According to ICD 10 & DSM 5 , 12 categories of substances have been listed here alongwith their signs ,symptoms . terminologies related to susbstance use ,their etiology ,management .

1. SUBSTANCE USE AND ADDICTIVE
DISORDERS
Sakshi Maheshwari
M.Phil clinical psychology
Gwalior mansik arogyashala ,2021-23

2. TERMINOLOGIES
1. CRAVING : regarded as a desire to use drug.
It is a combination of thoughts and feelings
. There is a powerful physiological
component to craving that makes it difficult
to resist .
It is sometimes defines as a “subjectively
experienced” desire or urge to approach and
consume a substance

4. 4. CODEPENDENCE – behavioral pattern of family affected by another member’s
substance use
5. ENABLING – family either blame themselves for or think they have no control over
the person’s habits or deny the problems of substance use
7. CROSSTOLERANCE : when two or more drugs are similar in their actions on brain
,when body develops tolerance for one ,it develops tolerance for similar drugs
even if user has never taken it
8. SYNERGISTIC EFFECT : when different drugs are present in body ,they may multiply
each other’s effects. The combined effect is often greater than individual drug
taken alone.
 similar effects : alcohol ,opioids ,benzodiazepines (depressants)
 opposite effects : stimulant drugs may interfere with liver’s usual disposal of alcohol . Thus
combining these two may build up toxic ,even lethal levels of depressants in the system

5. 9. DENIAL –not seeing the problems caused by substance use
10. ABUSE – use of drug that deviates from approved norms
11. MISUSE – applies to physicians approved drugs
12. NEUROADAPTATION- neurochemical changes that result from
repeated use of drugs . Tolerance phenomenon
Pharmacokinetic – adaptation of metabolizing systems in body
Pharmacodynamic – ability of nervous system to function
despite high blood levels of the substance

6. ICD -10 Criteria

8. 13. Acute intoxication : a transient condition following
administration of a psychoactive substance ,resulting
in disturbances in levels of consciousness ,cognition,
perception, affect or behavior
• Acute intoxication is usually closely related to dose
levels .
• Exceptions can occur in underlying organic conditions
• Disinhibition due to social context be taken into
account
• Symptoms of intoxication need not always reflect
primary actions of substance

9. 14. Harmful use : a pattern of psychoactive substance use that is causing
damage to health. The damage may be physical (as in cases of hepatitis
from self administration of injected drugs ) or mental (eg, episodes of
depressive disorder secondary to heavy consumption of alcohol)
• Diagnosis requires that actual damage should have been caused to
mental or physical health
• Harmful use not diagnosed if dependence syndrome /psychotic
disorder/another specific form of drug related disorder is present

10. 15. Dependence syndrome
• Cluster of physiological ,behavioral and cognitive phenomena in which
the use of a substance takes on a much higher priority than other
behaviors for the individual
• Central characteristic is desire(often strong, sometimes overpowering) to
take psychoactive drugs
• There may be evidence that return to substance use after period of
abstinence leads to a more rapid reappearance of other features of
syndrome than occurs with nondependent individuals

11. • A definite diagnosis be made if 3 or more have been present at
some time during previous year :
1. A strong desire or sense of compulsion to take the substance
2. Difficulties in controlling substance-taking behavior in terms of
its onset ,termination or levels of use
3. A physiological withdrawal state when substance has been
ceased ,as evidenced by characteristic withdrawal symptoms for
substance or use of same (closely related) substance with
intention of reliving or avoiding withdrawal symptoms

12. 4. Evidence of tolerance
5. Progressive neglect of alternative pleasures or interests because
of psychoactive substance use, increased amount of time
necessary to obtain or take the substance or to recover form its
efforts
6. Persisting with substance use despite clear evidence of overtly
harmful consequences ; efforts should be made to determine
that the user was actually, or could be expected to be aware of
nature or extent of the harm

13. 16. Withdrawal state
• A group of symptoms of variable clustering and severity occurring on
absolute or relative withdrawal of a substance after repeated, prolonged
and/or high-dose ,use of that substance .
• Onset and course of withdrawal state are time limited and are related to
type of substance and are related to type of substance and dose being
used immediately before abstinence .
• State may be complicated by convulsions

