ALCOHOL &

SUBSTANCE ABUSE
RELATED PROBLEMS
NUR SAKINAH HAMZAH 1120472
NUR ATHIRAH ISMAIL

1120475

FATIN AFIFAH ROSLI 1120476

MUHAMMAD AIMAN ARIFIN1120478
MUHAMMAD LUQMAN YUNUS 1120479
AIMI SYAIRAH ISMAIL 1120481

Terminologies :
ABUSE/ HARMFUL USE/ MISUSE
Maladaptive patterns of substance use that impair
health in a broad sense
DEPENDENCE
Certain physiological and psychological phenomena that are
induced by the repeated taking of a substance including:
a strong desire to take the substance
progressive neglect of alternative sources of satisfaction
the development of tolerance
a physical withdrawal state

Terminologies :
TOLERANCE
State in which, after repeated administration, a drug produces a decreased
effect, or increasing doses are required to produce the same effect
WITHDRAWAL
Group of symptoms and signs that occur when a drug is reduced in amount
or withdrawn, which last for a limited time
INTOXICATION
Transient syndrome due to recent substance ingestion that produces
clinically significant psychological and physical impairment

ALCOHOL RELATED
DISORDERS
4

An Outline of Alcohol-Related
Disorder :
Alcohol intoxication
Alcohol withdrawal
Delirium Tremens

Alcohol abuse
Alcohol related psychiatric disorder
Wernickes encephalopathy
Korsakov syndrome
Alcohol dementia

Associated psychiatric disorder

Personality deterioration
Mood and anxiety disorder
Suicidal behavior
Pathological jealousy
Alcoholic hallucinosis
Sleep disorder

Causes of excessive drinking & alcohol misuse

Treatment of alcohol misuse

Alcohol

Alcohol
Activate :
Gamma-aminobutyric acid (GABA)
(inhibitory)
Dopamine
Serotonin

Inhibit :
Glutamate receptor activity
(excitatory)
Voltage-gated calcium channel
Thus, alcohol is a potent CNS
depressant.

Epidemiology
Rate of alcohol misuse and dependence are consistently
higher in men than women
Heaviest drinkers are men in late teens or early
twenties and lower in over 45 years
Followers of certain religion are less likely than general
population.
About 200,000 death each year related to alcohol abuse
About 50% of all automotive fatalities involve drunken
drivers.

Screening alcohol misuse

C

Have you ever felt you ought

Have people

G
E

Cut down on your drinking ?

Annoyed you by criticizing your drinking ?

Have you ever felt Guilt about your drinking ?
Have you ever had a drink first thing in the morning (an
to steady your nerves or get rid of hangover ?

For male, a score of 2 is a positive screen

For female, a score of 1 is a positive screen
If positive CAGE, distinguish between drinking and dependence

Eye-opener)

Alcohol intoxication
Also called as simple drunkenness, is the recent ingestion of
sufficient amount of alcohol to produce acute maladaptive
behavioral changes.

Alcohol intoxication (DSM-V)

A.

Recent ingestion of alcohol

B.

Clinically significant problematic behavioral and psychological changes (e.g :

inappropriate sexual or aggressive behavior, mood lability, impaired judgement)

C.

One (or more) of the following signs and symptoms developing during, or shortly
after, alcohol use :
1. slurred speech
2. incoordination
3. unsteady gait
4. nystagmus
5. impaired in attention and memory
6. stupor or coma

D. The sign or symptom are not attributed to another medical condition, and are not
better explained by another mental disorder, including intoxification with another
substance.

Alcohol Intoxication
EFFECT

BLOOD ALCOHOL LEVEL

(BAL)

Decrease fine motor control

20-50 mg/dL

Impaired judgement and coordination

50-100 mg/dL

Ataxic gait and poor balance

100-150 mg/dL

Lethargy, difficult sitting upright, difficulty in

150-250 mg/dL

memory, nausea/vomiting
Coma in the novice drinker

300 mg/dL

Respiratory depression, death possible

400 mg/dL

In most state, legal limit is 80-100mg/dL

Alcohol Withdrawal (DSM-V)

symptoms usually begin in 6-24hours and last for 2-7 days.

