Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA

Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA
University of the East Medical Center Veterans memorial Medical Center Past President, PPA Advisory Board Abbott Laboratories- mood stabilizer Eli Lilly antidepressant Astra Zeneca antipsychotic Medichem GSK Speaker’s Bureau Abbott Laboratories Astra Zeneca Researches/GrantSupport Eli Lilly Les Servier Janssen Pharmaceutica Otsuka Novartis Astra Zeneca Lundbeck Pfizer

On Addiction.... . . . “ An enemy more insidious than those that offer overt threats to national security; for it strikes deep at the physical condition and moral fiber of our national strength; and lays to waste our most valuable assets, namely, the people”. . . The Late PRES. CORY C. AQUINO

SUBSTANCES of ABUSE: its Related Disorders
Felicitas Artiaga- Soriano, M.D., FPPA

Objectives: To know the drugs of abuse and its psychological and physical effects. To learn the substance-related disorders. What is drug abuse/dependence? Signs and Symptoms. How can one become a drug abuser/dependent? (neurobiology of addiction). The Philippine drug scene

Joaquin Phoenix Eva Mendes Heather Locklear Edgar Allan Poe Mel Gibson He went into rehab for six weeks in 2005, admits he was ‘close to dying‘. The acclaimed actor was quoted as saying “I was drunk or high since I was 14.” Collin Farrell

DRUG ADDICTION IS A COMPLEX ILLNESS
Addiction, is not merely the chronic use of drugs, it is characterized by compulsive, craving, seeking, and use/practice that persists even in the face of negative consequences DRUG ADDICTION IS A COMPLEX ILLNESS “loss of control”

Drug Addiction is also known as:
A.) Drug Abuse B.) Drug Dependence C.) Both D.) None of the Above

Common Underlying Neurobiological
Factors Can Be: Neurochemical (imbalance of neurotransmitters) Structural/anatomical (same regions and pathways) Genetic (inherited factors that compromise function)

Factors Affecting Vulnerability
Presence of a psychiatric disorder Physical abuse Poor social skills

Mental and Addictive Disorders
Double People With Comorbid Mental and Addictive Disorders Have a Brain Disease Mental Disorder Addictive Disorder Comorbid Disorders

Why do people use drugs? A.) To experiment/curiosity
B.) Recreational use/casual users-for fun and thrill C.) Peer pressure D.) Iatrogenic E.) Help deal with social interactions F.) Self medication-to decrease anxiety, depression, fears, pain or fight insomnia, etc

DRUG USE (Self-Medication) What Role Does Stress Play
Anxiety DRUG USE (Self-Medication) What Role Does Stress Play In Initiating Drug Use? CRF CRF STRESS Anxiety

ADDICTION IS A DEVELOPMENTAL DISEASE
starts in adolescence and childhood 1.8% TOBACCO THC 1.6% ALCOHOL 1.4% 1.2% % in each age group who develop time dependence 1.0% 0.8% 0.6% first 0.4% 0.2% 0.0% 5 10 15 21 25 30 35 40 45 50 55 60 65 Age Age at tobacco, at alcohol and at cannabis dependence as per DSM IV NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

HOW DOES ADDICTION OCCUR?

Brain Regions and Their Functions
Certain parts of the brain govern specific functions. For example, the cerebellum is involved with coordination; the hippocampus with memory. Nerve cells (neurons) are the basic unit of communication in the brain. Information is relayed from one area of the brain to other areas through complex circuits of interconnected neurons. Information via electrical impulses transmitted from one nueron to many others is done through a process called “neurotransmission.”

Dopamine Pathways Serotonin Pathways striatum frontal hippocampus
nucleus accumbens hippocampus striatum frontal cortex substantia nigra/VTA raphe Functions reward (motivation) pleasure, euphoria motor function (fine tuning) compulsion perseveration decision making Functions mood Memory processing sleep cognition

Important neurotransmitters in the reward pathway
Norepinephrine – chemical messenger to cause us to protect ourselves when we are angry or afraid, the flight-or fight responses.( modulate reward dependence) Dopamine – chemical messenger for exploratory behavior and pleasure. (well-being, arousal, reward) Endorphins – chemical messengers for relieving pain and stress Gamma-aminobutyric Acid (GABA)- inhibition of stimulation Serotonin- modulate harm avoidance (tendency to respond intensely to aversive stimuli and their conditional signals) Glutamate- excitatory Opioid rewarding and reinforcing

Different Drugs, Same Ultimate Effect
Source: Nestler, EJ and Malenka, RC, Scientific American, pp , March 2004.

