Alcolism and drug dependence

DR RAHIM IQBAL MBBS(Pb).MPH(H.S.A) Senior Demonstrator Rawalpindi Medical college Rawalpindi

Situation in Pakistan

According to UNO survey conducted in 1986, The number of addicts in Pakistan is 2,066,862. Urban area addicts 768,411 and in Rural area 1,298,451. Total heroine addicts 657,392 in urban area 355,421 and rural area 301,971. The projected increase of addicts in Pakistan every year is estimated at 10%. 10,000 addicts were prosecuted in Sindh a few year ago. According to a survey , an amount of Rs 6,840 million per annum is being spent on drugs by the addict in country.
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Drug
Any substance that when taken
into the living organism may modify one or more of its functions (WHO).
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DRUG DEPENDENCE
It is described as a state of psychic and
sometimes also Physical resulting from the interaction between a living organism and a drug characterized by behavioral and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience a psychic effects and sometimes to avoid the discomforts of its absence. A person may be dependent upon more than one drug. 5

Drug Addiction
It is defined as a state of periodic or
chronic intoxication detrimental to the individual and society produced by the repeated attacks of habit-forming drugs. Drug abuse has become an alarming problem in our society

Phases of Drug Addiction

Drug Tolerance
Drug Habituation Physical dependence

Psychological dependence

There is an overpowering desire

(compulsion) to take the drug and obtain it by any means.

Drug Tolerance
Physical Tolerance: When drugs is withdrawn the patient shows Withdrawal Symptoms: such as irrational and violent behavior nausea, diarrhoea, watering of eyes and nose etc. Development of Tolerance There is a tendency to increase the dose.
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Harmful Effects of Drug Addiction

Physical and sexual energy of addict weaken.

Breakdown of the family economics. Physically and mentally retarded babies birth in addicts family. Loss of self-confidence and the will to work. Male addicts indulge in crime and female in prostitution. Drugs addicts are responsible for most of the accidents on road.
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Agents Factors
1) Alcohol. 2) Opioids. 3) Cannabinoids (Marijuana, Hashish). 4) Sedatives or hypnotics. 5) Cocaine . 6) Other Stimulants including Caffeine. 7) Hallucinogens. 8) Tobacco. 9) Volatile Solvents. 10) Other Psychoactive substances and drugs from different
class used in combination.

Dependence producing agents

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Agents Factors(A guide of the drugs)

Drugs 1
Hallucinogenic cactus(mescalin peppte)

Medical use sedation

None No

physical
Yes

tolerance
Yes

Hallucinogenic mushroom(Pislocybin) Cocaine (from coca bush) Amphetamine

None Anesthesia Narcolepsy and behavioral disorders Antisepsis pneumia None in modren medicine Relief of pain

No No No

Yes Yes Yes

Yes Yes Yes

3
4

5
6 7 8

Alcohol Cannabis(marjuana,hashish) Narcotics(opium,heroine,mor phine,codeine)pethine LSD(synthetics derived from fungus on grain) Hallucinogenic morning glori

Yes Late if any Yes

Yes Yes Yes

Yes Yes Yes

Essentially none None

No None

Yes Yes

Yes Yes

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The Drugs, Which are in common use today 1. Amphetamines and cocaine 2. Barbiturates 3. Cannabis 4. Heroin 5. LSD (Lysergic acid Diethylamide) 6. Alcohol 7. Tobacco 8. Volatile solvents 9. Caffeine
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1) Synthetics drugs, just like adrenaline.

Amphetamines and Cocaine

2) Used for obesity, mild depression, and narcolepsy (10-30 mg) 3) Common names are Benzedrine, Dexedrine, methedrine 4) Produces mood elevation, feeling of well being and increased alertness. 5) Increases self-confidence and energy so called superman drugs. 6) Derives from leaves of coca plant and formally used as local anesthetics. 7) It is CNS stimulant. 8) Very notorious for Psychic dependence with large doses and rapid and strong.
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2) Barbiturates
1) 2) 3) 4)
They are sedative drugs. Major ingredients of sleeping pills Mainly used in anesthesia department. Causes both physical and psychic dependence.

