Unit – 8

Substance abuse
Objectives
 Define substance abuse and dependence

 Describing the magnitude, distribution and risk factors

of substance Abuse

 Identify common substance of abuse and dependence

 Understand the danger of substance abuse & dependence

 Manage substance abusers and dependant

 List and implement the prevention and control strategies
of substance abuse.
Introduction
• Substance abuse is a mal – adaptive pattern of substance use
resulting in repeated problems and adverse consequences.

• Substance abuse, also known as drug abuse, is a patterned

use of a substance (drug) in which the user consumes the
substance in amounts or with methods which are harmful to
themselves or others.
• It is harmful or hazardous use of psychoactive substances,
including alcohol and illicit drugs.
• Psychoactive substance use can lead to dependence
syndrome
Substance abuse
• A psychoactive drug or psychotropic is a chemical substance
that crosses the blood–brain barrier and acts primarily upon
the central nervous system where it affects brain function,
resulting in alterations in perception, mood, consciousness,
cognition, and behavior
Uses:
– Recreationally, to purposefully alter one's consciousness
and augmenting the mind.
– Some categories for medical therapeutic utility, such as
anesthetics, analgesics, hormonal preparations,
anticonvulsant and antiparkinsonian drugs or for the
treatment of neuro-psychiatric disorders, as hypnotic
drugs, anxiolytic.
 Commonly used psychoactive drugs and groups:
1. Anxiolytic: Example: Benzodiazepine
2. Euphoriants, Example, Indopan
3. Stimulants ("uppers"), that wake one up, stimulate the mind,
and may even cause euphoria, but do not affect perception.
Examples: amphetamine, caffeine, cocaine, nicotine
4. Depressants ("downers"), including sedatives, hypnotics, and
narcotics. This are sleep-inducing, anxiety-reducing,
anesthetizing substances, which sometimes induce perceptual
changes, such as dream images, and also often evoke feelings of
euphoria. Examples: alcoholic beverages (ethanol), opioids.
5. Hallucinogens . that produce distinct alterations in perception,
sensation of space and time, and emotional states, Example:
nitrous oxide
Performance inducing drugs
• also known as PEDs are substances used to improve
performance.
• are used by athletes and bodybuilder, students is referred to as
academic doping. They are also used by military personnel to
enhance combat performance.
Types of PEDs
• Lean mass builders, amplify growth of muscle and lean body
• Stimulants - enhance cognitive and athletic performance by
increasing focus, energy, metabolic rate, Some examples are
caffeine, ephedrine, amphetamine,
• Nootropics can increase cognition including memory short
term and long term.
• Painkillers allow performance beyond the usual pain
threshold. e.g. narcotics.(morphine, codeine)
• Sedatives and anxiolytics are sometimes used in sports and
to overcome excessive nervousness or discomfort. Diazepam
and propranolol .
• Blood boosters (blood doping) increase the oxygen-carrying
capacity . are used in endurance sports like long-distance
running, cycling.
 Some Important Terms related to Substance Abuse

1. Abuse: Mis-use, mal-treatment or excessive use.

2. Dependence: The psychophysical state of a substance users
in which the usual or increasing dose of the substances are
required to prevent the on set of withdrawal symptoms.
– It is a compulsion to take subs. To prevent on set of
withdrawal symptoms or discomfort
– A strong desire to obtain and take the substance.
– It is a persistent seeking behavior of substance.
Psychological dependence:
– require periodic or continues exposure to a substance to
produce pleasure and or void discomfort.
– Is a continues or intermittent craving of a substances
Terms ….
3. Physical (physiological) dependence:
– It is a body’s biological need evidence by tolerance or with
drawl symptoms
A, Tolerance:
– is the requirement for an increased amount of the
substance to achieve a desired effect or there is markedly
diminished effect regular use of the same dose
B, With-drawl:
– Specific organic brain syndrome that resulting from
cessation or reduction in intake of substance.
– The development of symptoms like morning shakes after
cessation or deduction in using substance.
Alcohol dependence

• Teetotaler : Person who do not drink alcohol at all

• Social drinker : Person who drinks moderately but who may

get drunk from time to time.