Medial Forebrain Bundle
REWARD SYSTEM Medial Forebrain Bundle Dopamine Positive reinforcement c J Pleasure

c L WITHDRAWAL SYSTEM Abstinence Locus Ceruleus Negative reinforcement
Dopamine Noradrenaline Negative reinforcement L Discomfort c G-proteins Adenylate Cyclase CAMP Kinase

What Happens When A Person
Stops Taking A Drug? Anxiety RELAPSE Prolonged DRUG USE CRF Abstinence

Drugs & its Psychological and Physical Effects
Good afternoon. This afternoon, I shall be discussing drugs, what its effects in our brain, as well as societal effects.

Substance A substance is any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors. It may be: Legal but controlled or taxed Legal prescribed with restrictions Illegal Naturally occurring synthetic Felicitas I. Artiaga-Soriano, M.D., FPPA

The Commonly abused drugs/substances
Opioids and opiates- opium, morphine, methadone, codeine, meperidine (Demerol) Sedatives/Hypnotics- barbiturates, benzodiazepines, chloral hydrate and others Hallucinogens- LSD, phencyclidine (PCP), cannabis (marijuana) Felicitas I. Artiaga-Soriano, M.D., FPPA

The Commonly abused drugs/substances:cont……
Stimulants- amphetamines, metamphetamine (Shabu) and cocaine Alcohol- beer, gin, wine Caffeine- coffee, softdrinks Nicotine- cigarettes, chewing tobacco Inhalants and Solvents- (volatile hydrocarbons)- rugby, kerosene, gasoline, thinner Felicitas I. Artiaga-Soriano, M.D., FPPA

Categories of Drugs Felicitas I. Artiaga-Soriano, M.D., FPPA

Categories of Drugs Stimulants - “uppers”
- stimulate the central nervous system - amphetamines, amyl nitrite, cocaine, crack, ecstasy Depressants - “downers” - depress the central nervous system - alcohol, barbiturates, benzodiazepines Analgesics - powerful painkillers - from opium poppy or synthetically produced Hallucinogens - “psychedelics” - dramatically alter perception - LSD, psilocyn, psilocybin, cannabis, ecstasy

Views of the Seriousness of Health Problems (Top Ten of Thirty-Six Problems)
65% 68% 69% 71% 73% 74% 75% 78% 82% Stress Alcohol abuse Smoking Child abuse Violence HIV/AIDS Heart disease Drunk driving Cancer Drug abuse % saying “very serious problem” Harvard School of Public Health/Robert Wood Johnson Foundation/ICR, August 2000 Drug abuse Drug Abuse and Addiction are Among the Most Serious Public HealthProblems Facing Our Society Cancer Drunk driving Heart disease HIV/AIDS Violence Child abuse Smoking Alcohol abuse Stress

Worldwide Estimated 190 million addicts around the world
About 3-4% of the total world population regularly abuse drugs 140 million marijuana addicts 30 million amphetamine-type stimulants addicts 13 million heroin addicts 8 million cocaine addicts Int’l drug cartel earn $400B/year=8% of the world trade

The Philippine Drug Scene

Philippines 2.0 million drug users
1.2 million Filipino Youth using drugs (National Youth Commission)- 15 – 17 years old Monthly consumption of 5-10 grams At 5 gms=8.5 million grams total consumption per month=17B pesos monthly=204 B pesos annually expected to hit 300B (50% national budget in 2002)

The Philippine Drug Scene
RA 9165 – Comprehensive Dangerous Act of 2002 signed June 7, 2002 stiffer penalties for illegal drug possession and pushing RA 7624 – Integrated Drug Prevention Control in the Intermediate & Secondary Curricula signed July 22, 1991 Drug users:  300% annually Growing number of executives – hooked on drugs Growing problem: production of shabu in the country Philippines: serves as a transit point – strategic location

Profile of a Filipino Drug User:
Age: 26 years old (24-29 years old) Sex: male (11:1) Civil Status: single 55.78% Birth order: eldest Family size: three (3 )-four (4) siblings Educational Attainment: High School level 27.77% IQ: Average Felicitas I. Artiaga-Soriano, M.D., FPPA

