Substance abuse power presentation

Substance relatedSubstance related
DisordersDisorders

Psychoactive SubstancePsychoactive Substance
Psychoactive (psychotropic)Psychoactive (psychotropic) substancesubstance isis
any substance which after absorptionany substance which after absorption
has influence on mental processes bothhas influence on mental processes both
cognitive and affectivecognitive and affective..

Substance abuseSubstance abuse
 Substance abuse can be defined as usingSubstance abuse can be defined as using
a drug in a way that is inconsistent witha drug in a way that is inconsistent with
medical or social norms and despitemedical or social norms and despite
negative consequences.negative consequences.

DetoxificationDetoxification
 Detoxification is the process of safelyDetoxification is the process of safely
withdrawing from a substance.withdrawing from a substance.

IntoxicationIntoxication
 Intoxication is use of a substance thatIntoxication is use of a substance that
results in maladaptive behavior.results in maladaptive behavior.

Withdrawal syndromeWithdrawal syndrome
 Withdrawal syndromeWithdrawal syndrome refers to therefers to the
negative psychological and physicalnegative psychological and physical
reactions that occur when use of areactions that occur when use of a
substance ceases or dramaticallysubstance ceases or dramatically
decreases.decreases.

BlackoutBlackout
 It is an episode during which the personIt is an episode during which the person
continues to function but has no consciouscontinues to function but has no conscious
awareness of his or her behavior at theawareness of his or her behavior at the
time nor any later memory of the behavior.time nor any later memory of the behavior.

ToleranceTolerance
 Tolerance is defined as the need forTolerance is defined as the need for
increasingly larger or more frequent dosesincreasingly larger or more frequent doses
of a substance in order to obtain theof a substance in order to obtain the
desired effects originally produced by adesired effects originally produced by a
lower dose.lower dose.

DependenceDependence
 DependenceDependence A compulsive or chronicA compulsive or chronic
requirement. The need is so strong as torequirement. The need is so strong as to
generate distress (either physical orgenerate distress (either physical or
psychological) if left unfulfilled.psychological) if left unfulfilled.

Substance ClassesSubstance Classes
 AlcoholAlcohol
 CaffeineCaffeine
 CannabisCannabis
 HallucinogensHallucinogens

PCPPCP

othersothers
 InhalantsInhalants
 OpioidsOpioids
 Sedatives, hypnotics,Sedatives, hypnotics,
and anxiolyticsand anxiolytics
 StimulantsStimulants
 TobaccoTobacco
 OtherOther

EtiologyEtiology
 Biological factorBiological factor
 Social factorsSocial factors
 Psychological factorPsychological factor
 Psychiatric disordersPsychiatric disorders
 Environmental factorsEnvironmental factors

Biological FactorsBiological Factors
1.Genetics1.Genetics
 Children of alcoholics are three timesChildren of alcoholics are three times
more likely than other children to becomemore likely than other children to become
alcoholicsalcoholics
 Biological offspring of alcoholic parentsBiological offspring of alcoholic parents
have a significantly greater incidence ofhave a significantly greater incidence of
alcoholism than offspring of nonalcoholicalcoholism than offspring of nonalcoholic
parents.parents.

 Monozygotic twins have a higher rate forMonozygotic twins have a higher rate for
concordance of alcoholism than dizygoticconcordance of alcoholism than dizygotic

2. Biochemical factors2. Biochemical factors
 Norepinephrine and dopamine have beenNorepinephrine and dopamine have been
implicated in opioid, cocaine and ethanolimplicated in opioid, cocaine and ethanol
dependence.dependence.
 Abnormalities in alcohol dehydrogenase inAbnormalities in alcohol dehydrogenase in
alcohol dependencealcohol dependence

Psychological factorsPsychological factors
 LonelinessLoneliness
 Unmet needsUnmet needs
 Low self esteemLow self esteem
 Desire to escape from realityDesire to escape from reality
 Sense of adventureSense of adventure
 Pleasure seekingPleasure seeking
 Sense of inferioritySense of inferiority
 Poor impulse controlPoor impulse control

Social factorsSocial factors
 Religious reasonsReligious reasons
 Peer pressurePeer pressure
 UrbanizationUrbanization
 Extended period of educationExtended period of education
 UnemploymentUnemployment
 OvercrowdingOvercrowding
 Poor social supportPoor social support
 Effect of tv and other mass mediaEffect of tv and other mass media

 Occupation: barmen, executives,Occupation: barmen, executives,
salesmen, actors, entertainers, armysalesmen, actors, entertainers, army
personnel, medical personnel.personnel, medical personnel.

