SUBSTANCE USE DISORDER

dr. Hartati Kurniadi SpKJ (K),MHA

= SIDE EFFECT OF DRUG ABUSE =Substance abuseODdeathinvalidintoxtraffic accidentfightCriminal actsDO or loss of jobFinancial ProblemsMaritalproblemDivorceCriminal actsImprisonImprisonDeptoleranceNeeds more rupiahsFinancial ProblemabstinenceOther medical complications :Depends on type of drugsLife- threatening (alc., sedativeAmph)HospitalizationNot life threatening(others)

THE QUICKEST WAY TO THE BRAINMETHOD 1. SMOKING 2. INJECTING : - IV - IM/SC 3. SNORTING 4. CONTACT : - EYE - SKIN & OTHER 5. INGESTING

TIME TO BRAIN 7 - 10 SECONDS

15 - 30 SECONDS 3 - 5 MINUTES 3 - 5 MINUTES

3 - 5 MINUTES15 - 30 MINUTES20 - 30 MINUTES

DRUGS & THEIR NEURO TRANSMITTERSIllegal drug

- Amphetamine

- MDMA

- Cocaine

- Flunitrazepan - Marijuana - Opiates

Affect Primarily these neuro transmitters epi, nor epi, acetylcholine,dopamine, serotonin epi, nor epi, dopamine, serotonin

epi, nor epi, dopamine, serotonin

GABA, glycine anandamide, acetylcholine,dopamine endorphins, enkephalins, dopamine

OPIAT

OPIAT INTOXICATIONEUPHORIA

SEDATION OR SLEEPINES (NODDING)

RESPIRATORY DEPRESSION

PUPILLARY CONSTRICTION (PINPOINT PUPILS)

DYSARTHRIA

PERCEPTUAL DISTURBANCES

IMPAIRMENT OF MEMORY OR ATTENTION

NAUSEA

CONSTIPATION WITH DECREASED BOWEL SOUNDS

REDUCED SEXUAL DESIRE

DELIRIUM MAY OCCUR WITH INTOXICATION

OPIATE WITHDRAWALMILD WITHDRAWAL MORE SEVERE DYSPHORIC MOOD, ANXIETY,NAUSEAAND RESTLESSNESSVOMITINGLACRIMATION OR RHINORRHEAMUSCLE ACHESPUPILLARY DILATATION SEIZURESPILOERECTION (IN MEPERIDINESWEATING WITHDRAWAL)HYPERTENSIONABDOMINAL CRAMPSTACHYCARDIAHOT AND COLD FLASHESFEVERSEVERE ANXIETYDIARRHEA INSOMNIAYAWNING

THE OPIATE FAMILYOpium poppyOpiumMorphineCodeinThebaineHeroinHydromophone DihydrocodeineOxycodoneEtorphine

GANJA

C A N N A B I S INTOXICATIONEUPHORIADEPERSONALIZATIONDEREALIZATIONSENSATION OF SLOWED TIMEIMPAIRED COORDINATIONSILLY OR INAPPROPRIATE AFFECT OR LAUGHINGAMOTIVATIONCONJUNCTIVAL INJECTIONINCREASED APPETITEDRY MOUTH

TACHYCARDIAPERCEPTUAL DISTURBANCESPSYCHOSIS, INCLUDING AUDITORY AND VISUAL HALLUCINATIONS AND PARANOID DELUSIONS (USUALLY THAT PEOPLE ARE WATCHING THEM OR ARE AWARE OF THEIR USE).DELIRIUM MAY OCCUR WITH INTOXICATION.

C A N N A B I S WITHDRAWALNOTE : NO DSM CATEGORYINSOMNIANAUSEAIRRITABILITY AND RESTLESSNESSYAWNINGCHILLSDIARRHEAINFREQUENT OCCURRENCE, ONLY IN CHRONIC USERS OF LARGE AMOUNTS.

SYMPTOMS ARE SELF-LIMITED AND MILD, AND NO PHARMACOLOGIC MANAGEMENT HAS BEEN DEMONSTRATED TO BE USEFUL.

KOKAIN

COCAINE INTOXICATION

MALADAPTIVE BEHAVIORAL CHANGES ( e.g. EUPHORIA OR HYPERVIGILANCE);TACHYCARDIA OR BRADYCARDIA;PUPILLARY DILATATION;HYPER OR HYPOTENSION;PERSPIRATION OR CHILLS;NAUSEA OR VOMITING;WEIGHT LOSS;PSYCHOMOTOR AGITATION OR RETARDATION;MUSCULAR WEAKNESS, RESPIRATORY DEPRESSION, CHEST PAIN, CARDIAC DYSRHTHMIAS;CONFUSION, SEIZURES, DYSKINESIA, OR COMA

COCAINE WITHDRAWALOCCURS SHORTLY AFTER CESSATION FROM PROLONGED USE (12 HRS) AND CAN PERSIST FOR DAYS TO MONTHS.DYSPHORIC OR DYSTHYMIC MOOD.FATIGUE AND SLEEP CHANGES (USUALLY HYPERSOMNIA).PSYCHOMOTOR RETARDATION OR ACTIVATION.VIVID OR UNPLEASANT DREAMS (OFTEN CRACK DREAMS ARE OF USING).PATIENTS MAY DEVELOP SUICIDAL IDEATION AND A PROFOUND SENSE OF GUILT AND HOPELESSNESS.

