Drug abuse

DRUG ABUSE
PRESENTEDBY DR.SHEFALI RANA
MD 1ST YEAR
DRAVYAGUNADEPTT.
RGPGGAC, PAPROLA

General introduction
What is drug ?
• Any substance, when taken into living
body may modify one or more of its
function.
• In other word, a pharmaceutical
preparation or a naturally occurring
substance used primarily to bring
about any change in existing process
or state (physiological, psychological
or biochemical) is called – DRUG
• An overdose of any drug may lead to
death.

Termrelated to drug
• Hard drug (lead to severe physical
addiction / dependence) :
 Drug that is generally considered to be
more dangerous, with higher risk of
dependence that soft drugs.
Eg. Heroin, cocaine, methamphetamine etc.
• Soft drug (Do not cause physical
addiction / dependence) :
 While they do not cause physical
addiction, some of them may still lead to
psychological dependency.
Eg. Cannabis, lysergic acid diethylamide
(LSD) etc.

• Dependence:
A Drug dependence is the situation or
condition that a person find himself in
which he uses or abuse a drug to the
point that the drug become the main
focus of his life.
There are two types of dependence -
Psychological dependence - is the subjective
feeling that the user needs the drug to maintain
a feeling of well-being.
Physical dependence - is characterized by
tolerance( the need for increasingly larger doses
in order to achieve the initial effect) and
withdrawal symptoms when the user is
abstinent.

Use vs abuse
• USE :
 Intake of drugs –
1. To treat an illness
2. To prevent a disease
3. To improve health condition
• ABUSE :
 Intake of drugs, for reason other than medical in such a manner that the drug affects
the physical or mental functioning of the person.
 In short :
• Drug abuse is intentional chronic and excessive use of drugs.
OR
• Drug abuse is the non permissive consumption of certain substance that may lead to
physical and psychological dependence. And it is also called as SUBSTANCE ABUSE.

Reason why do people abuse drugs ?
Curiosity
Low- self esteem
Peer - pressure
Adult modelling
Boredom
Relief of discomfort
Depression, anxiety, stress
Family dysfunction
Unemployment
Mental conditions
Life events
Family and social environment
disturbance
Poverty
Neglected children
Lack of education

STAGES OF DRUG ABUSE /
DEPENDENCE

STAGESOF DRUGABUSE / DEPENDENCE:

• Stage 1 : Experimentation
1. Here Curiosity is the motivator.
2. Experimentation is defined as the voluntary use of drugs without experiencing any
negative social or legal consequences.
3. For many , experimentation may occur once or several times as a way to “ HAVE
FUN” OR may occur without any desire to continue using the drug.
4. But for other, it can start to become a problem when it moves into the next stage.
• Stage 2 : Regular use
1. Here user is thinking more about drugs and always carves for drugs.
2. The problem with regular use is that the risk for drug abuse greatly increases
during this stage.
3. It also increase risky behaviours such as driving under the influence, unexplained
violence and symptoms of depression and anxiety.

• Stage 3 : Risky use / abuse
1. The line between regular and risky use/abuse is very thin one, but is usually
defined as continued use of drugs in spite of severe social and legal
consequences
2. This is the stage where the warning sign of addiction will begin to appear like
craving, irritability , fatigue etc if the drug is not used.
• Stage 4 : Drug dependence
1. Here drugs become the centre of their life.
2. Characteristics of dependence include withdrawal symptoms and compulsive use
of the drug along with severe negative consequences to his or her relationships,
physical and mental health, personal finance etc.

Illegal drug usage :
• All over the world :
230 million people have used an illegal drug in all over the world.
Cocaine-dependent people number about 27 million.
0.6% of world adult population.
Global illegal drug use is expected to rise by 25% over the next few decades.
• In india :
An NGO survey revealed that 63.6% of population are involved and out of
them 13.1% are at young age of 20 yrs.
And on an average – everyday 10 -12 suicide are happened due to drug
abuse.

• In Punjab :
 Around 2.7lakh people addicted to drugs.
Out of them :
 89% of drug addict are educated and
literate.
 99% are male
 Half of Punjab’s drug abuser are from
village.
 Mostly involve age group –are 18- 35 yrs
The most common drug consumed is heroin
(chitta)

 On an average – Rs 1400 is spent on
heroin by drug abuser everyday in
Punjab ; Opium user spend Rs 340 per
day and pharmaceutical opioid user
spend Rs 265 per day.
Some fact regarding children of age
group 12- 13yrs :
1. Around 10,000 children are into
alcohol consumption.
2. 7000 children are consuming
inhalants.
3. 5600 children are in the habit of
taking cannabis.

