1. 11
Substance Abuse

2. Introduction Substance abuse is a major issue in today’s society.
The most commonly abused substances include: alcohol, prescription and OTC medications, and illegal drugs.
The most common addiction is to nicotine, found in tobacco products.

3. Substance Abuse
A substance abuse problem exists when 3 of the following occur:
Failure to fulfill obligations
Hazardous behavior
Recurrent related legal problems
Continued use despite social or interpersonal problems

4. Substance Dependence
A person is substance dependent if any 3 of the following exist:
Tolerance
Withdrawal
Increasing consumption
Desire to quit
Excessive time spent on abuse
Fewer social activities
Continued use while understanding the effects

5. Addiction
Addiction is defined as progressive, chronic use of a substance that causes the user to continue to use it despite serious health and social consequences.
The additive effect is any combination of substances that may be lethal.

6. Addictive Drugs Cannabinoids – marijuana, hashish
Depressants – barbiturates, benzodiazepines
Dissociative anesthetics – ketamine, PCP
Hallucinogens – LSD, mescaline
Opioids – morphine, codeine
Others – anabolic steroids, dextromethorphan

7. Polysubstance Abuse
Polysubstance abuse is the use of two or more substances of abuse.

8. Most Abused Drugs Marijuana – 5.8 percent of Americans
Sedatives –2.8 percent
Opioids – 2.1 percent
Cocaine – 0.8 percent
Hallucinogens – 0.4 percent
Methamphetamine – 0.2 percent

9. Early Substance Abuse
The earlier in life that substance abuse begins, the higher the chance for long-term effects.

10. CNS Depressants CNS depressants cause relaxation or sedation.
Except for alcohol, they are controlled due to their abuse potential.
Examples of CNS depressants are included in the following slides.

11. Barbiturates and Non-barbiturate Sedative-Hypnotics
These agents are known as sedatives (hypnotics).
They are used for sleep disorders and certain forms of epilepsy.
They may cause physical or psychological dependence as well as tolerance.

12. Benzodiazepines These agents have widely replaced barbiturates.
They are usually used to treat anxiety, but also for muscle relaxation and prevention of seizures.
Withdrawal is not as severe as from barbiturates or alcohol.

13. Opioids These agents are derived from unripe poppy seeds.
Parenteral forms cause a euphoric rush, intense sedation, an abnormally slow body functions.
Overdose is potentially fatal, and withdrawal is extremely unpleasant.

14. Cannabinoids These agents are obtained from the hemp plant.
They are usually smoked to obtain their effects.
The most psychoactive agent they contain is delta-9-tetrahydrocannibol (THC).

15. Marijuana Marijuana is regularly referred to as:
Pot, weed, grass, reefer, or dope
Daily use increases risk of lung cancer since it is inhaled more deeply than tobacco products.
It has recently been approved for restricted sale in some states for certain conditions, but is still a Schedule I drug.

16. Hallucinogens These agents produce “dreamlike” effects.
They are all Schedule I drugs with no approved medical use.
The prototype drug is lysergic acid diethylamide (LSD).

17. LSD
Common effects include hallucinations, visions, afterimages, and religious revelations.
Terrifying, negative experiences may also occur, with effects lasting up to 12 hours.

18. LSD
Flashbacks may occur, in which the user experiences the drug’s effects at a later date without recurrent use of the drug.

19. Other Related Drugs
Various forms of methamphetamines, including “Ecstasy”
Ketamine
Mescaline
PCP

20. CNS Stimulants Legally available by prescriptions
Used to treat narcolepsy, attention deficit hyperactivity disorder, and obesity
They improve mental and physical performance, but overdosage may cause seizures and cardiac arrest.

21. Amphetamines
Though amphetamines cause short-term alertness, long-term effects outweigh their benefits.
Illegally produced amphetamines are popular drugs of abuse (methamphetamine).
Common terms include: “meth,” “ice,” and “cat”.

