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De addiction
1 Facilities available 1. Inpatient facility: 20 beds 2. OPD facility 3. Counselling room 4. Group therapy room 5. Recreation room 6. Library 7. Yoga room 8. Meditation room Records maintained 1. Admission register 2. Case papers 3. Treatment chart 4. Progress notes 5. Discharge summary 6. Follow up register 7. Indoor patient register 8. OPD register 9. Stock register Treatment modalities 1. Detoxification 2. Pharmacotherapy 3. Individual counselling 4. Group therapy 5. Family therapy 6. Occupational therapy
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De addiction
- 2. VISIT TO DE-ADDICTION CENTER Ms.Rama Ms. Renu Mr. Pramod M.Sc. Nursing 1st year
- 3. Objectives • To knowabout the organizational setup of the centre. • To know about the physical set up of the de-addiction centre. • To know about the background of the centre. • To know about various facilities provided by the De- addiction centre. • To know about records and reports maintained. • To gain knowledge regarding the treatment measures for patients with drug addiction
- 4. INTRODUCTION • Disorders dueto psychoactive substance use refer to conditions arising from the abuse of alcohol, psychoactive drugs and other chemicals such as volatile agents • Substance abuse has also been referred to as any use of substances that poses significant hazards to health.
- 5. CENSUS Every year 2.5million people die due to alcohol use disorder world wide. In INDIA, there are around 75 crore drug abusers. In Haryana – 63.3% In Ambala – 60% 12-18 years abusers of alcohol – 21.9% Cannabis – 3% Opiates – 0.7% Illicit drug – 3.6%
- 6. Definition • SUBSTANCE: Theterm substance is used in reference to any drug, medication or toxin that shares the potential for abuse.
- 7. Definition • ADDICTION: Addictionis a psychological and physiological dependence on alcohol or other drugs of abuse that effects the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued
- 8. Classification F10-F19 Mental andbehaviours disorders due to psychoactive substance use • F10 Mental behaviours disorders due to use of alcohol • F11 Mental and behavioural disorders due to use of opioids • F12 Mental and behavioural disorders due to use of cannabinoids
- 9. Classification contd….. • F13Mental and behavioural disorders due to use of sedatives or hypnotics • F14 Mental and behavioural disorders due to use of cocaine • F16 Mental and behavioural disorders due to use of hallucinogen
- 10. Commonly used psychotropic substance •Alcohol • Opioids • Cannabis • Cocaine • Amphetamines and other sympathomimetics
- 11. Commonly used psychotropic substance •Hallucinogens for example, phencyclidine • Sedatives and hypnotics, for example, barbiturates • Inhalants, for example, volatile solvents • Nicotine
- 12. Etiological factors inpsychoactive substance use 1. Biological factors: • Genetic vulnerability • Biochemical factors • Neurobiological theories • Withdrawal • Comorbid medical disorder
- 13. Etiological factors inpsychoactive substance use 2. Behavioural theories • Behavioural scientists view drug abuse as the result of conditioning, or cumulative reinforcement from drug abuse. • Drug use causes euphoric experience perceived as rewarding, thereby motivating user to keep taking the drug (which then serves as a biological reward).
- 14. Etiological factors inpsychoactive substance use • Stimuli and settings associated with drug use may themselves become reinforcing or may trigger drug carving that can lead to relapse (many recovering addicts change their environment cues that that could promote drug use).
- 15. Etiological factors inpsychoactive substance use 3. Psychological factors: • General rebelliousness • Sense of inferiority • Poor impulse control • Low self esteem • Inability to cope with the pressure of living and society (poor stress management skills)
- 16. Etiological factors inpsychoactive substance use • Loneliness, unmet needs • Desire to escape from reality • Desire to experiment, a sense of adventure • Pleasure seeking
- 17. Etiological factors inpsychoactive substance use 4. Social factors: • Religious reasons • Peer pressure • Urbanization • Extended periods of education • Unemployment • Overcrowding
- 18. Etiological factors inpsychoactive substance use • Poor social support • Effects of television and other mass media • Occupation: Substance use is more common in chefs, barmen, executives, salesmen, actors, entertainers, army personnel, journalists, medical personnel etc.