14. 16. Psychotic disorder
• Cluster of phenomenon that occur during or immediately(usually
within 48 hours) after psychoactive substance use and
characterized by visual hallucinations ,misidentifications
,delusions ,psychomotor disturbances ,and an abnormal affect
,which may range from intense fear to ecstasy .
• Late onset psychotic disorder (onset after 2 weeks) coded
different
• Sensorium usually clear but some degree of clouding of
consciousness ,though not severe confusion ,may be present
• Disorder typically resolves atleast within 1 month and fully within
6 months
• Diagnosis not me made when substances have primary
hallucinogenic effects

15. 17. Amnesic syndrome
• Syndrome associated with chronic prominent impairment of recent
memory ,remote memory sometime impaired ,while immediate recall
preserved
• Disturbances of time sense and ordering of events are usually evident,as
are difficulties in learning new material
• Confabulation may be marked but is not invariably present
• Other cognitive functions are usually relatively well preserved
• Amnesic defects are out of proportion to other disturbances

16. SUBSTANCE USE
CRITERIA
(DSM 5)
2 or more in 12-month period

18. SPECIFIERS INDUCED DISORDERS
SEVERITY No of criteria
Mild 2-3 symptoms
Moderate 4-5 symptoms
severe 6 or more
Intoxication Use disorder
Withdrawal Delirium
Psychotic disorder Neurocognitive disorder
Amnestic disorder Mood disorders
Anxiety disorders Sexual dysfunctions
Sleep disorders

19. SUBSTANCE INTOXICATION
• Diagnosis used to describe a syndrome(eg.alcohol intoxication or
simple drunkenness)characterized by specific signs and symptoms
resulting from recent ingestion or exposure to the substance .
Includes following points :
1. The development of reversible substance-specific syndrome due to
recent ingestion of(or exposure to)a substance .NOTE: Different
substances may produce similar or identical syndromes
2. Clinically significant maladaptive behavioural or psychological
changes that are due to effect of the substance on the CNS and
develop during or shortly after use of substance
3. The symptoms are not due to a general medical condition and are
not better accounted for by another mental disorder

20. SUBSTANCE WITHDRAWAL
• Diagnosis used to describe a substance specific syndrome
that results from the abrupt cessation of heavy and
prolonged use of a substance . Required criteria to be met :
1. The development of a substance –specific syndrome due
to cessation of(or reduction in)substance use that has
been heavy and prolonged
2. It causes clinically significant distress or impairment in
social,occupational or other areas of functioning
3. The symptoms are not due to a general medical condition
and are not better accounted for by another mental
disorder

21. ETIOLOGY

22. SOCIOCULTURAL VIEW
• Many theories propose that people develop substance use disorder when
they are under stressful socioeconomic conditions(Gardner etal,2010)
• Studies found regions with higher unemployment levels have higher
alcoholism rates.
• People in lower SES have higher rates of substance use disorders (Marsiglia &
Smith,2010 ;Franklin & Markarian,2005)
• 18% of unemployed adults currently use an illegal drug compared with 9% of
full timed employee workers and 12.5% of part-time employees

23. • Studies conducted with Hispanic and African
American people found higher rates of SUDs among
those participants who live or work in environments
of particularly intense discrimination(Clark,2014
;Unger et al 2014)
• Other theorists propose that people are more likely
to develop SUDs if they are part of a family or social
environment in which substance use is valued or at
least accepted(Chung et al;Washuburn et al 2014)

24. PSYCHODYNAMIC VIEWS
• Theorists here believe that people with SUDs have powerful dependency needs that
can be traced to their early years
• They suggest when parents fail to satisfy a young child’s need for nurturance ,the child
is likely to grow up depending excessively on others for comfort and help. If this search
for outside support includes experimentation with drugs ,the person may well develop
a dependent relationship
• Some theorists believe that certain people respond to early deprivations by developing
substance abuse personality that leaves them particularly prone to drug abuse
• Personality inventories ,patient interviews have indicated that individuals who abuse
drugs tend to be more dependent ,antisocial,impulsive than others. However these
studies are correlational

25. • People with SUDs also seem to have regressed to oral stage of
development
• Some formulated SUDs as a reflection of disturbed ego
functions(inability to deal with reality)

26. COGNITIVE-BEHAVIORAL VIEWS
• According to behaviorists ,operant conditioning may play a key roles in SUDs.
• They argue that the temporary reduction of tension or raising of spirits
produced by a drug has a rewarding effect ,thus increasing the likelihood that
the user will seek this reaction again
• Similarly ,the rewarding effects may eventually lead users to try higher
dosages or more powerful methods of ingestion
• Cognitive theorists further argue that such rewards eventually produce an
expectancy that substances will be rewarding ,and this expectation motivates
people to increase drug use at times of tension

