Global and National scenario for Addiction

1. Addiction and Substance Use
Dr. Rakesh Verma
1st Year Junior Resident
Department of Clinical Pharmacology
& Therapeutics

2. CONTENTS
 Addiction
 Types of Addiction
 Prevalence of Addiction
 Treatment of Behavioral Addiction
 Substance Use
 Common Substance Use
 Prevalence of Substance Use
 Etiopathogenesis of Substance Use Disorders
 Recent Studies
 Treatment of Substance Use Disorders
 Take Home Message
 List of Abbreviation
 Reference

3. Addiction
• Addiction is a treatable, chronic medical disease involving complex interactions among brain
circuits, genetics, the environment, and an individual’s life experiences.
• People with addiction use substances or engage in behaviors that become compulsive and often
continue despite harmful consequences.
American Society of Addiction Medicine, 2019

4. Types Of Addiction
• Substance addiction-
Abusive use of any substance (e.g. illegal drugs, OTC drugs,
prescription medicines, food, coffee, and even sugar) despite
harmful effects and negative consequences.
• Behavioral addiction-
Self-destructive, compulsive, recurring behavior (e.g. gambling,
using internet, falling in love, playing video games, working,
shopping, and working out) to an extent which causes adverse
consequences to personal and social life as well as mental and
physical health.

5. Most Common Addictions
• Tobacco/Nicotine Highest number of Addicts
• Alcohol
• Drugs (OTC, prescription,illegal)
• Gambling
• Coffee
• Food DSM-5
• Video games
• Internet/Social Media
• Sex/Pornography
• Shopping
• Work

6. Signs of a Behavioral Addiction
• Obsessive thoughts about the behavior
• Hiding the behavior from friends and family
• Inability to stop engaging in the behavior despite negative consequences, such as failing
relationships, health problems, or financial instability
• Irritability and restlessness
• Isolation
• Depression

8. Prevalence of Addiction
American Addiction Centre, Internet Sources
NSDUH National Findings Report 2018

9. Prevalence of Addiction
American Addiction Centre, Internet Sources

10. Treatment of Behavioral Addiction
• Detox Therapy
• Individual Therapy
• Group Therapy
 Short term rehab programs typically last for 28 to 30 days
 Long term rehab programs anywhere from 60 days to a year
National Institute on Drug Abuse. (2012)
Note-

11. Detox Therapy
 Completed within few days to few weeks
 Depends on substance used and severity of physical addiction
 Completely eliminates the drugs or alcohol from the body
 Withdrawal can be medically monitored for patient safety

13. Individual therapy
• Once detox is over, healing can begin
• Through intensive individual psychotherapy and
counseling sessions
• Start to identify unhealthy behavior patterns, triggers,
and traumas from past that may have led to addiction

14. Group Therapy
• Group counseling sessions are crucial part of addiction treatment
• Engaging with other members of inpatient health community
• Foster a supportive environment
• Build a sense of structure and routine
• Develop meaningful relationships in society

15. Substance Use
• Refers to the use of drugs or alcohol, and includes substances such as cigarettes, illegal drugs,
prescription drugs, inhalants and solvents.
• Quite common on international scale
• Statistics vary depending on the substance being consumed
• Estimated that
-Nearly 5% of the world’s population have used an illicit substance
-About 240 million people around the world use alcohol problematically
-Approximately 15 million people use injection drugs
World Drug Report (2015)

16. Common Substance Use
• Alcohol (Ethanol)
• Tobacco/Nicotine
• Marijuana/Cannabis
• OTC Medications
• Inhalants
• Sedative-Hypnotics
• Hallucinogens
• Stimulants/Sympathomimetics
• Amphetamines (Including Methamphetamines, MDMA)
• Methylxanthines (Caffeine, Theophylline, Theobromine)
• Cocaine
• Opioids/Opiates

17. Prevalence of Subtance Use

19. Narcotics Control Bureau Nepal.2016

20. Nepal’s Data on Drug Abuse
• 75 percent of drugs users are between 15 to 30 years of age
• 6-7 percent users are girls
• 35 percent prison inmates abuse drugs
• Around 0.2 percent of school children are users
• About 300 rehab centers across the country
• Only 104 rehab centers are registered with the Narcotic Drugs
Control Division, according to MoHA

21. Marijuana
•Psychoactive drug derived from the Cannabis sativa
plant with main constituent THC
•Classified under the Controlled Substances Act as a
Hallucinogen
•Street names for marijuana include:
Aunt Mary, BC Bud, Blunts, Boom, Dope, Gangster,
Ganja, Grass,
Hash, Smoke, Weed, Yerba
•Smoked as a rolled cigarette (a joint), in a pipe, or a
bong.

