Substance Use Disorder.pdf

Substance Use Disorder PPT for M. Sc and B. Sc Nursing Students

1. SUBSTANCE
USE
DISORDERS
Prof Sathish Rajamani
DSCON -CUTTACK

2. Basic terms to know in this chapter
●Tolerance–Increaseinthelevelofsubstanceuseinordertogetthesamedesiredeffect.
●Dependence –Compulsiveandrepeateduseofsubstance,whichresultsintolerance
towardsthesubstanceandalsoleadstowithdrawalsymptomswhenitiscommencedtoquit
ordecreasethedosageofthesubstance.
●Psychologicaldependence –Continuouscravingforsubstancetoavoiddysphoria
(unpleasantmood)
●Physiologicaldependence –Physicaleffectsareseenandwithdrawalsymptoms
appearifonequitsadrug.

3. Basic terms to know in this chapter
●Behaviouraldependence –Drugseekingactivitiesandpathologicalusesareseen.
●Abuse–Maladaptivepatternofsubstanceuseleadingtoclinicallysignificantdistressor
impairmentwithoneormoreofthefollowing.
○Recurrentsubstanceuseresultsinfailuretoperformwellinhome,schoolandatwork.
○Recurrentsubstanceuseinsituationwhichisphysicallyhazardous(e.g,.Driving
vechicle)
○Recurrentlegalproblemsrelatedtosubstanceusage.
○Continuedsubstanceusemightleadstorecurrentinterpersonalproblems.

4. Basic terms to know in this chapter
●Harmfuluse–Apatternofpsychoactivesubstanceusewhichharmsthephysicalhealth
(cirrhosisofliver)orpsychologicaluse(depression).
●Withdrawal–Symptomsoccurswhenbloodlevelofabuseddrugsgetsdecreasedand
symptomsceasewhenthatsubstancehasbeentakenbytheindividual.
●Intoxication–Substancerelatedsyndromeoccursduetothestrongexposuretothe
substance.
●Detoxification–Itistheprocessofeliminatingorneutralizingthetoxinsfromthehuman
body.

5. Basic terms to know in this chapter
●Codependency –Itisanexcessiveemotionalorpsychologicalrelianceonotherpeople
forsupport.Itisabehaviouralproblemandmostlyitisaffectedduetosubstanceabuse
byafamilymember
●CrossTolerance–Effectofonedrugproducestolerancetoanotherdrugthatusually
happensbetweentwodrugswithsamefunction.

6. COMMON SUBSTANCE ABUSE IN INDIA
Alcohol
1 2 3
4 5 6
Cannabis
Hypnotics, Sedatives and
Anti –anxiety drugs
Amphetamine Barbiturates Cocaine

7. COMMON SUBSTANCE ABUSE IN INDIA
Hallucinogens
7 8 9
10 11 12
Inhalants Nicotine
Opioids –Heroin, MorphinePhencyclidinePolysubstances

8. ICD –10 Classification
F10 –F19: Mental and Behavioural disorders due to osychoactive substance use and mental
and behavioural disorder due to the use of
●F10 –Alcohol
●F11 –Opioids
●F12 –Cannabinoids
●F13 –Hypnotics and Sedatives
●F14 –Cocaine
●F16 -Hallucinogens

9. ETIOLOGY
Etiology and Risk factors of Substance Abuse /
Dependency

10. 1
Heredity, Genetics, Physiological vulnerability,
Gender
Biological Factors

11. Heredity Factors
The exact causes of substance abuse are
unclear. Psychological and coping factors
plays an important role in causation. Substance
addiction runs in families.
Children who grow up seeing their parents
using drugs may have a high risk of
developing substance use problem later in life
for both environmental and genetic reasons.

12. Genetics Factors
Genes account for 40 –60 % of the risk factor for addiction
development.
The genetic connection to addiction comes through inherited
levels ofdopamine, a neurotransmitter made in your brain.
High levels of dopamine can fuel poor impulse control and tilt
someone toward addictive behaviors.

13. Physiological Vulnerability
Differences in metabolic variations by
different races. For examples polymorphism
of liver enzymes.

