Professional Documents
Culture Documents
Alcohal Misuse
Alcohal Misuse
Alcohal Misuse
2009
Regular training on substance use management to medical and other health professionals
ALCOHOL
o It is the most widely used substance in the world, and has been for thousands of years
o Alcohol is a potentially addictive substance.
Types of alcohols in India
o Indian Made Foreign Liquors [IML] Whisky, Brandy, Rum, Vodka, Gin etc.
manufactured in India
o Beers of different strengths and wine
o Country liquor manufactured in government-licensed factories, commonly called
arrack
o Illicit drinks are illegal, but consumed widely. Examples are toddy, mahua and chang
o Methanol is the most dangerous adulterant in illicit alcohol and is often the cause of
life threatening hooch tragedies
How does alcohol act
o Alcohol depresses the normal functions of the brain. At first it depresses the part of
the brain that controls inhibitions.
o In small amounts: seems to calm down and relieves anxiety
o In higher doses: talkativeness, boisterousness
o At even higher doses: increased sedation, loss of control and balance
o And finally: unconsciousness, coma and even death.
Effect of alcohol on health
Alcohol consumption has
o numerous health and social consequences
o is an important contributor to death and disability
o affects most of the organs of the body
o Worldwide, alcohol causes 1.8 million deaths each year
Cirrhotic liver
Consequences of intoxication
o Motor vehicle crashes. Alcohol complicates diagnosis of trauma-related injury, may
mask or mimic the signs of a head injury and complicate treatment
o Workplace accidents
Enlargement of heart due to alcohol consumption
o unsafe sex
o financial problems
Family problems
Alcohol destroys the home much before it destroys the liver
Occupational problems
o Poor work performance,
o Absenteeism
o Poor relationship with colleague
o Discipline problems
o Loss of job
o Industrial losses
o Losses to society
Does alcohol have protective
properties?
o Incidence of heart disease in
those who consume moderate amounts
of some kinds of alcohol (an average of 1 to 2 drinks per day) has been shown to be lower
than that in nondrinkers in some countries
o However with increased consumption the bad effects on health are many more and serious
o For the person beginning to drink alcohol, alcohol addiction and alcoholism is a real threat
and it is NOT advisable to issue guidelines that may lead some persons to increase intake of
alcohol or start drinking if they do not already do so.
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BEHAVIOURAL ADDICTION
What is behavior addiction?
Some activities which are normally performed may some times become so excessive that
they have features similar to that of substance addiction
Normal behaviors become addiction when:
o They increase and become repetitive
o The person gradually gets preoccupied with these activities neglecting his/her
other aspects of life
How are behavioral addictions similar to substance addiction?
Behavioral addictions have similarities with substance dependence like :
Recurrent failure (pattern) to resist impulses to engage in specific behavior
Frequently engaging in these behaviors to a greater extent or over a longer period of time
than intended
Persistent desire or unsuccessful efforts to stop, reduce, or control these behaviors
When does a normal behavior become addiction?
A normal behavior would become an addiction when there is:
o Continuing the behavior despite knowing that it is causing harm
o Need to increase the behavior to achieve the same pleasure as before
o Giving up or your social life,work and resposibilities because of the behavior.
o Distress, anxiety, restlessness, or irritability if unable to perform the behavior
Gambling
Sex addiction
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BENZODIAZEPINES
What are benzodiazepines?
o Class of drugs familiar as sleeping pills
or minor tranquilizers
o Only available on doctors prescription,
usually given for treatment of
sleeplessness, anxiety disorders
Brand names of common benzodiazepines
o Calmpose, Valium (diazepam )
o Clonotril, Lonazep, Zicam (clonazepam)
o Alprax (alprazolam)
o Librium (chlordiazepoxide)
How do they act on the brain?
o Are brain depressants and induce
sleep
o Act on specific brain regions and lead to chemical changes in the brain
o At lower doses they cause feeling of pleasure
o In higher doses they can depress the areas of brain related to breathing and can cause
death
How do they cause addiction?
o They act of certain areas in the brain and effect the functions of the brain
o Finally they release the chemical dopamine at the pleasure circuit and the person feels
good
o The person is motivated to continue the drug for these pleasurable effects
o Later on he requires higher dose to get the same effects and may be using doses that
are lethal to another person.
What are the signs of intoxication ?
o Drowsiness
o Tremors
o Nausea
o Vomiting
o Difficulty in walking
o In excessive doses can cause coma and
death
What are the withdrawal signs?
o Sleeplessness
o Tremors
o Body aches
o Irritability
o Lack of interest in activities
o Tension and worries
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CANNABIS
It is a common psychoactive substance used widely.