Profile of the Filipino Drug Abusers, cont…..
Occupation: Workers/employees 42.51% Unemployed % Self-employed % Students % OSY % Economic Status: middle income Place of Residence: Urban esp. NCR % Region IV % Region III % Region VII % Region X % Felicitas I. Artiaga-Soriano, M.D., FPPA

Profile of the Filipino Drug Abusers, cont…..
Nature of Drug Taking- Mono drug-use Drugs of Use Shabu, Marijuana Duration of Drug-Taking More than two ( 2 ) years Felicitas I. Artiaga-Soriano, M.D., FPPA

Use of Illegal Substances by Age Group
by the Mcgraw-Hill Co. Inc, All right reserved Felicitas I. Artiaga-Soriano, M.D., FPPA

Terminology II. Substance-induced disorder I. Substance use disorder
Substance-related disorder II. Substance-induced disorder I. Substance use disorder Substance intoxication Substance withdrawal Substance abuse Substance-induced Delirium, Dementia, Amnestic disorder Psychotic disorder Mood disorder Anxiety disorder Sexual dysfunction Sleep disorder Substance dependence

Identification of a Drug User

Identification of a Drug User
excitable, hostile, violent, destructive behavior, outbreaks of temper unsteadiness, clumsiness slurred speech, talking to oneself in a state of confusion dreamy, hallucinations lack of personal hygiene loss of concentration or attention loss of interest in personal care & appearance, food, family activity social withdrawal sudden decline in attendance or performance in school frequent job hopping frequents places like storage rooms, toilets, isolated corners sores on nose & mouth (glue sniffers), runny nose, bloodshot eyes smell solvents on breath, clothes, hair (glue sniffers)

I’ve slept with too many women, done too many drugs and been to too many parties. I loved acid (LSD) when I was at college. It was an escape. I liked mushrooms (PCP). They were like easy acid. I did like blow…Blow would dress you up for a party, but never take you there. You’re always like, This is going to be great! Then you’re just depressed.” – George Clooney, in 1997

The User The Abuse The Dependence

I. Substance Abuse vs. Substance Dependence
DRUG ABUSE; 1 of Recurrent substance use: -failure to fulfill major obligations at work, school, or home. -physically hazardous -related legal problems - persistent or recurrent social or interpersonal problems Drug Dependence; 3 of ---same Tolerance- markedly increased amounts; markedly diminished effect taken in larger amounts or over a longer period Withdrawal unsuccessful efforts to reduce/ cut down great deal of time is to obtain or use or recover Important activities are given up or reduced Use continues despite problems 12-month period Felicitas I. Artiaga-Soriano, M.D., FPPA

Examples of Drug Addiction: People who could not quit
actor Robert Downey, Jr. nominated for Academy Award for his role in “Chaplin” (1992), when he was 27 years old played a cocaine addict in “Less Than Zero” (1987) own drug problems began at an early age Served a 3-year prison term for drug possession (released in 2000)

II. Substance-induced disorders:
symptoms of the disorder are present, having developed during or within a month of substance intoxication or withdrawal the symptoms are in excess of those usually associated with the intoxication and withdrawal syndrome and sufficiently severe to warrant independent clinical attention. Felicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders
Substance intoxication: Experience reversible, substance-specific, 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 Substance withdrawal: Experience of clinical significant distress in social, occupational, or other areas of functioning due to the cessation or reduction of substance use. Felicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders Narcotics- Opium, Morphine,Codeine,Heroin Intoxication Withdrawal
M ood is dysphoric A ches in muscles and bones N ausea, vomiting Y awning P iloerection-gooseflesh A gonist removes withdrawal symptoms I nsomnia N ot life threatening D iarrhea E levated temperature,RR, BP A bdominal cramps L acrimation and rhinorrhea Judgment is impaired Apathy Dysphoria Eye changes- constriction Drowsiness Psychomotor changes Attention is impaired Speech is slurred Triad - of coma, pinpoint pupils, and respiratory depression Felicitas I. Artiaga-Soriano, M.D., FPPA

“I hate heroin because I’ve been fascinated by it
“I hate heroin because I’ve been fascinated by it. I’m not immune, but I won’t do it now, at all.” “I’ve done just about every drug possible. Coke, heroin, ecstasy, LSD, everything. The worst effect, for me, was pot (MJ). I felt silly and giggly, and I hate feeling like that,” before recalling, “I remember taking LSD before I went to Disneyland. I started thinking about Mickey Mouse being a short, middle-aged man in a costume who hates his life. Those drugs can be dangerous if you don’t go into it positively. I gave them up long ago.” – Angelina Jolie, in 1998 “If someone wants to do drugs…as long as he or she isn’t corrupting minors or driving under the influence or endangering others, shouldn’t a person have that right?” – Brad Pitt, in 2006