Psychiatric disordersPsychiatric disorders
 DepressionDepression
 Anxiety disorderAnxiety disorder
 SchizophreniaSchizophrenia
 Personality disorder.Personality disorder.

Social and EnvironmentalSocial and Environmental
FactorsFactors
 laws,laws,
 cost, and availabilitycost, and availability

Substance-Related DisordersSubstance-Related Disorders
 2 Groups:2 Groups:

Substance Use DisordersSubstance Use Disorders
• Abuse or dependenceAbuse or dependence

Substance-Induced DisordersSubstance-Induced Disorders

Intoxication, withdrawal, delirium, dementia,Intoxication, withdrawal, delirium, dementia,
amnesia, psychosis, mood disorder, anxietyamnesia, psychosis, mood disorder, anxiety
disorder, sexual dysfunction, and sleepdisorder, sexual dysfunction, and sleep
disordersdisorders

ComorbidityComorbidity
 Up to 50% of addicts have comorbidUp to 50% of addicts have comorbid
psychiatric disorderpsychiatric disorder

Antisocial PDAntisocial PD

DepressionDepression

SuicideSuicide

Options for where to treatOptions for where to treat
 Hospitalization-Hospitalization-
-Due to drug OD, risk of severe withdrawal, medical-Due to drug OD, risk of severe withdrawal, medical
comorbidities, requires restricted access to drugs,comorbidities, requires restricted access to drugs,
psychiatric illness with suicidal ideationpsychiatric illness with suicidal ideation
 Residential treatment unitResidential treatment unit
-No intensive medical/psychiatric monitoring needs-No intensive medical/psychiatric monitoring needs
-Require a restricted environment-Require a restricted environment
-Partial hospitalization-Partial hospitalization
 Outpatient Program -No risk of med/psych morbidity andOutpatient Program -No risk of med/psych morbidity and
highly motivated patienthighly motivated patient

TreatmentTreatment
 Behavioral InterventionsBehavioral Interventions
Motivation to changeMotivation to change
Group TherapyGroup Therapy
Individual TherapyIndividual Therapy
Self-Help Recovery Groups (AA)Self-Help Recovery Groups (AA)
Therapeutic CommunitiesTherapeutic Communities
Aversion TherapiesAversion Therapies
Family Involvement/TherapyFamily Involvement/Therapy
Relapse PreventionRelapse Prevention

TreatmentTreatment
 Pharmacologic InterventionPharmacologic Intervention
 Treat Co-Occurring Psychiatric DisordersTreat Co-Occurring Psychiatric Disorders

50% will have another psychiatric disorder50% will have another psychiatric disorder
 Treat Associated Medical ConditionsTreat Associated Medical Conditions

cardiovascular, cancer, endocrine, hepatic,cardiovascular, cancer, endocrine, hepatic,
hematologic, infectious, neurologic,hematologic, infectious, neurologic,
nutritional, GI, pulmonary, renal,nutritional, GI, pulmonary, renal,
musculoskeletalmusculoskeletal

AlcoholismAlcoholism
 Alcoholism refers to the use of alcoholicAlcoholism refers to the use of alcoholic
beverages to the point of causing damagebeverages to the point of causing damage
to the individual, society or both.to the individual, society or both.