27. • In a manner of speaking, theorists here are arguing that many people take drugs to
“medicate” themselves when they feel tense .If so, one would expect higher rates of
SUDs among people who suffer from anxiety, depression etc . And it has been found
that 19% of all adults who suffer from psychological disorders also display SUDs
(Keyser-Marcus et al,2014 ;NSDUH ,2013)
• Classical conditioning works in SUDs through cues .Cues or objects present in
environment at the time a person takes a drug may act as classically conditioned
stimuli and comes to produce some of the same pleasure brought on by drugs
themselves .
• Just the sight of hypodermic needle ,drug buddy or regular supplier has been known to
comfort people whoa re addicted to heroin or amphetamines and to relieve their
withdrawal symptoms

28. BIOLOGICAL VIEWS
1. Genetic Predisposition
• Some research with human twins suggested that people may inherit a predisposition
to misuse substances(Ystrom et al,2014)
• One classic study found an alcoholism concordance rate of 54% in a group of identical
twins i.e. if one twin displayed alcoholism ,the other twin also did it in 54% cases
• A group of fraternal twins had a concordance rate of 28%(Kaij,1960 ; Koskein et al
2011)
• A cleared indication comes from adoption studies of alcoholism. By adulthood
,individuals whose biological parents abused alcohol typically show higher rated than
nonalcoholic biological parents

29. 2. Biochemical factors
• When a person keeps on taking drug ,the brain apparently makes an
adjustment and reduces its own production of neurotransmitters ,and thus a
person builds tolerance for the drug
• If person suddenly stops taking the drug ,the natural supply of
neurotransmitters will be low for a time ,producing the symptoms of
withdrawal . And withdrawal continues until brain resumes its normal
production of neurotransmitters
• Drugs stimulate the reward center directly (cocaine ,amphetamines ,caffeine )
or indirectly (alcohol ,opioids ,marijuana )

30. • Some theorists believe that when substances repeatedly stimulate
this reward center ,it develops a hypersensitivity to the substance .
Neurons in the center fire more readily when stimulated by the
substances ,contributing to future desires of them. This is k/as
incentive-sensitization theory
• Others believe that people who chronically use drugs may suffer from
a reward-deficiency syndrome. Their reward center is not readily
activated by usual events in life ,so they turn to drugs to stimulate this
pleasure pathway ,particularly in times of stress

32. TREATMENT

33. PSYCHODYNAMIC THERAPY
• Therapists here first guide clients to uncover and work through the underlying
needs and conflicts than they believe have led to SUDs
• They then try to help clients change their substance-related styles of living .
• Although this approach if often used ,it had not been found to be particular
effective(McCrady et al.,2014)
• It may be that SUDs .regardless of their cause,eventually become stubborn
independent problems that must be the direct target of treatment if people
are to become drug-free

34. BEHAVIOURAL THERAPY
1. Aversion therapy
• Clients are repeatedly presented with an unpleasant stimulus(eg. Drug
induced nausea and vomiting) at the very moment that they are taking the
drug
• One version requires to imagine extremely upsetting,repulsive or frightening
scenes while taking the drug
• After repeated pairings ,they are expected to react negatively to the
substance itself and lose craving for it
• Mostly used for alcohol treatment

35. 2. Contingency management
• Short term approach for cocaine and other drugs
• Here incentives(such as cash,vouchers etc) are given on submission of
drug free urine specimens(Godley et al,2014)
• In one study ,68% of cocaine abusers who completed 6-month
contingency training program achieved at least 8 weeks of continuous
abstinence(Higgins et al,2011)

37. COGNITIVE-BEHAVIOURAL THERAPY
1. Relapse prevention training
• Goal is for clients to gain control over their substance-related behaviours
• To help reach this goal, clients are taught to identify high-risk situations
,appreciate the range of decisions that confront them in such
situations,change their dysfunctional lifestyles and learn from mistakes
and lapses
• It has been found to lower some people’s frequency of intoxication and
binge drinking(Jhanjee,2014;Borden et al,2011)

38. BIOLOGICAL TREATMENT
1. Detoxification
• It’s a systematic and medically supervised withdrawal from a drug
• One approach is to have clients withdraw gradually from substance
,taking smaller and smaller doses until they are off completely
• Second approach is to give other drugs that reduce symptoms of
withdrawal (Anxiolytics sometimes used to reduce severe alcohol
withdrawal reactions)