22. Marijuana’s Effect On The Body
• Short term use
Impairment of memory & learning problem, difficulty in problem-solving, loss of coordination &
impaired judgment
• Long-term use
Addiction and Permanent Impairments and Reduced IQ
• Physical complications
Bronchitis, Emphysema, Asthma, Suppressed Immune System
• Daily or frequent use
Pre-malignant lesions leading to Lung cancer, Schizophrenia
• Acute marijuana use
Stroke and Heart Attack

23. Data on Marijuana Addiction
• 188 million worldwide used marijuana in 2019
• In March 2020, retail marijuana sales due to the COVID-19 outbreak increased by 159% in
California, 100% in Washington State, and 46% in Colorado
• 30% of user have marijuana use disorder & 1 in 6 users who start using it before 18 are addicted
• In 2019, 43% of college students consumed marijuana, the highest number since 1983
• Teenage girls who use marijuana are 5 times more likely to face depression by age 21
• Suicides where toxicology tests showed marijuana use increased from 7.6% in 2006 to 23% in 2017
• Use of amphetamines or combining drugs increases the risk by 5-30 times
• Alcohol combined with drugs increases the risk factor by 20-200 times

25. Etiopathogenesis of Substance Use Disorders
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14 (2020)

27. Relationship between COVID-19 and Addiction

28. Recent Studies on SUD

29. • A cross-sectional survey using a self-administered health professional questionnaire was conducted
among 407 pharmacy, nursing, and public health students at three universities in Nepal in 2010
• Data were collected using a modified version of the Health Professional Questionnaire
• The overall lifetime prevalence of substance use was 42.8%
• Marijuana was the most commonly used illegal drug (8.8%)
• Minor opiates (e.g., codeine cough syrups) were the most widely used illegal prescription drugs
(32.4%)
Study-1
BMC Public Health (2017)

30. • 1054 Canadian adolescents completed an online survey which reported on their frequency of alcohol use,
binge drinking, cannabis use, and vaping in 3 weeks before and directly after social distancing practices had
taken effect.
• McNemar’s test to examine if the proportion of adolescents who used each substance changed from pre-
COVID to 3 weeks post-COVID
• Series of Binary Logistic Regressions with the following dichotomous dependent variables were assigned
• For most substances, the percentage of users decreased; however, the frequency of both alcohol and
cannabis use increased.
• Although the greatest percentage of adolescents was engaging in solitary substance use (49.3%), many were
still using substances with peers via technology (31.6%) and, shockingly, even face to face (23.6%)
Study 2
Journal of Adolescent Health (2020)

31. Treatment of Substance Use Disorders
• Methadone
• Buprenorphine Approved for treating Heroin and Opioid Addicts
• Naltrexone
• Acamprosate Approved for treating alcohol dependence
• Disulfiram
• Nicotine replacement product Approved for treating Nicotine Addicts
(available as patches, gum, lozenges, or nasal spray)
• Bupropion Approved as Comprehensive Behavioral treatment Program
• Varenicline

33. Take Home Messages
• Drug use and Addiction causes lot of disease and disability in the world
• Research is still needed to sort out the relative impact of environment and individual traits on
alcohol and other drug use across the globe
• Recent advances in neuroscience may help improve policies to reduce the harm that the use of
tobacco, alcohol, and other psychoactive drugs impose on society

34. List of abbreviations
• OTC- Over The Counter
• DSM-5- Diagnostic and Statistical Manual of Mental Disorders-5th edition
• IHME- Institute for Health Metrics and Evaluation
• NSDUH- National Survey on Drug Use and Health
• MDMA- 3,4-methylene dioxy meth amphetamine
• MOHA- Ministry Of Health Administration
• THC- Delta9-tetrahydrocannabinol
• PTSD- Post Traumatic Stress Disorder
• SUD- Substance Use Disorders

35. References
• American Society of Addiction Medicine, 2019. www.ASAM.org
• Engs, R.C. (1996). Alcohol and other drugs: Self-responsibility. Bloomington, IN: Tichenor. (“Addictive Behaviors” chapter).
• Mayo Clinic. (2014). Drug addiction.
• UCLA Dual Diagnosis Program. (2016). Sex Addiction, Pathological Gambling, And Other Mental Health Disorders.
• Alavi, S.S., Ferdosi, M., Jannatifard, F., Eslami, M., Alaghemandan, H., & Setare, M. (2012). Behavioral addiction versus substance addiction:
Correspondence of psychiatric and psychological views. International Journal of Preventive Medicine, 3(4), pp. 290-294.
• Grant, J., Potenza, M.N., Weinstein, A., & Gorelick, D.A. (2010). Introduction to Behavioral Addictions. The American Journal of Drug and Alcohol
Abuse, 36(5), pp. 233-241.
• Substance Abuse and Mental Health Services Administration. (2005). Groups and Substance Abuse Treatment.
• Wilson, A.D., & Johnson, P. (2016). Counselors’ Understanding of Process Addiction: A Blind Spot in the Counseling Field.
• Smith, L. (2015). Treatment Strategies for Substance and Process Addictions. Alexandria, VA: American Counseling Association, pp. 20-21.
• National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd edition).

36. References
• "DrugFacts: Marijuana." NIDA. December 2012. National Institute on Drug Abuse. March,
2013 <https://www.drugabuse.gov/publications/drugfacts/marijuana>
• World Drug Report. (2015). United Nations Office on Drugs and Crime. Retrieved
from: https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf
• Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the
2016 National Survey on Drug Use and Health. (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral
Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 2017. https://www.samhsa.gov/data/. Accessed May 15,
2018
• Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE . Monitoring the Future National Survey Results on Drug Use, 1975-2016:
Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, University of Michigan; 2017
• Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndrome 2020.
https:// doi.org/10.1016/j.dsx.2020.05.035
• Panthee et al. Prevalence and correlates of substance use among health care students in Nepal: a cross sectional study .BMC Public Health (2017)
17:950 DOI 10.1186/s12889-017-4980-6