- 19. Etiological factors inpsychoactive substance use 5. Easy availability of drugs • Taking drugs prescribed by doctors (for example, benzodiazepine dependence) • Taking drugs that can be bought legally without prescription (for example, nicotine, opioids) • Taking drugs that can be obtained from illicit sources (for example, street drugs)
- 20. Etiological factors inpsychoactive substance use 6. Psychiatric disorders: • Substance use disorders are more common in depression • anxiety disorders (particularly social phobias) • personality disorders (antisocial personality) • occasionally in organic brain disease
- 21. Consequences of substanceabuse • Physical dependence, psychological dependence • Unhealthy lifestyles and behaviours such as poor diet • Impairs social and occupational functioning, creating personal, professional, financial, and legal problems
- 22. Consequences of substanceabuse • In early adolescence may lead to emotional and behavioural problems • In pregnant women, substance abuse jeopardizes foetal well-being • Psychoactive substances produce negative outcomes including maladaptive behaviour, ‘bad trips’, and even long term psychosis • Illicit street drugs pose added dangers; materials used to dilute them can cause toxic or allergic reactions
- 23. Dynamics of substancerelated disorders 1. Alcohol dependence syndrome: It refers to the use of alcoholic beverages to the point of causing damage to the individual, society or both. Signs and symptoms of alcohol dependence: • Minor complaints: Malaise, dyspepsia, mood swings or depression, increased incidence of infection. • Poor personal hygiene, untreated injuries (cigarette burns, fractures that cannot be explained)
- 24. Dynamics of substancerelated disorders • Unusually high tolerance for sedatives and opioids • Nutritional deficiency • Consumption of alcohol containing products (mouthwash, aftershave lotion, lighter fluid etc.) • Denial of problem • Tendency to blame others and rationalize problem
- 25. Dynamics of substancerelated disorders ICD10 Criteria for Alcohol Dependence • A strong desire to take the substance • Difficulty in controlling substance taking behaviour. • A physiological withdrawal state • Development of intolerance • Progressive neglect of alternative pleasures of interests. • Persisting with substance use despite clear evidence of harmful consequences
- 26. Dynamics of substancerelated disorders 2. Opioids use disorders: India, surrounded on both sides by routes of illicit transport, namely Golden Triangle (Burma, Thailand, Laos) is particularly affected. The most important dependence producing derivatives are morphine and heroin.
- 27. Dynamics of substancerelated disorders • Acute Intoxication: It is characterized by apathy, bradycardia, hypotension, respiratory depression, subnormal temperature and pinpoint pupils. Later delayed reflexes, thread pulse and coma can occur.
- 28. Dynamics of substancerelated disorders 3. Cannabis use disorder: Cannabis is derived from hemp plant, Cannabis sativa. The dried leaves and flowering tops are often referred to as ganja or marijuana. The resin of the plant is referred to as hashish. Bhang is a drink made from cannabis. Cannabis is either smoked or taken in liquid form.
- 29. Dynamics of substancerelated disorders 4. Cocaine use disorder: Common street name is ‘crack’. It can be administered orally, intranasally by smoking, or parentally. • Acute intoxication: Characterized by pupillary dilatation, tachycardia, hypertension, sweating, and nausea.
- 30. Dynamics of substancerelated disorders 5. Amphetamine use disorder: Amphetamines are powerful CNS stimulants with peripheral sympathomimetic effects. EX. Pemoline and methylphenidate. 6. LSD Use disorder (Lysergic acid diethylamide): LSD is a powerful hallucinogen, and was first synthesized in 1938.
- 31. Dynamics of substancerelated disorders • Barbiturate use disorder: The commonly abused barbiturates are secobarbital, phenobarbital. • Inhalants or volatile solvent use disorder: The commonly used volatile solvents include petrol, aerosols, thinners, varnish remover and industrial solvents.
- 32. De-Addiction • Drug rehabilitationis a term for the processes of medical or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cocaine. • The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse.