39. 2. Antagonist Drugs
• After successfully stopping a drug ,people must avoid falling back into a
pattern of chronic use
• As an aid to resisting temptation ,some people are given antagonist drugs
,which block or change the effects of the addictive drug
• Disulfiram(Antabuse) given for alcohol
• Naloxone given for opioids ,sometimes for alcohol or cocaine too
• Rapid detoxification done with partial antagonists as they have less severe
withdrawal symptoms

40. 3. Drug maintenance therapy
• A drug related lifestyle may be a bigger problem than drug’s direct
effects
• To treat heroin addiction ,methadone maintenance programs were
developed in 1960s ,but were later found that the alternative drug
became addictive and thus people believed that drug substitution is not
an acceptable ‘solution’

41. SOCIOCULTURAL THERAPY
1. Self-help and Residential Treatment Programs
• Alcoholic Anonymous(AA) : offers support along with moral and spiritual guidelines to
help overcome alcoholism. It helps members abstain “one day at a time”. Today it has
20lakh people across 1,14,000 groups across world
• Al-Anon ,Alateen offer support for alcoholism
• Narcotics anonymous & cocaine anonymous for other SUDs
• Residential centers –Daytop Village & Phoenix House-where people formerly addicted
to drugs live,work,socialize in adrug-free environment while undergoing therapy
• The good prognosis of these programs comes largely from individual testimonies

42. 2. Community Prevention Programs
• These programs are based on total abstinence model ,while others teach responsible use.
Some seek to disrupt drug use ;others try to delay the age at which people first experiment
with drugs .
• Prevention programs may focus on individual(eg. By providing education about unpleasant
drug effects),family(by teaching parenting skills),peer group(by teaching resistance to peer
pressure),school(by setting up firm enforcement on drug policies pr community at large
• Most effective prevention is provide consistent message about drug misuse in all areas of
people’s lives
• Two leading programs are : The Truth.com & Above the Influence

43. QUESTIONS TO BE ASKED ?
Name of
substance
Duration Quantity frequency Abstinence
and
withdrawal
symptoms
Effects
• In case of multiple substances taken ,diagnosis be made according to
most important single substance .
• This may be done in regard to particular drug ,or type of drug ,causing
presenting disorder or type of drug most frequently misused
• In case of chaotic patterns ,F 19 (multiple substances be code )

44. MAJOR SUBSTANCES CATEGORIES
• Marijuana
• Hashish
• LSD
• MDMA
• Cocaine
• Amphetamine
s
• Caffeine
• nicotine
• Alcohol
• Sedative-
hypnotics
• opioids
DEPRESSANTS STIMULANTS
CANNABIS
HALLUCINO
GENS

45. • “stoned” ,
• calm ,munchies ,chilled out,
floaty, giggly, sensual
paranoid ,dry mouth, anxiety
,lazy ,mental health issues
• “trips”
• spiritual connection
,heightened senses ,visual or
auditory hallucinations
,anxiety ,panic ,mental health
issues
• “uppers” ,
• increased energy ,heart rate ,
euphoria,
• dilated pupils , paranoia,
anxiety ,sexual arousal
,comedowns
• “buzzing” ,
• euphoric ,confident ,relaxed
• , risk taking ,
• withdrawal : unconsciousness
,coma, vomiting, death
DEPRESSA
NTS
STIMULAN
TS
CANNABIS
HALLUCI
NOGENS

46. ROUTES OF ADMINISTRATION

47. ALCOHOL

48. INTRODUCTION
• Alcohol produces both stimulant and
sedating effects
• Stimulatory effects : increased heart rate,
aggression
achieved through straital dopamine
release
• Sedative effects : motor slowing
,cognitive impairment
• In general stimulatory effects are thought
to be more rewarding

49. EPIDEMIOLOGY
• WHO estimates that 2 billion(200 cr) people worldwide consume alcohol
• In INDIA ,23-74% males in general and 24-48% females in certain
sections . In 2005 ,6.25 cr consumed alcohol ,in which 17.4 % had alcohol
use disorder
• In U.S. 90% have consumed alcohol at some time during life . Around 30-
45 % of them had atleast one transient episode of alcohol related
problem
• GENDER : male > female
• AGE : commonly mid 20-s

50. MECHANISMS OF ALCOHOL
ABSORPTION
• Peak blood concentration of alcohol is reached in 30-90 mins.
• Absorption most rapid with beverages containing 15-30 % alcohol
• If the absorption process is hampered ,a large amount of alcohol
remains in stomach for hours ,leading to pylorospasm causing nausea and
vomiting
• Alcohol is dissolved in body’s water and thus high proportion
of water receive high alcohol concentration. The intoxicating effects
are greater when concentration is rising than falling .

