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Alcohol and substance abuse

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Alcohol and substance abuse

  1. 1. ALCOHOL AND SUBSTANCE ABUSE Dr Opadotun O.A Family medicine Resident Babcock University Teaching Hospital
  2. 2. The following are commonly abused in this environment except A. Alcohol B. Tramadol C. Methamphetamine D. Marijuana E. Caffeine
  3. 3. The region with the highest A. Southwest B. Northwest C. Northeast D. Southeast E. Southsouth
  4. 4. The following are true except A. Cocaine most widely used illegal drug. B. Marijuana is a gateway drug C. Men should drink no more than 21 units of alcohol per week D. Pregnant women: the exact amount that is safe is not known
  5. 5. Risk factors for substance abuse include A. Peer pressure B. Low self esteem C. Dysfunctional family D. Old age
  6. 6. Outline  Introduction  Magnitude of alcohol and substance abuse  Substances commonly abused  Causes of Alcohol and Substance use Disorder  Health effects of alcohol & substance abuse  Tools for assessing alcohol and substance use disorders.  Intervention strategies  Recommendation  Conclusion  References
  7. 7. Alcohol abuse  Use of alcoholic beverages to excess, either at once ("binge drinking") or as a regular practice. ◦ For some individuals-children or pregnant women, for example-almost any amount of alcohol use may be legally considered "alcohol abuse," depending on local laws.  The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) (psychiatric diagnosis) describes alcohol abusers as those who drink despite recurrent social, interpersonal, health and legal problems as a result of alcohol use. ◦ It is differentiated from alcohol dependence by the lack of symptoms such as tolerance and withdrawal. 7
  8. 8. Substance Abuse • Substance abuse refers to the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others. • Substance abuse refers to the use of substances in a manner outside socio-cultural conventions. • There are on-going debates as to the exact distinctions between substance abuse and substance dependence 8
  9. 9. Substance Abuse (Cont’d) ◦ Current practice standard distinguishes between the two by defining substance dependence in terms of physiological and behavioral symptoms of substance use, and substance abuse in terms of the social consequences of substance use  The disorder is characterized by a pattern of continued pathological use of a medication, non-medically indicated drug or toxin, which results in repeated adverse social consequences related to drug use, such as failure to meet work, family, or school obligations, interpersonal conflicts, or legal problems.  Substance abuse may lead to addiction or substance dependence. Medically, physiologic dependence requires the development of tolerance leading to withdrawal symptoms. 9
  10. 10. Substance Abuse (Cont’d) ◦ Both abuse and dependence are distinct from addiction  Addiction involves a compulsion to continue using the substance despite the negative consequences.  May or may not involve chemical dependency. ◦ Dependence almost always implies abuse  but abuse frequently occurs without dependence, particularly when an individual first begins to abuse a substance. ◦ Dependence involves physiological processes  while substance abuse reflects a complex interaction between the individual, the abused substance and society. 10
  11. 11. Intro Cont’d…  Substance dependence, also known as drug dependence, is a maladaptive state that develops from repeated drug administration and which results in withdrawal symptoms upon cessation of drug use.  Alcohol, marijuana, and tobacco use is prevalent among population aged 15- 24 years
  12. 12. Magnitude of Alcohol and Substance Abuse Cont’d …  Williams, (2016) maintained that, over 6 million bottles of codeine are sold on a daily basis in the North-West part of the country. He also said that due to the rise in drug addiction, young people make use of cough syrups to make themselves high. National Drug Law Enforcement Agency (NDLEA) report of 2010 also shows that over 11% of people in the North-West zone use drugs.
  13. 13. Magnitude of Alcohol and Substance Abuse Cont’d …  From the record of drugs abuse in Nigeria, the Northwest has a statistics of 37.47% of the drug victims in the country, while the Southwest has been rated second with 17.32%, the south- East is been rated third with 13.5%, North-central has 11.71%, while the North-east zone has 8.54% of the drug users in the country (Akannam, 2016).
  14. 14. continues…  NAFDAC said that drug abuse is the excessive, maladaptive or addictive use of drugs for NON –MEDICAL PURPOSE.  In Kano, 37% of the population are drug abusers  2/3 of American youths try drug abuse before they finish from High School and 90% try alcohol!