Commonly abuseddrugs
• Marijuana
• Cocaine
• Heroine
• Alcohol
• Lysergic acid diethylamide (LSD)
• Inhalants
• Methylene-di oxy-methamphetamine (MDMA)
• Barbiturates
• Tobacco
• Opium
• Prescription drugs such as tranquilizers, steroids, analgesics etc

Classificationof abuse drugs
• Stimulant
• Depressant
• Cannabinoids
• Hallucinogen
• Inhalants
• Narcotics

Stimulants
• Stimulants are the drugs which excite or speed up/ stimulate the central nervous system.
• DRUGS –
I. Cocaine
II. Amphetamine
III. Methamphetamine
• EFFECTS –
I. Restlessness
II. Headache
III. Increased energy
IV. Sense of power
V. Give rise to alertness
VI. Blurred vision
VII. Confusion and impaired judgment
VIII. Reduced appetite
IX. Increased appetite
X. Elevated BP with dilated pupil
XI. Very rapid or irregular heart rate
XII. Collapse
XIII. Even death COCAINE

2. Alcohol
Depressant
• Depressant are the drugs which depress or slow down the
functions of central nervous system.
• DRUGS –
I. Barbiturates
II. Benzodiazepine
III. Tranquilizer
IV. Alcohol
• EFFECT-
I. Highly addictive, impaired co-ordination, balance and
judgment.
II. Produce sedation, hypnosis, anxiety and dizziness
III. Tremors , hypertension, seizures
IV. If taken by pregnant mother – cause permanent damage to
the developing fetus
V. Coma followed by death can occur in some cases.
• LONG TERM EFFECT-
I. Chronic fatigue and sleep problem
II. Depression , confusion
III. Impaired sexual function
IV. Poor memory and personality change
1. Barbiturates

Cannabinoids
• Cannabinoids produce a strong psychological dependence with mild withdrawal syndrome.
• Most common modes of intake is – smoking.
• DRUGS :
I. Marijuana
II. Charas
III. Ganja and bhang
• EFFECTS :
I. Strong dependency
II. Increased heart rate
III. Dry mouth
IV. Reddening of eye
V. Muscle relaxation
VI. Lung infection
VII. Lethargy
VIII. Bodyache
IX. Drug craving
• LONG TERM EFFECT –
I. Decreased cognitive ability Cannabis ( bhang )
II. Psychosis
III. Sterility/ impotence

Hallucinogens
• Hallucinogens are the drugs which affect perceptions, emotions and mental processes.
• Also cause feeling of dissociation from oneself.
• DRUGS –
I. Lysergic acid diethylamide (LSD)
II. Phencyclidine (PCP)
III. Mushrooms
IV. Methylene – dioxy – methamphetamine (MDMA)
• EFFECTS –
I. Rapid breathing 1. Mushrooms
II. Dizziness
III. Dilated pupils
IV. Hyperactive reflexes
V. Raised BP
VI. Delusion
VII. Distorted sensory perception
VIII. Even depression
IX. Panic attack 2. LSD . 3. PCP
X. Increased emotional energy

Inhalation
• Inhalation drugs are the volatile substance that produce chemical vapours that can be inhaled to induce a psychoactive
or mind altering effects.
• They are commonly abused because of their easily availability, rapid action and low cost.
• There are three major classes of inhalants are :
I. Solvents : - paint thinner, glues , dry cleaning fluids etc.
II. Gasses :- propane tanker, spray paints, deo , chloroform etc.
III. Nitrites :- butyl nitrite and amyl nitrite .
• EFFECTS –
I. Slurred speech
II. Lack of co-ordination
III. Euphoria
IV. Lightheadedness
V. Tremors
VI. Suffocation
VII. Limbs spasms
• LONG TERM EFFECTS :
I. Severe CNS , KIDNEY , LIVER damage
II. Behavioral disturbances Inhalants

Narcotic drugs
• Also called as pain killing or relieving drugs.
• DRUGS –
I. Heroin
II. Codeine
III. Opium
IV. Morphine and Methadone 1. Morphine
• EFFECT –
I. Watery eyes
II. Cramps
III. Anorexia
IV. Sweating
V. Mood instability 2. Heroine
VI. Reduced libido
VII. Constricted pupil
VIII. Constipation
IX. Physical deterioration
X. Respiratory impairment 3. Codeine 4. Opium
• In female abuser – menstrual irregularity and fetal addiction/ abnormality.

