause convulsions, heart irregularities, high blood
pressure, depression, restlessness, tremors, severe fatigue.
• An overdose can cause coma and death.
• When you stop using ice you may experience a deep
depression.
• Ice causes a very jittery high, along with anxiety,
insomnia, sometimes paranoia
• degeneration of neurons  underlying cause of
Parkinson’s disease
How is Meth addiction different
than other addictions?
(Dr. Elizabeth Faust, testimony to ND legislature June 2004.

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High is stronger, better, faster, lasts longer
Onset of dependence more intense and rapid
Relatively cheap and plentiful
Synthetic – can be made anywhere
Cognitive impairment lasts longer and some
cognitive impairment may be permanent
 Source of a serious crime problem
Club Drugs
METHAMPHETAMINE
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other names: Ice, speed, tweak, crank , glass, shabu
white powder or clear, crystal “rock”
release large amounts of dopamine = highly addictive stimulant
enhance mood and body movement
• taken orally, intranasally, intravenously, rectally
Desired effects
• smoking, intravenous: intense, very pleasurable sensation
• intranasal and oral: “high” feeling
• 3 – 5 mins (intranasal); 15-20 mins (oral); can last: 24 hours
Cocaine Powder
Cracked cocaine
cocaine
Amphetamines in various capsules
Methamphetamine
shabu
ICE
Speed
II. Substance-Induced Disorders
Hallucinogens, PCP, Designer Drugs-XTC
(Ecstasy)-Methylenedioxymethamphetamine
Intoxication
• Vision is blurred
• Incoordination
• Synesthesias- blending of
sensory perceptions
• Illusions
• Tremors
•
Withdrawal
•
While not strictly withdrawal
symptoms, some other sideeffects include flashbacks and
dehydration.
Thought content changes- ideas of
reference, paranoia
• Hallucinations
• Euphoria
• Pupillary dilatation,
Palpitations
• Altered perceptiondepersonalization,
derealization
• Sweating
• Tachycardia
• Death
Severe Effects
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altered mental status
hyper/hypothermia
Convulsions
Hypertension
Coagulopathy
Acute renal failure
Hepatotoxicity
Death
Felicitas I. Artiaga-Soriano, M.D., FPPA
Stacy
ecstasy
lover’s
speed
xtc
E
Essence
x
Club Drugs
ECSTASY
The E “Rush”
• Instantaneous rush – 30-45 sec, lasting to 15-30 mins
• Sudden clarity, intensification of perceptions, altered perception
of time
• Inner sensation of happiness, sense of loving (sensual drug)
• “booster dose” – hope to prolong the sensations
•  tolerance: desired effects;  in adverse effects
• “bubble bursting” – anxiety, paranoia, nausea, panic
• 30 mins–3 hrs after initial rush: “plateau” phase of > intense
feelings
• trance-like movements  long lasting ecstatic “trancedancing” Hangover effect Anhedonia
Club Drugs
ECSTASY
The After “Rush”
• coming down: 3 – 6 hrs after initial ingestion
• feelings of disappointments: anxiety, depression
• sluggishness & residual effects: lasts up to several days
• 6-7 hours to fall asleep after returning to “normal”
• “Tuesday blues” – from depletion of serotonin
Long term effects
• still uncertain BUT subsequent depression may occur
• due to short-circuit of serotonin pathway & serotonin
shortage
LSD
in Blotter Paper
LSD in forms
Ketamine - special
Ketamine
Solvent and Aerosol Inhalants
Glue sniffing
Street Names
Poppers, Snappers, Bolt, Bullet, Climax, Locker Room, Rush, Buzz
Bombs, Whippets
Some of the substances that are abused:
Butyl nitrite, Amyl nitrite, Gas in aerosol cans
Gasoline and Toluene vapors, Correction fluid, glue, marking pens, nail
polish, lighter fluids, lacquers, cleaning fluids and spot removers
You probably know why inhalants
are abused –
• Cheap High
• Quick buzz
• Fun
But did you know that inhalants may
cause –
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•
•
•
Loss of muscle control
Slurred speech
Drowsiness or loss of consciousness
Excessive secretions from the nose and
watery eyes
• Brain damage and damage to lung cells
II. Substance-Induced Disorders
Inhalants-glue, gasoline, chloroform
Intoxication
• Gait is unsteady
• Aggressiveness or
assaultiveness
• Speech is slurred
• Ocular changes- blurred
vision or diplopia(Glass
eyed appearance)
• Lethargy
• Incoordination
• Nystagmus
• Euphoria
• Dizziness
• Apathy
• Reflexes are depressed
• Tremor
Withdrawal
• No specific
withdrawal symptoms
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
II. Substance-Induced Disorders
• What is dementia?
• Dementia is a problem in the brain that makes it
hard for a person to remember, learn and
communicate. After a while, this makes it hard for
the person to take care of himself or herself.
Dementia may also change a person's mood and
personality. At first, memory loss and trouble
thinking clearly may bother the person who has
dementia. Later, disruptive behavior and other
problems may start. The person who has dementia
may not be aware of these problems
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
•
What is Delirium?
The symptoms of delirium can start rather suddenly--within a few hours or a few
days. There should be fluctuations of the symptoms over an hour or throughout the
day. Delirium is usually characterized by:
•
Unawareness of surroundings.