PHYSIOLOGIC EFFECTS OFPHYSIOLOGIC EFFECTS OF
LONG-TERM ALCOHOL USELONG-TERM ALCOHOL USE
 Cardiac myopathyCardiac myopathy
 •• PancreatitisPancreatitis
 •• EsophagitisEsophagitis
 •• HepatitisHepatitis
 •• CirrhosisCirrhosis
 •• LeukopeniaLeukopenia
 •• ThrombocytopeniaThrombocytopenia
 Protein malnutritionProtein malnutrition
 Vitamin deficiencyVitamin deficiency

Cont….Cont….
 Sexual dysfunctionSexual dysfunction
 Fetal alcohol syndrome(low birth weightFetal alcohol syndrome(low birth weight
and inteligency)and inteligency)
 Social problemsSocial problems
 Financial problemFinancial problem
 Occupational problemOccupational problem
 CriminalityCriminality
 Marital dishormonyMarital dishormony

Psychiatric disorders due toPsychiatric disorders due to
alcohol dependencealcohol dependence

1. Acute Intoxication1. Acute Intoxication

Blood Alcohol Level -Blood Alcohol Level -
0.08g/dl0.08g/dl

Progress from moodProgress from mood
lability, impairedlability, impaired
judgment, and poorjudgment, and poor
coordination tocoordination to
increasing level ofincreasing level of
neurologic impairmentneurologic impairment
(severe dysarthria,(severe dysarthria,
amnesia, ataxia)amnesia, ataxia)
 Can be fatal (loss ofCan be fatal (loss of
airway protectiveairway protective
reflexes, pulmonaryreflexes, pulmonary
aspiration, profound CNSaspiration, profound CNS
depression)depression)

2. Alcohol Withdrawal syndrome2. Alcohol Withdrawal syndrome
 EarlyEarly

anxiety, irritability, tremor, insomnia, nausea,anxiety, irritability, tremor, insomnia, nausea,
tachycardia, HTN, hyperthermia, hyperactive reflexestachycardia, HTN, hyperthermia, hyperactive reflexes
 SeizuresSeizures

generally seen 24-48 hoursgenerally seen 24-48 hours

most often Grand malmost often Grand mal
 Withdrawal Delirium TremensWithdrawal Delirium Tremens

generally between 48-72 hoursgenerally between 48-72 hours

altered mental status, hallucinations, markedaltered mental status, hallucinations, marked
autonomic instabilityautonomic instability

life-threateninglife-threatening

Alcohol Withdrawal (cont.)Alcohol Withdrawal (cont.)
 BenzodiazepinesBenzodiazepines

GABA agonist - cross-tolerant with alcoholGABA agonist - cross-tolerant with alcohol

reduce risk of SZ; provide comfort/sedationreduce risk of SZ; provide comfort/sedation
 AnticonvulsantsAnticonvulsants

reduce risk of SZreduce risk of SZ

Carbamazepine or Valproic acidCarbamazepine or Valproic acid
 Thiamine supplementationThiamine supplementation

Risk thiamine deficiency (Wernicke/Korsakoff)Risk thiamine deficiency (Wernicke/Korsakoff)

3.Alcohol induced amnestic3.Alcohol induced amnestic
disorderdisorder
 Thiamine deficiency is most frequentThiamine deficiency is most frequent
cause of amnestic disorder.cause of amnestic disorder.
 Wernicke’s encephalopathy:Wernicke’s encephalopathy:
 Cerebral ataxiaCerebral ataxia
 66thth
cranial nerve palsycranial nerve palsy
 Periperal neropathyPeriperal neropathy

 Korsakoff’s psychosisKorsakoff’s psychosis
 Gross memory disturbanceGross memory disturbance
 DisorientationDisorientation
 ConfusionConfusion
 Confabulation: the unconscious filling ofConfabulation: the unconscious filling of
memory gaps by imagined or untruememory gaps by imagined or untrue
experience due to memory lossexperience due to memory loss
 Poor attention spanPoor attention span
 Impaired insightImpaired insight

4. Alcohol induced psychiatric4. Alcohol induced psychiatric
disorderdisorder
 Alcohol induced dementiaAlcohol induced dementia
 Alcohol induced mood disorderAlcohol induced mood disorder
 Alcohol induced anxiety disorderAlcohol induced anxiety disorder
 Suicidal behaviourSuicidal behaviour
 Pathological jealousyPathological jealousy
 Alcoholic seizuresAlcoholic seizures
 Alcoholic hallucinosis: auditoryAlcoholic hallucinosis: auditory

Alcohol treatmentAlcohol treatment
 Outpatient CD treatment:Outpatient CD treatment:

support, education, skills training, psychiatricsupport, education, skills training, psychiatric
and psychological treatment, AAand psychological treatment, AA
 Medications:Medications:

