1	Psychoactive Substances
2	Substance Abuse What is use versus abuse?
3	Substance Dependence Tolerance Withdrawal (symptoms vary between classes) The substance is taken in larger amounts over a longer period of time than was intended Persistent desire or repeated unsuccessful efforts to cut down A great deal of time spent to obtain the substance Important social, occupational, or recreational activities given up because of substance use Continued use despite knowledge of physical problem from using
4	List of Psychoactive Drugs Caffeine Nicotine Alcohol Opiods Sedatives Amphetamines Cocaine Marijuana Hallucinogens
5	Caffeine Used by three quarters of adults in US
6	Nicotine Demographics 1/3 of all adults in Europe are smokers
7	Nicotine Physical effects increased catecholamine release (vasoconstriction and increased blood pressure) increased peristalsis tremor low birth weight infants in mothers who smoke
8	Nicotine Withdrawal and Relapse Signs of withdrawal Irritability Headache Anxiety Weight gain 80% of people who stop smoking relapse within the first year
9	Quitting Nicotine Role of physician is to provide education and medication to help curb desire for nicotine (ie Buproprion and transdermal patches) Factors that improve prognosis support of spouse or child fear of ill effects membership in support group counseling by a non smoking physician
10	Alcohol Demographics Almost every adult has tried alcohol at some time in their lives 13% lifetime risk of abuse or dependence Use is greatest in the 21-34 year old age group Alcoholism is more prevalent in men (although alcoholism in women is increasing)
11	Epidemiology Alcoholism by Religion Lowest rates of alcoholism seen amongst Muslim, Jews, Asians and conservative Protestants Liberal protestants and Catholics have higher rates
12	Effects of Alcohol Physical Effects (Short term) Intoxication - depressed CNS activity is GABA mediated (can reach coma at blood concentrations of 0.40% - 0.50%)
13	Alcohol & Health CNS (neuropathies, Wernicke-Korsakoff) Cardiac (cardiomyopathy) GI (cirrhosis, pancreatitis, portal hypertension, ulcers) Nutritional deficiency - thiamine, folate, B12 Fetal Alcohol Syndrome (facial abnormalities, reduced height and weight, mental reatrdation)
14	Alcohol Withdrawal Tremor Tachycardia Hypertension Malaise Nausea DT’s Siezures
15	Treatment of Alcoholism
16	Opiods Include: Morphine, Heroin, Methadone, Codeine Act on mu receptors Opiods are cross-reactive Therefore we can substitute methadone to prevent heroin withdrawal.
17	Heroin Facts & Figures 50% of the heroin addicts in the USA live in New York City Males outnumber females 3:1 Overdose can lead to fatal respiratory depression Withdrawal is rarely fatal
18	Heroin Withdrawal anxiety insomnia anorexia and nausea stomach cramps sweating and fever rhinorhea piloerection
19	Quitting Heroin Methadone can be used for maintenance or on sliding scale to decrease withdrawal symptoms Methadone is legal, can be taken orally, and has longer half life than heroin. It causes less euphoria and sedation. Naloxone (opioid antagonist) can be used to maintain abstinence
20	Sedatives Amobarbital, Pentobarbital, and Secobarbital are most commonly abused. Taken in overdose will lead to respiratory depression. Withdrawal can be very dangerous (presents as DT’s plus cardiovascular collapse) Therefore, gradual reduction with long acting barbituates (phenobarbital) is recommended.
21	Sedatives Used as sedatives, muscle relaxants, anticonvulsants, and anesthetics. Also used to treat alcohol withdrawal. Less risk of overdose (except when mixed with alcohol). May cause amnesia. Withdrawal - presents with anxiety, insomnia, tremor and seizures.
22	Amphetamines General Classified as a stimulant; Currently indicated for ADHD and narcolepsy. Causes increased catecholamine release from presynaptic terminals. These drugs act rapidly and produce euphoria, reduced fatigue, elevated pain threshold, reduced appetite and increased libido.
23	Amphetamines Adverse effects - cardiac symptoms, hypertension and delusions resembling schizophrenia. Overdose can be fatal. Withdrawal - Post use “crash” - anxiety, lethargy, headache, stomach cramps, hunger and severe depression (Also applies to Cocaine).
24	Cocaine Is a stimulant which acts by blocking reuptake of dopamine and serotonin. Produces euphoria and crash similar to amphetamines. Cocaine psychosis as well as fatal overdose may be seen. Use has declined since mid 80’s but crack use is still prevalent. Newborns show hyperactivity and IUGR (due to placental vasoconstriction)
25	Marijuana Most frequently used Schedule I drug in the USA THC is active ingredient Physiological effects: include orthostatic hypotension and tachycardia Psychological effects: include euphoria, relaxation and sleepiness No physiological withdrawal symptoms
26	Side effects of Marijuana
27	Hallucinogens LSD (aka acid) Mechanism: increases 5HT (lasts approx 8-12h) Physical effects: diaphoresis, blurred vision, mydriasis, tachycardia, tremor, palpitations Withdrawal and tolerance rarely seen Risk of “bad trip” similar to panic attack Risk of flashbacks and possible schizophrenia in susceptible individuals
28	PCP aka Angel Dust Similar effects as LSD, but more episodes of violent behavior Physical effects: hypertension, hyperthermia, and nystagmus Psychological effects: hallucinations and even psychosis (may last days) Overdose may occur with as little as 20 mg Long term: memory loss, lethargy and reduced attention span
29	MDMA aka Ecstasy
30	MDMA continued Tolerance will develop with repeated use Overdose: reports of sudden death; can happen to new or chronic users. Withdrawal: No physical problems, but some users suffer anxiety, mood swings, irritability and depression