22. Methylphenidate
This drug, sold as “Ritalin,” is a CNS stimulant used for children with ADHD.
It helps children to relax and focus, while having the opposite effect in adults.
It is a Schedule II drug that is commonly inhaled, injected, or mixed with heroin (a form known as a speedball).

23. Cocaine
Cocaine is obtained from the leaves of the South American coca plant.
A Schedule II drug with limited use, it is illegally used by inhaling, injecting, or smoking.
It has rapid, intense effects, but may cause serious nasal problems, convulsions, dysrhythmias, stroke, and death from respiratory arrest.

24. Caffeine
Caffeine is obtained from many different plants, and is commonly used in coffee, tea, soda, chocolate, and ice cream.
It causes increased alertness and insomnia.
Repeated use causes tolerance and dependence, but approved use includes being added to OTC pain relievers.

25. Effects of Substance Abuse
Anxiety and depression often lead to substance abuse.
Substance abuse often leads to:
Imprisonment
Unemployment
Cognitive dysfunction
Family problems
Financial loss
Poor decisions
Potentially hazardous sexual relationships

26. Risk Factors Risk factors for drug abuse include:
Absent or problem parents
Substance-abusing peers or parents
Permissive parents
Poor parental discipline
Access to prescriptions

27. Additional Risk Factors
Student absenteeism
Aggressive behavior
Poor social skills
Poor academic performance
Early drug use

28. Treatment
When treating addiction, detoxification must first take place.
This is the period of getting over physical withdrawal symptoms.
Psychological treatment involves motivational therapy, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

29. Allihays / Dreamstime
Figure Alcoholics Anonymous is one of the most popular treatment programs available for substance abusers.

30. Therapies
Often, therapies include interactions with the user, peers, and families.
Psychotherapy, drug counseling, and urine testing may be required.
Pharmacological treatments may be indicated for certain addictions (example: methadone, which is used for heroin addictions).

31. Cigarette Smoking
The single largest preventable cause of death and illness in the United States is smoking (mostly due to lung cancer).
Tobacco dependence is its continued consumption despite significant physical, economic, or social side effects.

32. Cigarette Smoking
Smoking-related cancers often occur when the smoker is in his or her 30s, and often lead to death

33. Smailhodz / Shutterstock
Figure Smoking is the single-largest preventable cause of death and illness in the United States.

34. Nicotine
Nicotine is highly addictive and carcinogenic, affecting most body systems.
It accelerates heart rate, increases blood pressure, and may result in abnormal muscular contractions.
Withdrawal causes anxiety, insomnia, headaches, and gastrointestinal disturbances.

35. Effects of Smoking
Family incidence of cancer means the smoker has a much more likely chance of neoplasms.
Heart disease is greatly increased.
Chronic lung diseases will shorten life.

36. Effects of Smoking Lower back pain is greatly increased.
Smoking repels many potential relationships.
It causes premature aging and wrinkling.

37. Smoking Cessation Techniques
Clinics
Hypnotherapy
Progressive filters
Bupropion
Varenicline
Employer-offered financial incentives
Drug counseling
Acupuncture
Literature
Nicotine replacement

38. Alcoholism Long-term abuse causes devastating effects. Alcohol causes:
Relaxation or sedation
Memory impairment
Loss of coordination
Decreased inhibition
Reduced judgment

39. Alcohol Metabolism
Alcohol is metabolized at the rate of about one serving per hour.
This means:
12 ounces of beer
5 ounces of wine
1.5 ounces of “hard liquor”

40. Effects of Alcoholism
More than 85,000 Americans die every year due to alcohol use and related behaviors.
Withdrawal is severe, including delirium tremens (DTs), which includes confusion, agitation, panic, “crawling skin,” and paranoia.
Cirrhosis of the liver is debilitating and potentially fatal.

41. Treatment of Alcoholism
Acute withdrawal is treated with benzodiazepines and antiseizure medications.
Behavioral counseling, self-help groups, and drugs such as disulfiram may all be beneficial.
Additional treatments include acamprosate calcium and naltrexone.