TERMINOLOGIES

Intoxication- use of a substance that result in maladaptive behavior

Withdrawal Syndrome- refers to the negative physiologic and physical
reactions that occur when use of substance ceases or dramatically
decreases.
Detoxification-is the process of safely withdrawing from a substance.
Substance Abuse- can be defined as using a drug in a way that is
inconsistent with medical or social norms and despite negative
consequences. It denotes problems in social, vocational, or legal areas of the
persons life, whereas SUBSTANCE DEPENDENCE also includes problems
associated with addiction such as tolerance, withdrawal, and unsuccessful
attempts to stop using the substance.

ETIOLOGY
-the exact cause of drug use, dependence, and addiction are not known, but
various factors are thought to contribute to the development of substancerelated disorder.
Different factors
1.

biologic factors

2.

Psychologic Factors

3.

Social and environmental factors

CNS STIMULANTS
CAFFEINE
-is a stimulant drug, which means it speeds up the messages travelling
between the brain and the body.
Its found in the seeds, nuts and leaves of a number of different plants,
including:

COFFEA ARABICA (used for coffee)

CAMELIA SINENSIS (used for tea)
Cola acuminate (used as a nut, tea or in soft drinks including cola)
THEOBROMA CACAO (used in cocoa and chocolate)
PAULINIA CUPANA (used as guarana in snack bars and energy drinks)

Approximately 80% of the inhabitants of affluent countries drink coffee or tea

daily. Caffeine Is appreciated because it Is a stimulant; It induces alertness,
elevates mood, and facilitates Ideation. Subjectively, caffeine Increases
feelings of well-being, motivation for work, and desire to socialize.

Effects of caffeine
There is no safe level of drug use. Use of any drug always carries some
risk. Its important to be careful when taking any type of drug.
Caffeine affects everyone differently, based on:

Size, weight and health

Whether the person is used to taking it

Whether other drugs are taken around the same time

The amount taken

The following effects may be experienced between 5 to 30 minutes after

consuming caffeine, and may continue for up to 12 hours:

Feeling more alert and active

Restlessness, excitability and dizziness

Anxiety and irritability

Dehydration and needing to urinate more often

Higher body temperature

Faster breathing and heart rate

Headache and lack of concentration

Stomach pains

*Children and young people who consume energy drinks containing caffeine
may also suffer from sleep problems, bed-wetting and anxiety.

Overdose
If a large amount of caffeine is consumed it could also cause an overdose.
Tremors
Nausea and vomiting
Very fast and irregular heart rate
Confusion and panic attack
Seizures

It is possible to die from having too much caffeine, but this is extremely rare.
This would usually only happen if 510 grams of caffeine (or 80 cups of
strong coffee) were consumed one after the other.
In small children, caffeine poisoning can happen if a lower amount, such as
around 1 gram of caffeine (equal to around 12 energy drinks) is consumed
one after the other.

Long-term effects
Regular, heavy use of caffeine (such as more than 4 cups of coffee a day)
may eventually cause:

Osteoporosis

High blood pressure and heart disease

Heartburn

Ulcers

Difficulty sleeping

Infertility (in men and women)

Anxiety

Depression

Needing to use more to get the same effect

Dependence on caffeine

Withdrawal
Withdrawal symptoms usually start within 24 hours after the last dose or
even within 6 hours for people who consume a lot of caffeine regularly. The
symptoms can last for around 36 hours, or even longer for people who
consume a lot.
These symptoms can include:

Headache

Tiredness

Sweating

Muscle pains

Anxiety and tension

NICOTINE
-may be regarded as a stimulant.
-is an addictive chemical in tobacco that makes it hard to stop smoking.
-Nicotine Is not directly associated with psychiatric disorders, apart from the
observation that psychiatric patients smoke more than the general
population.
-Nicotine's toxicity concerns mostly the cardiovascular system and cancer.
The neurotoxic and neuroprotective properties of nicotine had not been
thoroughly Investigated until recently.
-A significant public health concern Is the risk to pregnant women.
-Nicotine has a neuroprotective action In neurodegenerative disorders such
as Parkinson's and Alzheimer's diseases
The onset of smoking typically occurs In the teenage years.

