Substance use disorder

Overview of Substance Use Disorder.

1. Dr. Sujit Kar

2. ntroduction

3. Definition - The World Health Organization's 1957 Expert Committee on Addiction-Producing Drugs offered the following definition : Drug addiction is a state of periodic or chronic intoxication produced by repeated consumption of a drug (natural or synthetic). Its characteristics include: (1) An overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (2) A tendency to increase the dose; (3) A psychic (psychological) and generally a physical dependence on the effects of the drug; (4) Detrimental effect on the individual and society. Ref : WHO,1957

4. Ref: APA: 1987, 1994, 2000

5. Commonly used substances are Nicotine Alcohol Cannabis Opium Benzodiazepines Inhalants Stimulants

6. Alcohol consumption per capita (age 15 or older), per year, by country, in liters of pure alcohol

7. BAC (mg/dl) Effects <80 Euphoria, feeling of relaxation and talking freely, clumsy movements of hands and legs, reduced alertness but believes himself to be alert >80 Noisy, moody, impaired judgement, impaired driving ability 100-200 Electroencephalographic changes begin to appear, Blurred vision, unsteady gait, gross motor in-coordination, slurred speech, aggressive, quarrelsome, talking loudly. 200-300 Amnesia for the experience – blackout 300-350 Coma 350-600 May cause or contribute to death

8. Mental & Behavioural Effects Drowsiness Impaired attention Impaired memory Impaired judgement Impulsive behaviour Inappropriate sexual behaviour Aggressive behaviour Inappropriate social conduct Impaired occupational performance Mood lability(rapid changes) Stupor/Coma

9. Physical Effects Flushed face Rapid pulse Headache Stomach ache Diarrhoea Sweating Slurred speech Motor in coordination Unsteady gait Nystagmus Respiratory depression

10. Management of substance abuse at primary care level

11. # Assessment can be done using structured screening questionnaires ( eg - CAGE questionnaire for alcoholism) # Laboratory investigations help in assessing the degree of damage to body

12. Motivation

13. Management strategy for individual substances

14. Management of specific issues in substance abuse at primary care level