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
B. Two (or more) of the following, developing within several hours to a few days after the
cessation of (or reduction in) alcohol use described in Criterion A :

1. Autonomic hyperactivity (e.g: sweating or pulse rate greater than 100bpm)

2. increased hand tremor
3. insomnia
4. nausea and vomiting
5. transient visual, tactile, or auditory hallucination or illusion.
6. psychomotor agitation
7. anxiety
8. generalized tonic-clonic seizure.
C. The sign or symptoms in criterion B cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D. The sign or symptom are not attributed to another medical condition, and are not better
explained by another mental disorder, including intoxification with another substance.

Alcohol-related psychiatric disorder

Intoxication phenomena
Pleasurable effect- Release of dopamine
Anxiolytic effect - Activation of GABA
Idiosyncratic alcohol intoxication maladaptive behavior such
as aggression when taking an amount of alcohol insufficient to
cause intoxication in most people.
Memory blackout or short term amnesia reported after heavy
drinking in people who are not dependent on alcohol
Withdrawal phenomena
Delirium tremens

Toxic or nutritional condition

Korsakovs psychosis
Wernickes encephalopathy
Alcoholic dementia

Wernickes encephalopathy
Acute syndrome caused by thiamine deficiency
secondary to chronic alcohol dependent causing
damage in hypothalamus and thalamus.
Characterised by :

Ataxia
Ocular abnormalities (gaze palsies, nystagmus)
Delirium
Peripheral neuropathy

Treatment
100 300mg of thiamine per day until opthalmoplegia
resolve.
Magnesium (a cofactor for thiamine metabolism)

Korsakoffs syndrome
Untreated Wernickes encephalopathy
Chronic amnestic syndrome.
Often coexist with alcohol-related dementia.
Characterised by :

Retrograde and anterograde amnesia

Disorientation
Confabulation
Polyneuritis

Alcoholic dementia
Chronic alcohol misuse cause
cognitive impairment : memory,
apraxia, agnosia and executive
function (Sullivan et al.,2010)
Excessive alcohol consumption
Enlarged lateral ventricle
Focal deficit with loss of grey matter
in both cortical and subcortical area.
Demyelination
Atrophy of frontal lobe

Repeated occurrence of
Wernickes encephalopathy

Personality
deterioration
Concerned need
to obtain alcohol
deteriorate
interpersonal and
social function

Suicidal behavior
Alcohol dependent
show risk of suicide of
7% (Inskip et. al,1998 ;
Wilcox, 2004)
Male, older, has long
history of drinking,
depression and previous
attempt

Pathological
jealousy
Excessive drinker
develop an
overvalued idea or
delusion that their
partner is being
unfaithful.

Associated psychiatric
disorder
Alcoholic hallucinosis

Mood and anxiety disorder

Excessive drinking induce
persistent depression and
anxiety
Alcohol dependence :
- fourfold risk of getting
major
depression,
even no longer drinking.
-High risk of experiencing
anxiety disorder (Anthenelli,
2010)

Auditory hallucination insult or

threat in clear consciousness that
make patient anxious and restless.
Not due to acute alcohol withdrawal,
may persist after several month of
abstinence
Is an alcohol induced organic
psychosis, distinct from
schizophrenia and has a good
prognosis if abstinence is maintained
(Mann and Kiefer, 2009)

Sleep disorder
Intoxication
cause increase
non-rapid eye
movement
(NREM) and
reduce rapid
eye movement
(REM)
Increase
wakefulnes
s, restless
sleep and
vivid
dreams or
nightmare

Treatment in Alcohol Misuse

Early detection & treatment

(can be used for other subs. misuse cases)