14. GENDER
Males are more likely than females to
develop a substance use disorders.

15. 2
Family, Peer and Other factors
Social Factors

16. Family Factors
Having a parent or sibling that has a substance
use disorders
Poor quality of the parent –child relationship.
Family disruptions such as divorce.
Social isolation.
Abuse (Physical, Verbal and Sexual)

17. Peer Factors
Poor social skills
Excessive time spending with substance using
peers.
Substance uses during birthday and college
parties.

18. Socio-Cultural Factors
Media influences
Social and legal policies
Low SES
Community drug use norms
Accessibility and availability of drugs

19. Other Factors
Exposure to physical, sexual and emotional
abuse.
Religious rituals, modernization and rapid
urbanization.

20. 3
Family, Peer and Other factors
Psychological Factors

21. Psychological Factors
Sensation Seeking Behaviour
High Impulsivity
Anti –Social Personality

22. Mental Health Disorders
Major depression
ADHD
PTSD
Anxiety disorders
Schizophrenia

23. ALCOHOLISM

24. WHAT IS ALCOHOLISM?
●Alcohol(ethylalcoholorethanol)isthemostcommonlyused
psychoactivesubstanceworldwide.
●Alcohol–CNSDepressant
●Alcoholaffectsaperson’semotions,thinkingprocesses,motor
functionandbehaviour.
●BloodAlcoholConcentration(BAC)leadstoallthesechangesin
anindividualwhoconsumesalcohol.

25. DEFINITION OF ALCOHOLISM
●Alcoholismisastatewherepersonispowerlesstostopthe
drinkingthatseriouslyaltershisnormallivingpattern.
○National Council on Alcoholism (USA)

26. 3 –6 % Alcohol
16 –24 % Alcohol
14 –16 % Alcohol
36 –50 % Alcohol
36 –50 % Alcohol 36 –50 % Alcohol
Beer Wine Whisky
Rum
Scotch
COMMON ALCOHOLIC BEVERAGES
Gin
40 –45 % Alcohol
Vodka
40 –95 % Alcohol

29. BLOOD ALCOHOL CONCENTRATION
●What is the normal blood alcohol concentration in the body? At a blood
ethanol level of less than 50 mg/dL, or0.05%concentration, an individual is
not considered to be intoxicated.
●How do you calculate blood alcohol concentration?

30. BLOOD ALCOHOL CONCENTRATION & ITS EFFECTS
BAC Mg / dl Effects of Alcohol in Body
20 –30 Slow motor activity
30 –80 Decline in Cognition
80 –200 Lack of coordination, Decline in cognition,
Poor judgement
200 –300 Alcohol blackout, Slurring of speech,
Nystagmus
300 –350 Hypothermia, Dysarthria
350 –400 Coma Respiratory depression
> Than 400 Death might occur

31. Physical dependence, psychological
dependence tolerance, inability to
control and withdrawal symptoms
are present
GAMA
CLINICAL TYPES OF ALCOHOLISM
ALPHA
Increased consumption of alcohol to
come out of physical or emotional pain.
BETA
Increased consumptions of alcoholism
lead to physical consumptions but no
dependence to alcohol.
DELTA
Inability to stop alcohol
completely but it can
be controlled.
EPSILON
Dipsomania
(Uncontrollable
craving of alcohol)

32. STAGES
OF
ALCOHOLISM

34. STAGE –1: EXPERIMENTATION
●Mostpeoplehavetheirfirsttasteofalcoholwhenthey
areteenagers,butsomemaytryitatanevenyoungerage.
●Atthispoint,theymaydecidewhetherornottheylike
thetasteorhowdrinkingmakesthemfeel.Someyoung
peopledrinkeveniftheydon’tliketheeffects.
●Thisisusuallybecauseofpeerpressureorfearofmissing
out.

35. STAGE –2: INCREASED TOLERANCE
●Ifapersoncontinuestodrinkalcoholregularly,theywill
buildupatolerance.
●Thismeanstheeffectsarereducedeachtimetheydrink.
Iftheyareseekingtoachieveaparticularfeeling,they
willneedtoconsumemoreandmorealcoholeachtime.

