SUBSTANCE ABUSESUBSTANCE ABUSEbyby

Dr. C. S. UmehDr. C. S. Umeh

Consultant Clinical PsychologistConsultant Clinical Psychologist

LUTH LUTH

Concept of Substance AbuseConcept of Substance Abuse

• Substance abuse is what the lay person calls drug abuse. In both ICD -10 and DSM – IV, substance abuse was preferred because not all substances that are abused are necessarily drugs eg inhalants

• However drug abuse is more popular

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• A few authors have gone further to use the terms, Alcohol, Tobacco and other drugs Abuse (ATODA) in order to reflect the fact that the use of tobacco products is as harmful to health as the more popular drugs of abuse.

• In 1969, WHO defined a drug as any substance when taken into the body may modify one or more of its functions.

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• Since many substances can do this without affecting the psychological functioning of the individual, the term psychoactive substances were then used to categorize this group of substances which are capable of producing psychological effects such as the alteration of moods, perception and consciousness

Development of Substance Development of Substance Dependence behaviourDependence behaviour

• Substance dependence behavior develops gradually over a long time. Three factors influence the rate of development:

• The type of substance

• The dosage

• The frequency of use

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• The combined effect produce dependence through the following:

1. Substance use2. Substance misuse3. Substance abuse4. Craving5. Tolerance6. Psychological dependence (Habituation)7. Physiological dependence (Drug addiction)8. Withdrawal syndrome (Abstinence syndrome)

Other Features of Substance abuseOther Features of Substance abuse

• Flashback

• Bad Trip

• Blackout

• Substance – induced psychosis

CLASSES AND EFFECTS OF CLASSES AND EFFECTS OF PSYCHOACTIVE SUBSTANCESPSYCHOACTIVE SUBSTANCES

• The effects of any psychoactive substance depends upon– the class or category to which it belongs,– the quantity used at a time and– the frequency of use.

• However, each class of psychoactive substances has distinctive psychopharmacological properties.

CLASSES AND EFFECTS CLASSES AND EFFECTS CONTN’DCONTN’D

• The classes are:

1. DEPRESSANTS

2. STIMULANTS

3. HALLUCINOGENS

4. INHALANTS

5. DESIGNER SUBSTANCES

6. ANABOLIC STEROIDS

DEPRESSANTSDEPRESSANTS

• These are substances which slow down or reduce the rate of functioning of the body organs and systems. The rate of slowing down depends on the sub-category the substance belongs. The common sub-categories are – alcohol, – narcotics,eg opium, codeine, heroine, morphine– barbiturates,eg phenolbarbitone andAmylobarbitone – minor tranquilizers eg benzodiazepine and diazepam – major tranquilizers.eg chlopromazine (largactil

STIMULANTSSTIMULANTS

• These are substances which promote wakefulness, increase body activities, induce mental alertness and generally increase heartbeat. Subcategories of stimulants are:

• cocaine, • amphetamines,eg

Benzedrine,Dextroamphetamine (dexedrin) methylphenidate (Ritalin)

• caffeine, • nicotine and • anti depressants

HALLUCINOGENSHALLUCINOGENS

• These are substances popularity called mind benders, psychedelic drugs or psychotomimetics. They produce radical changes in the mind of users. Some changes include vivid imagery, hallucinations, distortion of awareness and displacement of reality. Categories of hallucinogens are :

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• CANNABIS-

• L S D – ( Lysergic acid diethylamide)

• PSILOCYBIN

• MESCALINE

• PCP (PHENCYCLIDINE) (Angel dust)

INHALANTS.INHALANTS.

• These are commonly available commercial products eg include petrol, glue, shoe polish, nail vanish, aerosols and floor wax. Related substances are the synthetic substance otherwise called designer drugs. They are manufactured in the labs as isotopes or derivatives of other substances. The effect of both inhalants and designers drugs are similar to the combined effects of stimulants and hallucinogens

ANABOLIC STEROIDSANABOLIC STEROIDS

• These are substances which are used essentially to enhance performance in sports. Most of them are derivatives of the hormone-testosterone. They therefore have very powerful effects in influencing the hormonal activities of the body. Essentially, anabolic steroids are used to build muscles and to enhance the individuals stamina.

DSM ClassificationDSM Classification

• There are 4 substance related conditions recognized by DSM-IV. They are:

1. Substance intoxication

2. Substance withdrawal

3. Substance abuse

4. Substance dependence

Substance intoxicationSubstance intoxication

• 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, particularly alcohol.

Substance withdrawalSubstance withdrawal

• Experience of clinically significant distress in social, occupational or other areas of functioning due to the cessation or reduction of substance use. It can begin a few hours after cessation and could last for weeks.eg tremor, craving, seizure, sleep disturbances, fatigue, nausea, hallucination, anxiety, etc.

Substance abuseSubstance abuse

• One or more of the following occurs during a 12 month period leading to significant distress:

1. Failure to fulfill important obligations at work, home or school due to substance use.

2. Repeated use of substance in hazardous situations

3. Repeated legal problem due to use.

4. Continued use of substance despite repeated legal or social problems

Substance dependenceSubstance dependence

• Three or more of the following:1. Tolerance2. Withdrawal3. Substance taken for a longer time or greater

amount than intended4. Desire or effort to reduce or control use5. Much time spent in activities to obtain it6. Given up occupational or recreational activities7. Use continued despite knowing worsening

psych and physical problems.

ASSESSMENTASSESSMENT

• Clinical interview

• Psychological tests

• Urine and blood screening tests

Cage questionnaire (Ewing,1984)Cage questionnaire (Ewing,1984)

1. Have you ever felt you should cut down on your drinking?Yes No 2. Have people annoyed you by criticising your drinking?Yes No 3. Have you ever felt bad or guilty about your drinking?Yes No 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?Yes No

MANAGEMENTMANAGEMENT

• Assessing for level of motivation for change. • There is a model for change. It comprises

Stage 1: Precontemplation - the client is not yet considering change or is unwilling to change

Stage 2: Contemplation – the client acknowledges concernsand is considering the possibility of change but is ambivalent and uncertain

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Stage 3: Preparation – the client is commited to and is planning to make a change in the near future but is still considering what to do

Stage 4: action: the client is actively taking steps to change but has not yet reached a stable state

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Stage 5: maintenance – The client has achieved initial goals such as abstinence and is now working to maintain gains

Stage 6: the client has experienced a recurrence of symptoms and must now cope with consequences and decide what to do next.

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• Detoxification• Psychotherapy• Rehabilitation

• Thank you for your attention