It is obtained from the plant cannabis sativa
How is cannabis used?
Commonly used forms are
Marijuana or ganja: The leaves and flowering
tops of female plant
Hashish or charas: Concentrated resin
Bhang: A beverage prepared by grinding
cannabis leaves in milk and boiling with spices
and other ingredients
Hash oil: An highly concentrated oily mixture
These forms are either eaten smoked or vaporized
Cannabis contains a chemical 9 tetra hydrocannabinol that affects the brain and like other
substances finally is release of dopamine at the pleasure centers and continued use causes
dependence
What are the immediate effects of using cannabis?
Initially cannabis causes a feeling of relaxation
In Higher doses it causes
Behavioral problems
Dry mouth
Increased heart rate
Red eyes
hallucinations and sensory distortions
Nausea and vomiting
What are the features of cannabis withdrawal?
Irritability,anger
Anxiety
Physical tension ,restlessness
Decreases in appetite and mood
Decreased body weight
Shakiness and sleep problems
Withdrawal first appear within 24 hours,most pronounced for the first 10 days and can
last up to 28 days.
How is cannabis harmful to health?
o Cannabis contains more tar than tobacco, and has a higher concentration of cancercausing agents
o With more tar smoking cannabis presents the same health problems as tobacco:
bronchitis, emphysema and lung cancer.
o It can disrupt the control of blood pressure increasing the risk of fainting
o Many people use cannabis initially and then switch to more dangerous drugs
o Cannabis can cause psychosis in people who are predisposed
Cannabis has been used as medicine too
Cannabis is used for some illnesses like
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OPIOIDS
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TOBACCO
What are the contents of cigarette?
Cigarettes contain more than 4000 chemical compounds and at least 400 toxic substances .
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VOLATILE SOLVENTS
What are inhalants?
Inhalants are substances that produce chemical vapors that are inhaled and used as psychoactive
substance.
Which are commonly used inhalants?
o Eraser fluids
o Petroleum products
o Paint thinners or removers
o Dry-cleaning fluids
o Gasoline
o Glue
How are inhalants used?
o Inhalants can be
o "Sniffing" or "snorting" fumes from containers
o Spraying directly over the nose or mouth
o "Bagging:inhaling from substances put inside a plastic bag
o "Huffing" : Inhalant-soaked cloth is stuffed in the mouth
o Inhaling from balloons filled with nitrous oxide.
How do they affect the body?
o Inhaled
o Absorbed throught he lungs
o Within seconds reaches brain
o Intoxication effects as sluring of speech,
incoordination, euphoria, dizziness.
Complications
o With successive inhalations,
o can suffer loss of consciousness and
death.
o After heavy use of inhalants, abusers may
feel drowsy for several hours
o experience a lingering headache.
Problem with use of inhalants
1. Are often among the first drugs that young
children use.
2. Gateway to other hard drugs
3. Suffer from memory and neurological
dysfunction and may experience multiple
psychological and social problems.
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TYPES OF TREATMENT
1.
Pharmacological Treatment
Medications are given to control the withdrawal symptoms just after stopping drugs
Alcohol: Diazepam and lorazepam
Opioid: Buprenorphine or clonidine
Cannabis, inhalants: diazepam/ lorazepam
Detoxification
o Process by which an alcohol or drug dependent person is helped to stop the use of the
substance in a supervised manner
o withdrawal symptoms and the attendant risks are minimized.
o Detoxification is the first step towards the treatment .
Assessment for Detoxification
Aim :
o establish a diagnosis of alcohol or drug dependence
o detect those at significant risk of developing a withdrawal syndrome
o determine if a patient can be managed in a particular setting
Duration for Detoxification
o Detoxification takes from 24-48 hours to 2-3 weeks, depending on the predominant
substance used and the severity of dependence.
Setting for Detoxification
o At home,
o On an ambulatory care (outpatient) basis,
o In a community residential detoxification unit, in a hospital ward or in a specialist
detoxification unit.
The severity of dependence and the patients medical condition determine the appropriate
setting.