Brief intervention
Motivational interviewing

Treatment plan for more established alcohol misuse and

dependence
Total abstinence vs controlled drinking
Psychological treatment
Pharmacological treatment

24

www.health.gov.au/internet/alcohol/publishing.nsf/Content/864FDC6AD475CB2CCA257693007CDE3A/$File/treatqui.pdf

25

Approach to treatment of alcohol

misuse
Raise
awareness of
problem

Increase
motivation to
change

High intensity
psychological
treatment

Support &
advice

Alcoholic
anonymous

Withdraw
alcohol/controll
ed drinking

Medication
Disulfiram,
Acamprosate

26

Brief intervention
Simple education and advice
Aim- promote safer drinking
not usually sufficient in individuals who have developed dependence or
experiencing more severe alcohol related harms (for whom more intensive
treatment is recommended).
Delivered in one to four sessions, each lasting from 5-10 minutes to 1 hour.
May be opportunistic, offered to individuals identified through screening who have
not sought treatment.
FLAGS

Feedback
Listen
Advice
Goals
Strategies
27

Motivational interviewing
Express empathy
Avoid arguing
Detect and roll with resistance
Point out discrepancies in patients hx
Raise awareness about contrast between substance
users aims and behaviour

29

Withdrawal from alcohol

Setting : ambulatory alcohol withdrawal or inpatient
detoxification. (based on Severity of Alcohol Dependence
General mx of alcohol
Questionnaire)
detoxification:
Indication for inpatient detoxification
1. Explain process to the
SADQ score >30
High alcohol consumption, over 30 units daily patient & their family.
2. Pt. should stay off work &
Concomitant benzodiazepine misuse
rest. They should not drive.
Medical/psychiatric comorbidity
Considerations before alcohol
3. Patient should take plenty
detoxification
of fluids but avoid
1. What are the medical risk?
caffeinated drinks
2. What setting is appropriate?
4. Daily visit by health
3. What does pt want from detoxification?
professionals.
4. What kind of aftercare is needed to help
5. Maintain abstinence.
maintain abstinence?
6. Reducing course of 30

Pharmacology treatment for alcohol withdrawal

Benzodiazepines
o Smoother withdrawal & general better relief of withdrawal symptoms
o Risk of over sedation in elderly, liver disease
o Chlordiazepoxide (most long BDZ, Not available in KKM, use diazepam)
o Outpatient: 20-30 mg,4x daily. (reduce, stop over 5-7 days)
o Inpatient : higher doses

Carbamazepine
Alternative to benzodiazepine
No added benefit of combining carbamazepine and benzodiazepine

Chlomethiazole
o Not recommended dt toxicity when combined with alcohol & danger in overdose
o Use in most severe withdrawal states

Antipsychotic drugs
Lower seizure threshold
Less effective than benzodiazepine to reduce delirium
Reduce agitation
Pt with delusion not respond to benzodiazepine

Vitamin supplement
Thiamine to prevent Wernicke-Korsakof Syndrome

31

Psychological treatment
Community reinforcement approach
Social behavior & network therapy
Behavioural self control training
Coping& social skills training
Cognitive behavioral relationship therapy
Cue exposure
Relapse prevention

32

Pharmacological treatment
Disulfiram (Antabuse)
To achieve abstinence but concerned of relapse, or have had previous relapses
Block oxidation of alcohol >> acetaldehyde accumulate >> unpleasant reaction to
alcohol >> deter from drinking alcohol
What is the unpleasant reaction?