• Alcohol dependence is a substance related disorder in which

an individual is addicted to alcohol either physically or
mentally, and continues to use alcohol despite significant
areas of dysfunction, evidence of physical dependence
Alcohol dependence

• Alcoholism means having unhealthy or dangerous drinking

habits, such as drinking every day or drinking too much at a
time.
How too much?
• drinking until blood alcohol content (BAC) of 0.08, or for
most adults, five drinks for men or four for women over a 2-
hr period.

• Is alcohol consumption exceeds 14 standard drinks per week

or 4 drinks per day, for men.
• women more than 7 standard drinks per week or 3 drinks
per day.
Factors Associated with Substance Abuse and
Dependence
Many variables(3 categories) operate simultaneously to influence
on becoming a substance abuser or dependent.
1. Agent / Drug Variables., The abuse liability is enhanced by
its:
– Availability: easily available, likely to be abused.
– Cost: low cost of substance, increase abuse /dependent
– Mode of administration: Include chewing, PO, SC, IM, IV, &
inhalations. easily modes of administration chewing, PO,
inhalation increase abused.
– Speed of onset: effect that occur soon after administrative
more likely to initiate the chain of event.
– Termination effect: Substance that has longer duration of
action is more likely to be abused
2. Host / Users variables.
the effect and the likelihood of an individuals
becoming substance abused depend on:
– Genetic predisposition and vulnerability Psychiatric
disorder
– Psychiatric disorder
– Prior experience or expectations
– Propensity for risk taking behavior
3. Environmental Variables
Include: Social setting and community attitudes
– peer influence
– Paucity of other option for pleasure or diversion
– Low employment or educational opportunities.
Some of commonly used substance
Substances that are commonly abused in Ethiopia
- Alcohol
- Khat
- Tobacco/shisha
- Hashish
- Benzene
- Pethidine
- Benzodiazepine
Substance Dependence
A maladaptive pattern of use, leading to impairment as manifested
by three (or more) of the following, occurring at any time in the
same 12-month period:
• tolerance
• withdrawal
• the substance is often taken in larger amounts or over a
longer period than was intended
• there is a persistent desire or unsuccessful efforts to cut
down or control substance use
• a great deal of time is spent in activities necessary to
obtain the substance, use the substance, or recover from its
effects
• important social, occupational, or recreational activities
are given up or reduced because of substance use
1. Cannabinoids
• Hashish, Marijuana
• How Consumed: swallowed, smoked
• Effects: euphoria, slowed thinking and
reaction time, confusion, impaired balance
and coordination
• Consequences: cough, frequent respiratory
infections, impaired memory and learning,
increased heart rate, anxiety, panic attacks
Marijuana and canabis
Stimulants
• Amphetamine, cocaine, methamphetamine, nicotine,
• How Consumed: injected, smoked, snorted, swallowed
• Effects: increased heart rate, blood pressure, metabolism,
feelings of exhilaration, energy, increased mental alertness
• Consequences: rapid or irregular heart beat, reduced
appetite, weight loss, heart failure, nervousness, insomnia
Long Term Methamphetamine Use
3. Khat

• The chewing of the stimulant leaf khat is a habit that is

widespread in certain countries of east Africa and the
Arabian peninsula.
• It was noticed, long ago, that the plant of khat growing
in some regions of East Africa including Ethiopia, has a
certain influence of the psychic and physical state of
persons who uses it.. ‘Chat edulis’ or
• khat is short evergreen plant or shrub from family
celestraceae which grows in higher altitude, with green
glossy leaves, a small crown and diminutive white
flowers in a small branches.