36. STAGE –3: ADVERSE EFFECTS
●Withcontinuedmisuseofalcohol,thesubstancemay
begintohaveanegativeimpactontheuser’slife.
●Excessivedrinkingcandamagerelationshipswith
relativesandfriendsandimpacttheindividual’swork
performance.Itcanalsoleadtofinancialproblems.

37. STAGE –4: DEPENDENCE
●Overtime,thebrainandbodygetusedto
thepresenceofalcoholandtheybecome
physicallydependent.
●Whenyou’renotdrinking,youwill
experiencewithdrawalsymptomslike
nausea,vomiting,sweating,shakingand
headaches.

38. STAGE –5: ADDICTION
●Whenyoudevelopanalcoholaddiction,youloseallcontroloveryourconsumption.
●Youwilldrinktoreducethephysicalsymptomsofwithdrawalorbecauseyoufeel
anxiouswhenyou’renotdrinking.
●Youwon’tbeabletostopdrinkingevenifyouwantto.Youcouldalsostartto
experiencemorehealthproblemsincludingheart,liverorkidneydisease,paranoia,
anddementia.

40. Diagnosis of Alcohol Abuse
Blood Alcohol Concentration –Normal level
in India is < 30 mg / dl or 0.03 % g/dl.
Gama Glutamyl Transferase (GGT) -> 40
IU/L.
Mean Corpuscular Value (MCV) -> 92fL /
red cell.
Liver Function Test (LFT) –Increased
SGOT, SGPT, ALT and Ammonia.
Haematologic Studies –Anaemia,
Thrombocytopenia, Raised PT and Partial PTT.

41. Diagnosis of Alcohol Abuse (Cont)
Serum Glucose Level–Decreased in case of
severe liver disease.
Urine Toxicology-To screen out other
diseases
Serum Electrolyte Analysis –To screen out
the electrolyte imbalances due to alcohol abuse
ECG –Cardiac problems due to alcoholism are
screened out.

42. ASSESSMENT TOOLS
FOR
PROBLEM DRINKERS
CAGE Questionnaire, MAST, AUDIT, PAT

43. CAGE QUESTIONNAIRE

44. MICHIGAN ALCOHOLISM SCREENING TEST (MAST)
●MAST is a tool for assessment of problem drinkers and to screen
individuals who met alcohol related offences.
●It is a tool which consisted of 24 items and the client has to answer it
in ‘yes or no’ format.

45. Alcohol Use Disorders Identification Test (AUDIT)
●AlcoholUseDisordersIdentificationTest(AUDIT)TheAUDIT
(AlcoholUseDisordersIdentificationTest)isasimpleandeffective
methodofscreeningforunhealthyalcoholuse,definedasrisky
orhazardousconsumptionoranyalcoholusedisorder.
●TheAUDIT-Cisscoredonascaleof0-12(scoresof0reflectno
alcoholuse).Inmen,ascoreof4ormoreisconsideredpositive;in
women,ascoreof3ormoreisconsideredpositive.Generally,the
highertheAUDIT-Cscore,themorelikelyitisthatthepatient's
drinkingisaffectinghis/herhealthandsafety.

46. PADDINGTON ALCOHOL TEST (PAT)
●ThePaddingtonAlcoholTest(PAT)hasdeveloped
pragmaticallyforemergencydepartment(ED)staffto
givepatientsbriefadvice(BA)aboutalcohol.
●ThePaddingtonAlcoholTest,designedtoscreenfor
alcoholrelatedproblemsamongstthoseattending
AccidentandEmergencyDepartments

47. ALCOHOL
RELATED
DISORDERS

48. Alcohol
related
Disorders
Alcohol
Amnestic
Syndrome
Alcoholic
Psychosis
Delirium
Tremens
Alcohol
Withdrawal
Syndrome

49. Alcoholic Amnestic Syndrome
(Wernicke Korsakoff’s Syndrome)
“A mental disorder associated with
chronic ethanol abuse (ALCOHOLISM)
and nutritional deficiencies
characterized by short term memory
loss, confabulations, and disturbances of
attention.”