Facial flushing
Throbbing headache
Hypotension
Palpitation
Tachycardia
Nausea
Vomitting

Contraindication : heart failure, coronary artery disease, hypertension, psychosis,

pregnancy.
Side effect : drowsy, bad breath, nausea, constipation.
Dosage : single dose 800 mg (1 st day tx)
33
: reduce over 5 days to 100-200 mg daily

 Acamprosate ( calcium acetyl homotaurinate )

help prevent arelapse in people who have successfully achieved
abstinence from alcohol.
Stimulate GABA-inhibitory neurotransmission & decrease excitatory
effect of glutamate.
Dosage : 333 mg (2 tablets), three times daily
Not metabolized in liver, excreted by kidney.
>> drug interaction unlikely to occur.

Adverse effect

Diaorrhea
Nausea
Vomitting
Abdominal pain
Skin rashes
Fluctuations in libido
34

 Naltrexone (Opioid antagonist)

to prevent a relapse or limit the amount of alcohol someone drinks.

blocking opioid receptors in the body, stopping the effects of alcohol.
usually used in combination with other medicine or counselling.
Side effects :

Nausea
Vomitting
Headache
Dizziness
Weight loss

Topiramate
Anticonvulsant drug
Improve drinking outcome at dose 100 mg/day
Adverse effects:

Paraesthesia
Anorexia
Headache
Abd. Pain
Sleep disturbance
Cognitive impairment
35

 Antidepressant medication
Persistent symptoms of major depression after detoxification
TCA not recommended dt potential serious interactions :
cardiotoxicity, death following overdose.
SSRI
Improve drinking outcome in type 1 alcohol dependence
Later age of onset
Anxious trait

Worsen outcome in type 2 alcohol dependence

Early age of onset
Positive family hx
Impulsive/antisocial personality trait
36

Agencies concerned with

drinking problems
Alcoholics anonymous
Al- Anon
Al- Ateen
Non-statutory agencies
Hostels

37

Prognosis of treatment
Better prognosis
Good insight
Social stability (fixed abode,
family support, ability to keep a
job)
Ability to control impulsiveness,
to defer gratification, & to form
satisfactory emotional
relationship

38

Prevention of alcohol misuse &

dependance
Pricing of alcohol beverages
Controls on advertising
Controls on sale
Health education

39

SUBSTANCE USE
DISORDERS
40

An Outline of Substance Abuse-Related Disorder :

Opioid
Cannabis
CNS Stimulant cocaine no need
Hallucinogens no need
CNS Depressant
Inhalant
41

Buku Maklumat Dadah 2015, AADK

43

OPIOIDS
Opiates VS opiods.
Opiates are natural
analgesics derived from
opium in poppy plant.
Opiods are synthetic
analgesic.
Currently, the term opiods
is used for both natural
and synthetic analgesics.
Natural morphine,
heroine

INTRODUCTION
Misused for euphoriant and anxiolytic effects.
Methods of administration

Intravenous
Subcutaneous (skin popping)
Sniffing (snorting)
Heated on metal foil and inhaled (chasing the dragon)

44

Epidemiology
In 2012, the prevalence of illicit opioids use in England is 0.3%.
(Psychiatric Morbidity Survey)

Meanwhile in 2015, opioids covers 60% from all cases of drug

abuse in Malaysia. It is the highest followed by
methamphetamine(30%), cannabis(5%) and others. (Maklumat Dadah
Malaysia, 2015)

Higher rates expected in homeless and in prisons. (McManus et al., 2007)

Most cases have a chronic relapsing and remitting course, with
mortality of 10%-20% over 10 years.
Though, 50% of the users have been abstinent at 10 year
follow-up. (Robson, 2009)
45

HEROINE
a powdery or crumbly substance
ranging all the way from off-white to dark
brown.
White is the purest form of heroin.
Black tar heroin is nearly black and is
sticky instead of powdery.
Other names:
Fit, Fun, Ubat, Panas, Stuff, Tepung, Cik putih,
Penang pink.