Opium Opium pod & derivatives oxycontin

Codeine in various forms
Morphine Codeine in various forms Methadone Morphine in various forms

Heroin in plastic Heroin in various forms with balloons Heroin in off white powder form

II. Substance-Induced Disorders CNS Depressants- Alcohol, Sedative/Hypnotic, Anxiolytics
Intoxication Withdrawal Speech is slurrred Incoordination, Ataxia Nystagmus Gait is unsteady Inattention and memory deficits Numb- pain threshold increases Appears drunk with drowsiness Pupil size is normal Respiratory Depression Perceptual disturbances- hallucinations or illusions Insomnia, Irritability Nausea, vomiting Tremor-usually seen in the hands Delirum tremens Confusion Disorientation Delusional thinking Onset is from hours to 3 days after last consumption Flushing of the face Autonomic hyperactivity- heart rate, BP, temperature Seizures- grand mal (tonic-clonic) Agitation Death Felicitas I. Artiaga-Soriano, M.D., FPPA

DepressantPills Downers (various) Barbiturate Pills Benzodiazepine Pills

Alcohol Abuse and Alcoholism
Relaxation Sociability Cheap High Brand / Generic Names Beer, Wine, Brandy, Gin, Tequila, Vodka, Whiskey. Street Names Booze, Brew, Cold One, Juice, Sauce, Wahoo Juice

ALCOHOL Ethyl alcohol=ethanol=beverage alcohol
1 oz of alcohol/hour is metabolized by an average, healthy person 30mg/dL=signs of intoxication in an in experienced drinker 200mg/dL=everyone is intoxicated 500mg/dL=unconsciousness occurs mg/dL=death Felicitas I. Artiaga-Soriano, M.D., FPPA

Alcoholism Alcohol is a depressant that decreases the responses of the central nervous system. Excessive drinking can cause liver damage and psychotic behavior. As little as two beers or drinks can impair coordination and thinking. Alcohol is often used by substance abusers to enhance the effects of other drugs. Alcohol continues to be the most frequently abused substance among young adults.

‘Celebrity Alcoholics’
67

Celebrity Alcoholics Betty Ford Nick Nolte Lindsay Lohan
David Hasselhoff Ernest Hemmingway Kiefer Sutherland Amy Winehouse 68

Alcoholism and Nicotine Addiction
Heavy smokers > 20 cigarettes / day 70% of alcoholics 10% of the general population

Nicotine Tobacco Street Names
Butts, Coffin Nails, Fags, Snuff, Chew, Nicotine, Chaw, Stogies, Skag, Gasper, Cig, Smoke, Pill, Dog Turd

CIGARETTES Physical dependence and brain rewards without intoxication
Serious habit without impairment in everyday life. Most lethal of all dependencies, causing more deaths than alcohol and all other drugs combined. Cigarette smoking is highly correlated with drug and alcohol use

II. Substance-Induced Disorders Nicotine-cigarettes, tobacco
Intoxication Withdrawal Highly toxic alkaloid Doses of 60 mg are fatal Nausea, vomiting Pallor Weakness Diarrhea Dizziness Headache Hypertension Tachycardia Tremor Cold sweats Confusion Sensory disturbances Depressed mood Insomnia Irritability, frustration or anger Anxiety Difficulty concentrating Restlessness Bradycardia Increased appetite or weight gain Most lethal of all dependencies, causing more deaths than alcohol and all other drugs combined Felicitas I. Artiaga-Soriano, M.D., FPPA 72

II. Substance-Induced Disorders Caffeine
Intoxication Withdrawal Insomnia Flushed face Arrythmia Rambling-thought and speech Muscle twitching GI disturbances Restlessness Excitement Nervousness Agitation Diuresis Energy level increases Several cups of coffee (250mg or more of caffeine)-2-3 cups of instant coffee agitation depression irritability insomnia loss of appetite severe trembling shaking and increase heart rate 330ml can of Coke -11mg Cup of tea mg Instant coffee mg Felicitas I. Artiaga-Soriano, M.D., FPPA 73

Marijuana Cannabis sativa (Brand / Generic Names)
Hash Oil, Hashish, Marijuana, Marinol, Dranabinol, Thai Stick.

