ADDICTION

By
WAN MOHD FIKRI BIN WAN MOHD NASIR
 DEFINITION OF ADDICTION
• Addiction is a primary, chronic disease of brain
reward, motivation and memory. Dysfunction
in these circuits leads to characteristic
biological, psychological, social and spiritual
manifestations.
 ALCOHOL

SUBSTANCE CAFFEINE
RELATED
ADDICTIVE DISORDER
DISORDER
CANNABIS

HALLUCINOGEN

INHALANT

OPIOID

NON-SUBSTANCE
RELATED
DISORDER STIMULANT

TOBACCO

GAMBLING
DISORDER
REWARD PATHWAY
 NEUROTRANSMITTER
NEUROTRANSMITTER NORMAL FUNCTIONS

Dopamine (pleasure, learning) Pleasure (hunger/thirst/sexual), attention,

organization of thought, muscle control
and motor function

Serotonin (emotional stability) Regulates mood, emotions, thought

processes, sleep, and appetite

Energy, motivation, attention span,

Norepinephrine alertness, confidence, heart rate, blood
(behavioral & physical activity) pressure, etc.
 DEPRESSANT Eg: Alcohol

OPIATE Eg: Heroin, Morphine

PSYCHOACTIVE
DRUGS
Eg: Caffeine, Cocaine,
STIMULANTS
Amphetamine, Ectasy

Eg: Ectasy, LSD, PCP,

HALLUCINOGENS
Cannabis
 CRITERIA OF SUBSTANCE USE
DISORDERS
Problematic pattern of substance use impairment or distress manifest at
least 2 of the following criteria within a 12-month period:

1. Using substance more than originally intended

2. Persistent desire or unsuccessful efforts to cut down on use
3. Significant time spent in obtaining, using, or recovering from substance
4. Craving to use substance
5. Failure to fulfill obligations at work, school, or home
6. Continued use despite social or interpersonal problems due to substance
use
7. Decrease social, occupation, or recreational activities because of
substance use
8. Use in dangerous situation
9. Continued use despite subsequent physical or psychological problem
10. Tolerance
11. withdrawal
 DIRECT TEST FOR SUBSTANCE
SUBSTANCE USE
DIRECT TEST
ALCOHOL Blood/ urine test
COCAINE Urine drug screen (+ in 2-4 days)
AMPHETAMINES Urine drug screen (+ in 1-3 days)
PHENCYCLIDINES (PCP) • Urine drug screen (+ in 4-7 days)
• CPK and AST often elevated
SEDATIVE-HYPNOTICS Urine and blood for variable amount of time
BARBITURATE :
Short acting (pentobarbital): 24 hours
Long acting (phenobarbital) : 3 weeks
BENZODIAZEPINES:
Short acting (lorazepam) : up to 5 days
long acting (diazepam): up to 30 days
OPIOIDS Urine drug test (+ for 1-3 days)
Methadone and oxycodone will come up with negative on
general screen.
MARIJUANA Urine detection
• After a single use (+ about 3 days)
• Heavy users (+ up to 4 weeks)
 ALCOHOL INTOXICATION
DIAGNOSTIC CRITERIA TREATMENT

A. Recent ingestion of alcohol. • Monitor: Airway, Breathing,

B. Clinically significant problematic that developed
during, or shortly after, alcohol ingestion.
C. One (or more) of the following signs or symptoms
developing during, or shortly after, alcohol use:
1. Slurred speech.
2. Incoordination.
3. Unsteady gait.
4. Nystagmus.
5. Impairment in attention or memory.
6. Stupor or coma
Circulation, glucose, electrolytes,
acid-base status
• Thiamine (to prevent or treat
Wernicke’s encephalopathy) and
folate
• Gastrointestinal evacuation (e.g
gastric lavage, induction of emesis
and charcoal)