Some American studies found that the median age of initiation is 16 to

17 years.
38 According to recent French epidemiological data, the mean age of
smoking onset is as early as 14 years
People choose to smoke because they appreciate the psychoactive,
stimulant effect of nicotine. Smokers report that smoking helps them
concentrate, reason, and perform - observations consistent with
studies demonstrating that nicotine improves attention, learning,
reaction time, and problem solving
smoking helps them relax, particularly In stressful situations, and
improves their mood.
They report pleasure and reduced anger, tension, depression, and
stress.

Smoking withdrawal and cessation

Motivation and education are key factors. Clinical practice shows that
smoking cessation can only be successful when an Individual has made up
his or her mind, is motivated, and has devised a personal strategy for how
and when to stop.
Signs and symptoms at 2 days post-cessation in individuals who quit
smoking without assistance (self-quitters) is as follows:

anxiety

craving

decreased heart rate

depression

difficulty concentrating

Hunger

Irritability

nocturnal awakening

restlessness

Most symptoms begin 6 to 12 hours following smoking cessation, peak

In 1 to 3 days, and last on average 3 to 4 weeks
Nicotine Replacement Therapy and drug treatment

Most smokers quit by using their own, personally devised

method, and most quit without any pharmacological or
professional assistance.
NRT is available in the form of nicotine gum or transdermal
patches. NRT facilitates the initial period of cessation by
reducing the severity of withdrawal symptoms such as craving
and affective discomfort. Studies have demonstrated that (I)
pharmacological treatment is efficacious.
NRT should not be considered if motivation, the mainstay of
smoking cessation, is not clearly present.
The urge to use tobacco is also elicited by many
environmental stimuli.

AMPHETAMINE AND COCAINE

use to treat attention deficit hyperactivity and a high potential for
abuse

Amphetamines
(Speed, fast, up, uppers, louee, goey, whiz.2)

were popular in the past

used by people who wants to lose weight or to stay awake
are stimulant drugs, which means they speed up the messages
travelling between the brain and the body.
Some types of amphetamines are legally prescribed by doctors to treat
conditions such as attention deficit hyperactivity disorder (ADHD) and
narcolepsy

These drugs may be in the form of a powder, tablets and capsules. They may
be packaged in 'foils' (aluminium foil), plastic bags or small balloons when
sold illegally
Amphetamines are generally swallowed, injected or smoked. They are also
snorted

Methamphetamines
o is particularly dangerous
o it is highly addictive
Amphetamine psychosis

and

causes

psychotic

behaviour

Treatment
Chlorpromazine
-an antipsychotic, controls hallucination, lowers blood pressure and relieves
nausea
Effects may be experienced:

Happiness and confidence

Talking more and feeling energetic
Repeating simple things like itching and scratching
Large pupils and dry mouth
Fast heart beat and breathing
Teeth grinding
Reduced appetite
Excessive sweating
Increased sex drive

Overdose
If a large amount or a strong batch is taken, it could also cause an overdose

Racing heartbeat

Passing out

Stroke, heart attack and death

Snorting amphetamines can damage the nasal passage and cause nose
bleeds.
Injecting amphetamines and sharing needles can increase the risk of:

Hepatitis B

Hepatitis C

HIV/AIDS

Tetanus

Long term effects

Regular use of amphetamines may eventually cause:

Reduced appetite and extreme weight loss

Restless sleep

Dry mouth and dental problems

Regular colds and flu

Trouble concentrating

Difficulty breathing

Muscle stiffness

Anxiety and paranoia

Depression

Heart and kidney problems

Increased risk of stroke

Needing to use more to get the same effect

Dependence on amphetamines

Financial, work and social problems

INTOXICATION AND OVERDOSE

Intoxication from stimulants develops rapidly:
Effects:

Euphoric feeling
Hyperactivity
Hyper vigilance
Talkativeness
Anxiety
Grandiosity
Hallucinations
Stereotypic
Anger
Fighting
Impaired judgement

Psychological effects

Tachycardia
Elevated BP
Dilated pupils
Perspirations/ chills
Nausea
Chest pain
Confusion

 Cardiac dysrhythmias

Overdoses
Seizure
Coma
Death

WITHDRAWAL AND DETOXIFICATION

-occurs within few hours to days after several cessation of the drug and is
not life-threatening
Marked dysphoria (primary symptom)
Accompanied by:

Fatigue
Vivid and unpleasant dreams
Insomnia
Increased appetite
Psychomotor retardation

Marked withdrawal

Cashing- the person may experience depressive symptoms, including

suicidal ideation
Stimulant withdrawal is not treated pharmacologically

COCAINE
(C, coke, nose candy, snow, white lady, toot, Charlie, blow, white dust or
stardust.)

is an illegal drug with virtually no clinical use in medicine

is highly addictive and a popular recreational drug because of
the intense and immediate feeling of euphoria it produces
is a stimulant drug, which means that it speeds up the messages
travelling between the brain and the rest of the body.