You probably know why marijuana is abused
Relaxation Euphoria “Pot--'Gateway'to Harder Drugs”

Marijuana Called the “careless drug” because pot users often lose the capacity to care. In the most extreme form, this is called the “amotivational syndrome,” meaning that chronic pot smokers become listless and apathetic, not just when using the drug but all of the time.

II. Substance-Induced Disorders Cannabis- Marijuana
Intoxication Withdrawal Mouth is dry Appetite increases- “the munchies” Tachycardia Conjunctival injection Heightened sensitivity to stimuli Drowsy Euphoric states Disturbance in perception of time and space Hallucinations No specific withdrawal symptoms Felicitas I. Artiaga-Soriano, M.D., FPPA 77

Marijuana leaves seeds In joint rolling In plastic bag In block

Cannabis Hashish oil Coca leaves and powder

CNS Stimulants Uppers (Brand / Generic Names)
Cocaine, Amphetamine, Methamphetamine, Methylphenidate, Phenmetrizine

II. Substance-Induced Disorders CNS Stimulants- Cocaine, Amphetamine, Methamphetamine, Methylphenidate Intoxication Withdrawal Dilated pupils Arrythmias Respiratory depression Nausea and vomiting Blood pressure changes- increase or decrease, CVA Anorexia,insomnia Psychomotor agitation or retardation Sweating- perspiration or chills Pulse changes-tachycardia or bradycardia Paranoid thoughts Neurologic abnormalities-confusion,seizures, death Sleep problems-insomnia or hypersomnia Psychomotor changes- agitation or retardation Appetite increases Crusty mood-dysphoria Energy level decreases- fatigue Dreams-unpleasant and vivid Suicidal depression Felicitas I. Artiaga-Soriano, M.D., FPPA

“My mind seemed to have a huge neon sign in it that blinked nonstop: COKE. GET COKE. So I did. It was great for dieting, partying and picking up my mood.” – Drew Barrymore (who had gone through rehab twice by age 13), in 1996

You probably know why ice is abused –
Temporary mood elevation Exhilaration (high) Increased mental alertness Upper-increase wakefulness Also known as: Meth, Crystal, Crank, ICE Methamphetamine

But did you know that – Ice is extremely addictive - sometimes with just one use! Ice can cause convulsions, heart irregularities, high blood pressure, depression, restlessness, tremors, severe fatigue. An overdose can cause coma and death. When you stop using ice you may experience a deep depression. Ice causes a very jittery high, along with anxiety, insomnia, sometimes paranoia degeneration of neurons  underlying cause of Parkinson’s disease

How is Meth addiction different than other addictions. (Dr
How is Meth addiction different than other addictions? (Dr. Elizabeth Faust, testimony to ND legislature June 2004. High is stronger, better, faster, lasts longer Onset of dependence more intense and rapid Relatively cheap and plentiful Synthetic – can be made anywhere Cognitive impairment lasts longer and some cognitive impairment may be permanent Source of a serious crime problem

Club Drugs METHAMPHETAMINE
other names: Ice, speed, tweak, crank , glass, shabu white powder or clear, crystal “rock” release large amounts of dopamine = highly addictive stimulant enhance mood and body movement taken orally, intranasally, intravenously, rectally Desired effects smoking, intravenous: intense, very pleasurable sensation intranasal and oral: “high” feeling 3 – 5 mins (intranasal); mins (oral); can last: 24 hours

C candy Charlie coke bump blow
Cocaine Powder Cracked cocaine C candy Charlie coke bump blow cocaine Amphetamines in various capsules

Methamphetamine S p e e d shabu I C E

II. Substance-Induced Disorders Hallucinogens, PCP, Designer Drugs-XTC (Ecstasy)-Methylenedioxymethamphetamine Intoxication Withdrawal Vision is blurred Incoordination Synesthesias- blending of sensory perceptions Illusions Tremors Thought content changes- ideas of reference, paranoia Hallucinations Euphoria Pupillary dilatation, Palpitations Altered perception- depersonalization, derealization Sweating Tachycardia Death While not strictly withdrawal symptoms, some other side-effects include flashbacks and dehydration. Severe Effects altered mental status hyper/hypothermia Convulsions Hypertension Coagulopathy Acute renal failure Hepatotoxicity Death Felicitas I. Artiaga-Soriano, M.D., FPPA