  15. 15. Causes of Alcohol and Substance Use Disorder. As a general rule, the greater the number of risk the person experience the greater the likelihood of drug use problems occurring. I. Individual factors which includes; low self-esteem, poor self control, inadequate social coping skills, sensation seeking, depression, anxiety and stressful life events. II. Being Young: The adolescent is constantly struggling to define and affirm his/her identity. In the cause of the process, adolescent often start experimenting as part of their search for
  16. 16. Causes Cont’d… III. Genetic factors: Genetic predisposition accounts for half of the risk in the development of alcohol dependence. Adolescent with a positive family history of alcohol problems are at greater risk of developing alcohol problems than their peers with negative family histories. IV. The family: Family dysfunction, ineffective family supervision, criminality and drug use in the family.
  17. 17. V. Gender: Being male (worldwide, more males use alcohol and drugs than females). VI. . Mental Health: Research has demonstrated that there is a high incidence of drug abuse in psychiatric patients as well as a high incidence of mental disorders among alcoholics and drug abusers. Also teenagers with ADHD, conducts disorders are especially at risk .
  18. 18. Causes Cont’d … VII. Peer Network: Social interaction with friends and peers may provide opportunity for alcohol or drug use in adolescent or may encourage or support this type of behaviour. VIII. Social/ Environmental Milieu: Situations where there are few or no jobs opportunity for the teeming youths have been associated with alcohol and illicit drug use.
  19. 19. Types of Alcohol and Substance Abuse • Alcohol: ▫ Social acceptability makes alcohol one of the most abused substances. ▫ Because access to alcoholic beverages is convenient, alcohol abuse affects a large population. • Cocaine: ▫ Cocaine addiction can be detrimental to the substance abuser because it drains all aspects of his life. (financial, family and emotional issues). • Lysergic Acid Diethylamide (LSD): ▫ LSD can be a drug of choice for individuals wanting to escape the reality of life. ▫ Many addicts choose LSD because it is undetectable in drug tests. 31
  20. 20.  Marijuana: ◦ A common, inexpensive drug that is usually inhaled is marijuana. ◦ Also referred to as pot, stone, guff, igbo, ganja, etc. ◦ Unlike other substances, marijuana is not as physically addictive. ◦ Viewed as a gateway drug to other substances.  Prescription Drugs: ◦ The most common prescription drugs that are known to be abused ◦ are sedatives, opioids and tranquilizers; narcotic painkillers and stimulants. ◦ Prescription substance abuse is on the rise and affects teens as well as adults. ◦ Prescription drugs are usually found by the addict initially in the home.  OTC drugs: ◦ Over the counter medicines are actually another common substance abuse. ◦ It's more common because it's easily obtainable. 32
  21. 21. .  Coffee: ◦ Coffee is part of most morning addiction. ◦ Coffee may be considered something that one can get addicted to but it isn't as harming as the other substances. ◦ Caffeine is a drug easily acceptable, readily affordable, and of course perfectly legal. ◦ Drinking coffee gives an extensive high and once one comes down from the huge amount of energy one had, there is a crash. ◦ So then one goes back to coffee which gives another artificial high. ◦ The only reason it is not considered a drug is because it's something almost half of the population enjoy. ◦ If drunk just because it has become routine or out of habit then there is an addiction to coffee 33
  22. 22. • Cigarette: ▫ Cigarettes consist of nicotine, tar and carbon monoxide. ▫ Nicotine is a drug equivalent to cocaine and heroin.  It alters the brain and a person's mood. ▫ Tar is a substance that damages the lungs. ▫ Carbon monoxide is a gas which is poisonous. 34
  23. 23. Amphetamines:  (Speed, uppers, dexies, bennies). ◦ Can be swallowed, inhaled, or injected. ◦ Swallowed or snorted, these drugs hit users with a fast high, making them feel powerful, alert and energized. ◦ Uppers pump up heart rate, breathing, and blood pressure, and they can also cause sweating, shaking, headaches, sleeplessness, and blurred vision. ◦ Prolonged use may cause hallucinations and intense paranoia. ◦ Amphetamines are psychologically addictive. ◦ Users who stop using them report that they experience various mood problems such as aggression and anxiety and intense cravings for the drugs. 35
  24. 24.  Cocaine and Crack: (Cocaine -Coke, snow, blow, nose candy, white, big C,; Cracks -Freebase, rock) ◦ Cocaine is inhaled through the nose or injected. Crack is smoked. ◦ Cocaine is a stimulant that rocks the central nervous system, giving users a quick, intense feeling of power and energy. ◦ Snorting highs last between 15 and 30 minutes; smoking highs last between 5 and 10 minutes. ◦ Cocaine also elevates heart rate, breathing rate, blood pressure, and body temperature. ◦ Snorting can put a hole inside the lining of the nose. 36
  25. 25. ◦ First-time users-even teens-of both cocaine and crack can stop breathing or have fatal heart attacks. ◦ Using either of these drugs even one time can kill. These drugs are highly addictive, and as a result, the drug, not the user, calls the shots. ◦ Even after one use, cocaine and crack can create both physical and psychological cravings that make it very, very difficult for users to stop.
