Content

Historical highlights. Terminology. Etiology, Level of

PAS use, Effects, Biomolecular aspects, Signs of
possible PAS use , Diagnosis, Symptoms of usage,
Abstinence and Intoxication, Management , Prognosis
Referal

Kaplan HI., Sadock BJ., Comprehensive Textbook of Psychiaty
vol. I, 7
th.
Ed., Lippincot, Williams & Wilkins, Baltimore, 2000.
Diagnosis and Statistical Manual of Mental Disorder , 4
th.
Ed.,
American Psychiatric Association, Washington DC, 1994.
Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di
Indonesia III , cetakan 1, DirJen YanDik DepKes RI, Jakarta.
Kaplan HI. Sadock BJ., Synopsis of Psychiatry , Behavioral
Sciences / Clinical Psychiatry 8
th.
Ed., Williams & Wilkins,
Baltimore, 1998.
Undang-undang Narkotika & Psikotropika , cetakan kedua . Sinar
Grafika , Jakarta 1999
Historical Hightlights

Used since ancient time ^ rituals,
socialization, recreation .
INDONESIA
Opiate ordonance 1927
Import, distribution, usages
regular opiate distribution for personal
consumption ( old Chinese people )
Brisbane ordonance

Terminology

Psychoactive substance (PAS)
a substance when ingested acts on
the mind
SUBSTANCES:
PPDGJ III , ICD 10

DSM IV
V Dependence syndrome

V Tolerance

V Withdrawal syndrome
Inter-relation of PAS, the individual person and
the enviroment
Characteristics
PAS : effect , accessibility
Person : high risk, curiousity ,peer solidarity ,
identity, escapism, misuse [ abuse
Environment : family disharmony, authority crisis,
norm - value changes, morale & religiousities
forced by peers, less facililities for youth
activities, less employment and education
facilities.
High rik individuals Potential user

Easily disappointed aggressive,
instant gratification ,
bored easily depresive
risk taking behaviour
psychosexual problems
personality disturbance
lower intelligence

Physically and mentally healthy
Socially well adjusted
Honest
Responsible
Able to handle severe / acute stress
Able to fulfill leisure time
Rationale expextations
dependence
abuser
situational
Low risk
High risk
occational
experimental
Treatment &
rehabilitation
intervention
promotion
Promotion &
prevention
Level of PAS
Use
user
Non
user


Physical q the substance, ingredients and
method of usage
- pulmonary & respiratory system
- Cardiovascular - GI tract
- dermatologic - urinary tract
- haemopoetic - endocrine
- bone & muscle - nervous system
- other (AIDS)
HIV infection

^ Flulike syndrome after 3 -- 6 weeks
becoming infected
^ Seroconversion 6 -- 12 weeks,
6 -- 12 month
(Elisa , Western blot )
^ HIV AIDS 8 -- 11 years
Psychological
several kind of mental and behavioural
problems due to PAS use

Social
disturbance of produtivty and social live
} Alcohol } amphetamine
} halucinogen } opiate
} cocaine } cannabis
} sedatives / hypnotics
} designer amphetamines ( e.g. ecstasy )

_ Achievement ( work , academic )
_ irritable
_ Socialization
_ Dicipline
_ No sense of responbility
_ Stealing , cheating , dishonest
_ Not well groomed
_ Use to be alone in certain special places
_ Use to wear sun glasses, longleeves shirt
Diagnosis

_ PPDGJ III / ICD 10

_ DSM IV

Dependence Syndrome

1. A strong desire or sense of compulsion to take
the substance
2. Difficulties in controlling substance taking
3. A physiological withdrawal state
4. Evidence of tolerance
5. Progressive neglect of alternative pleasure or
interests because of PAS use
6. Persisting with substance use despite clear
evidence of overtly harmful consequences

