SUBSTANCE ABUSEpresentation Level 4

SUBSTANCE ABUSE
Disorders
BY Prof. M.WANGARI KURIA

Phd MMED PSYCH. MBCHB
Objectives
• Definitions
• classifications
• Current pattern of drugs used
• Stages of substance use
• Alcohol related disorder
• Substance related disorder
DEFINITIONS
DRUG
Any chemical substance or a mixture of
substance which when introduced in to
the living organism may modify one or
more of its function
DRUG ABUSE
• Drug abuse is persistence and/or

excessive use of a drug inconsistent with
or unrelated to medical practice, resulting
to harmful effects.
• This harmful effects may be physical,
mental social or otherwise
DRUG MISUSE.
• Unsanctioned or illegal use of drug. I.e.

• The society or group within the society
does not sanction the use of the drugs.
DEPENDENCE.
• Drug dependence is an emotional and

sometimes a physical need experienced
by a drug abuser. The drug abuser feels a
compulsion to take the drug on a regular
basis to feel its effect to avoid the
discomfort of its absence
TOLERANCE.
• The repeated use of a drug leads to changes in

the brain and nervous system so that the user
needs more of the drug in order to get expected
results.
• Tolerance develops when the person has been
taking the drugs regularly and in sufficient doses
over a period of time.
• Once the person stops taking the drug the
tolerance is lost. Cross-tolerance can occur
between drugs with similar mechanisms of
action.
Classification of drugs
• Depressants
• Stimulants
• Hallucinogens
• Inhalants
• Depressant/Stimulant
DEPRESSANTS
• These are substances that suppress the
central nervous system
• This includes
– Alcohol
– Opiates(Pethidine, morphine and heroine)
– Tranquillizers
STIMULANTS
• These are substances that stimulate the
CNS and includes
• Caffeine, amphetamines, khat, tobacco,
cocaine and methylphenidate(Ritalin)
Hallucinogens
• These are substances that have the

ability to cause hallucinations. They
include
• Lysergic Acid Diethyl amine (LSD)
• Phencyclidine
• Ectasy
• Mescalidine.
Depressant/stimulant
Cannabis
• This is derived from marijuana plant
• It produces a combination of effects to
the central nervous system.
• It has a depressant and stimulant effect
as well as hallucinogenic properties
Factors that contribute to use
and abuse of drugs
• Easy accessibility
When the drug is accessible then the person
is more likely to abuse the drugs.
Peer pressure
• Most of the people using drugs receive the

first dose free of charge from the peer
group.
• Peer pressure is an important factor not
only leading individual to begin use of drug
but also in sustaining use of drug.
Poor parentage
• Learning through modeling occurs in

children where they do as their parents
do.
Media influence
• Advertisement of drugs portrays it as a

drug worth trying.
• Among the youth media influence their
use alcohol.
Gender
• The cultural setup is more permissive

when it comes to men drinking and using
drugs.
• Men also have more leisure time than
women who have various scores to keep
them busy.
Gender ctd.
• Until recently African man handled all
financial matters.
• Due to this financial ability males abuse
alcohol more than females.
Stages of substance use
1. No Use
• The person does not use any mood altering
substances.
• This is either by choice
• due to never having the chance to use,
• having a belief or value against using, or
• having a previously bad experience with drugs
or alcohol and deciding that this is not a good
thing, for the person to be doing
• Majorities of Kenyans are in this category
2. Experimental Use
This the Novel (new) Experience
• The person tries the drug once or twice
to experience the effects.
• The decision to continue using the drug or
not depends upon the person's subjective
experience.
• they may use because they are curious,
their friends are using, or it is available to
them.
3. Social Use
Substance use ‘Adds to Life ‘
• The person uses the drug occasionally, and can
readily control the use of the drug.
• Their Major Life Areas are not affected. No
emotional pain results from the drug use.
• The drug use patterns, and reactions and
consequences of drug use are known and
predictable.
Social use
• During this stage the person's tolerance to the drug
begins to increase, and they may develop a pattern of
using such as every weekend, or every day after school.
• The reason for the social gatherings (friends getting
together) starts to revolve around the substance use.
• At this point the person has begun to experience a few
negative consequences from using such as a
hangover, or missing an appointment, school or work,
and tries to set a few self-imposed rules for using
such as only using on weekends, only using at certain
times, or only using a certain amount.
4. Harmful Use
Substance use “Becomes Life” - Compulsive use
• The person uses the drug regularly and frequently