  26. 26. • Cold and Cough Medicines (DXM): (triple C, candy, DM, drex, red devils, robo, rojo, skittles,tussin,velvet, vitamin D) ▫ Several over-the-counter cough and cold medicines contain the ingredient dextromatorphan (also called DXM). ▫ If taken in large quantities, these over-the-counter medicines can cause hallucinations, loss of motor control, and “out-of-body” (or disassociative) sensations. ▫ Cough and cold medicines, which come in tablets, capsules, gel caps, and lozenges as well as syrups, are swallowed. ▫ DXM is often extracted from cough and cold38
  27. 27. ▫ Small doses help suppress coughing, but larger doses can cause fever, confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, redness of face, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death. ▫ Sometimes users mistakenly take cough syrups that contain other medications in addition to dextromethorphan. ▫ High doses of these other meds can cause serious injury of death. ▫ People who use cough and cold medicines and DXM regularly to get high can become psychologically dependent upon them. •
  28. 28. • Marijuana: (Pot, weed, blunts, chronic, grass, reefer, herb, ganja, igbo, stone, etc) ▫ Marijuana also elevates heart rate and blood pressure. ▫ Some people get red eyes and feel very sleepy or hungry. ▫ The drug can also make some people paranoid or cause them to hallucinate. ▫ Marijuana is as tough on the lungs as cigarettes- steady smokers suffer coughs, wheezing, and frequent colds. ▫ Those who use marijuana can become psychologically dependent upon it to feel good, deal with life, or handle stress. 40
  29. 29. ▫ The most widely used illegal drug. ▫ A stronger form of marijuana called hashish (hash) looks like brown or black cakes or balls. ▫ Marijuana is often called a gateway drug because frequent use often leads to the use of stronger drugs. ▫ Marijuana is typically smoked in cigarette (joints), hollowed out cigars (blunts), pipes (bowls), or water pipes (bongs). ▫ Some people mix it into foods or brew it as a tea, or with alcohol (combine). ▫ Affects mood and coordination. ▫ Users may experience mood swings that range from stimulated or happy to drowsy or
  30. 30.  Inhalants: Inhalants are substances that are sniffed or “huffed” to give the user an immediate rush or high. ◦ They include household products like glues, paint thinners, dry cleaning fluids, gasoline, felt-tip marker fluid, correction fluid, hair spray, aerosol deodorants, and spray paint. ◦ Inhalants are breathed in directly from the original container (sniffing or snorting), from a plastic bag (bagging), or by holding an inhalant-soaked rag in the mouth (huffing). 42
  31. 31. ◦ Inhalants make one feel giddy and confused, as if one were drunk. ◦ Long time users get headaches, nosebleeds, and may suffer the loss of hearing and sense of smell. ◦ Inhalants are the most likely of abused substances to cause severe toxic reaction and death.(even from one use) ◦ Inhalants can be very addictive. ◦ Those who use inhalants can become psychologically dependent upon them to feel good, deal with life or handle stress
  32. 32. • Liver health and alcohol: ▫ Liver induces enzyme (alcohol dehydrogenase) that break down alcohol and burns it as fuel. ▫ But alcohol exhausts the liver's ability to do this and too much too often can damage it permanently. ▫ Given a chance, the liver can repair a lot of damage. ▫ This is why it's important to drink sensibly and have non-drinking days as well as not drinking too much at any one time. 44
  33. 33. • Cancer: ▫ After smoking, drinking alcohol is the second biggest risk factor for cancers of the mouth and throat. ▫ Drinking and smoking together carries the highest risk of all. ▫ People who develop cirrhosis of the liver (often caused by too much drink) can develop liver cancer. ▫ Women who drink more than three drinks a day increase their risk of breast cancer. • Mental health problems: ▫ There is a link between drinking too much alcohol and mental health problems. ▫ Heavy long-term drinking also risks problems with memory loss.
