Disclosure StatementFelicitas I. Artiaga-Soriano, MD., DPBP, FPPA

University of the East Medical CenterVeterans 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• Medichem• GSK• Astra Zeneca

Researches/GrantSupport

• Eli Lilly • Les Servier• Janssen Pharmaceutica • Otsuka

• Novartis• Astra Zeneca• Lundbeck• Pfizer

. . . “ 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

Felicitas Artiaga- Soriano, M.D., FPPA

SUBSTANCES of ABUSE: itsRelated Disorders

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

• 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.”

•Heather Locklear

Eva Mendes

•Mel Gibson•Edgar Allan Poe

•Collin Farrell

Joaquin Phoenix

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 ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESS

““loss of control” loss of control” 

Drug Addiction is also known as:

A.) Drug Abuse

B.) Drug Dependence

C.) Both

D.) None of the Above

Drug Addiction is also known as:

A.) Drug Abuse

B.) Drug Dependence

C.) Both

D.) None of the Above

Common Underlying NeurobiologicalFactors Can Be:

Common Underlying NeurobiologicalFactors Can Be:

Structural/anatomical (same regions and pathways)Structural/anatomical (same regions and pathways)

Neurochemical (imbalance of neurotransmitters)Neurochemical (imbalance of neurotransmitters)

Genetic (inherited factors that compromise function) Genetic (inherited factors that compromise function)

Factors Affecting Vulnerability Factors Affecting Vulnerability

• Presence of a psychiatric disorder

• Physical abuse

• Poor social skills

• Presence of a psychiatric disorder

• Physical abuse

• Poor social skills

Double

People With Comorbid Mental and Addictive DisordersHave a Brain Disease

People With Comorbid Mental and Addictive DisordersHave a Brain DiseaseDoubleDouble

MentalDisorder

MentalDisorder

AddictiveDisorder

AddictiveDisorder

ComorbidDisordersComorbidDisorders

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 USEDRUG USE(Self-Medication)(Self-Medication)DRUG USEDRUG USE

(Self-Medication)(Self-Medication)

STRESSSTRESSSTRESSSTRESS

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

What Role Does Stress Play In Initiating Drug Use?

What Role Does Stress Play In Initiating Drug Use?

NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

AgeAgeAge at tobacco, at alcohol and at cannabis dependence as per DSM IV

0.0%0.0%

0.2%0.2%

0.4%0.4%

0.6%0.6%

0.8%0.8%

1.0%1.0%

1.2%1.2%

1.4%1.4%

1.6%1.6%

1.8%1.8%

55 1010 1515 2121 2525 3030 3535 4040 4545 5050 5555 6060 6565

% in

eac

h ag

e gr

oup

who

dev

elop

%

in e

ach

age

grou

p w

ho d

evel

op

firs

tti

me

dep

ende

nce

tim

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e

THCALCOHOL

TOBACCO

ADDICTION IS A DEVELOPMENTAL DISEASE

starts in adolescence and childhood

ADDICTION IS A DEVELOPMENTAL DISEASE

starts in adolescence and childhood

HOW DOES ADDICTION OCCUR? HOW DOES ADDICTION OCCUR?

www.drugabuse.gov

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

Source: Nestler, EJ and Malenka, RC, Scientific American, pp. 78-85, March 2004.Source: Nestler, EJ and Malenka, RC, Scientific American, pp. 78-85, March 2004.

Different Drugs, Same Ultimate Effect Different Drugs, Same Ultimate Effect

Medial Forebrain

Bundle

Dopamine

Positive reinforcement

Pleasure

REWARD SYSTEM

WITHDRAWAL SYSTEM

Abstinence Locus Ceruleus

Dopamine NoradrenalineG-proteins Adenylate Cyclase CAMP Kinase

Negative reinforcement

Discomfort

ProlongedProlongedDRUGDRUGUSEUSE

ProlongedProlongedDRUGDRUGUSEUSE

AbstinenceAbstinenceAbstinenceAbstinence

RELAPSERELAPSERELAPSERELAPSE

CRFCRFCRFCRF

AnxietyAnxietyAnxietyAnxiety

What Happens When A Person Stops Taking A Drug?

What Happens When A Person Stops Taking A Drug?