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3) Cannabis (Marijuana, Hashish)

1) Most widely drug used today. 2) Obtained from Hemp plants-Cannabis Sativa C-indica 3)
and C-Americana. The Resinous exudate from the tops of flowers contains most of the active ingredient called hashish or Charas. The dried leaves are called Bhang. The resinous mass from the small leaves and the brackets of inflorescence is called Ganja. It causes dreamy state of altered Consciousness, relaxation, euphoria and tendency to laugh. Greater awareness of colours and sounds, Interference of both time and space and Paranoia(fear) are the Psychological effects. Human deaths appears a rare Phenomenon. 16

4) 5)
6)

7)

Cannabis (Marijuana, Hashish)

4) Heroin
1) Heroin, Morphine, Codeine, Methadone,
Pathidine are Narcotic Analgesics. 2) It causes worse type of addictions. because it produces craving. 3) It Causes Psychic dependence and tends to develop early. 4) Tolerance to Heroin is very rapid so the dose of its is increased to achieve the same effect.
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Addict person

Heroin

5) LSD (Lysergic Acid Diethyl amide)

1. LSD was synthesized in 1938 by Hoff Mann in the

2.
3. 4. 5. 6. 7.

Sandoz Laboratories in Switzerland. Its Psychic properties were notice in 1943 accidentally. It oral dose range is 100-250 Micro gram. Its side effects are disturbance in colour person and auditory acuity body image distortion, visual illusions, and Pseudo hallucinations are common. Colours are heard and music become palpable. Subjective time is deranged so that seconds to be minutes and minutes passed slowly as hours Physical dependence does not developed with LSD, hence there is no addiction liability.
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6) ALCOHOL
1) By Pharmacological definition, Alcohol is a Drug and may be 2) 3) 4) 5)
Classified as sedative, tranquillizer, hypnotic and anesthetic, depending upon the quantity. Its rapidly absorbed in stomach and in small intestine. With in 23 minutes of consumption it can be detected in the blood. For last 30-40 years young people are started drinking it more as compare to older peoples so the liver cirrhosis and rode side accidents are common Alcohol has a marked effect on CNS. It is not stimulant as longed believed. According to current concept alcohol is considered a disease, which causes acute and chronic intoxication, cirrhosis of the liver, toxic psychosis, gastritis, pancreatitis, cardiomyopathy and peripheral neuropathy It can cause cancer of mouth, pharynx, Larynx, and esophagus. It is an important etiological factor in suicide, RTA, violence, 21 family disorganization, crime and loss o productivity.

6)

Socio economical aspects from some parts of the world of ALCOHOL

1) Chile.30% of medical budget is spent. 2) England and Wales. Admission to hospitals for alcoholism 3) 4)

5)
6) 7) 8)

increased twenty times in25 years. Honduras.65% rural population spending 33% of their salary. Kuwait. Road Side accidents increased three times from 1975 to 1985. The united kingdom. one out nine at an advanced stage of alcohol dependence receives care by medical or social services. United States .The cost-medical, psychiatrics and social- of the consequences of drinking is estimated at US dollars 43,000 million each year. Venezuela. Traffic accident ranks as the fifth leading cause of death, with alcohol implicated in 36% to 60% of all cases. Zambia. study of autopsies showed a high level of alcohol content in the blood of victims of traffic accidents.
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Alcohol

7) TOBACCO
1. Its illegal use is every where in the world 2. About 3 million premature death occurred
every where. 3. It causes 30% of all cancer death. 4. It causes stroke, MI, Aortic aneurysm, Peptic ulcer, and Bronchitis, Emphysema and Lung Cancer.