•
Confusion - they don't know where they are or what they're doing.
•
Not knowing the time, date, day, etc.
•
Difficulty concentrating.
•
Forgetting past events or recent information.
•
Incoherent or rambling speech.
•
Disorganized thinking.
•
Misinterpretations of other's speech.
•
Hallucinating.
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
Amnestic disorder includes the 3
symptoms listed below:
• Memory disturbances
• Memory loss
• Decline in memory ability
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
• What is a psychotic disorder?
Psychotic disorders are mental disorders in
which the personality is seriously
disorganized and a person's contact with
reality is impaired. During a psychotic
episode a person is confused about reality
and often experiences delusions and/or
hallucinations.
Felicitas I. Artiaga-Soriano, M.D., FPPA
Amphetamine-induced Psychosis vs. Schizophrenia
ATS-Psychosis
Schizophrenia
Delusions
Paranoia
Paranoia
Affects
Appropriate
Flattening
Hallucination
Visual
Auditory
Thinking
Intact
Disordered
Hyperactivity
Common
Hypersexuality
Common
Substance-Induced Disorders
• Mood Disorders
• Mania-expansive or irritable mood, inflated selfesteem, decreased need for sleep; increased energy;
racing thoughts; feelings of invulnerability; poor
judgment; heightened sex drive; and denial that
anything is wrong.
• Depression-feelings of hopelessness, guilt,
worthlessness, or melancholy; fatigue; loss of
appetite for food or sex; sleep disturbances,
thoughts of death or suicide; and suicide attempts.
Mania and depression may vary in both duration
and degree of intensity.
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
Anxiety Disorder• produces an intense, often unrealistic and
excessive state of apprehension and fear.
This may or may not occur during, or in
anticipation of, a specific situation, and may
be accompanied by a rise in blood pressure,
increased heart rate, rapid breathing,
nausea, and other signs of agitation or
discomfort.
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
Sexual Dysfunctions:
•
•
•
•
Impaired Desire
Impaired Arousal
Impaired Orgasm
Sexual Pain
Felicitas I. Artiaga-Soriano, M.D., FPPA
Alcohol and Sex
• In small amounts alcohol has been reported to
have a positive impact on sexual desire and
arousal.
• At the same time, research shows that even
after a few drinks sexual response is reduced.
• In large amounts alcohol makes sex difficult to
impossible. While in moderate amounts
alcohol can have an impact on engaging in
risky sexual behavior, although this impact is
not fully understood.
• As drinking increases both men and women
will experience a reduction in sexual arousal,
men may have difficulty getting erections, and
both men and women may have difficulty
experiencing orgasm.
Felicitas I. Artiaga-Soriano, M.D., FPPA
Substance-Induced Disorders
Sleep Disorders
• There are more than 70 different sleep disorders
that are generally classified into one of three
categories:
• lack of sleep (e.g., insomnia),
• disturbed sleep (e.g., obstructive sleep apnea), and
• excessive sleep (e.g., narcolepsy).
Felicitas I. Artiaga-Soriano, M.D., FPPA
Alcohol as an example
 Substance use disorders:
 Alcohol Dependence
 Alcohol Abuse
 Substance-Induced
Disorders
 Alcohol Intoxication
 Alcohol Withdrawal
 Alcohol Intoxication
Delirium
 Alcohol Withdrawal
Delirium
 And so on.
• Delirium,
Dementia,
Amnestic disorder
• Psychotic disorder
• Mood disorder
• Anxiety disorder
• Sexual
dysfunction
• Sleep disorder
Felicitas I. Artiaga-Soriano, M.D., FPPA
Non-drug addictions
Non-drug addiction
Non-drug addiction
Matt Damon- Gambling
David DuchovnyBen Affleck- Gambling
Sex addiction
Kate MossIsopropyl nitrite
(Poppers)-for
extra sexual
pleasure or
response
Check out this list: bet some of them are a real shocker! This is a list we’re starting to
track every last celebrity who has been to rehab for alcohol/drug/sex etc rehab.
Remember to click the read more link to see the FULL list! We’re going to keep this
list updated so we have ALL the celebrity addicts who have been to rehab
- Betty Ford
- Kirsty Alley
- J. Paul Getty, Jr.
- Robert F. Kennedy, Jr.
- Robin Williams
- Robert Downey, Jr.
- Ray Kroc
- Eminem
- Patrick Kennedy
- Ben Affleck
-
- James Frey
- Nick Nolte
- Jan Michael Vincent
- Nick Carter
- Boy George
- Michael Jackson
- Keith Richards
- Robert Mitchum
- Judy Collins
- Rush Limbaugh
Your Brain on Drugs
1-2 Min
3-4
6-7
7-8
8-9
9-10
10-20
20-30
Your Brain After Drugs
The Memory of Drugs
Amygdala
not lit up
Amygdala
activated
Anterior
Posterior
Nature Video
Cocaine Video
control
on cocaine
"Addicts" have a brain disease
that goes beyond their use of
drugs.”
Felicitas I. Artiaga-Soriano, M.D., FPPA
Their Brains…
Get Rewired
by Drug Use
Drug Abuse is a
preventable behavior
and
Drug Addiction is
a treatable disease
Felicitas I. Artiaga-Soriano, M.D., FPPA
Is it
worth
the
risk?
Felicitas I. Artiaga-Soriano, M.D., FPPA