Symptoms of Usage , Abstinence
& Intoxication
1. Opiate
Symptoms of Usage , Abstinence &
Intoxication
2. Cannabis
Symptoms of Usage , Abstinence
& Intoxication
3. Sedative - hypnotic
Symptoms of Usage , Abstinence
& Intoxication
4. Alcohol
Symptoms of Usage , Abstinence
& Intoxication
5. Amphetamine
Symptoms of Usage , Abstinence
& Intoxication
6. Cocaine
Symptoms of Usage , Abstinence
& Intoxication
7. Inhalants
Symptoms of Usage , Abstinence
& Intoxication
8. Hallucinogens
Management
Basic principles
Supply
Needs
abuse

Prosperity approach

Promotion
education
prevention
Treatment
rehabilitation
Security approach
NEEDS
2 major goals of treatment

[ Complete abstinence

[ Physical, psychiatric and
psychosocial well - being
= Adequate psychosocial
supports are very important for
changes of behaviour

= urine drug screens
Treatment

1. By laws
UU no. 5 1997 (Psikotropika)
UU no. 22 1997 (Narkotika)
2.1. Potential users
2.2. Users
2. 1. Potential users
q Prevention (parent, families,teachers, tutors)
q develop alternate activities

2. Users
q Physical, psychological, social.
q Treatment & rehabilitation are not separate
q Long - term
q Need broad cooperation

Treatment phases

1. Initial, 1- 3 days (in patient)
2. Detoxification and treatment for medical
complications , 1- 3 weeks (in patient)
3. Stabilization , 3 - 9 months
4. Preparation for reintegration to the
community , 3 - 12 months
5. Resocialization , approx. 3 years.
treatment
Opiate

[ Education
[ Methadone
[ Naltrexone
[ Psychotherapy
treatment
Cannabis

[ Amotivational syndrome
[ Abstinence & suport
education
[ Psychotherapy,
[ Antianxiety, antidepressant
treatment
Sedative - hypnotic

+ Withdrawal
+ Overdose
treatment
Alcohol

+ Psychotherapy
+ Behaviour therapy
+ Pharmacotherapy

treatment
Amphetamine & cocaine

Very difficult to remain abstinent
powerfully reinforcing & induces craving
Psychotherapy
Antipsychotic
Anticraving
treatment
Inhalant

+ Short lived cease or change to
another substance
+ Counselling, education about PAS
+ DA antagonist

treatment
Hallucinogens

+ Talking down
+ DA antagonist, bzd.
Referals

[ Early phases GPs
[ Advance phase Psychiatric facilities
[ Acute intoxication (emergency situation)
& medical complications
General hospital : ER, ICU.
[ Psychiatric symptom
Psychiatric facilities
Treatment facilities

^ Mental hospital, Psychiatric departements
10 % of bed capacities
^ RSKO ( Jakarta )
^ Police facilities ( Pamardi Siwi , Jakarta )
^ Religion - based facilities
^ Social wellfare facilities (Lembang , Parung)
^ Rehabilitation centers
Prognosis
Remission specifiers
) Early partial remission
) Early full remission
1 month -- 12 months , no dependence
) Sustained partial remission
) Sustained full remission
12 months , no dependence
Alcohol

^ 20 % spontaneous remission
^ no antisocial personality
^ no other PAS use
^ general life stability
^ joining full course of initial rehabilitation
60 % chance for 1 year abstinence
Amphetamine

] 25 % have unfavorable outcomes in
daily living affairs (family, work, drug use)
Cannabis

Those who does not understand the
intellectual reasons for addressing a
substance abuse problem has a little
motivation to stop .
Hallucinogens

Lifetime character of hallucinogen
abuse : bell curve
Inhalants

Low prevalence in adulthood , associated
with increased risk for future diagnosis of
antisocial personality disorder and other PAS
use disorder
Opiate

^ Relapse rate : high
relapse mostly at the first 3 month ,
2 out of 3 patients relapse within
6 months.
33 % of those with 3 years
abstinence , eventually relapsed
^ Death rate 1 - 3 % / year.
Sedative - hypnotics


10 months -- 6 years follow up ,
45 -- 70 % no longer taking bzd.