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Tobacco

1. These are substances, which are sniffed.

They include glue, patrol, diethyl ether, and type writer correction fluid. 2. These substances are CNS depressant its side effects are confusion, disorientation and Ataxia. 3. Sudden death may occur even on the first occasion. Its used is decreasing slowly in developed countries but it consumption is rising is developing countries both in men and women. 6. The withdrawal symptoms include irritability, anxiety, Graving, sleep problems, headache, tremors and lethargy.
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8) VOLATILE SOLVENTS

9) CAFFINE
1. Most commonly used drugs world wide. 2. About 10 billion pounds of Coffee are

consumed yearly throughout the world 3. It causes anxiety, agitation, and restlessness. 4. Withdrawal from Caffeine can produced headache, irritability, lethargy and nausea.
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HOST FACTORS
1. 2. 3. 4. 5. 6.
To get pleasure. Desired to experiment. Thinking it an adventure. Wish for self-knowledge. Desire to Escape. Age(mostly teenagers)

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Symptoms of Drug addictions

1) Loss of interest in sports and daily routine. 2) A Loss of appetite and body weight. 3) Unsteady gait, Clumsy movements, tremors. 4) Reddening and puffiness of eyes blurred vision. 5) Slurring of Speech. 6) Fresh Numerous marks on body and blood passivity. 7) Nausea, vomiting and body pain. 8) Drowsiness or sleeplessness, lethargy and passitivity. 9) Acute anxiety and depression, profuse sweating. 10) Changing mood, Temper, Tantrums (bad temper) 11) Depersonalization and emotional detachment. 12) Impaired memory and concentration. 13) Presence of needles, syringes and strange packets at
home.
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ENVIRONMENTAL FACTORS

Unemployment. Living away from home . Migration to cities . Relaxed parental control. Alienation (isolation) from family. Early Exposure to drugs. Leavings School early . Broken homes . Large urban environment. Areas where drugs are sold traded or produced. Certain Occupations (Tourism, drug production or sale areas with a high rates of Crimes. Areas where there are drug using Granges Areas where delinquency is common

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PREVENTION
Legal Approach: 1) Strict Law implementation. 2) Prohibition of the sale of Tobacco products to minors 3) Restriction on the sale of Cigarettes through automatic wending machines 4) Prohibition of smoking in schools and other public places. 5) Prohibition Cigarettes Advertising. 6) Public Health Education posters on prominent places.
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Educational Approach
1. Educational Programs for Children. 2. Public Information campaigns on
Electronic media.

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Community Approach
1. Community should take active part for
2. 3.
prevention of drugs . Teen centers providing activities attractive to the adolescents who might otherwise drift in a drug taking subculture . Establishment of groups of organizations interested in athletics,sports,music,public policy,religion and artistic activities of various kinds.
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Treatment
1. Identification of Drug addicts and their
motivation for detoxication 2. Detoxication (needs Hospitalization) 3. Post-detoxication counseling and follow up(based on Clinic and home visits). 4. Rehabilitation.

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Rehabilitation of Addicts Welfare Home

It should have the following units.

1. Assistant Unit.
2. Occupational and vocational training
unit.

3. Medical and physiotherapy unit.

4. Educational and recreational unit.

5. Management unit
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Rehabilitation of Addicts Welfare Home

A Psychiatrist,psychologist,a doctor and a

Assistant Unit

social worker. Occupational and vocational training unit. Sewing, weaving carpets, dune making, Preparing nawar o baan,cane work,basket making, shoe making, carpentry,blackmith,pottery and 36 handicrafts.

Rehabilitation of Addicts Welfare Home

Medical and physiotherapy unit.

Here the patient is admitted for

Educational and recreational unit.

treatment under strict supervision.

The addicts are reluctant to stay so

indoor games facility should be present.

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Rehabilitation of Addicts Welfare Home

This unit is responsible to help the addicts

Management Unit

for getting the employment in factories, offices and business firms and watch the welfare and conduct. It will also arrange supply of raw material required for vocational training centre and marketing of the manufactured articles.
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Rehabilitation of Addicts
Solve the problems of the addicts.
Shelter provision outside the city. Religion support. Re-educating the addicts.
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Charas

Bhang

Addicts people of older times

Shisha

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