AMPHETAMINE

AMPHETAMINE INTOXICATION

MALADAPTIVE BEHAVIORAL CHANGES ( e.g., EUPHORIA OR HYPERVIGILANCE);TACHYCARDIA OR BRADYCARDIA;PUPILLARY DILATATION;HYPER- OR HYPOTENSION;PERSPIRATION OR CHILLS;NAUSEA OR VOMITING;WEIGHT LOSS;PSYCHOMOTOR AGITATION OR RETARDATION;MUSCULAR WEAKNESS, RESPIRATORY DEPRESSION, CHEST PAIN, CARDIAC DYSRITHMIAS;CONFUSION, SEIZURES, DYSKINESIA, OR COMA.

AMPHETAMINE WITHDRAWALOCCURS SHORTLY AFTER CESSATION FROM PROLONGED USE (12 HRS) AND CAN PERSIST FOR DAYS TO MONTHS.DYSPHORIC OR DYSTHYMIC MOOD.FATIGUE AND SLEEP CHANGES (USUALLY HYPERSOMNIA).PSYCHOMOTOR RETARDATION OR ACTIVATION.VIVID OR UNPLEASANT DREAMS (OFTEN CRACK DREAMS ARE OF USING).PATIENTS MAY DEVELOP SUICIDAL IDEATION AND A PROFOUND SENSE OF GUILT AND HOPELESSNESS.

SEDATIVES/HYPNOTICINTOXICATIONDYSARTHRIAATAXIAIMPAIRED ATTENTION OR MEMORYAMNESIA (BLACKOUTS)NYSTAGMUSSTUPOR OR COMAAFFECTIVE LABILITYDELIRIUM OR HALLUCINOSIS MAY BE PRESENT

SEDATIVES/HYPNOTICWITHDRAWALAUTONOMIC INSTABILITY (DIAPHORESIS, ELEVATED HEART RATE, ELEVATED BP, ANXIETY )TREMORN/VINSOMNIAPSYCHOMOTOR AGITATIONDELIRIUM WITH VISUAL, AUDITORY, OR TACTILE HALLUCINATIONSGENERALIZED TONIC-CLONIC SEIZURESIRRITABILITY

= SMOKING = STOP ?>3 days: free of nicotine>1 month: lungs clean themselves >3 months: - sperms to normal - fertility level>1 year: - risk of heart disease - risk of lung cancer

= SMOKING = STOP ?

Appearance: - look better - feel betterStained fingersYellow teeth< WrinklesNo more stale breath

= SMOKING = STOP ?BANK ACCOUNT: >>

CONFIDENCE SOARS : IF YOU CAN QUIT SMOKING, YOU CAN HANDLE OTHER CHALLENGES IN LIFE

NICOTINE INTOXICATION

?

NICOTINE WITHDRAWALDYSPHORIA OR DEPRESSED MOODINSOMNIAIRRITABILITY, FRUSTRATION OR ANGERANXIETYDIFFICULTY CONCENTRATINGBREATHLESSNESSDECREASED HEART RATEINCREASED APPETITE OR WEIGHT GAIN

ALKOHOL

ALKOHOLGol. A: Ethanol 1% s/d 5%Gol. B: Ethanol > 5% s/d 20%Gol. C: Ethanol > 20% s/d 55%

Gol. B & Gol.C

Minuman Keras

ALCOHOL INTOXICATION

DYSARTHRIAATAXIAIMPAIRED ATTENTION OR MEMORYAMNESIA (BLACKOUTS)NYSTAGMUSSTUPOR OR COMAAFFECTIVE LABILITYDELIRIUM OR HALLUCINOSIS MAY BE PRESENT

ALCOHOL WITHDRAWALAUTONOMIC INSTABILITY (DIAPHORESIS, ELEVATED HEART RATE, ELEVATED BP, ANXIETY)TREAMORN/VINSOMNIAPSYCHOMOTOR AGITATIONDELIRIUM WITH VISUAL, AUDITORY, OR TACTILE HALLUCINATIONSGENERALIZED TONIC-CLONIC SEIZURESIRRITABILITY

ALCOHOLSocial drinking

At risk drinking regularly exceeding 21 units/week for men, or 14 units/week for women

Problem drinking serious family and social problems occur as a result of drinking

Alcohol dependence

10 hari stop alkohol20 hari stop alkohol30 hari stop alkohol