• uses more of the drug over a longer period of time,
• makes attempts to control use of the drug but has difficulty doing
so,
• some Major Life Areas are affected, drug use continues despite
the appearance of negative drug use patterns & consequences,
Harmfully invoved
• emotional pain starts to result from the use
of the drug, experiences withdrawal
symptoms, tolerance begins to increase,
minimizes or rationalizes drug use,
• may deny drug is causing problems,
begins to make promises to self and
others about quitting or cutting down).
• The person is beginning to feel that they
have less control over their substance
use..
5. Dependent
• The person (uses the drug very regularly and very

frequently, feels they have lost control over the use of
the drug,
7 Signs of substance
dependence
1. Tolerance: The person requires an
increasing amount of alcohol to produce
the same effect as previously used doses
of alcohol.
2. Withdrawal syndrome: The person
develops symptoms when he has not taken
alcohol.
3. Primacy: Alcohol takes primacy over other
activities including, employment, business,
and family education e.t.c.
Signs of dependence - ctd
4. Stereotyped pattern of use:There is a
regular pattern of use of the drug to avoid
withdrawal syndrome.
5. Relieve drinking: The person takes
alcohol to relief the withdrawal symptoms.
6. Reinstatement after period of
abstinence: There is a quick
reinstatement to full drinking once the
person resumes drinking.
ctd
7. The substance use is continued despite
knowledge of having a persistent or
recurrent physical or psychological
complications.
Treatment of alcohol dependence involves:
- Detoxification
- rehabilitation
Alcohol related disorders
• Alcohol use disorder
• Alcohol dependence
• Alcohol intoxication
• Alcohol withdrawal delirium
• Alcohol induced persisting dementia
• Alcohol induced amnestic disorder
Alcohol related disorders
Alcohol induced;
- Psychotic disorder
- Mood
- anxiety disorder
- Sexual disorders
- Sleep disorders
- Alcohol related disorder not otherwise
specified
Alcohol intoxication
The diagnosis of Intoxication emphasizes:
 a sufficient alcohol consumption,
 specific maladaptive behavioural
changes
 signs of neurological impairment
 absence of other confounding diagnoses
or conditions
intoxication
Alcohol intoxication may cause:
 Coma
 Respiratory depression
 Death
Treatment may include ICU admission to
support respiration and balancing
electrolytes and controlling temperature
Alcohol withdrawal
• The classic sign of alcohol withdrawal is tremor.
–Others symptoms include
-hallucinations & delusions
- Irritability
- Gastrointestinal symptoms(nausea/ vomiting
-sympathetic hyperactivity- sweating anxiety,
flushing tachycardia and mild hypertension
 Alcohol withdrawal delirium or Delirium
tremens-
• Alcohol withdrawal may cause the
following:
 The psychotic features & perceptual
disorders occur within 8- 12 hours
 Withdrawal seizures- this are fits that
occurs in 12-24 hrs after stopping alcohol
 Delirium tremens occurs within 72 hours
Delirium tremens (alcohol
withdrawal delirium
 this is the most severe alcohol withdrawal
syndrome
 It is a medical emergency
 Untreated, It results to morbidity and
mortality(20%)
 Patient may be suicidal or assautive
 It occurs in the first week after stopping or
reducing alcohol intake
symptoms
 Autonomic hyperactivity
 Perceptual distortions
 Hallucinations- visual tactile
 Fluctuating levels of psychomotor activity
 Beware of unexpected DTs in patients
admitted for other reasons
Treatment of DTs
• Prevent by giving
 A benzodiazepine e.g diazepam
 Vitamin B& C(Pabrinex 1&2
 rehydration
 Diet supplementation
Alcohol induced persisting
dementia
 reduction of brain of cortex in persons who
have been taking alcohol for a long time.
 Patient losses memory and has
deterioration of the personality
Alcohol induced persisting
amnestic behaviour
• Loss of memory resulting from prolonged
alcohol use. it is rare in those <35years of
age
There are 2 forms
 Wernickes syndrome (acute syndrome.
Also called alcoholic encepalopathy. It is
reversible
 Korsakoff syndrome(chronic condition.
Only 20 % of the patients recover
 Early Treatment of wernickes
encephalopathy with thiamine may prevent
korsakoff syndrome
Substance use disorder
The following disorders are related to
substance use for every substance of
abuse
Substance related disorders
• substance use disorder
• substance dependence
• substance intoxication
• substance withdrawal delirium
• substance induced persisting dementia
Substance related disorders
• substance induced amnestic disorder
• substance induced;
- Psychotic disorder
- Mood
- anxiety disorder
- Sexual disorders
- Sleep disorders
- substance related disorder not otherwise
specified

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SUBSTANCE ABUSE

BY Prof. M.WANGARI KURIA

• Drug abuse is persistence and/or

• Unsanctioned or illegal use of drug. I.e.

• Drug dependence is an emotional and

• The repeated use of a drug leads to changes in

• These are substances that have the

• Most of the people using drugs receive the

• Learning through modeling occurs in

• Advertisement of drugs portrays it as a

• The cultural setup is more permissive

• The person uses the drug regularly and frequently

• The person (uses the drug very regularly and very

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