Erythroxylum coca

Cocaine comes from the leaves of the coca bush

is native to South America. The leaf extract is processed to produce

Cocaine hydrochloride

a white, crystalline powder with a bitter, numbing taste.

Freebase

Crack

a white powder that is more pure with less impurity than cocaine
hydrochloride.

crystals ranging in colour from white or cream to transparent with a

pink or yellow hue

Withdrawal

Giving up cocaine after using it for a long time is challenging because

the body has to get used to functioning without it.
Its therefore important to talk to your GP or another health
professional before trying to give up.

Phases of withdrawal
Withdrawal symptoms usually start around 12 days after last use and
can last for approximately 10 weeks days 4 to 7 will be the worst.
Withdrawal usually happens in 3 phases:
Crash agitation, depression or anxiety, intense hunger, cocaine cravings,
restless sleep, extreme tiredness (experienced in the first few days).
Withdrawal cocaine cravings, lack of energy, anxiety, angry outbursts and
an inability to feel pleasure (can last for up to 10 weeks).
Extinction intermittent cravings for cocaine (ongoing).

HALLUCINOGEN
are substance that distort the users perception of reality and produce
symptoms similar to psychosis, including hallucinations and
depersonalization
also cause increased pulse, blood pressure and temperature, dilated
pupil, and hyperreflexia
Examples:
LAD
mescaline
Psilocybin

LSD (Lysergic acid diethylamide)

Also known as acid, trips, tabs, microdots, dots.

In its pure state, LSD is a white odourless powder.
LSD is usually swallowed, but it can also be sniffed, injected or smoked.

Mescaline (peyote cactus)

Also known as cactus, cactus buttons, cactus joint, mesc, mescal.

Mescaline is the active ingredient of the peyote cactus plant. It is also
known to be made synthetically in a lab.

Magic mushrooms

Also known as shrooms, mushies, blue meanies, golden tops, liberty

caps.

There are many different types of magic mushrooms. The most

common ones in Australia are called golden tops, blue meanies and
liberty caps. Magic mushrooms look similar to poisonous mushrooms
that can cause a person to become very sick and can result in death

Intoxication and Overdose

-it is marked by several maladaptive behaviour or psychologic changes:

Anxiety
Depression
Paranoid ideation
Ideas of reference
Fear of losing ones mind
Suicidal tendency
Physiologic symptoms
Sweating
Tachycardia
Palpitation
Blurred vision
Tremor and lack of coordination

INTOXICATION

Belligerence
Aggression
Impulsivity
Unpredictable behaviour

Withdrawal and detoxification

no withdrawal syndrome has been identified

Cravings
Fatigue
Irritability
Reduced ability to experience pleasure
Hallucinogens can also produce flashbacks
few months to 5 years-duration

Cannabis

is the hemp plant that is widely cultivated for its fiber used to make
rope and cloth and for oil from seeds.
it has been known for its psychoactive resin
refers to upper leaves, flowering tops, and stem of the plants
it can be smoked in cigarettes but it can be eaten
most widely used illicit substance in the United States
has been studied for relieving the nausea and vomiting and associated
with cancer chemotherapy and the anorexia and weight loss of AIDS

is a depressant drug, which means it slows down messages travelling

between your brain and body. When large doses of cannabis are taken,
it may also produce hallucinogenic effects

3 different forms:
Marijuana the dried plant that is smoked in a joint or a bong. This is the
most common form.
Hashish the dried plant resin that is usually mixed with tobacco and
smoked or added to foods and baked; such as cookies and brownies.
Hash oil liquid that is usually added to the tip of a cigarette and smoked

Intoxication and overdose

begins to act less than 1 minute after inhalation

peak effects usually occurs in 20 to 30 minutes and last at least 2 to 3
hours

Symptoms in intoxication

Impaired motor coordination

Inappropriate laughter
Impaired judgement and short term memory
Distortion of time and perception
Anxiety, dysphoria and social withdrawal may occur in some users

Withdrawal and detoxification

no clinically significant withdrawal syndrome is identified (lehne)