Illegal narcotic analgesic due to strong

effect.
Many people use it without becoming
dependant, but repeated use can lead to
rapid development of dependence and
physiological tolerance.
46

MORPHINE
in pill or liquid form.
Other names: M, White Powder, Monkey,
Morpho, Pok Teh
High potential for addiction and abuse. If
dose is reduced after long-term use,
withdrawal may occur.
Legally used in hospitals.
Clinically cause slow breathing, lowered
heart rate, dopiness, constipation,
euphoria and itchiness.
Overdose symptoms include cold,
clammy skin, low blood pressure, slow
pulse rate and even coma and death.
47

SIGNS & SYMPTOMS OF OPIOID ABUSE

euphoria, dry mouth, flushed skin, constricted pupils, feeling of heaviness and dopey,
fade in and out of wakefulness, breathing slowed, memory loss, poor decision
making, reduced self-control, itching, nausea and vomiting.
Prolonged use chronic constipation, prone to infections.

OVERDOSE symptoms
Bluish nails or lips, depressed breathing, weak pulse, small pupils, delirium, extreme
drowsiness, coma

ADVERSE EFFECT
BABIES of opioid abuser likely to be premature and have low birth weight.
Withdrawal symptoms after birth irritability, restlessness, tremor and a high pitched
cry.
Other factors include poor nutrition & heavy smoking
Later effect overactive and poor resistance
48

TOLERANCE & WITHDRAWAL

Tolerance develops rapidly, leading to the need for increasing dose.
When the drug is stopped, tolerances diminishes rapidly, so the dose taken after a
period of abstinence would have a greater effects compared with previous.
Most common cause of death in opioids abuser is due to loss of tolerance effect after a
period of enforced abstinence, followed by suicide, HIV infections and Hepatitis.
Withdrawal features usually begins about 6 hours after the last dose, reach a peak after
36-48 hours and then wane.
Cause great distress and drive the user to seek further supply of drug.
Withdrawal symptoms include

Intense craving for drug

Restlessness and insomnia
Pain in muscles and joints
Running nose and eyes
Abdominal cramps, vomiting and diarrhoea
Piloerection, sweating, dilated pupils and raised pulse rate
Disturbance of temperature.
49

MANAGEMENT
Identify opioid users, they present to doctors in 3 situations:
1) Supplies running out. They may request directly or by feigning a painful disorder
2) Drug overdose. Most present with respiratory depression.
3) Acute complication of intravenous drug usage such as local infection, necrosis at
infection site or infection of a distant organ, heart or liver.

Detoxification
) Duration of 4 weeks in residential setting and 12 weeks in community setting.
) When the dose is LOW, opioids can be withdrawn more quickly while giving
sympathetic treatments for withdrawal effects.
) When previous daily dose is HIGH, it is necessary to prescribe an opioid, reducing the
dose gradually.
) Other option: Rapid opioid detoxification- usage of opioid antagonist (naltrexone) +
sedation, but requires a high level of nursing support due to severe withdrawal
symptomatology + need to monitor airway in sedated patient.
50

MANAGEMENT
Drug used for treating withdrawal symptoms:

Gastrointestinal: loperamide or metoclopramide

Aches and pains: non-steroidal analgesics
A2 adrenoceptor agonist: lofexidine
Partial opioid receptor agonist: Buprenorphine

In pregnant users
in first trimester, avoid detoxification and aim for mother to engage in a
multidisciplinary care programme for
stabilization on a suitable dose of methadone
Avoidance of illegal drug use
High level of antenatal care

- In second trimester, carry out detoxification by employing small frequent

reduction of methadone or buprenorphine.
51

Methadone Maintenance
therapy

Criteria to proceed with the therapy:

1) Heroin / morphine abuser

2) Opioid dependent
3) Age between 18 to 50 years old

Part of Harm Reduction

Programme since 2005.
Aim for
fight HIV infection and other
IVDU chronic infections
Reduce opioids addiction
Increase mental, physical and
socioeconomic of patient

Methadone is used because

longer half life(1-2 days)
Late onset of withdrawal
syndrome (begin only after 36
hours, reach peak after 3-5 days)
able to inhibit euphoric and

4) No chronic illness
5) Intra-venous drug user
6) High self-motivation to stop
HOW

7) Titration dose. Initial dose of 20 30 mg.