51. METABOLISM
• women have lower ADH blood content ,which may account for getting
more intoxicated than men for same amount of alcohol
alcohol
(ADH)Alc.
Dehydrogenase
Acetaldehyde
Inhibited by
Antabuse
Aldehyde
dehydrogenase
Acetic acid

52. BIOCHEMISTRY
• In short term effects alcohol intercalates
itself into membranes increasing their
fluidity
• In long term effects membranes become
rigid and stiff
• Activities associated with nicotinic Ach , 5-
HT3 ,GABA-A receptors are enhanced
• Activities associated with glutamate and
Ca+2 channeld are inhibited

53. EFFECTS OF ALCOHOL
BEHAVIOURAL
At higher levels ,primitive
centers of brain that control
breathing and heart rate are
affected ,and death can occur
Concentrat
ion (%)
Effects
0.05 Thought ,judgement, restraints loosened
0.1 Voluntary motor actions become perceptibly clumsy
0.1-0.15 Legal intoxication
0.2 Function of entire motor area of brain is measurably
depressed ,emotional behaviour affected
0.3 Person is confused and may become stuporous

54. SLEEP EFFECTS
• Consumed in evening ,increases ease of falling asleep
• Associated with decrease in REM sleep ,stage 4 sleep ,with more and longer
episodes of awakening
• Thus, the idea that drinking alcohol always help persons falls asleep is a myth!
LIVER DAMAGE
• Even as short as week long episodes can result in accumulation of fats and
proteins
• Associated with development of alcohol hepatitis and hepatic cirrhosis

55. GASTROINTENSTINAL SYSTEMS
• Long term heavy drinking can result in esophagitis ,gastritis ,achlorhydria
,gastric ulcers
• Development of esophageal varices can occur
• Disorders of small intestine occasionally occur ,and pancreatitis
,pancreatic insufficiency ,and pancreatic cancer can also occur
• Heavy alcohol intake interfere with normal processes of food digestion
and absorption ,particularly causing Vitamin B deficiency

56. OTHER BODILY SYSTEMS
• significant intake associated with increased BP ,dysregulation of
lipoprotein ,triglyceride metabolism ,increased risk for myocardial
infarction ,cerebrovascular disease
• Adversely affect hematipoietic system
• Acute intoxication associated with hypogylcemia ,which when
unrecognised can result in death
• Muscle weakness

57. INTOXICATION
• In India ,permissible blood
alcohol content is set at 0.03
%(30mg) per 100ml blood

58. WITHDRAWAL
• Classic sign : tremulousness( commonly
called “shakes” or “jitters”) develop 6-
8hrs after cessation
• Tremor here can be similar to
physiological tremor(continuous) or
familial(bursts of tremor activity)
• Withdrawal Seizures are generally
stereotyped ,generalized ,tonic-clonic .
Often occurring more than once in 3-6hrs
after first seizure

60. • Most severe form of withdrawal ,occasionaly life threatening ,toxic
confusional state with accompanying somatic disturbances
• Essential feature is delirium occuring within 1 week after cessation
• Begins in 30s-40s after 5-15yrs heavy drinking
Delirium
tremens
• Heterogenous long term cognitive problem .
• Global decreases in intellectual functioning ,cognitive abilities,memory
observed, recent memory difficulties are consistent
• Brain functions improve after abstinence ,but 50-70% get permanent
difficulties
Alcohol induced
Persisting dementia
• Disturbance of short term memory
• Wernickes’s encephalopathy (set of acute symptoms ) : recover completely
• korsakoff’s syndrome (chronic condition) , impaired recent memory
,anterograde amnesia : 20% recovery
• Thiamine deficiency ,characterised by ataxia,confusion ,lateral orbital palsy
Alcohol induced
persisting amnestic
disorder(wernicke-
korsakoff syndrome)

61. ASSESSMENT

63. OPIOIDS

64. INTRODUCTION
• Include opium- taken from sap of opium poppy . Has been used
for 1000s of yrs for medicinal usage of reliving pain ,by attaching
to endorphin receptors
• Eventually ,was discovered to be addictive
1804 ,derived from opium .relived
pain better than opium .was later
found addictive
•morphine
1898 ,morphine converted into new
pain reliever .was wonder drug for
several yrs .found more addictive
• Heroin ( brown sugar ,china
white ,dope ,smack ,junk )

65. • Most narcotics are smoked ,inhaled ,snorted, injected
• Injection is most common . Quickly brings rush- a spasm of
warmth and ecstasy that is sometimes compared with orgasm
. Brief spasm followed by several hours of pleasurable feeling.
• Additionally cause nausea, narrowing of pupils ,constipation
,heaviness of extremities ,dry mouth ,itchy face
• High dose effects include lethargy ,withdrawn states in which
bodily needs are diminished
• Immune system altered rendering person vulnerable to organ
damage ,respiratory depression ,constipation, changes in B.P.