Commonwithdrawal symptoms of drugs
1. Sleep disturbances
2. Loss of appetite
3. Irritability
4. Depression or psychotic symptoms may become prominent
5. Tremors
6. Insomnia or hypersomnia
7. Seizure
8. Blackout
9. Nausea and vomiting
10. Abdominal pain
11. Suicidal tendency

Different routeof administrationand their effect:
• Route of drug administration is a method in which a drug is taken into body. It can split
into three categories :
1. Oral route
2. Parental route
3. Inhalation route
Oral route :
 In form of pills or drinks.
 Is one of the simplest way.
 It allow the drug to move onto the stomach through mouth where they are absorbed
by stomach lining and then enter the blood steam.
 May cause ulcers in mouth and stomach, dental decay and malnutrition.

 Parental route :
 It includes various types of injection like
subcutaneous, intravenous and intramuscular.
 Here drugs being injected directly into the blood
stream.
 The peripheral vein in arm, hands, legs and
sometimes abdomen , groin or neck are damaged.
 It may produce thrombosis, phlebitis , gangrene,
cellulitis, skin abscess, septicaemia and pulmonary
embolism.
 Shared syringe and needles can transmit hepatitis B
and C, HIV , syphilis and malaria.
 Inhalation or nasal route :
 It include inhalation where drugs are inhaled in form
of smoke where drug get absorbed through mucus
membrane in nose and enter into blood stream.
 It may cause asthma or bronchitis, pneumothorax
and vomiting.

Impactof drugabuse
• To one’s self : Drug abuse lead to –
1. Loss of co-ordination
2. Poor judgment and personality deterioration
3. Slowed reflexes
4. Distorted vision
5. Memory loss
6. Blackout
7. Frequent mood swings
8. Sudden change in appearance
9. Carelessness
10. Coma – Confusion – Convulsion
11. Numbness
12. Nausea
13. Vomiting
14. Loss of appetite
15. Constipation
16. Depression , anxiety , fatigue
17. Even death

• To the family : Drug abuse may lead to –
1. Loss of money
2. Increased incidents of abusing and domestic violence
3. Marital problem
4. Intense feeling of humiliation and guilt are felt by
family members
5. Financial issues
6. Bad influence
• To the children : Drug abuse may lead to –
1. Lack of care and warmth
2. Lack of a role model
3. Birth defects
4. Living in constant fear and anxiety
5. Emotional disturbance

• To the society : Drug abuse may lead to –
1. Crimes like rape , robbery , kidnapping
2. Violence
3. No role in nation’s construction.
4. Limited movement of people, specially at night.
5. Downfall of social values of country.

Sign of drug abuse
 Physical warning :
Bloodshot eyes
Pupils larger or smaller than usual
Changes in appetite or sleep patterns
Sudden weight loss or weight gain
Deterioration of physical appearance
Unusual smells on breath
Impaired coordination
Cold/bluish fingers
Needle marks on his arms
Puffy eyelids
Sleeping problems
Excessive sweating and increased heart rate
Suicide attempt

 Behavioural warning :
 Poor work
Decline in performance
Financial problems
Secretive or offensive behaviour
Lack of motivation
Unexplained anxiety
 Impulsiveness
Aggressiveness
Mood swings

Drug testing
• There are different types of drug test like :
1. Blood sample testing
2. Urine sample testing
3. Saliva testing
4. However, drug may be test using
stomach content that are obtained
through gastric lavage or after vomiting.
• URINE DRUG TESTING :
Is most common method of all above
Here the urine is use to detect the trace of
drug.
Drug concentrations are higher in urine
than in blood – so it is easier to detect.
Detection periods typically 1-3 days

• SALIVA TESTING :
 Is less invasive
Detection period from hours to 1-2 days
One study reports that saliva testing can only detect cannabinoids when subjects
have smoked cannabis only 4-10 hrs beforehand.
• BLOOD TESTING :
Is most expensive and invasive testing methods
It actually detects right at the time of testing the presence of substance and its
metabolites in the blood.
The actual amount of drugs in the blood at the time of test can also be measured
by a blood drug test.
However , its cost make it used less frequently.
Detection period: 0-2 days for most drugs.