DisulfiramDisulfiram

NaltrexoneNaltrexone

AcamprosateAcamprosate

Medications-alcohol deterrentMedications-alcohol deterrent
therapytherapy
 Disulfiram (antabuse) 250mg-500mg po dailyDisulfiram (antabuse) 250mg-500mg po daily

Inhibits aldehyde dehydrogenase andInhibits aldehyde dehydrogenase and
dopamine beta hydroxylasedopamine beta hydroxylase

Aversive reaction when alcohol ingested-Aversive reaction when alcohol ingested-
vasodilatation, flushing, hypotenstion/ HTN,vasodilatation, flushing, hypotenstion/ HTN,
coma / deathcoma / death

Psychiatric side effects - psychosis,Psychiatric side effects - psychosis,
depression, confusion, anxietydepression, confusion, anxiety

Dermatologic rashes and itchingDermatologic rashes and itching

Watch out for forms of alcohol - sauces,Watch out for forms of alcohol - sauces,
mouth wash, cough meds, alcohol basedmouth wash, cough meds, alcohol based
hand sanitizers, etchand sanitizers, etc

MedicationsMedications
 Naltrexone 50mg po dailyNaltrexone 50mg po daily

Opioid antagonist thought to block mu receptorsOpioid antagonist thought to block mu receptors
reducing intoxication euphoria and cravingsreducing intoxication euphoria and cravings

Hepatotoxicity at high doseHepatotoxicity at high dose
 Acamprosate(Campral) 666mg po tidAcamprosate(Campral) 666mg po tid

Unknown MOA but thought to stabilize neuronUnknown MOA but thought to stabilize neuron
excitation and inhibition - may interact with GABA andexcitation and inhibition - may interact with GABA and
Glutamate receptor - cleared renally (check kidneyGlutamate receptor - cleared renally (check kidney
function)function)

Benzodiazepine( BZD)/Benzodiazepine( BZD)/
BarbituratesBarbiturates

Benzodiazepine( BZD)/Benzodiazepine( BZD)/
BarbituratesBarbiturates
 IntoxicationIntoxication

Similar to alcohol but less cognitive/motorSimilar to alcohol but less cognitive/motor
impairmentimpairment

Variable rate of absorption (lipophilia) andVariable rate of absorption (lipophilia) and
onset of action and duration in CNSonset of action and duration in CNS

The more lipophilic and shorter the duration ofThe more lipophilic and shorter the duration of
action, the more "addicting" .action, the more "addicting" .

BenzodiazepineBenzodiazepine
 WithdrawaWithdrawall

Anxiety, irritability, insomnia, fatigue, HA,Anxiety, irritability, insomnia, fatigue, HA,
tremor, sweating, poor concentrationtremor, sweating, poor concentration

Common detox mistake is tapering too fast;Common detox mistake is tapering too fast;
symptoms worse at end of tapersymptoms worse at end of taper

Convert short elimination BZD to longerConvert short elimination BZD to longer
elimination half life drug and then slowly taperelimination half life drug and then slowly taper

Outpatient taper- decrease dose every 1-2Outpatient taper- decrease dose every 1-2
weeks and not more than 5 mg Diazepamweeks and not more than 5 mg Diazepam
dose equivalentdose equivalent

BenzodiazapinesBenzodiazapines
 AlprazolamAlprazolam
 OxazepamOxazepam
 TemazepamTemazepam
 ClonazepamClonazepam
 LorazepamLorazepam
 ChlordiazepoxideChlordiazepoxide
 DiazepamDiazepam

OPIOIDSOPIOIDS
 The commonly abused opioids(narcotics)The commonly abused opioids(narcotics)
are heroin(brown sugar).are heroin(brown sugar).
 Synthetic preparation like pethidine,Synthetic preparation like pethidine,
fortwin.fortwin.