Max 40 mg.
) Patient is monitored for 3-4 hours for
withdrawal symptoms.
) If withdrawal symptoms present, 5 ml
supplementary Methadone syrup will be given.
2) Maintainance dose. 60-80 mg daily.
) Aim to maintain level of plasma methadone.
3) Reduction of dose
) Reduction of 10 mg/week, until reach
40mg/day, eventually 5 mg/week.

52

53

CANNABIS
Derived from the plant
Cannabis sativa
Marijuana Grass, Ganja
Epidemiology
The most commonly used
illicit drug
Most frequent use - Czech
Republic (45%)
Lowest use - Armenia (3 %)
Third highest rate - UK (29

Clinical effects
Cannabis intoxication
Exaggerate the pre-existing mood
(exhilaration or depression)
Increased enjoyment of aesthetic
experiences
Distortion of the perception of
time and space.
Reddening of the eyes, dry
mouth, tachycardia, irritation of
the respiratory tract, and
coughing.
Can lead dangerous driving

Mechanical action

psychoactive substance: delta-9-tetrahydrocannabinol

(D9-THC)

Pharmacological effects

mediated through
interaction with a specific
cannabinoid receptor in the
central nervous system.

54

Adverse effects
Medical illness

Social
Poor psychosocial outcomes
mood disorder
poor educational performance
job instability,
uptake of more harmful illegal
drugs.

Chronic use of cannabis state

of
apathy &indolence

Inhaled cannabis smoke irritates the respiratory tract and is

potentially carcinogenic.

*Urine drug screen is +ve for up to 4

weeks

Psychological effects

Anxiety.

Mild paranoid ideation

Toxic confusional states

Dependence
Tolerance
Withdrawal syndrome
( irritability, nausea,
insomnia, and
anorexia)

Psychosis

Depersonalization

55

Cannabis & Mental illness

Modify the course of an established schizophrenic
More likely to experience psychotic episodes and relapse (Hall
and Dengenhardt, 2011)
Can predispose to the later development of schizophrenia
(controversial).
Relative risk of developing schizophrenia
Used cannabis 2.5x higher
Heavy users -6x higher
It is also possible that those who are predisposed to develop
schizophrenia are also predisposed to misuse cannabis.
Removal of cannabis from society would prevent about 8 % of
cases of schizophrenia (Arseneault et al. 2004)

56

Treatment
Cannabis dependence
Behavioural and psychological interventions to maintain
an abstinent state
Motivational enhancement therapy (MET)
Cognitive Behavioural Therapy (CBT)
* both are some thing

57

58

CNS
STIMULANT
Amphetamine
Methamphetamine (syabu,
sejuk, batu)
Cocaine
Ectasy

59

AMPHETAMINE
used as a street drug,
known as speed, whizz, ice,
Other name: kuda, yaba.
Epidemiology:
Currently used rather less
than
cocaine in the UK,
although
they were used more
previously.

Clinical effects

Adverse effects

Over-talkativeness, overactivity,
insomnia, dryness of the lips,
mouth, and nose, and anorexia.
The pupils dilate, the pulse rate
increases, and the blood pressure
rises.
Large doses

Cardiac arrhythmia, severe

hypertension, cerebrovascular
accident, and occasionally
circulatory collapse.

Increasingly high doses

-

Neurological symptoms such

as seizures and coma may
occur.