• How long after usage of drug can be detected ?
 It depend on following factors :
1. Substance or drug itself
2. Dosage
3. Frequency of abuse
4. Individual rate of drug metabolism and excretion.
5. Sensitivity of the particular test carried out.

drug abuse prevention and control
• Also called substance abuse prevention.
• It is a process that attempt to prevent the onset of drug use or to limit
the development of problem associated with using drugs.
• Here are the following ways to prevent drug abuse:
UNDERSTAND the reasons behind children or adults using drugs and alcohol.
AVOID BAD COMPANY and TEMPTING SITUATION –
• It is the biggest reason for teen to start using drugs.
• In these cases, all what need is to either found a better groups of friends that won’t pressurize
for doing anything harmful.
• or find a good excuse to say NO , just to keep getting away from such a tempting situations.

PROVIDE SUPPORT-
A good bond and support between you and the abuser help to prevent from using drugs.
PROVIDE GUIDANCE AND CLEAR RULES ABOUT NOT USING DRUGS
AVOID UNDUE PEER PRESSURE –
• Every child has his or her own choice and personality which should be kept in mind.
• So a child should not be pressed unduly to do beyond his or her capacities because this may
lead them to use drugs.
GIVE PROPER COUNSELLING to the teens and adults , which are very important to face
problem, stress, disappointment and failure in life.
GIVE EDUCATION to children or teen regarding risk or consequences of drugs use.
LOOK FOR THE DANGER SIGN , so that an appropriate measures would be taken.
TRY TO GET INVOLVE OWNSELF OR OTHER INTO THE WORTHWHILE ACTIVITIES,
just to distract.
PRACTICE HEALTHIER LIVING HABBIT –
Exercise, eating well, yoga, meditation and getting good sleep are excellent way to avoid using
drug and alcohol. This will help to resist the temptations to use drugs or alcohol.

ORGANISING YOUTH CENTRE –
• Drug addiction may be caused due to feeling of isolation, loneliness, anxiety etc.
• Hence , social service organization and NGO should establish youth centre to over come such
feelings.
ROLE OF GOVERNMENT –
• The government can play vital part in this regard by –
1. By reducing the scale of unemployment.
2. By controlling the production and availability of these drugs.
3. By spreading knowledge about harmful effect of abused drugs through campaign.

Management
• PRINCIPLES :
1. Addiction is complex but also treatable.
2. No single treatment is appropriate for everyone.
3. Counselling and other behavioural therapies are most commonly used.
4. Medication are an important elements of treatment for many patient, especially when
combined with counselling and other behavioural therapies.
• METHODS OF MANAGEMENT :
1. Pharmacotherapy
2. Behaviour therapy
3. Family therapy
4. Group therapy
5. Psychotherapy
6. Motivational enhancement therapy (MET)

 Pharmacotherapy :
• GOAL:
1. To prevent withdrawal symptoms
2. To reduce drug cravings
3. To normalize any physiological functions disrupted by drug abuse
• Alcohol :-
 Drug of choice are BENZODIAZEPINE
1. Chlordiazepoxide – 80-200 mg/day
2. Diazepam – 40-80 mg/day
 Vit B complex is also added
 For craving – naltrexone are used.
• Opioids : -
 Here drug which are use for detoxification are –
1. Methadone – 25-50mg BD daily
2. Clonidine – 0.3 – 1.2 mg daily along with NALTREXONE
• Cocaine : -
 Bromocriptine and amantadine are use for reducing craving.

• Other drugs :
1. Mood stabilising drug – Lithium, valproate and carbamazepine.
2. Antidepressant drug - amitriptyline and imipramine
3. Antipsychotic drug – chlorpromazine and clozapine
4. And for other symptoms – give symptomatic treatment
Behavioural therapy:
 It is based on theories of learning and aims at changing
maladaptive behaviour and substituting it with adaptive behaviours.
 Family therapy :
 This is not an individual based therapy but is a family based
approach in which family act as a unit.
It include –
Problem solving
Training in communication skill
Home assignment etc

Psychotherapy :
This therapy help to remove, modify or retard
existing symptom.
And promote positive personality growth and
development.
And also help in correcting the disturbed pattern of
behaviour.
Group therapy :
It is a type of psychotherapy in which a group of 8-
10 person can be treated at one time.
It provide the patient and their relative a platform
to share problem with other which are very similar
in nature and to make them realise that they are
not alone in their suffering.

Motivational enhancement therapy :
It is a counselling approach that help the individual to resolve their ambivalence
about engaging in treatment and stopping their drug use.
This approach has been used successfully with people addicted to alcohol to both
improve their engagement in treatment and reduce their drinking problem.
MET has also been used successfully with marijuana dependent adult when
combined with cognitive behavioural therapy, constituting a more comprehensive
treatment approach.

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