50. Wernicke –Korsakoff Syndrome
Korsakoff syndrome (also called Korsakoff's
amnesic syndrome) isa memory disorder that
results from vitamin B1 deficiency and is
associated with alcoholism.
Korsakoff's syndrome damages nerve cells and
supporting cells in the brain and spinal cord, as
well as the part of the brain involved with
memory.

51. Alcoholic Amnestic Syndrome
Wernickeencephalopathy(WE)isanacute
neurologicalconditioncharacterizedbyaclinical
triadofophthalmoparesiswithnystagmus,
ataxia,andconfusion.Thisisalife-threatening
illnesscausedbythiaminedeficiency,which
primarilyaffectstheperipheralandcentralnervous
systems.
Treatment: 50 –100 mg Thiamine Hydrochloride

52. Wernicke –Korsakoff’s Psychosis
COAT RACK
Wernicke’s
Encephalopathy
•C –Confusion
•O –Opthalmoplegia
•A –Ataxia
•T –Thiamine Deficiency
Korsakoff’s
Psychosis
•R –Retrograde Amnesia
•A –Anterograde Amnesia
•C –Confabulation
•K –Korsakoff’s Psychosis

53. ALCOHOL
WITHDRAWAL

54. Stage -1
Mild Symptoms
6 to 12 Hours
Stage -2
Moderate Symptoms
12 to 48 Hours
Stage -3
Severe Symptoms
48 to 72 Hours
1 2 3
STAGES OF ALCOHOL WITHDRAWAL

58. Alcoholic Psychosis
“Alcohol-related psychosis is a secondary psychosis that
manifests as prominent hallucinations and delusions
occurring in a variety of alcohol-related conditions. For
patients with alcohol use disorder, previously known as
alcohol abuse and alcohol dependence, psychosis can occur
during phases of acute intoxication or withdrawal, with or
without delirium tremens.”

59. DELIRIUM TREMENS
“Delirium tremens (DTs) is the most severe form of ethanol withdrawal, manifested
by altered mental status (global confusion) and sympathetic overdrive (autonomic
hyperactivity), which can progress to cardiovascular collapse.
Minor alcohol withdrawal is characterized by tremor, anxiety, nausea, vomiting,
and insomnia.
Major alcohol withdrawal signs and symptoms include visual hallucinations and
auditory hallucinations, whole body tremor, vomiting, diaphoresis, and
hypertension (high blood pressure).”

60. Treatment of alcohol dependency and be divided into
three stages.:
Stages
●Medical Stabilization
●Detoxification
●Long-term abstinence rehabilitation
MANAGEMENT OF ALCOHOLISM

61. This includes treatment of associated medical
conditions as alcohol withdrawal and alcoholic
ketoacidosis
1
MEDICAL STABILIZATION

62. Oral or IV Hydration
Benzodiazepines
Diazepam, Chlordiazepoxide
& Lorazepam
Vitamin B12

63. This stage involves stopping alcohol consumption.
2
DETOXIFICATION

64. Benzodiazepines
Vitamin
Supplements
Thiamine
Disulfiram
Antabuse

65. Naltrexone and
Acamprosate
Calcium
Carbimide
Works like disulfiram
Ondansetron

66. Short and long –term residential programs aim
to build a recovery support system and for
replapse.
3
Rehabilitation

67. Short –term programs
Last less than 4 weeks. These are structured programs that provide
therapy, education, skills training and help to develop a long –term plan
to prevent relapsing.

68. Out-patient counselling
Outpatient counselling can provide education on alcoholism and
recovery. It can help the person to learn skills not to drink and spot
early signs of potential relapse.

69. Self Help Groups
A well known self –help group is “Alcoholic
Anonymous” (AA).
Founded by Bill Wilsonnand Dr Bob Smith (1935)
The primary purpose of the AA is to stay Sober (Self –
disciplined) and help other alcoholics to attain sobriety.

70. VARIOUS APPROACHES TO QUIT ALCOHOL
1 2 3 4
Group
Therapy
Cognitive
Therapy
Behaviour
Therapy
Motivational
Enhancement Therapy
(MET)

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