OPIOIDSOPIOIDS
Bind to the Opioid receptor in the CNS to modulate painBind to the Opioid receptor in the CNS to modulate pain
 Intoxication-Intoxication- pinpoint pupils, sedation, constipation,pinpoint pupils, sedation, constipation,
bradycardia, hypotension and decreased respiratory ratebradycardia, hypotension and decreased respiratory rate
 Withdrawal-Withdrawal-
 Not life threatening unless severe medical illness butNot life threatening unless severe medical illness but
extremely uncomfortable.extremely uncomfortable.
 dilated pupils lacrimation, goosebumps, diarrhea,dilated pupils lacrimation, goosebumps, diarrhea,
myalgias, arthralgias, dysphoria or agitationmyalgias, arthralgias, dysphoria or agitation

 Neuroadaptation:Neuroadaptation: increased DA andincreased DA and
decreased NEdecreased NE

Treatment - Opiate Use DisorderTreatment - Opiate Use Disorder

RxRx- symptomatically with antiemetic, antacid,- symptomatically with antiemetic, antacid,
antidiarrheal, muscle relaxantantidiarrheal, muscle relaxant
(methocarbamol), NSAIDS, clonidine and(methocarbamol), NSAIDS, clonidine and
maybe BZDmaybe BZD

support, education, skills building, psychiatricsupport, education, skills building, psychiatric
and psychological treatment.and psychological treatment.


 MedicationsMedications

Methadone (opioid substitution)Methadone (opioid substitution)

NaltrexoneNaltrexone

Buprenorphine (opioid substitution)Buprenorphine (opioid substitution)

Treatment - Opiate Use DisorderTreatment - Opiate Use Disorder
 NaltrexoneNaltrexone

Opioid blocker, mu antagonistOpioid blocker, mu antagonist

50mg po daily50mg po daily
 MethadoneMethadone

Mu agonistMu agonist

Start at 20-40mgStart at 20-40mg

Average dose 80-100mg dailyAverage dose 80-100mg daily
 BuprenorphineBuprenorphine

Partial mu partial agonistPartial mu partial agonist
Mu= opioid receptorMu= opioid receptor

 Stimulants (Amphetamines, Cocaine,Stimulants (Amphetamines, Cocaine,
Others)Others)
 Stimulants are drugs that stimulate orStimulants are drugs that stimulate or
excite the central nervous system.excite the central nervous system.

STIMULANTSSTIMULANTS
 Intoxication (acute)Intoxication (acute)

Psychological signsPsychological signs

euphoria, hyperactivity, restlessness, interpersonaleuphoria, hyperactivity, restlessness, interpersonal
sensitivity, anxiety, tension, anger, impaired judgmentsensitivity, anxiety, tension, anger, impaired judgment

Physical signsPhysical signs

tachycardia, papillary dilation, HTN, diaphoresis,tachycardia, papillary dilation, HTN, diaphoresis,
chills, weight loss, chest pain, cardiac arrhythmias,chills, weight loss, chest pain, cardiac arrhythmias,
confusion, seizures, comaconfusion, seizures, coma

STIMULANTSSTIMULANTS
(cont.)(cont.)
 Chronic intoxicationChronic intoxication

affective blunting, fatigue, sadness, socialaffective blunting, fatigue, sadness, social
withdrawal, hypotension, bradycardia, musclewithdrawal, hypotension, bradycardia, muscle
weaknessweakness
 WithdrawalWithdrawal

Not severe but have exhaustion with sleepNot severe but have exhaustion with sleep
(crash)(crash)

Treat with rest and supportTreat with rest and support

CocaineCocaine
 Route: nasal, IV or smokedRoute: nasal, IV or smoked
 Has vasoconstrictive effects that may outlastHas vasoconstrictive effects that may outlast
use and increase risk for CVA and MIuse and increase risk for CVA and MI
 Neuroadaptation:Neuroadaptation: cocaine mainly preventscocaine mainly prevents
reuptake of DAreuptake of DA

Treatment - Stimulant UseTreatment - Stimulant Use
Disorder (cocaine)Disorder (cocaine)
 Treatment including support, education,Treatment including support, education,
PsychotherapyPsychotherapy
 PharmacotherapyPharmacotherapy

Amyl nitrite is an antidoteAmyl nitrite is an antidote

AntidepressentAntidepressent

AmphetaminesAmphetamines
 Similar intoxication syndrome to cocaine butSimilar intoxication syndrome to cocaine but
usually longerusually longer
 Route - oral, IV, nasally, smokedRoute - oral, IV, nasally, smoked
 No vasoconstrictive effectNo vasoconstrictive effect
 NeuroadaptationNeuroadaptation

inhibit reuptake of DA, NE, SE - greatest effect on DAinhibit reuptake of DA, NE, SE - greatest effect on DA