• Khat is cultivated in Ethiopia both for export and for

local connsumption
Khat
Effect of khat
• It have psychosocial, economical and medical effects
both the individual and the community.
• It induces mild euphoria and excitement.
• psychotic episode can result, resembling a
hypomanic state
Immediate effects:
– increased heart rate, blood pressure
– Euphoria,
– hyperactivity,
– decreased appetite
Long-term effects:
– Depression,
– infrequent hallucinations
– increased risk of myocardial infarction (heart attack)
– psychosis in extreme cases
– oral cancer
– death and stroke following acute coronary syndrome
– Stomach ulcers.
– Elevating mood.
– Male infertility.
– Reducing the need for food and sleep.
– Decreasing sexual desire
Treatment

• Treatment includes providing reassurance in a

quiet place and
• diazepam may 5-10mg every 3hrs IM or P.O
can be given.
Diagnostic criteria for substance abuse

The definite diagnosis of dependence drawn up by WHO require

three or more of the following features.
a. A strong desire or sense of compulsion to take the substance
b. Difficulties in controlling subs. Taking behavior in terms of its
on set, termination, or level of use.
c. A physiological with drawl state when substance users have
ceased or been reduced, as evidenced by withdrawl syndrome
d. Evidence of tolerance, such that increased doses of the
psychoactive substance are required in order to achieve
effects originally produced by lower dose.
 Criteria ..
e. Progressive neglect of alternative pleasures or interest because of
psychoactive substance use increased the amount of time
necessary to obtain or take the substance or to recover from its
effect.

f. Persisting with substance use despite clear evidence of overtly

harmful consequences, such as harm to liver through excessive
drinking, depressive mood states consequent to periods of heavy
substance use, or drug related impairment of cognitive
functioning, efforts should be made to determine that the user was
actually, or could be expected to be, aware of the nature and
extent of the harm.
Diagnostic and Statistical Manual (DSM-IV) of APA uses
the following criteria

If an individual have one or more of the following

at any time for at least in one-month period:
– Recurrent drug use resulting in failure to fulfill major
responsibilities.
– Recurrent drug use in physically hazardous situation
– Recurrent drug – related legal problems
– Continued use despite drug related social / inter
personal problem
 Problems associated with substance abuse and
dependence
The substance on the abuser & the society virtually, all
substance that producer dependence can cause
varying degree of health, social & economic problems.

The degree of harm produced in general depends on

– The quantity of a substance consumed per oceasion
– The frequency with which it is consumed
– The duration of consumption
Problems
1. Health related problems
a. Acute – toxicities – can cause death and / or ill health
b. chronic toxicities – e.g., liver damage, coronary heart d
2. Economic consequence (problems)
a. Un employment resulting in decrease national productivity
b. Economic crisis–because increase expenditure for buying.
c. Decrease school performance
d. Increase school drop out
e. increase absenteeism des/d performance at school, work
f. Decrease productivity occupies vast area of the land that
other wise be used for cultivation of useful crop and food.
3. Social consequence
– Divorce - broken families– prostitution
– Crime (theft, hijacking, rape…)
– Violence
– Accident
– Dangerous vagrancy
Management of problems related to substance abuse and
dependence
to reduce the incidence & severity of problems use the f/g:
 Early detection of cases and intervention
- Gradual withdrawal
- Substitution of less addictive
- Symptomatic treatment
 Pharmacotherapy (to prevent relapse once on initial
remission)
 Psychotherapy and counseling Rx designed to produce a
response by mental ratter than by physical effects
 Long term Rx and rehabilitation include
- education
- family / friend support
- self – help group
- vocation rehabilitation
Prevention and control
1. Primary prevention
- identifying and avoiding drugs ,alcohols from the community
- information and education about alcohol, drug, miss- use to
the community to avoid the appearance of the new cases of
drug or other substance users
2. Secondary prevention
- early detection and management be fore complication occur
3. Tertiary prevention
- To avoid further disabilities & to reintegrate in to society
Control methods

Control of production, supply and availability, Include:

– stopping the supply process as its source
– crop eradication
– crop substitution
– control of distribution & access
Demand reduction
– reducing consumption
– increase price
– control of advertisement and promotion
Rational prescribing, dispensing and uses of
narcotic and psychotropic drugs
– Proper diagnosis and decide on the use of drugs
– Keep records
– Take as prescribed
– Not use for non – medical purpose etc…
– Increasing individual resistance from social
pressure by health education.
 Summery
 common types
major problems and health consequences
managements and controlling
 important variables to influence the
individuals becoming substance abused or
dependent
Thank you!