  34. 34.  Alcohol  We drink, we feel different.  We stop drinking and sooner or later we feel 'normal' again.  Alcohol affects the brain like an anaesthetic.  One of the very first anaesthetics used in medicine – ether – is alcohol- based.  As with anaesthetics, the more alcohol take the more of our brain it shuts down. The stages of intoxication  Stage 1 (Social lubricant): After one or two drinks (1-3 units), there is talkativeness, heart rate speeds up a little, gives an 'up' feeling.  (This is the effect that people refer to when they say alcohol makes them feel more sociable).  The 'warm feeling', or flushes, is caused by alcohol in the blood making small blood vessels in the skin expand, allowing more blood to flow closer to the surface and lowering blood pressure at the same time. 46
  35. 35. • Stage 2 (Giddiness): ▫ After a couple more drinks (4-6 units) there is light headedness, co-ordination and reaction times are impaired, ability to make decisions is also slowed down due to alcohol acting on nerve cells all around the body and making them work more slowly. • Stage 3 (Sober): ▫ Another few drinks (7-9 units), reaction times are much slower, vision becomes blurry and speech is slurred. ▫ Drinking more than eight units at a time seriously overloads the liver. ▫ If self is taken care of in the days to come, it should repair itself but for tomorrow a hangover is sure. 47
  36. 36. • Stage 4 (Unfriendliness): ▫ Drinking more than 10 units, staggering, and accidents are commonplace. ▫ This amount of alcohol will be affecting cells all over the body. ▫ In an effort to rid itself of the poison, the body tries to pass the alcohol out mixed with water in our urine. ▫ This is why alcohol makes one visit the rest room a lot and is the cause of the dehydration that gives morning-after headaches. • Stage 5 (Unconscious or dead): ▫ Drinking more than 30 units (that's about twelve pints of strong lager) is enough to knock most people out. ▫ It is a short step to heart failure and breathing slowing to a stop. ▫ Even when people are already unconscious, alcohol in the stomach can continue to be absorbed and can reach lethal levels. ▫ People can also be sick and suffocate on their vomit. ▫ For these reasons, it's crucial never to leave very drunk people on their own.
  37. 37.  Large amount of alcohol can lead to alcoholic cardiomyopathy, commonly known as "holiday heart syndrome."  Chronic heavy alcohol consumption impairs brain development, causes brain shrinkage, dementia, physical dependence, increases neuropsychiatric and cognitive disorders and causes distortion of the brain chemistry.
  38. 38. ▫ One of the organs most sensitive to the toxic effects of chronic alcohol consumption is the brain. ▫ In France approximately 20% of admissions to mental health facilities are related to alcohol related cognitive impairment most notably alcohol related dementia. ▫ Alcoholic liver disease is a major public health problem. ▫ Alcohol misuse is a leading cause of both acute pancreatitis and chronic pancreatitis.69,70 ▫ The International Agency for Research on Cancer, IARC, (Centre International de Recherche sur le Cancer) of the World Health Organization has classified alcohol as carcinogenic to humans. ▫
  39. 39.  Sleep: ◦ Chronic use of alcohol use to induce sleep can lead to insomnia. ◦ Frequent moving between sleep stages occurs, with awakenings due to headaches and diaphoresis. ◦ Stopping chronic alcohol abuse can also lead to profound disturbances of sleep with vivid dreams. ◦ Chronic alcohol abuse is associated with NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. ◦ During withdrawal REM sleep is typically is exaggerated as part of a rebound effect. 51
  40. 40. Alcohol withdrawal syndromes Uncomplicated alcohol withdrawal syndrome  Occurs 4–12hrs after the last alcoholic drink.  Features—coarse tremor, sweating, insomnia, tachycardia (pulse >100), nausea and vomiting, psychomotor agitation, and generalized anxiety.  Occasionally, transitory visual, tactile, or auditory hallucinations or illusions.  There may be increasing craving for alcohol both in itself and as a relief from withdrawal symptoms.  Symptoms increase in severity in rough proportion to the habitual alcohol consumption, peaking at 48hrs and lasting 2– 5 days, with symptoms being more prolonged in heavier drinkers.