 Chronic use results in neurotoxicityChronic use results in neurotoxicity
possibly from glutamate and axonalpossibly from glutamate and axonal
degenerationdegeneration
 Can see permanent amphetamineCan see permanent amphetamine
psychosis with continued usepsychosis with continued use
 Treatment similar as for cocaine but noTreatment similar as for cocaine but no
known substances to reduce cravingsknown substances to reduce cravings

Treatment – Stimulant UseTreatment – Stimulant Use
Disorder (amphetamine)Disorder (amphetamine)
 Treatment: including support, educationTreatment: including support, education
 No specific medications have been foundNo specific medications have been found
helpful in treatmenthelpful in treatment

TobaccoTobacco
 Most important preventable cause of death /Most important preventable cause of death /
diseasedisease
 45% of smokers die of tobacco induced disorder45% of smokers die of tobacco induced disorder
 Second hand smoke causes death / morbiditySecond hand smoke causes death / morbidity
 Psychiatric pts at risk for Nicotine dependence-Psychiatric pts at risk for Nicotine dependence-
75%-90 % of Schizophrenia pts smoke75%-90 % of Schizophrenia pts smoke

Tobacco (Tobacco (cont.)cont.)
 No intoxication diagnosisNo intoxication diagnosis

initial use associated with dizziness, nauseainitial use associated with dizziness, nausea

nicotine acetylcholine receptors on DA neurons innicotine acetylcholine receptors on DA neurons in
ventral tegmental area release DAventral tegmental area release DA
 ToleranceTolerance

rapidrapid
 WithdrawalWithdrawal

irritability, anxiety, decreased concentration,irritability, anxiety, decreased concentration,
insomnia, increased appetiteinsomnia, increased appetite

Treatment – Tobacco UseTreatment – Tobacco Use
DisorderDisorder
 Cognitive Behavioral TherapyCognitive Behavioral Therapy
 Agonist substitution therapyAgonist substitution therapy

nicotine gum , transdermal patch, nasal spraynicotine gum , transdermal patch, nasal spray
 MedicationMedication

Bupropion 150mg po bid,Bupropion 150mg po bid,

Inhalants or volatileInhalants or volatile
solventssolvents

Commonly used solvents are:Commonly used solvents are:
 PetrolPetrol
 AerosolsAerosols
 ThinnersThinners
 Industrial solventsIndustrial solvents

 EuphoriaEuphoria
 ExcitementExcitement
 Slurring of speechSlurring of speech
 Impaired judgementImpaired judgement

Withdrawal symptomsWithdrawal symptoms
 AnxietyAnxiety
 DepressionDepression

COMPLICATIONSCOMPLICATIONS
 Liver, kidney and brain damageLiver, kidney and brain damage
 Peripheral neuropathyPeripheral neuropathy

TreatmentTreatment
 ReassuranceReassurance
 Diazepam for intoxicationDiazepam for intoxication

 Commonly abused are:Commonly abused are:
 SecobarbitalSecobarbital
 PentobarbitalPentobarbital
 AmobarbitalAmobarbital

 Inco-ordinationInco-ordination
 Slurred speechSlurred speech
 Attention and memory impairmentAttention and memory impairment
 IrritabilityIrritability

ComplicationComplication
 IV route use can cause cellulites,IV route use can cause cellulites,
embolism, abscesses.embolism, abscesses.

Withdrawal syndromeWithdrawal syndrome
 Delirium tremensDelirium tremens
 SeizuresSeizures
 RestlessnessRestlessness

TreatmentTreatment
 Symptomatic treatmentSymptomatic treatment
 Induction of vomitingInduction of vomiting
 Use activated charcoal to reduce aUse activated charcoal to reduce a
absorptionabsorption

