SUBSTANCE USE DISORDERSNiharika Thakkar

Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune

What are Substances??

•Alcohol•Opioids•Cannabinoids•Sedatives/Hypnotics•Cocaine•Caffeine•Hallucinogens•Tobacco•Volatile solvents

http://learn.genetics.utah.edu/content/addiction/drugs/abuse.html

How to identify?Self report dataAnalysis of blood, urine etcPresence of drug samples Clinical signs and symptoms (Disturbances in

levels of consciousness, perception, affect, behavior, psycho-physiological functions and responses)

Informant historyComorbidity with other psychotic disorders

Acute IntoxicationSmall doses of substance

produce disproportionately severe intoxication effect

Causes behavioural disinhibition

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Harmful UsePattern of UseAbusing the SubstanceBinging

Dependence Syndrome

Strong desire or compulsionDifficulty in controlling in terms of onset,

termination or levels of useWithdrawal stateEvidence of toleranceNeglect of alternative pleasuresPersistent use inspite of consequences

Tolerance

Increased doses required

- Alcohol and opiate-dependent individuals take daily doses sufficient to incapacitate or kill non-tolerant users

Withdrawal State Indicator of Dependence

Syndrome Repeated prolonged high dose Onset and Course is time

limited Physical symptoms Psychological disturbances:

Anxiety, Depression & Sleep disorders

Withdrawal State with DeliriumDelirium tremens: Short livedOccasionally life threateningToxic-confusional state with accompanying

somatic disturbances: Insomnia, tremulousness and fear

Clouding of consciousness, vivid hallucinations and illusions affecting any sensory modality, delusions, agitation, automatic over activity.

http://learn.genetics.utah.edu/content/addiction/drugs/abuse.html

Psychotic Disorder During or immediately after psychoactive substance use Vivid hallucinations Misidentifications Delusions or ideas of reference Psychomotor disturbances Abnormal affect : Fear to ecstasy Immediately or in 48 hours (or late onset) Resolves within a month and fully within 6

months

Amnesic SyndromeChronic impairment in memoryRemote memory lost, immediate memory

preservedDisorientationConfabulationPersonality changes

Korsakov’s syndrome ..\Requiem for a Dream.flv

Residual and Late onset Psychotic DisorderBeyond the period during which psychoactive

substance related effect might reasonably be assumed to be operating

Not always reversible: DementiaNot to be confused with Withdrawal stateNegative history: Rule out acute and transient

psychotic disordersFlashbacks

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Articles SUBSTANCE ABUSE IN INDIA, Ahmad Nadeem, Bano

Rubeena, Agarwal V.K., Kalakoti Piyush

Tobacco use in India: prevalence and predictors of smoking

and chewing in a national cross sectional household surveyM Rani, S Bonu, P Jha, S N Nguyen, L Jamjoum