Dysphoria, irritability, insomnia, and

confusion.
Anxiety and panic
Tolerance
Obstetric complications include
Dependence
miscarriage,
premature labour, and

Withdrawal syndrome
placental
mild cases - low mood
and abruption
decreased energy.
heavy users- depression,anxiety,
tremulousness, lethargy, fatigue,
and nightmares. Craving for the
drug may be intense, and suicidal
ideation may be prominent.
*Notes : - This drugs are quickly
eliminated
- urine sample should be taken

60

Amphetamine-induced psychosis
Repetitive stereotyped behaviour
(e.g. repeated tidying).
Paranoid psychosis
persecutory delusions, auditory and visual hallucinations, and
sometimes hostile and dangerously aggressive behaviour

61

Treatment
Acute overdoses
Sedation
Management of hyperpyrexia and cardiac arrhythmias.
Toxic symptoms
resolve quickly when the drug is stopped.
Antipsychotic drug - control florid symptoms.
Dependence
Abstinence is the usual goal
Social and psychological interventions (CBT, contingency management)
Withdrawal syndrome
Benzodiazepines
62

63

COCAINE
INTRODUCTION
Strong illicit stimulant used as
recreational drug.
Made from leaves of coca
plant
EPIDEMIOLOGY
Lifetime use of cocaine in
households in England is 6.3%
0.4% of them meets the
dependence criteria.

COCAINE
CLINICAL EFFECTS

Psychological

Excitement
Increased energy
Euphoria
Grandiose thinking
Impaired judgement
Sexual disinhibition

Physical
Tachycardia
Increased blood pressure

ADVERSE EFFECTS
CVS - Cardiac arrhythmia, MI, Myocarditis, Cardiomyopathy
Cerebrovascular - Cerebral infarction, SAH, TIA
Infective abscess, septicaemia, hepatitis
Obstetric reduced fetal growth, miscarriage, premature labour, placenta abruption
Others - Seizures & respiratory arrest
Higher doses > visual and auditory hallucinations > paranoid ideation > aggressive behaviour
Prolonged use of high dosage > paranoid psychosis with violent behaviour + formication

64

WITHDRAWAL SYNDROMES
Dysphoria
Anhedonia
Anxiety
Irritability
Fatigue
Hypersomnolence

TREATMENT
Acute intoxication require
sedation with benzodiazepines
Management of hypertension
and seizures
Psychosocial approach
Cognitive-behavioural therapy
Contingency management
12 step approaches
programme
65

66

HALLUCINOGE
NS
Diverse group of drugs that
alter perception (awareness of
surrounding objects and
conditions), thoughts, and
feelings

Hallucinogen/ Psychotomimetic
Cause hallucinations, or sensations and images that seem real
though they are not
Do not cause physical dependence or withdrawal. Some develop
tolerance

Synthetic
Lysergic acid diethylamide
(LSD),
Methyldimethoxyamphetamin
e
Ketamine
Phencyclidine (PCP)
Dextromethorphan (DXM)

Natural
sp. Of mushrooms contain of
psilocybin (magic mushroom)
Peyote (spineless cactus)
Ayahuasca (plant tea)

67

Lysergic acid diethylamide (LSD)

Found in a fungus that grows on rye and other grains
The effect starts 2h after consumption, last from 8 -14h
Initial effect-sympathomimetic effects

periences of the trip

Distortios or intensifications of sensory perception, synaesthesia.
Objects may be seen to merge with one another or to move rhythmically.
Slowed passage of time,
distortion of the body image, lead to panic, with fears of insanity.
distress, acute anxiety, aggressiveness

Later develop : flashback/ hallucinogen persisting perception disorder

Rx- talking down, diazepam
68

Phencyclidine (PCP)
Angel Dust, Hog, Love Boat, and Peace Pill

Clinical effects: anaesthesia

Intoxication: prolonged effect such as
agitation, depressed, consciousness,
aggressiveness and psychotic-like
symptoms, rotatory nystagmus, and
raised blood pressure.

Serious overdose: hypertensive crisis, CVA, or malignant

hyperthermia. Status epilepticus, renal failure.

