Slide 1

Slide 2

DR. MUNIR A. BADAR DEPARTMENT OF COMMUNITY MEDICINE SH. ZAYED MEDICAL COLLEGE, RAHIM YAR KHAN

Slide 3

DRUG ABUSE AND DRUG DEPENDENCE

Slide 4

Drug: Any substance when taken into the living organisms may modify one or more of its functions Drug abuse: Self administration of drug for non-medical reasons which impair individuals ability to function, resulting in social, physical or emotional harm Long term drug use may damage the heart liver and brain. Drug Dependence: A state of interaction between a living tissue and a drug, characterised by Behavioural and other responses which include a compulsion to take the drug periodically or on continuous basis, in order to experience its psychic effects and to avoid the discomfort of its absence.

Slide 5

Drug Addiction A state of periodic or chronic intoxication determined to the individuals and society produced by the repeated intake of habit forming drugs. To call a person ----- a drug addict, following criteria is to be considered. 1. Psychological Dependence: An over powering desire to take the drug and obtain it by all means 2. Physiological Dependence: Show of withdrawal symptoms, --- Irritation, Violent behaviour, Nausea, Diarrhoea, watering of eyes and nose. 3. Development of Tolerance: A tendency to increase the dose.

Slide 6

Phases of Addiction: Tolerance diminished effect of the same dose of a drug or the need to increase the size of dose to get an effect to the earliest ones. Habitation the emotional and psychological need felt for a drug. Physical dependence: Bodys need to get the drug.

Slide 7

Agent factors Alcohol Opioids Cannabinoids Cocaine sedatives or hypnotics Caffeine Hallucinogens Tobacco Volatile solvents Amphetamine LSD (Lysergic acid diethylamide)

Slide 8

Symptoms of Drug Addiction: Loss of Appetite and Body weight Unsteady gait, Clumpsy movements, Tremors Reddening and puffiness of eyes, unclear vision Slurred speech Nausea, Vomiting and Body pains Fresh, numerous injection marks on body and Blood stains on cloths Drowsiness/Sleeplessness, Lethargy. Anxiety, Depression, Profuse Sweating Changing mood, Temper, The personalisation and Emotional detachment Impaired memory and concentration Presence of Needles, Syringes and strange packets at home Loss of interest in daily activities

Slide 9

ALCOHOL & ALOCOHOLISM Alcoholism: Ch. Diseases marked by a craving for alcohol. Alcoholics : Develop a craving or a strong urge to drink despite the awareness that drinking is creating problems in their lives. One drink of alcohol is defined as consuming: 12 oz of beer, 5 oz of wine, 1.5 oz of 90-proof liquor Ethyl Alcohol (Ethanol) ----- In beers and wines, and in distilled liquid (Whiskey, Gin & Rum) Alcoholic beverages contain: Beer (5-6 % of alcohol), Rum, Gin & Brandi (40-45 % alcohol) Moderate Drinking: One or less than two drinks a day Heavy Drinking: More than 14 drinks per week or 4-5 drinks at one sitting

Slide 10

ALCOHOL A symbol of prestige and social status Alcoholism is world wide social and medical problem Used as Sedative, Tranquillizer, Hypnotic or Anaesthetic Drinking by adults serves as a role model for the young Rapidly absorbed from the stomach and small intestine Can be detected in blood within 2-3 minutes after consumption. Food in the stomach inhabits its absorption. Supplies about 7 kcal / gm. A marked effect on CNS (not a stimulant but produces depression) Produces psychotic dependence of mild to strong but physiological dependence develops slowly.

Slide 11

Physical Effects Tension Fatigue Increase appetite Painful Numbness Depression Lose of self confidence Anxiety Guilt Loud and Slurred speech Impaired Judgment Affected Muscular coordination & physical reflexes Loss of physical control - --- ending in Stupor and Death

Slide 12

CAUSES 1. Physiological Causes: Large quantities of alcohol drink produces and enhances tolerance for alcohol Alcoholic are 6 times more likely than non- alcoholic to have blood relatives (who are alcoholic dependence) A genetic factor plays a role in alcoholic dependence Many genes are involved in increasing and individuals risk for developing alcoholic dependence.

Slide 13

CAUSES Environmental Causes: Direct Personal Behavioral skills Peer influences early in life Parenteral behaviour Society and cultural attitudes towards alcohol use. Life stress Availability of alcoholic beverages Indirect Unemployment Ignorance /Neglect Gang culture Tourism Sex workers Rapid urbanization Urban migration Family tensions Delinquency (Crime)

Slide 14

CAUSES 3. Psychological Causes: Many drinkers develop a psychological condition known as DENIAL, (in which they are unable to acknowledge that alcohol use lies at the root of many of their problems ) Cultural Factors: Upper class society use expensive drugs and lower class people use illegally manufactured drugs e.g. charas, bhang, tan, ganja etc. Drug addiction is more among beggars, mujawars of argahs, malangs and darveshes inhabiting takyas and shrines of saints.

Slide 15

Major alcohol related Problems Crime (e.g.: Rape, Assault, Homicides) Loss of self confidence and will to work Physical health and sexual energy weaken Traffic Accidents or injuries Absenteeism Family disorganization Loss of productivity Foetal growth retardation and mental retarded babies

Slide 16

Medical Complications: Liver damage (Fatty liver hepatitis, liver cirrhosis) Cardiomyopathy (Enlarged both ventricles, Flabby, Reduced heart pumping efficiency Reduces blood flow through the kindness resulting in salt retention and water loss from the blood. Arrhythmias (Heartbeat irregularities) Hypertension stroke Delirium tremens confusion, sleeplessness, depression and hallucinations. Gastritis & Pancreatitis Ca. mouth, pharynx, Larynx and oesophagus Peripheral Neuropathy Psychosis Foetal alcoholic syndrome (Intra-uterine growth retardation & Mental disorders, craniofacial abnorm. & limb dislocations)

Slide 17

Why do the Addicts use the drugs? To allay anxiety or fatigue To forget economic problems, social difficulties and worries To enhance sexual capacity To meditate and attain mystical state

Slide 18

Treatment of addiction Drug takers have little or no motivation to undergo treatment Alcoholics tend to deny that their consumption is abnormal, others openly defend their habits. Long term treatment is not only a medical problem but needs the cooperation of Psychologists and Sociologist. Drug addiction may be considered as the social problem so its management is medical care as Identification of drug addicts and their motivation for detoxification Detoxification (requires hospitalization for therapeutic treatment) Post detoxification counselling and follow up (based on clinic and home visits)

Slide 19

Prevention Cultivation of drug plants should be licenced Manufacture, Profession, Sale and Transport of all intoxication drugs should be checked and brought under control for appropriate use. The Law prohibits use of alcohol but the majority of population abstains from the use of alcohol. Legislation for dealing the offenders and smugglers Pharmacological solutions (Antidepressants & antipsychotic drugs) Prohibition of advertisements that promote use of tobacco and alcohol Public education and discussion. Rehabilitation of Ex-drug dependant persons Unemployment problem should be solved by increasing job opportunities

Slide 20

Slide 21