  41. 41. Alcohol withdrawal syndrome with seizures • In 5–15% of cases withdrawals are complicated by grand mal seizures occurring 6–48hrs after the last drink. • If seizures occur only during withdrawal they do not signify the development of idiopathic epilepsy. • Predisposing factors: previous history of withdrawal seizures, idiopathic epilepsy, history of head injury, hypokalaemia.
  42. 42. Delirium tremens  Acute confusional state secondary to alcohol withdrawal.  A medical emergency requiring inpatient medical care.  Occurs in 75% of episodes of withdrawal. Onset 1–7 days after the last drink with a peak incidence at 48hrs.  Risk is increased by severe dependence, comorbid infection, and preexisting liver damage.  In addition to the features of uncomplicated withdrawal there is:
  43. 43.  Clouding of consciousness.  Disorientation.  Amnesia for recent events.  Marked psychomotor agitation.  Visual, auditory, and tactile hallucinations (characteristically of diminutive people or animals— ‘Lilliputian’ hallucinations).  Marked fluctuations in severity hour by hour, usually worse at night.  In severe cases: heavy sweating, fear, paranoid delusions, agitation,
  44. 44.  suggestibility, raised temperature, sudden cardiovascular collapse.  Reported mortality of 5–10%. It is most risky when it develops unexpectedly and its initial manifestations are misinterpreted (e.g. in a patient not known to be alcohol-dependent developing symptoms post-operatively).  Differential diagnosis: hepatic encephalopathy, head injury, pneumonia, acute psychotic illness, acute confusional state with other primary cause.
  45. 45. • Wernicke-Korsakoff syndrome: ▫ Wernicke-Korsakoff syndrome is a manifestation of neuronal degeneration 2 thiamine deficiency, usually as a secondary effect of chronic alcohol abuse. ▫ Wernicke's encephalopathy: acute onset of triad 1.) Acute confusional state 2.) Occular signs (opthalmoplegia CNVI, nystagmus 3.) Ataxic gait, Associated features of peripheral neuropathy ▫ Due to poor intake, reduced absorption, impaired hepatic storage of Vit B1 57
  46. 46. ▫ Tx: high potent parenteral Vit B1, watch out for allergic reaction  Avoid carbohydrate load until thiamine replacement is complete (i.e. do not rehydrate with glucose solutions prior to thiamine). ▫ Treat immediately diagnosis is made or strongly suspected, treat all those at high risk prophylactically
  47. 47. Korsakoff syndrome  Clinical features Absence or significant impairment in the ability to lay down new memories, together with a variable length of retrograde amnesia. Working memory , procedural and emotional memory is unimpaired. Confabulation for the episodes of amnesia may be prominent.  Other neuropsychological deficits associated with ARBD may be seen.
  48. 48.  Most commonly due to thiamine deficiency, secondary to heavy alcohol use. Rarer causes are head injury, post- anaesthesia, basal/temporal lobe encephalitis, carbon monoxide poisoning, and thiamine deficiency secondary to other causes.  It should be remembered that Korsakoff syndrome is not invariably preceded by Wernicke encephalopathy, and can present in a ‘chronic’ form.  Tx: Continue oral thiamine replacement for up to 2yr.
  49. 49. Mental health effects ▫ High rates of major depressive disorder occur in heavy drinkers and those who abuse alcohol. ▫ Alcohol misuse is associated with a number of mental health disorders and alcoholics have a very high suicide rate. ▫ A study of people hospitalised for suicide attempts found that those who were alcoholics were 75 times more likely to go on to successfully commit suicide than non-alcoholic suicide attempters. ▫ About 33 percent of suicides in the under 35s are due to alcohol or other substance misuse.
  50. 50. • This is significantly higher than the increased risk of psychotic disorders seen from cannabis use making alcohol abuse a very significant cause of psychotic disorders. • Prominent hallucinations and/or delusions are usually present when a patient is intoxicated or recently withdrawn from alcohol. • Alcohol dependence relates directly to cravings and irritability. • Also alcohol use is a significant predisposing factor towards anti-social behaviour in children.
