SUBSTANCE ABUSE

 Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user
consumes the substance in amounts or with methods which are harmful to themselves or
others, and is a form of substance-related disorder.

 In some cases criminal or anti-social behavior occurs when the person is under the influence
of a drug, and long term personality changes in individuals may occur as well.

 Drugs most often associated with this term include: alcohol, barbiturates, benzodiazepines,

cannabis, cocaine, methaqualone, opioids

and substituted amphetamines.

Substance abuse has been adopted by the DSM as a blanket term to include 10 separate classes of
drugs, including alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics,
and anxiolytics; stimulants; tobacco; and other substances.

The ICD uses the term Harmful use to cover physical or psychological harm to the user from use.

Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is
outlined in the DSM as:

 When an individual persists in use of alcohol or other drugs despite problems related to use
of the substance, substance dependence may be diagnosed.

 Compulsive and repetitive use may result in tolerance to the effect of the drug and
withdrawal symptoms when use is reduced or stopped.{ DSM}

SIGNS AND SYMPTOMS

 Depending on the actual compound, drug abuse including alcohol may lead to health
problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor
vehicle accidents, homicides, suicides, physical dependence or psychological addiction.

 High rate of suicide in alcoholics and other drug abusers because the long-term abuse of
alcohol and other drugs cause physiological distortion of brain chemistry as well as the social
isolation.

 Drug abuse, including alcohol and prescription drugs, can induce symptomatology which
resembles mental illness. This can occur both in the intoxicated state and also during the
withdrawal state.

 Substance induced psychiatric disorders can persist long after detoxification, such as
prolonged psychosis or depression after amphetamine or cocaine abuse.

 A protracted withdrawal syndrome can also occur with symptoms persisting for months
after cessation of use.
  Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with
symptoms sometimes persisting for years after cessation of use.

 Abuse of hallucinogens can trigger delusional and other psychotic phenomena long after
cessation of use.

 Cannabis may trigger panic attacks during intoxication and with continued use, it may cause
a state similar to dysthymia.

 Researchers have found that daily cannabis use and the use of high-potency cannabis are
independently associated with a higher chance of developing schizophrenia and
other psychotic disorders.

 Individuals with substance abuse have higher levels of impulsivity, and individuals who use
multiple drugs tend to be more impulsive.

 There is a hypothesis that the loss of impulse control may be due to impaired inhibitory
control resulting from drug induced changes that take place in the frontal cortex.

 The neurodevelopmental and hormonal changes that happen during adolescence may
modulate impulse control that could possibly lead to the experimentation with drugs and
may lead to the road of addiction.

ALCOHOLISM

 -is defined by the regular and excessive use of alcohol with concomitant social,
occupational, and /or physical problems.

 Alcoholism is a multifactorial disorder in which genetic , biologic, and sociocultural factors

interact.

 Starts during early adulthood followed by periods of exacerbation and remission.

CLINICAL FEATURES

 Neurologic – blackouts, seizure, delirium, cerebellar degeneration, neuropathy.

 Gastrointestinal - esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis

 Cardiovascular –hypertension, cardiomyopathy

 Hematologic – folate deficiency, thrombocytopenia

 Endocrine- gynecomastia, testicular atrophy, amenorrhea.

 Skeletal –fractures,

 Cancer – breast cancer, oral and esophageal cancer, rectal cancer.

 Most alcoholics have psychosocial difficulties.

 Marital difficulties , job problems, legal problems.

  Behavioural, cognitive and psychomotor changes occur.

 Mild to moderate use causes incoordination, tremor, confusion, stupor, coma.

 Delirium tremens occurs 3-5 days after the last drink – severe withdrawal symptoms..

 Specific behaviour of ‘denial’.

NARCOTIC USE

 Narcotics or opiates bind to ‘opoid’ receptors in the CNS and induces a sense of

 Euphoria, analgesia, respiratory depression and constipation.

 Natural opioids – enkephalins and endorphins play a role in analgesia, memory, learning,
reward, mood regulation and stress tolerance.

COMMON NARCOTICS

 Natural – morphine and codeine derived from poppy

 Semi synthetic – hydromorphone, diacetylmorphine (heroin), oxycodone.

 Synthetic – meperidine ( demerol), propoxyphene (darvon), methadone.

Group of abusers

 ‘Medical abusers’ – patients with chronic pain syndromes who misuse their prescribed
analgesics

 Physicians, nurses, dentists and pharmacists with easy access to narcotics.

 ‘Street abusers’ – usually a high functioning individual who began by using tobacco, alcohol
and marijuana and then moved on to opiates.

CLINICAL FEATURES

 ACUTE – CNS effects - sedation , euphoria, analgesia, decreased respiratory drive, vomiting
eventually leading to stupor and coma.

 CHRONIC –tolerance and physical dependence.

 With shorter acting opioids withdrawal symptoms start 8 – 12 hrs after last intake peak at 2
– 3 days and subside over 7- 10 days.

 Long acting ones withdrawal symptoms start 2-4 days after intake peak over 3-4 days and
subside after several weeks .

 Withdrawal symptoms include

 Diarrhoea, vomiting,coughing, lachrymation,

Twitching mucles, fever, diuresis, hypertension, body pain, insomnia etc.

 In addition to acute and chronic effects drug users face

 Permanent nerve damage due to additives in street drugs and

 STIs and HIV- AIDS, endocarditis, septic arthritis, soft tissue infections and brain abscess due
to shared use of contaminated needles.
MANAGEMENT
YOGA THERAPY FOR SUBSTANCE ABUSE

 Inculcating right values – YAMA , NIYAMA

 Finding meaning and purpose of life – SWADHAYA, ISWARA PRANIDHANA

 Yogic counselling

 Nutritive diet, physical exercises – asanas , pranayam etc, rehabilitation.

 Sat sang, support groups etc.