Giving up cannabis after using it for a long time is challenging, because the
body has to get used to functioning without it. Withdrawal symptoms may
last for only a week, but sleep may be affected for longer. Symptoms include:

Anxiety
Irritability
Aggressive and angry behaviour
Loss of appetite and upset stomach
Sweating, chills and tremors
Restless sleep and nightmares
Muscle aches
Tremors

INHALANTS

Diverse group of drug that include anaesthetics, nitrates, and organic

solvents that are inhaled for their effect
are common household, industrial and medical products that produce
vapours, which some people inhale (breath in) to make them feel
intoxicated or 'high

Some common inhalants include:

Aerosol spray
Chrome-based paint
Pain t and paint thinner
Felt-tipped pens
Correction fluid (e.g. 'Liquid Paper')
Gas from lighters or barbecues (butane)
Cleaning fluid
Glue
Petrol
Nitrous oxide1

Intoxication and overdose

Dizziness
Slurred speech
Nystagmus
Lack of coordination
Unsteady gait
Tremor
Muscle weakness
Blurred vision

TOXICITY

Anoxia
Respiratory depression
Vagal stimulation
Dysrhythmias
Death may occur from:
Bronchospasm
Cardiac arrest
Suffocation
Asiration of the vomitus

Overdose

Nausea, vomiting and diarrhoea

Irregular heartbeat
Chest pain
Hallucinations
Blackout, seizures and coma
Sudden sniffing death
Low aromatic fuels

Withdrawal and detoxification

no withdrawal symptoms or ditoxification procedures for inhalants as

such, although frequent users report psychologic craving
People abuse inhalants may suffer from dementia anxiety, but are all
treated symptomatically
Giving up inhalants after using them for a long time is challenging
because the body has to get used to functioning without them.
Withdrawal symptoms usually start 24-48 hours after the last use, and
may last for 2 to 5 days.4 These symptoms can include:

Hangover

Headache, nausea and stomach pain

Tiredness, shakiness, tremors

Cramps
Hallucinations and visual disorders, such as seeing spots

ALCOHOL
Intoxication and Overdose
Alcohol is a central nervous system depressant that is absorbed rapidly
into the bloodstream. Initially, the effects are relaxation and loss of
inhibitions.
With intoxication, there is slurred speech, unsteady gait, lack of
coordination, and impaired attention, concentration, memory, and
judgment. Some people become aggressive or display inappropriate
sexual behavior when intoxicated. The person who is intoxicated may
experience a blackout.
An overdose, or excessive alcohol intake in a short period, can result in
vomiting, unconsciousness, and respiratory depression. This
combination can cause aspiration pneumonia or pulmonary
obstruction. Alcohol-induced hypertension can lead to cardiovascular
shock and death.
Treatment of an alcohol overdose:
Gastric lavage or dialysis
To remove the drug and support of respiratory and cardiovascular
functioning in an intensive care unit.

Symptoms of Substance Abuse

Denial of problems
Minimizes use of substance
Rationalization
Blaming others for problems
Anxiety
Irritability
Impulsivity
Feelings of guilt and sadness or anger and resentment
Poor judgment
Limited insight
Low self-esteem
Ineffective coping strategies
Difficulty expressing genuine feelings
Impaired role performance
Strained interpersonal relationships
Physical problems such as sleep disturbances and inadequate nutrition

PHYSIOLOGIC EFFECTS OF LONG-TERM ALCOHOL USE

Cardiac myopathy
Wernickes encephalopathy
Korsakoffs psychosis
Pancreatitis
Esophagitis
Hepatitis
Cirrhosis

 Leukopenia
Thrombocytopenia
Ascites
Withdrawal and Detoxification
Symptoms of withdrawal usually begin 4 to 12 hours after cessation or
marked reduction of alcohol intake. Symptoms include coarse hand
tremors, sweating, elevated pulse and BP, insomnia, anxiety, and
nausea or vomiting.
Severe or untreated withdrawal may progress to transient
hallucinations, seizures or delirium called delirium tremens (DTs).
Because alcohol withdrawal can be life-threatening, detoxification
needs to be accomplished under medical supervision.
Safe withdrawal is usually accomplished w/ the administration of
benzodiazepines such as lorazepam (Ativan), chlordiazepoxide
(Librium), or diazepam (Valium) to suppress the withdrawal symptoms.