Chronic use: aggressive behavior, memory loss

Tolerance occur, dependence on heavy USER, withdrawal sx is

rare

*Rx- symptomatic: haloperidol, diazepam, CHLORPROMAZINE

69

Ketamine
K, Special K, or Cat Valium.
Low dose- mood elevation
High dose- paranoia, hallucinations,
thought disorder, and confusion, sensory and perceptual
distortions and out-of-body experiences
Intoxification- sympathetic overactivity, with chest pain,
tachycardia, and palpitations. Difficulty in breathing, ataxia,
mutism, and temporary paralysis.
Rx- symptomatic and supportive.

70

71

CNS
DEPRESSANTS
-Anxiolytic & Hypotic Agents
-CLUB DRUGS : Erimin-5,
Rohypnol Dan Valium

BENZODIAZEPINES
Widely used for therapeutic purposes
Develop dependence high dose + prolonged usage
(>6 months)
Withdrawal symptoms
anxiety symptoms anxiety, irritability, sweating, tremor,
sleep disturbance
altered perception depersonalization, derealisation,
hypersensitivity to stimuli, abnormal body sensation and
abnormal sensation of movement
other features (rare) depression, suicidal behaviour,
psychosis, seizures, delirium tremens

72

BARBITURATES
Formerly used in general anaesthesia
Depression of CNS & respiratory system
CNS: cause sedation, reduce excitement, impaired concentration,
mental & physical sluggishness, higher dose ( anaesthesia, coma &
death)
Respi: suppress the baroreceptor & chemoreceptor response to CO2

Develop dependence
Withdrawal symptoms
Tremors, nausea vomiting, delirium, seizures, cardiovascular
collapse
73

74

INHALANTS
- Solvent / Volatile Substance
- Terms inhalation
- Huffing - Inhaling substances soaked
into a rag
- Sniffing/Snorting - Inhaling fumes
directly from a container
- Bagging - Inhaling fumes from a
substance placed inside of a bag

Types of inhalants

Liquids
Paint thinner
Paint Remover
Dry-Cleaning Fluids
Degreasers
Gasoline
Glues
Correction Fluids,
Felt-Tip Markers

Aerosols

Spray Paints
Deodorant
Hair Sprays
Vegetable Oil Sprays
Fabric Protector
Spray

Gases

Chloroform
Nitrous Oxide
Whipped Cream
Cans
Butane Lighters
Propane Tanks
Refrigerants

Nitrites

Leather Cleaner
Room Deodorizer
Food Preservatives
Sexual Enhancers
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Effects of Inhalant
Euphoria

Blurry
Vision
Slurred
speech

Hallucinati
ons

Drowsines
s

Disorientation

Coma,
Death
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Other adverse
effects of
inhalant
- Sudden sniffing death
syndrome
- Asphyxiation
- dependence can develop if
use is regular
- withdrawal symptoms
(sleep disturbance,
irritability, nausea,
tachycardia, rarely
hallucination)
77

Signs of Abuse
HELP acronym

Hidden chemical-soaked rags or clothes

Eyes and nose red or runny
Loss of appetite or nausea
Paint or chemical stains on face or fingers

Disorientation to time and space

Glue-sniffers rash

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Treatment
Treatment
approaches
for inhalant
abusers must
be tailored to
meet their
unique
needs.
A good
treatment
program for
anyone with
an inhalant
abuse
problem
includes:

Medical Intervention (no specific pharmacotherapy)

Detailed history of substances abused.
Identification and treatment of medical problems that resulted from inhalant
abuse.
Psychotherapy
Inhalant abusers may have psychological conditions, such as low self-esteem and
depression, which have not been properly treated in the past.
It is important to identify mental health needs and develop a therapy plan to
address the underlying problems that may have led to inhalant abuse.
Education on the dangers of inhalant abuse
Enlist family support .
Encouragement to form new friendships and avoidance of peers who
abuse inhalants.
Prevention by education and policies

79

Thanks!
Any questions?

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