66. • Adverse effects related to transmission of hepatitis ,HIV
through contaminated needles . Person can experience
idiosyncratic allergic reactions ,resulting in anaphylactic
shock ,pulmonary edema and death
•
• Opioids and MAOIs should not be given together ,as they
can cause gross autonomic instability
• Overdose symptoms : unresponsiveness ,coma,slow
respiration,hypothermia,hypotension ,bradycardia
• Clinical triad indicative of opioid overdose : coma
,pinpoint pupils ,respiratory depression

67. • Carfentanil : 10,000 times more powerful than morphine. Known as
elephant tranquilizer
• Codeine : cough relief
• Oxycodone : narcotic painkiller
• Opium was probably world’s 1st authentic anti-depressant
• Tolerance to some actions of opioids can be so high that a 100-fold
increase in dose is required to produce original effect

68. 1975 ,endogenous
opiods
endorphins ( neural
transmission and
pain suppression )
dynorphins enkephalins

69. EPIDEMIOLOGY

70. INTOXICATION
A. Recent use of an opioid
B. Clinically significant problematic behavior or psychological changes (e.g. initial euphoria
followed by apathy ,dysphoria ,psychomotor agitation or retardation ,impaired
judgement)that developed during ,or shortly after,opioid use
C. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose)and one(or
more) of the following signs developing during ,or shortly after use :
1. Drowsiness or coma
2. Slurred speech
3. Impairment in attention or memory
D. The signs or symptoms are not attributable to another medical condition and are not better
explained by another medical disorder ,including intoxication with another substance

71. WITHDRAWAL
A. Presence of either of the following :
1. Cessation of(or reduction)opioid use that has been
heavy and prolonged(i.e. several weeks or longer)
2. Administration of an opioid antagonist after a period
of opioid use
B. 3(or more) of the following developing within minutes
to several days after Criterion A
1. Dysphoric mood 2.nausea or vomiting
3. Muscle aches 4. lacrimation
5. Pupillary dilation ,piloerection or sweating
6. Diarrhea 7. yawning
8. Fever 9. insomnia

72. CANNABIS

73. INTRODUCTION
Cannabis sativa
Marijuana
,ganja,weed
(weak form)
Hashish (most
powerful)
cannabis
Each of these
drugs differ in
potency because
they are greatly
affected by the
climate they are
grown in

74. • Of several 100 chemicals
,tetrahydrocannabinol(THC) appears to be most
responsible for its effects.
• Higher THC = more powerful cannabis
• Initially was used as surgical anesthetic ,treating
cholera ,malaria ,coughs ,reduce nauseas and
vomiting in cancer patients
• When marijuana entered it started being used as
recreational drugs

75. • When smoked , cannabis produces mixture of hallucinogenic ,
depressant , stimulant effects .
• Low doses : feeling of joy ,relaxation and user may either become
quiet or talkative . Some however, become anxious , suspicious
,irritated especially if they have been in a bad mood .
• High doses : odd visual experiences , changes in body images
,hallucinations . Smokers become confused or impulsive
• Physical symptoms : reddening of eyes ,fast heartbeat ,increase
in B.P. and appetite ,dryness in mouth & dizziness
• Effect last for 2-6 hrs.

76. • Marijuana occasionally cause panic reactions similar to ones
caused by hallucinogens
• Some feel they are losing their mind(APA,2000)
• It interferes with performance of complex sensorimotor tasks
and cognitive functioning leading to accidents.
• Marijuana high often fail to remember information ,especially
anything that has been recently learned and even after
abstinence the problems linger in chronic users
• Some studies suggest that it reduces the ability to expel air from
lungs ,lower sperm counts in men ,abnormal ovulation in women

77. EPIDEMIOLOGY
• More than 1.9 crore people over age 11 currently
smoke marijuana atleast monthly ,more than 50
lakhs smoke it daily (NSDUH ,2013)
• Around 43 lakh ,1.7% of all teenagers and adults in
U.S. have displayed cannabis use disorder within
past month( NSDUH,2013)
• The reason for this surge in potency of marijuana
,which is now 4 times more powerful than used in
1970s.
• Average THC content is 8% compared with 2% in
1960s