D. The signs or symptoms are not attributable to

another medical condition and are not better
explained by another mental disorder.
 ALCOHOL WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Cessation of (or reduction in) alcohol use that has • Benzodiazepines (diazepam,
been heavy and prolonged. lorazepam) to keep pt calm and
B. Two (or more) of the following, developing within lightly sedated.
several hours to a few days after the cessation of (or Carbamazepine or valproic acid use
reduction in) alcohol use described in Criterion A: in mild withdrawal
1. Autonomic hyperactivity • Antipsychotics
2. Increased hand tremor. • Thiamine, folic acid, multivitamin
3. Insomnia. to treat nutritional deficiencies
4. Nausea or vomiting. • Electrolyte and fluid corrected
5. Transient hallucinations or illusions. • Check for sign of hepatic failure
6. Psychomotor agitation.
7. Anxiety.
8. Generalized tonic-clonic seizures.
C. The signs or symptoms in Criterion B cause
clinically significant distress or impairment
in social, occupational, or other important areas of
functioning.
 ALCOHOL USE
1ST LINE TREATMENT DISORDER
• Naltrexone (Revia, IM- Vivitrol)
• Acamprosate (Campral)
2nd LINE TREATMENT
• Disulfiram (Antabuse)
• Topiramate (Topamax)
• Opioid receptor blocker
• Work by diminished desire/craving and
“high” associated with alcohol
• Thought to modulate glutamate
transmission
• Can be used in patients with liver
disease
• Contraindicated in severe kidney
disease
• Blocks the enzyme aldehyde
dehydrogenase in the liver and cause
aversive reaction to alcohol
• Contraindicated in severe cardiac
disease, pregnancy, psychosis
• Anticonvulsant that potentiates GABA
and inhibits glutamate receptors
• Reduce craving for alcohol
 CAFFEINE INTOXICATION
DIAGNOSTIC CRITERIA TREATMENT

A. Recent consumption of caffeine (>250 mg). • Supportive

B. Five (or more) of the following signs or symptoms developing during, or and
shortly after, caffeine use: symptomatic
1. Restlessness
2. Nervousness
3. Excitement
4. Insomnia
5. Flushed face
6. Diuresis
7. Gastrointestinal disturbance
8. Muscle twitching
9. Rambling flow of thought and speech
10. Tachycardia or cardiac arrhythmia
11. Periods of inexhaustibility
12. Psychomotor agitation
C. The signs or symptoms in Criterion B cause clinically significant distress
or impairment in social, occupational, or other important areas of
functioning.
D. The signs or symptoms are not attributable to another medical
condition and are not better explained by another mental disorder
 CAFFEINE WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Prolonged daily use of caffeine. No treatment
B. Abrupt cessation of or reduction in caffeine use, followed 1
Resolve within 1 2 weeks
within 24 hours by three (or more) of the following signs or
symptoms:
1. Headache
2. Marked fatigue or drowsiness.
3. Dysphoric mood, depressed mood, or irritability.
4. Difficulty concentrating.
5. Flu-like symptoms (nausea, vomiting, or muscle pain /
stiffness).
C. The signs or symptoms in Criterion B cause clinically
significant distress or impairment
in social, occupational, or other important areas of
functioning.
D. The signs or symptoms are not associated with the
physiological effects of another
medical condition and are not better explained by another
mental disorder, including intoxication or withdrawal from
another substance
 CANNABIS INTOXICATION
CLINICAL PRESENTATION TREATMENT
A. Recent use of cannabis. Supportive
B. Clinically significant problematic behavioral or Psychosocial intervention
psychological changes that developed during, or shortly after,
cannabis use

C. Two (or more) of the following signs or symptoms

developing within 2 hours of cannabis use:
1. Conjunctival injection
2. Increased appetite
3. Dry mouth
4. Tachycardia

D. The signs or symptoms are not attributable to another

medical condition and are not better explained by another
mental disorder, including intoxication with another
substance.
 CANNABIS WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Cessation of cannabis use tliat lias been heavy and prolonged Supportive and
B. Three (or more) of the following signs and symptoms develop symptomatic treatment
within approximately 1 week after Criterion A:
• Irritability, anger, or aggression
• Nervousness or anxiety
• Sleep difficulty
• Decreased appetite or weight loss
• Restlessness
• Depressed mood
• At least one of the following physical symptoms causing
significant discomfort

C. The signs or symptoms in Criterion B cause clinically

significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The signs or symptoms are not attributable to another medical
condition and are not better explained by another mental
disorder, including intoxication or withdrawal from another
substance.
 HALLUCINOGEN
(Phencyclidine Intoxication)
DIAGNOSTIC CRITERIA TREATMENT
A. Recent use of phencyclidine (or a pharmacologically similar - Monitor vital,
substance). temperature,
B. Clinically significant problematic behavioral changes (e.g., electrolyte
belligerence, assaultiveness, - Benzodiazepine
impulsiveness, unpredictability, psychomotor agitation, impaired for agitation,
judgment) that developed during, or shortly after, phencyclidine use. anxiety,muscle
C. Within 1 hour, two (or more) of the following signs or symptoms: spasm, seizure
• Vertical or horizontal nystagmus - Antipsychotic to
• Hypertension or tachycardia control severe
• Numbness or diminished responsiveness to pain agitation or
• Ataxia psychotic
• Dysarthria symptoms.
• Muscle rigidity
• Seizures or coma
• Hyperacusis
 INHALANT INTOXICATION
DIAGNOSTIC CRITERIA TREATMENT
A. Recent intended or unintended short-term, high-dose exposure to Monitor Airway,
inhalant substances, including volatile hydrocarbons such as toluene or Breathing, and
gasoline. Circulation
B. Clinically significant problematic behavioral or psychological changes
that developed during, or shortly after, exposure to inhalants.
C. Two (or more) of the following signs or symptoms developing
during, or shortly after,
inhalant use or exposure:
1. Dizziness.
2. Nystagmus.
3. Incoordination.
4. Slurred speech.
5. Unsteady gait.
6. Lethargy.
7. Depressed reflexes.
8. Psychomotor retardation.
9. Tremor.
10. Generalized muscle weakness.
11. Blurred vision or diplopia.
12. Stupor or coma.
13. Euphoria.
 OPIOID INTOXICATION
DIAGNOSTIC CRITERIA TREATMENT