Stacy ecstasy x lover’s speed E xtc Essence

Club Drugs ECSTASY “Candyflipping” – combined used of ecstasy and LSD
“Stacking” – taking ≥ 3 E tablets at once, mixing it with other drugs How Ecstasy Works Half-life is 6 hours Onset action – vary from person to person Serotonin and dopamine – released into the brain  perception of pain, body temperature overheat – without feeling any discomfort

Club Drugs ECSTASY The E “Rush”
Instantaneous rush – sec, lasting to mins Sudden clarity, intensification of perceptions, altered perception of time Inner sensation of happiness, sense of loving (sensual drug) “booster dose” – hope to prolong the sensations  tolerance: desired effects;  in adverse effects “bubble bursting” – anxiety, paranoia, nausea, panic 30 mins–3 hrs after initial rush: “plateau” phase of > intense feelings trance-like movements  long lasting ecstatic “trance-dancing” Hangover effect Anhedonia

Club Drugs ECSTASY The After “Rush”
coming down: 3 – 6 hrs after initial ingestion feelings of disappointments: anxiety, depression sluggishness & residual effects: lasts up to several days 6-7 hours to fall asleep after returning to “normal” “Tuesday blues” – from depletion of serotonin Long term effects still uncertain BUT subsequent depression may occur due to short-circuit of serotonin pathway & serotonin shortage

Club Drugs HERBAL ECSTASY
Other names: Ma huang, ephedra, Cloud 9, Herbal Bliss, Rave Energy Combination of stimulants – to stimulate effects of XTC Common use: stimulant or weight loss agent Available: many health food stores or by mail order Present in food supplements: Metabolift or Metabolife 356 tachycardia – resting pulse rate or heartbeat: >100 bpm Bradycardia – resting pulse rate or heartbeat: <60 bpm In US: No regulation from US-FDA Found in many OTC cold preparations Adverse Effects Tachycardia, hypertension, stroke, seizure, heart attack, death

LSD in Blotter Paper Acid

LSD in forms

Ketamine - special Ketamine

Solvent and Aerosol Inhalants
Glue sniffing Street Names Poppers, Snappers, Bolt, Bullet, Climax, Locker Room, Rush, Buzz Bombs, Whippets Some of the substances that are abused: Butyl nitrite, Amyl nitrite, Gas in aerosol cans Gasoline and Toluene vapors, Correction fluid, glue, marking pens, nail polish, lighter fluids, lacquers, cleaning fluids and spot removers

You probably know why inhalants are abused –
Cheap High Quick buzz Fun

But did you know that inhalants may cause –
Loss of muscle control Slurred speech Drowsiness or loss of consciousness Excessive secretions from the nose and watery eyes Brain damage and damage to lung cells

II. Substance-Induced Disorders Inhalants-glue, gasoline, chloroform
Intoxication Withdrawal Gait is unsteady Aggressiveness or assaultiveness Speech is slurred Ocular changes- blurred vision or diplopia(Glass eyed appearance) Lethargy Incoordination Nystagmus Euphoria Dizziness Apathy Reflexes are depressed Tremor No specific withdrawal symptoms Felicitas I. Artiaga-Soriano, M.D., FPPA 104

Substance-Induced Disorders

II. Substance-Induced Disorders
What is dementia? Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate. After a while, this makes it hard for the person to take care of himself or herself. Dementia may also change a person's mood and personality. At first, memory loss and trouble thinking clearly may bother the person who has dementia. Later, disruptive behavior and other problems may start. The person who has dementia may not be aware of these problems Felicitas I. Artiaga-Soriano, M.D., FPPA

What is Delirium? The symptoms of delirium can start rather suddenly--within a few hours or a few days. There should be fluctuations of the symptoms over an hour or throughout the day. Delirium is usually characterized by: Unawareness of surroundings. Confusion - they don't know where they are or what they're doing. Not knowing the time, date, day, etc. Difficulty concentrating. Forgetting past events or recent information. Incoherent or rambling speech. Disorganized thinking. Misinterpretations of other's speech. Hallucinating. Felicitas I. Artiaga-Soriano, M.D., FPPA

Amnestic disorder includes the 3 symptoms listed below: Memory disturbances Memory loss Decline in memory ability Felicitas I. Artiaga-Soriano, M.D., FPPA

What is a psychotic disorder? Psychotic disorders are mental disorders in which the personality is seriously disorganized and a person's contact with reality is impaired. During a psychotic episode a person is confused about reality and often experiences delusions and/or hallucinations. Felicitas I. Artiaga-Soriano, M.D., FPPA