79. INTOXICATION
A. Recent use of cannabis
B. Clinically significant problematic behavioural or psychological changes( eg
impaired motor coordination ,euphoria,anxiety,sensation of slowed time
,social withdrawl)that developed during,or shortly after ,use
A. 2(or more) symptoms developing within 2 hours :
1. Conjuctival injection
2. Increased appetite
3. Dry mouth
4. tachycardia

80. WITHDRAWAL

81. HALLUCINOGENS

82. INTRODUCTION
• Substances that cause powerful changes in sensory
perception ,from strengthening a person’s normal
perceptions to include illusions and hallucinations
• Produce sensations so out of ordinary that they are
sometimes called “trips” ,which may be exciting or
frightening depending on person’s mind interaction
with the drug
• Common ones : LSD ,mescaline, psilocybin
,MDMA(ecstasy ,molly),phencyclidine(angel
dust)

83. LSD
• Most famous and powerful
• Derived from naturally occurring drugs called ‘ergot alkaloids’
• During 1960s millions of people turned to the drug as a way of
expanding their experience
• Within 2hrs of being swallowed ,brings a state of hallucinogen
intoxication ,marked by strengthening of perceptions ,particularly
visual perceptions .
• People may focus on small details ,colors seem enhanced ,have
illusions where objects seem distorted and appear to move
,breathe, change shape

84. • Hallucinosis may cause one to hear sounds more clearly ,feel
tingling and numbness in limbs .
• Drug also cause different senses to cross (effect k/as
synesthesia ).eg : colors may be “heard” or “felt”
• Can induce strong emotions ,perception of time gets slowed
,long forgotten memories resurface
• Physical symptoms : sweating ,palpitations ,blurred visions
,tremors ,poor coordination .
• Effects wear off in about 6hrs .some users may develop
‘flashbacks’ –recurrence of sensory and emotional changes
after LSD has left the body

85. EPIDEMIOLOGY

86. SEDATIVE -HYPNOTICS

87. INTRODUCTION
• Are also called anxiolytics (meaning “anxiety-reducing drugs”),produce
feelings of relaxation and drowsiness .
• At low dosages, they have calming or sedative effect ,intensification of sexual
activities ,period of mild euphoria by binding to GABA and increasing its
activity
• At higher dosages ,they are sleep inducers or hypnotics
• Generally taken orally or intravenously
• Also used as antiepileptics ,muscle relaxants ,anesthetics

88. EPIDEMIOLOGY
• About 6% of individuals used sedatives and tranquilizers
illicitly. Over 1-yr period , 0.03% adults in U.S. have
sedative-hypnotic use disorder ,and 1 % over the course
of their life
• Most prevalent age group : 26- 34 yrs
• Female : male = 3 : 1
• Barbiturates usually abused by mature adults
,benzodiazepines by group under 40
• Benzodiazepines generally used to experience general
relaxed feeling and not to get a “high”

89. BARBITURATES
• 1st discovered in Germany over 100yrs ago, prescribed to fight anxiety and
help people sleep
• They are taken in pill or capsule form .
• In low dose ,reduce person’s level of excitement by attaching to GABA
• In large dose ,can cause intoxication resulting in incoordination , dysrthria
,nystagmus ,impaired memory ,gait disturbances
• And at too high level can halt breathing ,lower B.P. ,lead to coma and death
• Major danger of tolerance is lethal dose of drug remains same even while
body is building up tolerance for its sedating effects
• Withdrawal causes convulsions

90. BENZODIAZEPINES
• Developed in 1950s
• Clinically used : Xanax, Ativan , Valium
• Relieve anxiety without making people as drowsy as other kinds of drugs
of this group
• Less likely to cause death in overdose ,although in high dose can cause
intoxication associated with behavioural disinhibition and lead to
addictive pattern of use

91. COCAINE

92. INTRODUCTION
• It’s the central active ingredient of coca plant ,and is the most powerful
natural stimulant now known( Acosta, haller ,Schnoll 2011)
• Drug 1st separated from plant in 1865
• People have been chewing its leaves for energy and alertness
• Processed cocaine(HCl powder) is odorless,white,fluffy powder
• It is snorted ,injected intravenously ,smoked for its effects