  51. 51. • Depression, anxiety and panic disorder are disorders commonly reported by alcohol dependent people. • Psychosis is secondary to several alcohol-related conditions including acute intoxication and withdrawal after significant exposure. • Chronic alcohol misuse can cause psychotic type symptoms to develop, more so than with other drugs of abuse. • Alcohol abuse has been shown to cause an 800% increased risk of psychotic disorders in men and a 300% increased risk of psychotic disorders in women which are not related to pre-existing psychiatric disorders. 63
  52. 52. • Whilst alcohol initially helps social phobia or panic symptoms, with longer term alcohol misuse can often worsen social phobia symptoms and can cause panic disorder to develop or worsen, during alcohol intoxication and especially during the alcohol withdrawal syndrome. • This effect is not unique to alcohol but can also occur with long term use of drugs which have a similar mechanism of action to alcohol such as the benzodiazepines which are sometimes prescribed as tranquillisers to people with alcohol problems. 64
  53. 53. What is a unit of alcohol? • One unit of alcohol is 10ml (1cl) by volume, or 8g by weight, of pure alcohol. • A more accurate way of calculating units is as follows: The percentage alcohol by volume (% abv) of a drink equals the number of units in one litre of that drink. • For example: Strong beer at 6% abv has six units in one litre. • If one drinks half a litre (500ml) - just under a pint - then one has had three units.65
  54. 54. What are the recommended safe limits of alcohol drinking?  Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).  Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).  Pregnant women: the exact amount that is safe is not known. Therefore, pregnant women and women trying to become pregnant should not drink at all. 66
  55. 55. • What about alcohol tolerance? • I can drink more than 10 units and be okay". • People who regularly drink too much develop a tolerance to alcohol. This means that more alcohol can be consumed than is normal, without the person seeming to suffer the same effects as outlined above. • Unfortunately, a tolerance to alcohol does not protect one from harm. • Having a high tolerance to alcohol can indicate that a person drinks too much and the more one drink, the more damage it will cause.67
  56. 56. Tools for Assessing Alcohol and Substance use Disorders Adolescents may not recognize that problem drinking or substance misuse can lead to future medical, legal and psychosocial problems. The Family Physician can intervene with screening and counselling. Tools recommended for screening all patients for alcohol intake include: 1. Alcohol Use Disorders Identification Test (AUDIT) or CAGE mnemonics. • The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems.
  57. 57. Tools for Assessing Alcohol and Substance use Disorders Cont’d … The minimum score (for non drinkers) is 0 and the maximum possible score is 40. A score of 8 or more indicates a strong likelihood of hazardous or harmful alcohol consumption and identifies mild dependence.
  58. 58. Tools for Assessing Alcohol and Substance use Disorders Cont’d …C – Have you ever felt you had to cut back on how much you drink? A – Have you ever felt annoyed by someone else asking about your drink? G – Have you ever felt guilty about your drinking or anything you did while drinking? E – Have you ever use alcohol as an eye-opener in the morning? Scoring: A “no” response = 0 point A “yes” response = 1 point 0-1 point = Negative screen 2-4 points = Positive Screen A score of 2 and above will prompt more questions 1.) what is the most alcohol you have drunk in a single day 2.) what is the most alcohol you have drunk in a single week
  59. 59. Tools for Assessing Alcohol and Substance use Disorders Cont’d …  CAGE – AID (Adjusted to Include Drugs): Its screens for alcohol in addition to drugs.
  60. 60. Intervention Strategies  Non-pharmacologic: Counselling is an important intervention which can be offered by the Family Physician/psychologist. Five “A’s” Intervention Technique use by Physicians: Assess the risk of behaviour for the patient. Advise the patient on the risk and how to modify. Agree come to an agreement with patient on treatment. Assist the patient with the treatment plan. Arrange follow-up or referral to treatment.
  61. 61. Intervention Strategies contd… Interventions in patients abusing alcohol or other substances must be tailored to the patient’s specific needs. Appropriate treatment programme should have strong family involvement by improving family relationship and bonding, total abstinence goals. - Demand Reduction: Is concerned with services which are aimed at discouraging the abuse of substances by members of the public. Demand reduction include strategies such as; prevention, early intervention, treatment, rehabilitation and after care
  62. 62. Intervention Strategies Cont’d … – Personal Level: High self esteem with high degree of motivation, feelings that one is in control of his/her life, optimism and willingness to seek support. – Cognitive Behavioural Therapy (CBT): Cognitive behavioural therapy are the mainstay of substance use disorder treatment. It is based on the assumption that the learning processes used by patient to initiate and continue their drug use behaviours can also be used to reduce or stop their drug use. CBT is primarily used in outpatient settings, usually with weekly individual sessions over several months.