Amphetamine-induced Psychosis vs. Schizophrenia
ATS-Psychosis Schizophrenia Delusions Paranoia Paranoia Affects Appropriate Flattening Hallucination Visual Auditory Thinking Intact Disordered Hyperactivity Common Hypersexuality Common

Mood Disorders Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong. Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts. Mania and depression may vary in both duration and degree of intensity. Felicitas I. Artiaga-Soriano, M.D., FPPA

Anxiety Disorder- produces an intense, often unrealistic and excessive state of apprehension and fear. This may or may not occur during, or in anticipation of, a specific situation, and may be accompanied by a rise in blood pressure, increased heart rate, rapid breathing, nausea, and other signs of agitation or discomfort. Felicitas I. Artiaga-Soriano, M.D., FPPA

Sexual Dysfunctions: Impaired Desire Impaired Arousal Impaired Orgasm Sexual Pain Felicitas I. Artiaga-Soriano, M.D., FPPA

Alcohol and Sex In small amounts alcohol has been reported to have a positive impact on sexual desire and arousal. At the same time, research shows that even after a few drinks sexual response is reduced. In large amounts alcohol makes sex difficult to impossible. While in moderate amounts alcohol can have an impact on engaging in risky sexual behavior, although this impact is not fully understood. As drinking increases both men and women will experience a reduction in sexual arousal, men may have difficulty getting erections, and both men and women may have difficulty experiencing orgasm. Felicitas I. Artiaga-Soriano, M.D., FPPA

Sleep Disorders There are more than 70 different sleep disorders that are generally classified into one of three categories: lack of sleep (e.g., insomnia), disturbed sleep (e.g., obstructive sleep apnea), and excessive sleep (e.g., narcolepsy). Felicitas I. Artiaga-Soriano, M.D., FPPA

Alcohol as an example Substance use disorders:
Alcohol Dependence Alcohol Abuse Substance-Induced Disorders Alcohol Intoxication Alcohol Withdrawal Alcohol Intoxication Delirium Alcohol Withdrawal Delirium And so on. Delirium, Dementia, Amnestic disorder Psychotic disorder Mood disorder Anxiety disorder Sexual dysfunction Sleep disorder Felicitas I. Artiaga-Soriano, M.D., FPPA

Non-drug addictions

Non-drug addiction

Non-drug addiction Matt Damon- Gambling
Kate Moss- Isopropyl nitrite (Poppers)-for extra sexual pleasure or response David Duchovny- Sex addiction Ben Affleck- Gambling 119

Check out this list: bet some of them are a real shocker
Check out this list: bet some of them are a real shocker! This is a list we’re starting to track every last celebrity who has been to rehab for alcohol/drug/sex etc rehab. Remember to click the read more link to see the FULL list! We’re going to keep this list updated so we have ALL the celebrity addicts who have been to rehab - Betty Ford - Kirsty Alley - J. Paul Getty, Jr. - Robert F. Kennedy, Jr. - Robin Williams - Robert Downey, Jr. - Ray Kroc - Eminem - Patrick Kennedy - Ben Affleck - - James Frey - Nick Nolte - Jan Michael Vincent - Nick Carter - Boy George - Michael Jackson - Keith Richards - Robert Mitchum - Judy Collins - Rush Limbaugh

Your Brain on Drugs This is literally the brain on drugs.
1-2 Min 3-4 6-7 7-8 8-9 This is literally the brain on drugs. When someone gets “high” on cocaine, where does the cocaine go in the brain? With the help of a radioactive tracer, this PET scan shows us a person’s brain on cocaine and the area of the brain, highlighted in yellow, where cocaine is “binding” or attaching itself. This PET scan shows us minute by minute, in a time-lapsed sequence, just how quickly cocaine begins affecting a particular area of the brain. We start in the upper left hand corner. You can see that 1 minute after cocaine is administered to this subject nothing much happens. All areas of the brain seem to be functioning normally. But after 3 to 4 minutes [the next scan to the rightl, we see areas highlighted in yellow where cocaine is starting to bind to the striatum [stry-a-tum] of the brain and activate it. At the 5- to 8-minute interval, we see that cocaine is affecting a large area of the brain. After that, the drug’s effects begin to wear off. At the 9- to 10-minute point, the high feeling is almost gone. Unless the abuser takes more cocaine, the experience is over in about 20 to 30 minutes. Scientists are doing research to find out if the striatum produces the “high feeling”and controls our feelings of pleasure and motivation. One of the reasons scientists are curious about specific areas of the brain affected by drugs such as cocaine is to develop treatments for people who become addicted to these drugs. Scientists hope to find the most effective way to change an addicted brain back to normal functioning. Photo courtesy of Nora Volkow, Ph.D. Mapping cocaine binding sites in human and baboon brain in vivo. Fowler JS, Volkow 9-10 10-20 20-30