How is it Done?
o Non-medicated detoxification
o but it is often necessary to prescribe sedatives for few days
Principles of Clinical Management of Withdrawal
They are summarized as the four S's:
1. Sedation (or substitution)
2. Symptomatic relief
3. Supplements
4. Supportive environment
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Benzodiazepine Detoxification
o The dosage of benzodiazepines must be reduced slowly. As rapid reduction can cause
unpleasant effects.
o Slow withdrawal means tapering dosage gradually, usually over a period of some
weeks or months.
o Initial few days substitution with long acting benzodiazepines as diazepam are used to
reduce the intensity of the withdrawal symptoms
Amphetamine Detoxification
o Sedation is provided in the first few days with diazepam usually. other drugs for
sedation have also been used
o For symptomatic relief of the aches and pains pain killers are prescribed for the initial
few days
o Supplementary vitamins are also prescribed
o Encouraged to maintain a good food intake
Cocaine Detoxification
o Initially used drugs help in controlling agitation of the patient. usually diazepam is used
in this phase.
o For supportive management pain killers and vitamin supplements are provided
Inhalants Detoxification
o There is no specific detoxification agent. Initial withdrawal symptoms are managed
with diazepam or other benzodiazepines
o Vitamin supplements
o supporting environment is provided
Cannabis
o
o
o
detoxification
Initial symptoms are usually managed with diazepam.
In some cases antipsychotic drugs in low doses may be needed.
Supportive caring environment is provided
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PSYCHOSOCIAL TREATMENT
Relapse Prevention
What is Relapse?
o Who is getting treatment for drugs or alcohol problem slips back or starts using the
substance again .
o Relapse does not mean that you would not get well , it is a part of the getting well
process
What is lapse?
o Lapse is the first episode of drug use after one stops taking the drug.
What are common causes of Relapse?
o Urge to take the drug
o Boredom , sadness, anger
o Activities that were associated
with prior drug use
o Pressure from friends
o Stress and tension
o Testing control
o Positive mood states like feeling happy
What Triggers the Relapse?
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Interpersonal Triggers
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Social pressure
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Relapse pathway
Use of substance to Test" if one can control or use once in a while; to Just try it once" to see
what happens; testing the effects of treatment or ones own Willpower".
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GROUP THERAPY
What is Group Therapy?
o Its is a form of counseling involving a group of people and a counselor in which
participants are encouraged to discuss and analyze their problems
o Participants join and leave the group according to their admission and discharge timings
o Groups are educative in nature.
How are they conducted?
o In a week four group sessions are conducted by psychiatric social workers at the
deaddiction center
o Group contains 5-10 members (often speaking same language)
o Each session lasts for a duration of 45 minutes to an hour
Why should one attend groups?
o Groups provide positive peer support and pressure to abstain from drugs
o Groups enable people who use drugs to witness the recovery of others
o Groups instill hope, and a sense that If he can make it, so can I
Why should one attend groups?
o Group acts as a forum for self-expression
o Group teaches new skills to handle your problems
o Groups enrich members with insight and guidance
Role of Family in the Treatment Process?
Why is the Family Important in Treatment?
o Families play an important role in recovery from drugs
o Family members help the patient to maintain abstinence
o They are the primary care givers for the person after discharge
o Families need support
How can Family help?
o Motivate the person to leave drugs
o Cooperate in the treatment process
o Supervise medications
o Reinforcing abstinence
o Supporting during stress
o Reintegrating with the society
How Addiction effects Family?
o The family members go through many difficulties due to drug problems like:
o Financial difficulty
o Fights with spouse
o Loss of support from neighbors and other family members
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o The behavior of the parents and problems at home can affect the children
psychologically
o Family counseling helps the family members to handle these problems effectively
o The aim is to help to be a Happy Family
Do I need admission ?
o May be done as inpatient or outpatient
o Depends from individual to individual and degree of problems
Home/Outpatient treatment:
Done if:
o not severely dependent on drugs
o no medical or psychiatric complications requiring close observation or treatment
o has a drug-free and supportive home environment and family members available to
support the patient
Hospital/Specialist Treatment:
Needs admission if
o Severely dependent
o Associated illness or injury
o Use of multiple drugs
o Poor family support
o Previously failed home treatment
Duration of stay
o The treatment at the center needs 21days stay at the hospital
o May require longer stay if there are severe problems
After discharge how often should one follow up?
o Usually once a week for first month after discharge
o Later twice a month for second month after discharge
o Later once a month for 1 year.
How long do I need to take medication ?
o For one year
Why I need to take medications for one year ?
o To control the craving
o To prevent relapse
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Contact Address:
The De-Addiction Center
National Institute of Mental Health and Neuro Sciences
Bangalore.
Out-patient days: Saturdays and Mondays
Screening time: 9.00 -11.30 am
Phone No: 080-26995360
Email: nimhansdeaddiction@gmail.com
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