HALLUCINOGENSHALLUCINOGENS
 Naturally occurring - Peyote cactus; magicNaturally occurring - Peyote cactus; magic
mushroom- oralmushroom- oral
 Synthetic agentsSynthetic agents
 LSD (lysergic acid diethyamide) - oralLSD (lysergic acid diethyamide) - oral
 DMT (dimethyltryptamine) - smoked, snuffed, IVDMT (dimethyltryptamine) - smoked, snuffed, IV
 MDMA (3,4-methyl-enedioxymethamphetamine)MDMA (3,4-methyl-enedioxymethamphetamine)
– oral– oral

MDMAMDMA
 Designer club drugDesigner club drug
 3-6 hour duration3-6 hour duration
 Tolerance develops quickly and unpleasant sideTolerance develops quickly and unpleasant side
effects with continued use (teeth grinding) soeffects with continued use (teeth grinding) so
dependence less likelydependence less likely

 illusions, sensitivity of touch, taste/ smellillusions, sensitivity of touch, taste/ smell
altered, tearfulness, euphoria, panic,altered, tearfulness, euphoria, panic,
impairment judgmentimpairment judgment

MDMAMDMA ..
 NeuroadaptationNeuroadaptation- affects serotonin (5HT), DA,- affects serotonin (5HT), DA,
NENE
 PsychosisPsychosis

Hallucinations generally mildHallucinations generally mild

Paranoid psychosis associated with chronic useParanoid psychosis associated with chronic use

Serotonin neural injury associated with panic, anxiety,Serotonin neural injury associated with panic, anxiety,
depression, flashbacks, psychosis, cognitive changes.depression, flashbacks, psychosis, cognitive changes.
 WithdrawalWithdrawal – unclear syndrome– unclear syndrome

Cannabis (Marijuana/ ganja)Cannabis (Marijuana/ ganja)
 Cannabis sativa is the hemp plantCannabis sativa is the hemp plant
 Cannabis is most often smoked inCannabis is most often smoked in
cigarettes but it can be eaten(bang).cigarettes but it can be eaten(bang).
 lipid soluble;lipid soluble;
 long half life of 50 hourslong half life of 50 hours

CANNABISCANNABIS
 IntoxicationIntoxication--
Appetite and thirst increaseAppetite and thirst increase
Colors/ sounds/ tastes are clearerColors/ sounds/ tastes are clearer
Increased confidence and euphoriaIncreased confidence and euphoria
RelaxationRelaxation
Increased libidoIncreased libido
Transient depression, anxiety, paranoiaTransient depression, anxiety, paranoia
Tachycardia, dry mouth,Tachycardia, dry mouth,
Slowed reaction time/ motor speedSlowed reaction time/ motor speed
Impaired cognitionImpaired cognition
PsychosisPsychosis

CANNABIS (cont.)CANNABIS (cont.)

Neuromodulator effect; decrease uptake of GABANeuromodulator effect; decrease uptake of GABA
and DAand DA
 WithdrawaWithdrawal - insomnia, irritability, anxiety, poorl - insomnia, irritability, anxiety, poor
appetite, depression, physical discomfortappetite, depression, physical discomfort

CANNABIS (cont.)CANNABIS (cont.)
 TreatmentTreatment
-Detox and rehab-Detox and rehab
-Behavioral model-Behavioral model
-No pharmacological treatment but-No pharmacological treatment but
maymay treat other psychiatric symptomstreat other psychiatric symptoms

PHENACYCLIDINE ( PCP)PHENACYCLIDINE ( PCP)
"Angel Dust""Angel Dust"
 Dissociative anestheticDissociative anesthetic
IntoxicationIntoxication::
 severe dissociative reactionssevere dissociative reactions – paranoid delusions,– paranoid delusions,
hallucinations, can become very agitated/ violent withhallucinations, can become very agitated/ violent with
decreased awareness of pain.decreased awareness of pain.
 Cerebellar symptomsCerebellar symptoms - ataxia- ataxia
 With severe over doseWith severe over dose - mute, catatonic, muscle rigidity,- mute, catatonic, muscle rigidity,
HTN, hyperthermia, coma and deathHTN, hyperthermia, coma and death

PCP cont.PCP cont.
 TreatmentTreatment

antipsychotic drugs or BZD if requiredantipsychotic drugs or BZD if required

Low stimulation environmentLow stimulation environment

opiate receptor effectsopiate receptor effects
 No tolerance or withdrawalNo tolerance or withdrawal

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Substance abuse power presentation