Your Brain After Drugs Side 45: Long-term effects of drug abuse.
This PET scan shows us that once addicted to a drug like cocaine, the brain is affected for a long, long time. In other words, once addicted, the brain is literally changed. Let’s see how... In this slide, the level of brain function is indicated in yellow. The top row shows a normal-functioning brain without drugs. You can see a lot of brain activity. In other words, there is a lot of yellow color. The middle row shows a cocaine addict’s brain after 10 days without any cocaine use at all. What is happening here? [Pause for response.] Less yellow means less normal activity occurring in the brain—even after the cocaine abuser has abstained from the drug for 10 days. The third row shows the same addict’s brain after 100 days without any cocaine. We can see a little more yellow, so there is some improvement— more brain activity—at this point. But the addict’s brain is still not back to a normal level of functioning. . . more than 3 months later. Scientists are concerned that there may be areas in the brain that never fully recover from drug abuse and addiction.

The Memory of Drugs Nature Video Cocaine Video Amygdala not lit up
Amygdala activated Anterior The memory of drugs. This slide demonstrates something really amazing—how just the mention of items associated with drug use may cause an addict to “crave” or desire drugs. This PET scan is part of a scientific study that compared recovering addicts, who had stopped using cocaine, with people who had no history of cocaine use. The study hoped to determine what parts of the brain are activated when drugs are craved. For this study, brain scans were performed while subjects watched two videos. The first video, a nondrug presentation, showed nature images—mountains, rivers, animals, flowers, trees. The second video showed cocaine and drug paraphernalia, such as pipes, needles, matches, and other items familiar to addicts. This is how the memory of drugs works: The yellow area on the upper part of the second image is the amygdala (a-mig-duh-luh), a part of the brain’s limbic system, which is critical for memory and responsible for evoking emotions. For an addict, when a drug craving occurs, the amygdala becomes active and a craving for cocaine is triggered. So if it’s the middle of the night, raining, snowing, it doesn’t matter. This craving demands the drug immediately. Rational thoughts are dismissed by the uncontrollable desire for drugs. At this point, a basic change has occurred in the brain. The person is no longer in control. This changed brain makes it almost impossible for drug addicts to stay drug-free without professional help. Because addiction is a brain disease. Posterior Nature Video Cocaine Video

control on cocaine Positron Emission Tomography (PET) Scan of a Person Using Cocaine Cocaine has other actions in the brain in addition to activating the brain’s reward circuitry. Using brain imaging technologies, such as PET scans, scientists can see how cocaine actually affects brain function in people. PET allows scientists to see which areas of the brain are more or less active by measuring the amount of glucose that is used by different brain regions. Glucose is the main energy source for the brain. When brain regions are more active, they will use more glucose and when they are less active they will use less. The amount of glucose that is used by the brain can be measured with PET scans. The left scan is taken from a normal, awake person. The red color shows the highest level of glucose utilization (yellow represents less utilization and blue indicated the least). The right scan is taken from someone who is on cocaine. The loss of red areas in the right scan compared to the left (normal) scan indicates that the brain is using less glucose and therefore is less active. This reduction in activity results in disruption of many brain functions.

"Addicts" have a brain disease that goes beyond their use of drugs.”
Felicitas I. Artiaga-Soriano, M.D., FPPA 125

Get Rewired by Drug Use Their Brains…

Drug Addiction is a treatable disease
Drug Abuse is a preventable behavior and Drug Addiction is a treatable disease Felicitas I. Artiaga-Soriano, M.D., FPPA 127

Is it worth the risk? Any Questions???
Felicitas I. Artiaga-Soriano, M.D., FPPA

Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA

Similar presentations

Presentation on theme: "Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA

Similar presentations

Presentation on theme: "Disclosure Statement Felicitas I. Artiaga-Soriano, MD., DPBP, FPPA"— Presentation transcript:

Similar presentations

About project

Feedback