  63. 63. A B S T I N E N C E AT- RISK USE ABUS E DEP Use - + + + Consequences - -/+ + ++ Repetition - - + + Loss of Control - - - + Preoccupation, Compulsivity Physical Dependence Continuum of drug use in patient with alcohol or substance use disorder
  64. 64. Intervention Strategies Contd  Pharmacologic Use of medications for the treatment of alcohol abuse and dependence as well as substance abuse and dependence. These medications include: Alcohol Abuse and Dependence - Disulfiram(Aversive drugs inhibits AcetaldehydeLDH) - Naltrexone(antag effects of endogenous endorphins) - Acamprosate(Anti craving drug)
  65. 65. Other medications include: - Anticonvulsants. E.g. Topiramate, Baclofen and Serotonergic agents. - Antipsychotics e.g Haloperidol if BZD fails in the settings of halucinations and delusions - Supplements e.g Parenteral vit B, minerals e.g Mg
  66. 66. Intervention Strategies Cont’d … Substance Abuse and Dependence Treatment of intoxication for most substances is supportive and symptomatic and typically occurs in inpatient settings. - Opiates: treatment of opiates overdose involves administration of naloxone. - Users of cocaine and amphetamines may take benzodiazepines to counter the stimulant effect. - Treatment of cannabis use: Abstinence and support which involves hospitalisation and through careful monitoring. Use of family and group psychotherapies.
  67. 67. Intervention Strategies Cont’d … - Nicotine: Patient who smoke should receive advice and encouragement at every clinic visit, counselling is an effective way to begin intervention. - Pharmacotherapy used in treating tobacco use and dependence: Tobacco users attempting to quit should be prescribed one or more effective first line pharmacotherapies for tobacco use cessation these include Nicotine patch, Nicotine gum, Nicotine lozenges, Nicotine inhaler, Nicotine nasal spray, Bupropion SR and Varenicline.
  68. 68. Recommendation  Nigerian Government should intensify efforts in preventing alcohol and substance abuse through NDLEA (National Drug Law Enforcement Agency) and other drug controlling groups like NAFDAC (National Agency for Food and Drug Abuse Control).  The government should have a well- defined comprehensive and realistic policy on control of drugs. This policy should include establishing a federal drug control centre, under the auspices of the ministries of health and internal affairs.  Public education should be targeted at the vulnerable segment of society, such as the older children, adolescent and young adults.
  69. 69. Conclusion  Alcohol and drug abuse is a disorder that is characterized by a self-destructive pattern of using a substance that leads to significant problems and distress.  Alcohol and substance abuse can be caused by the interplay of at least one or more factors.  Uncontrolled alcohol and drug abuse and its effect are accompanied by violence, crime, misbehaviour and hence a threat to society at large.  Alcohol and substance abuse is injurious to the health of the user, as a result has a lot of social and psychological problems.
  70. 70. Further Reading  Rakel Textbook of Family Practice (6th ed.)  Rakel RE and Rakel DP. Textbook of Family Medicine (8th ed.)  Oxford Handbook of Family Medicine by Bob Mash (3rd ed.)  https://en.wikipedia.org/wiki/Substance_depe ndence  Akannam, T. (2016). North-West Rank Highest in Drug Addiction. Nigerian Drug Statistics by Zone. Retrieved May 5, 20117. from http://www.nairaland.com/203955/nigerian- drug-statistics-zone.
  71. 71.  William, TK (2016). Psychoactive substances and the English language: "Drugs,“ discourses, and public policy. Contemporary Drug Problems,  Kaplan and Sadocks. Synopsis of Psychiatric (10th ed.)  Alcohol and Substance Abuse by Dr Ndifreke E. Udonwa  Alcohol and Substance Abuse in Adolescent by Dr Bello Abdulrasheed Abdulazeez  Oxford handbook of Psychiatry (3rd ed.)  Katzung BG. Basic and Clinical Pharmacology (10th ed.)
  72. 72. Questions???