DrugsDrugs & its& its

Psychological and Psychological and

Physical EffectsPhysical Effects

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

The Commonly abused drugs/substances

1. Opioids and opiates- opium, morphine, methadone, codeine, meperidine (Demerol)

2. Sedatives/Hypnotics- barbiturates, benzodiazepines, chloral hydrate and others

3. Hallucinogens- LSD, phencyclidine (PCP), cannabis (marijuana)

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

The Commonly abused drugs/substances:cont……

4. Stimulants- amphetamines, metamphetamine (Shabu) and cocaine

5. Alcohol- beer, gin, wine

6. Caffeine- coffee, softdrinks

7. Nicotine- cigarettes, chewing tobacco

8. Inhalants and Solvents- (volatile hydrocarbons)- rugby, kerosene, gasoline, thinner

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Categories of DrugsCategories of Drugs

Categories of DrugsCategories of DrugsStimulants - “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)

Views of the Seriousness of Health Problems(Top Ten of Thirty-Six Problems)

65%

65%

68%

69%

71%

73%

74%

75%

78%

82%

StressStress

Alcohol abuseAlcohol abuse

SmokingSmoking

Child abuseChild abuse

ViolenceViolence

HIV/AIDSHIV/AIDS

Heart diseaseHeart disease

Drunk drivingDrunk driving

CancerCancer

Drug abuseDrug abuse

% s

ayin

g “v

ery

seri

ous

pro

ble

m”

% s

ayin

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seri

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pro

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m”

Harvard School of Public Health/Robert Wood Johnson Foundation/ICR, August 2000Harvard School of Public Health/Robert Wood Johnson Foundation/ICR, August 2000

Drug abuseDrug abuse

SmokingSmoking

HIV/AIDSHIV/AIDS

Child abuseChild abuse

ViolenceViolence

StressStress

CancerCancer

Drunk drivingDrunk driving

Heart diseaseHeart disease

Alcohol abuseAlcohol abuse

Drug Abuse and Addiction are Among the Most SeriousPublic HealthProblems Facing Our Society

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

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Profile of the Filipino Drug Abusers, cont…..

Occupation: Workers/employees 42.51% Unemployed 21.75% Self-employed 12.58% Students 12.16% OSY 3.68%

Economic Status: middle income

Place of Residence: Urban esp. NCR 58.31% Region IV 22.31% Region III 5.37% Region VII 4.57% Region X 2.55%

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas 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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Use of Illegal Substances by Age Group

0

5

10

15

20

25

30

12-17 18-25 26-34 35-39 40-44 45-49 50-54 55-59 60-64 65+Age Group

Copyright@2007 by the Mcgraw-Hill Co. Inc, All right reserved

Terminology

Substance-related disorder

I. Substance usedisorder

II. Substance-induced disorder

Substanceabuse

Substance dependence

Substance intoxication Substance withdrawal

Substance-induced Delirium, Dementia, Amnestic disorder

Psychotic disorderMood disorder

Anxiety disorderSexual dysfunction

Sleep disorder

Identification

of aDrug 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 ofRecurrent 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., FPPAFelicitas 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)

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

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., FPPAFelicitas 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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders

Narcotics- Opium, Morphine,Codeine,Heroin

Intoxication Withdrawal• 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

• 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

• “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

Methadone

Morphine

Morphine in various forms

Codeine in various forms

Heroin in plastic

Heroin in off white powder form

Heroin in various formswith balloons

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced DisordersCNS Depressants- Alcohol, Sedative/Hypnotic, Anxiolytics

• 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

Intoxication Withdrawal

Barbiturate Pills

Benzodiazepine Pills

Downers (various)

DepressantPills

Alcohol Abuse and Alcoholism

Brand / Generic NamesBrand / Generic NamesBeer, Wine, Brandy, Gin, Tequila, Beer, Wine, Brandy, Gin, Tequila, Vodka, Whiskey.Vodka, Whiskey.Street NamesStreet NamesBooze, Brew, Cold One, Juice, Booze, Brew, Cold One, Juice, Sauce, Wahoo JuiceSauce, Wahoo Juice

Relaxation Relaxation Sociability Sociability Cheap HighCheap High

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

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• 600-800mg/dL=death

Alcoholism

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

‘Celebrity Alcoholics’

Celebrity Alcoholics

David Hasselhoff

Lindsay Lohan

Kiefer SutherlandAmy Winehouse

Betty Ford

Nick Nolte

Ernest Hemmingway

Alcoholism and Nicotine Addiction

Heavy smokers > 20 cigarettes /

day

70% of alcoholics 10% of the

general population

Nicotine

TobaccoStreet 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

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders Nicotine-cigarettes, tobacco

• 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

Intoxication Withdrawal

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced DisordersCaffeine

• 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 - 30-

60mg Instant coffee -75-150mg

Intoxication Withdrawal

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.

