1. SUBSTANCE ABUSE by Dr. C. S. Umeh Consultant Clinical Psychologist Consultant Clinical PsychologistLUTH

2. Concept of Substance Abuse Substance abuse is what the lay person calls drug abuse. In both ICD -10 and DSM – IV, substance abuse was preferred because not all substances that are abused are necessarily drugs eg inhalants However drug abuse is more popular

3. Concept contn’d A few authors have gone further to use the terms, Alcohol, Tobacco and other drugs Abuse (ATODA) in order to reflect the fact that the use of tobacco products is as harmful to health as the more popular drugs of abuse. In 1969, WHO defined a drug as any substance when taken into the body may modify one or more of its functions.

4. Concept contn’d Since many substances can do this without affecting the psychological functioning of the individual, the term psychoactive substances were then used to categorize this group of substances which are capable of producing psychological effects such as the alteration of moods, perception and consciousness

5. Development of Substance Dependence behaviour Substance dependence behavior develops gradually over a long time. Three factors influence the rate of development: The type of substance The dosage The frequency of use

6. Development Contn’d The combined effect produce dependence through the following: 1.Substance use 2.Substance misuse 3.Substance abuse 4.Craving 5.Tolerance 6.Psychological dependence (Habituation) 7.Physiological dependence (Drug addiction) 8.Withdrawal syndrome (Abstinence syndrome)

7. Other Features of Substance abuse Flashback Bad Trip Blackout Substance – induced psychosis

8. CLASSES AND EFFECTS OF PSYCHOACTIVE SUBSTANCES The effects of any psychoactive substance depends upon –the class or category to which it belongs, –the quantity used at a time and –the frequency of use. However, each class of psychoactive substances has distinctive psychopharmacological properties.

9. CLASSES AND EFFECTS CONTN’D The classes are: 1.DEPRESSANTS 2.STIMULANTS 3.HALLUCINOGENS 4.INHALANTS 5.DESIGNER SUBSTANCES 6.ANABOLIC STEROIDS

10. DEPRESSANTS These are substances which slow down or reduce the rate of functioning of the body organs and systems. The rate of slowing down depends on the sub-category the substance belongs. The common sub-categories are –alcohol, –narcotics,eg opium, codeine, heroine, morphine –barbiturates,eg phenolbarbitone andAmylobarbitone –minor tranquilizers eg benzodiazepine and diazepam – major tranquilizers.eg chlopromazine (largactil

11. STIMULANTS These are substances which promote wakefulness, increase body activities, induce mental alertness and generally increase heartbeat. Subcategories of stimulants are: cocaine, amphetamines,eg Benzedrine,Dextroamphetamine (dexedrin) methylphenidate (Ritalin) caffeine, nicotine and anti depressants

12. HALLUCINOGENS These are substances popularity called mind benders, psychedelic drugs or psychotomimetics. They produce radical changes in the mind of users. Some changes include vivid imagery, hallucinations, distortion of awareness and displacement of reality. Categories of hallucinogens are :

13. HALLUCINOGENS Contn’d CANNABIS- L S D – ( Lysergic acid diethylamide) PSILOCYBIN MESCALINE PCP (PHENCYCLIDINE) (Angel dust)

14. INHALANTS. These are commonly available commercial products eg include petrol, glue, shoe polish, nail vanish, aerosols and floor wax. Related substances are the synthetic substance otherwise called designer drugs. They are manufactured in the labs as isotopes or derivatives of other substances. The effect of both inhalants and designers drugs are similar to the combined effects of stimulants and hallucinogens

15. ANABOLIC STEROIDS These are substances which are used essentially to enhance performance in sports. Most of them are derivatives of the hormone-testosterone. They therefore have very powerful effects in influencing the hormonal activities of the body. Essentially, anabolic steroids are used to build muscles and to enhance the individuals stamina.

16. DSM Classification There are 4 substance related conditions recognized by DSM-IV. They are: 1.Substance intoxication 2.Substance withdrawal 3.Substance abuse 4.Substance dependence

17. Substance intoxication maladaptive behavioral or psychological changes directly resulting from the physiologic effects on the central nervous system of recent ingestion of or exposure to a psychoactive substance, particularly alcohol.

18. Substance withdrawal Experience of clinically significant distress in social, occupational or other areas of functioning due to the cessation or reduction of substance use. It can begin a few hours after cessation and could last for weeks.eg tremor, craving, seizure, sleep disturbances, fatigue, nausea, hallucination, anxiety, etc.

19. Substance abuse One or more of the following occurs during a 12 month period leading to significant distress: 1.Failure to fulfill important obligations at work, home or school due to substance use. 2.Repeated use of substance in hazardous situations 3.Repeated legal problem due to use. 4.Continued use of substance despite repeated legal or social problems

20. Substance dependence Three or more of the following: 1.Tolerance 2.Withdrawal 3.Substance taken for a longer time or greater amount than intended 4.Desire or effort to reduce or control use 5.Much time spent in activities to obtain it 6.Given up occupational or recreational activities 7.Use continued despite knowing worsening psych and physical problems.

21. ASSESSMENT Clinical interview Psychological tests Urine and blood screening tests

22. Cage questionnaire (Ewing,1984) 1. Have you ever felt you should cut down on your drinking? Yes No 2. Have people annoyed you by criticising your drinking? Yes No 3. Have you ever felt bad or guilty about your drinking? Yes No 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye- opener)? Yes No

23. MANAGEMENT Assessing for level of motivation for change. There is a model for change. It comprises Stage 1: Precontemplation - the client is not yet considering change or is unwilling to change Stage 2: Contemplation – the client acknowledges concernsand is considering the possibility of change but is ambivalent and uncertain

24. Management contn’d Stage 3: Preparation – the client is commited to and is planning to make a change in the near future but is still considering what to do Stage 4: action: the client is actively taking steps to change but has not yet reached a stable state

25. Management contn’d Stage 5: maintenance – The client has achieved initial goals such as abstinence and is now working to maintain gains Stage 6: the client has experienced a recurrence of symptoms and must now cope with consequences and decide what to do next.

26. Management contn’d Detoxification Psychotherapy Rehabilitation

27. Thank you for your attention