- 33. Prevention of substanceuse disorder 1.Primary prevention: • Reduction of over prescribing by doctors • Identification and treatment of family members who may be contributing to the drug abuse. • Introduction of social changes is likely to affect drinking patterns in the population as a whole. This is made possible by: Putting up the price of alcohol and alcoholic beverages.
- 34. Prevention of substanceuse disorder Controlling or abolishing the advertising of alcoholic drinks. Controls on sales Restricting availability • Strengthen the individual’s personal and social skills to increase self-esteem and resistance to peer pressure. • Health education to college students and the youth
- 35. Prevention of substanceuse disorder • Secondary prevention: • Early detection and counselling • Brief intervention in primary care • Motivational interviewing • A full assessment including an appraisal of current medical, psychological and social problems. • Detoxification with benzodiazepines (diazepam).
- 36. Prevention of substanceuse disorder 3. Tertiary prevention: • Alcohol deterrent therapy (Disulfiram) • Other therapies include assertiveness training, teaching copying skills, behaviour counselling, supportive psychotherapy • Agencies concerned with alcohol- related problems
- 37. Prevention of substanceuse disorder Some practical issues under relapse prevention include: • Motivation enhancement • Identifying high-risks situations and developing strategies to deal with them • Drink refusal skills (assertiveness training) • Dealing with faulty cognitions • Handling negative mood states • Time statement • Anger control’
- 38. Prevention of substanceuse disorder • Financial management • Developing the work habit • Stress management • Recreation and spirituality • Family counselling, to reduce interpersonal conflicts, which may otherwise trigger relapse.
- 39. Treatment • Treatment includesmedication for depression or other disorders, counselling by experts and sharing of experience with other addicts. • Some rehab centres include meditation and spiritual wisdom in the treatment process.
- 40. Types of treatment •Various types of programs offer help in drug rehabilitation • Some rehab centres offer age- and gender-specific programs. • The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication and behavioural therapy, followed by relapse prevention.
- 41. Treatment 1. Behavioural Therapy Cognitive-behavioural therapy Cognitive therapy of substance abuse 2. Pharmacotherapies 3. Counselling 4. Rehabilitation
- 42. Follow up andhome care • Some patients with drug problems complete treatment the first time and remain sober, while others have to repeat treatment several times. • Some patients do not succeed in staying sober. • Nurses remain hopeful and appropriately supportive but realistic when treating patients.
- 43. Patient and familyteaching • Teach the patient/family about the physical, psychological and social complications of drug and alcohol abuse use. • Inform the patient/family that psychoactive substances may alter a person’s mood, perceptions, consciousness or behaviour. • Explain to the family that the patient may use lies, denial or manipulation
- 44. Patient and familyteaching • Teach the patient/family that drug overdose or withdrawal can result in a medical emergency or death, give the family emergency resources for help. • Caution the patient that sharing dirty or used needles can result in a life threating diseases such as AIDS, hepatitis B. • Teach the family to establish trust with the patient to use firm limit setting, when necessary to help the
- 45. Patient and familyteaching • Provide the patient with a full range of treatment during hospitalization such as medication, individual therapy, and behaviour modification to strengthen the recovery process. • Teach the family/patient how to recognize psychosocial stressors that may exacerbate substance abuse problem and how to avoid or prevent them. • Emphasize to the patient the importance of changing lifestyle, friendships, and habits that promote drug use to remain sober.
- 46.
- 47. History The De-addiction centrein ambala city hospital was established as a psychiatry ward in 2004. Later, in January 2014 it was converted in to De- addiction centre.
- 48. Staffing pattern 1. Dr.K.S Rana M.B.B.S, D.P.M, HCMS, Psychiatrist 2. Dr. Sandeep Sohni M.O, Psychiatrist 3. Dr. Babita Gupta Counseller
- 49. Staffing pattern 3. Sr.Veena Sharma Staff nurse 4. Mr. Sumit Pal Ward servant Staff nurses: 4 Ward servant:4 Guard: 2