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced DisordersCannabis- Marijuana

Mouth is dryAppetite increases- “the

munchies”TachycardiaConjunctival injectionHeightened sensitivity to

stimuliDrowsyEuphoric statesDisturbance in perception

of time and spaceHallucinations

• No specific withdrawal symptoms

Intoxication Withdrawal

Marijuana leaves

In blockIn plastic bag

In joint rolling

seeds

Cannabis

Coca leaves and powder

Hashish oil

CNS Stimulants

Uppers(Brand / Generic Names)

Cocaine, Amphetamine, Methamphetamine, Methylphenidate, Phenmetrizine

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders CNS Stimulants- Cocaine, Amphetamine, Methamphetamine,

Methylphenidate

• 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 increasesCrusty mood-dysphoriaEnergy level decreases-

fatigueDreams-unpleasant and

vividSuicidal depression

Intoxication Withdrawal

• “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: Also known as: Meth, Crystal, Crank, ICEMeth, Crystal, Crank, ICE

MethamphetamineMethamphetamine

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. 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 DrugsMETHAMPHETAMINE

• enhance mood and body movement

• taken orally, intranasally, intravenously, rectally

• smoking, intravenous: intense, very pleasurable sensation

• other names: Ice, speed, tweak, crank , glass, shabu

• release large amounts of dopamine = highly addictive stimulant

• intranasal and oral: “high” feeling

Desired effects

• white powder or clear, crystal “rock”

• 3 – 5 mins (intranasal); 15-20 mins (oral); can last: 24 hours

Cocaine Powder

cocaine

Cracked cocaine

Amphetamines in various capsules

Methamphetamine

shabu

I C E

S p e e dS p e e d

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced DisordersHallucinogens, PCP, Designer Drugs-XTC

(Ecstasy)-Methylenedioxymethamphetamine

• 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

Intoxication Withdrawal

ecstasy

E

xlover’s speed

xtc

Stacy

Essence

Club Drugs

• Instantaneous rush – 30-45 sec, lasting to 15-30 mins• Sudden clarity, intensification of perceptions, altered perception of time• Inner sensation of happiness, sense of loving (sensual drug)

ECSTASY

• 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

The E “Rush”

• “booster dose” – hope to prolong the sensations

Club Drugs

• coming down: 3 – 6 hrs after initial ingestion

• feelings of disappointments: anxiety, depression

• sluggishness & residual effects: lasts up to several days

ECSTASY

• “Tuesday blues” – from depletion of serotonin

• still uncertain BUT subsequent depression may occur

• due to short-circuit of serotonin pathway & serotonin shortage

The After “Rush”

• 6-7 hours to fall asleep after returning to “normal”

Long term effects

LSDin Blotter Paper

LSD in forms

Ketamine - special

Ketamine

Solvent and Aerosol Inhalants

Glue sniffingStreet 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

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

II. Substance-Induced Disorders Inhalants-glue, gasoline, chloroform

• 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

Intoxication Withdrawal

Substance-Induced Disorders

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders• 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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

Amnestic disorder includes the 3 symptoms listed below:

• Memory disturbances

• Memory loss

• Decline in memory ability

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

• 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.

Amphetamine-induced Psychosis vs. Schizophrenia

ATS-Psychosis Schizophrenia

Delusions Paranoia Paranoia

Affects Appropriate Flattening

Hallucination Visual Auditory

Thinking Intact Disordered

Hyperactivity Common

Hypersexuality Common

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

• 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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

Sexual Dysfunctions:

• Impaired Desire 

• Impaired Arousal 

• Impaired Orgasm 

• Sexual Pain 

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas 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., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Substance-Induced Disorders

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., FPPAFelicitas 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

Non-drug addictions

Non-drug addiction

Non-drug addiction

David Duchovny- Sex addiction

Kate Moss- Isopropyl nitrite (Poppers)-for extra sexual pleasure or response

Matt Damon- Gambling

Ben Affleck- Gambling

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

1-2 Min 3-4

6-7 7-8 8-9

9-10 10-20 20-30

Your Brain After Drugs

The Memory of Drugs

Nature Video Cocaine Video

Anterior

Posterior

Amygdalanot lit up

Amygdalaactivated

control on cocaine

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

"Addicts" have a brain disease that goes beyond their use of drugs.”

Get Rewired by Drug UseGet Rewired by Drug Use

Their Brains…Their Brains…

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Drug Abuse is a preventable behavior

and

Drug Addiction is a treatable disease

Felicitas I. Artiaga-Soriano, M.D., FPPAFelicitas I. Artiaga-Soriano, M.D., FPPA

Is it worth

the risk?