A. Recent use of an opioid. • Ensure adequate airway, breathing,

B. Clinically significant problematic circulation
behavioral or psychological changes that • Administered naloxone (improve
developed during, or shortly after, opioid respiratory depression)
use. • Ventilatory support may be required
C. Pupillary constriction (or pupillary dilation
due to anoxia from severe overdose) and
one (or more) of the following signs or
symptoms developing during, or shortly after,
opioid use:
1. Drowsiness or coma.
2. Slurred speech.
3. Impairment in attention or memory.
 OPIOID WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Presence of either of the following; MODERATE SYMPTOMS:
1. Cessation of (or reduction in) opioid use that has Clonidine
been heavy and prolonged NSAIDs
2. Administration of an opioid antagonist after a
period of opioid use. SEVERE SYMPTOMS:
Detox with buprenorphine or
B. Three (or more) of the following developing within methadone
minutes to several days after Criterion A:
1. Dysphoric mood.
2. Nausea or vomiting.
3. Muscle aches.
4. Lacrimation or rhinorrhea.
5. Pupillary dilation, piloerection, or sweating
6. Diarrhea.
7. Yawning.
8. Fever.
9. Insomnia.
 STIMULANT INTOXICATION
DIAGNOSTIC CRITERIA TREATMENT
A. Recent use of an amphetamine-type substance, cocaine, or Rehydrate, correct
other stimulant. electrolyte balance, treat
B. Clinically significant problematic behavioral or psychological hyperthermia
changes that developed during, or shortly after, use of a stimulant.
C. Two (or more) of the following signs or symptoms, developing
during, or shortly after, stimulant use:
1. Tachycardia or bradycardia.
2. Pupillary dilation.
3. Elevated or lowered blood pressure.
4. Perspiration or chills.
5. Nausea or vomiting.
6. Evidence of weight loss.
7. Psychomotor agitation or retardation.
8. Muscular weakness, respiratory depression, chest pain, or
cardiac arrhythmias.
9. Confusion, seizures, dyskinesias, dystonias, or coma.
 STIMULANT WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Cessation of (or reduction in) Symptomatic treatment
prolonged amphetamine-type
substance, cocaine, or other stimulant
use.

B. Dysphoric mood and two (or more) of

the following physiological changes,
developing within a few hours to several
days after Criterion A:
1. Fatigue.
2. Vivid, unpleasant dreams.
3. Insomnia or hypersomnia.
4. Increased appetite.
5. Psychomotor retardation or agitation.
 TOBACCO WITHDRAWAL
DIAGNOSTIC CRITERIA TREATMENT
A. Daily use of tobacco for at least several weeks. Nicotine
replacement:
B. Abrupt cessation of tobacco use, or reduction in the amount of Patch, spray, gum,
tobacco used, followed within 24 hours by four (or more) of the lozenges
following signs or symptoms:
1. Irritability, frustration, or anger. Nicotine addiction:
2. Anxiety. Bupropion,
3. Difficulty concentrating. varenicline
4. Increased appetite.
5. Restlessness.
6. Depressed
 GAMBLING DISORDER
DIAGNOSTIC CRITERIA
Persistent and recurrent problematic gambling behaviour, as evidenced
by four or more of the following in a 12-month period:
1. preoccupation with gambling
2. need to gamble with increasing amount of money to achieve
pleasure
3. repeated and unsuccessful attempts to cut down on or stop
gambling
4. restlessness or irritability when attempting to stop gambling
5. gambling when feeling distressed
6. returning to reclaim losses after gambling
7. lying to hide level of gambling
8. jeopardizing relationship or job because of gambling
9. relying on others to financially support gambling
THANK YOU