93. • For many years people believed it posed few problems
aside from intoxication and temporary psychosis ,and
thus benefits outweighed the costs
• Insight came after its surge in popularity and
consequent damage in 1960s
• Many people now ingest cocaine by ‘freebasing’-
technique in which pure cocaine basic alkaloid is
chemically separated from processed cocaine

94. • Cocaine brings a euphoric rush of well being and confidence much like heroin
• At first it stimulates CNS making users feel excited, energetic ,talkative ,even euphoric
• As more is taken ,it produces faster pulse ,higher B.P. ,faster and deeper breathing ,and
further arousal and wakefulness
• It does this by increasing supplies of dopamine(primarily) and norepinephrine and
serotonin
• As stimulant effects subside ,user goes through a depression like letdown(called
crashing) ,pattern that include headaches ,dizziness ,fainting

95. • The greatest danger is an overdose ,which has strong effects on
respiratory center of brain ,at first stimulating it and then depressing it to
the point where breathing may stop
• It can also create major ,even fatal ,heart irregularities or brain seizures
that bring breathing or heart functioning to a sudden stop
• Pregnant women run risk of miscarriage ,having children predisposed to
later drug use and abnormalities in brain

96. EPIDEMIOLGY
• Today 2.8 cr have tried it ,16 lakh-most teenagers and young adults
• 1.1 % of all high scholers have used it within past month and 2.6 %
within past year(Johnston etal,2014)
• Since 1984, availability of newer ,more powerful ,cheaper forms of
cocaine has increased its use

97. AMPHETAMINES

98. INTRODUCTION
• Stimulant drugs produced in labs
• Common ones : Benzedrine ,dextroamphetamine (dexedrine
),methamphetamine (crank ,ice ,crystal meth)
• Produced in 1930s to help treat asthma
• Soon became popular for weight loss ,providing extra burst of energy

99. • Most often taken as pills ,can be injected intravenously and smoked too
• Small doses :increase energy ,alertness ,reduce appetite
• High doses : produce rush ,intoxication ,psychosis
• Cause emotional letdown when leaves the body
• It’s most serious damage is neurotoxicity
• But users focus more on positive impacts . including perception by many that
it makes feel hypersexual and uninhibited

100. EPIDEMIOLOGY
• Meth being the most abused is taken almost by 6% of all people over age
11
• Since 1989 ,its usage has increased dramatically
• Women =men
• It’s gained wide use as “club drug”

101. CAFFEINE

102. INTRODUCTION
• Most widely used stimulant .Around 80% of world
population consume it
• Most of it is taken in form of coffee ,tea ,chocolate,
energy drinks ,over the counter medications like
Excedrin
• Positive effects :raises person’s arousal and motor
activity and reduces fatigue .
• Negative effects : disrupts fine motor movement
,mood, reaction time ,sleep
• DSM 5 has till now listed only intoxication and
withdrawal criteria

103. • DSM 5 has till now listed only intoxication and withdrawal criteria
• It added ,key criteria would be 1-year period of problematic caffeine use,
unsuccessful efforts to reduce it, awareness that one’s continued caffeine use
is causing repeated physical, psychological problem
• Some studies have suggested link correlations between high doses of caffeine
and heart rhythm irregularities (Hart & Ksir ,2014)
• Some predict risk of miscarriage during pregnancy (Brent et al , weng et al
2011)

104. INTOXICATION
• More than 3 cups of brewed
coffee(250mg caffeine) can produce
intoxication
• Doses larger than 10gm of caffeine(100
cups) can cause grand mal seizures and
fatal respiratory failure

105. WITHDRAWAL
• Most people who cut suddenly stop their regular intake (even whose
regular consumption is low) have withdrawal symptoms.

106. TOBACCO
• Most prevalent ,deadly ,addictive,ignored
dependencies
• It doesn’t cause behvioural problems ,hence
rarely sought treatment
• Psychoactive substance : nicotine(affect the
CNS bya cting as agonist at nicotinic subtype
of Ach receptors)
• Stimulatory effects : improved attention
,learning,lifts mood ,decreases tension
• High doses are fatal secondary to respiratory
paralysis

107. INHALANTS
• Inhalant drugs(also k/as volatile substances or solvents) are
volatile hyrdocrabons that vaporize to gaseous fumes at
room temperature and are inhaled through nose or mouth
• Common ones : solvents for glues ,adhesives ;
propellants(aerosol sprays) ;thinners ;fuels
• People inhale these for their intoxicating
effects(euphoria,excitement,pleasant floating sensations)
• With high doses and long and exposures ,person may
progress to stupor and unconsciousness and later be
amnestic for period of intoxication