TERMINOLOGIESIntoxication- use of a substance that result in maladaptive behaviorWithdrawal 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 substance-related disorder.Different factors 1.biologic factors2.Psychologic Factors3.Social and environmental factors

CNS STIMULANTSCAFFEINE-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 caffeineThere 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 healthWhether the person is used to taking itWhether other drugs are taken around the same timeThe 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 activeRestlessness, excitability and dizzinessAnxiety and irritabilityDehydration and needing to urinate more oftenHigher body temperatureFaster breathing and heart rateHeadache and lack of concentrationStomach pains

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

OverdoseIf a large amount of caffeine is consumed it could also cause an overdose. TremorsNausea and vomitingVery fast and irregular heart rateConfusion and panic attackSeizures

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 effectsRegular, heavy use of caffeine (such as more than 4 cups of coffee a day) may eventually cause:OsteoporosisHigh blood pressure and heart diseaseHeartburnUlcersDifficulty sleepingInfertility (in men and women)AnxietyDepressionNeeding to use more to get the same effectDependence on caffeine

WithdrawalWithdrawal 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:HeadacheTirednessSweatingMuscle painsAnxiety 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 diseasesThe 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 cessationMotivation 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:anxietycraving decreased heart rate depression difficulty concentrating HungerIrritabilitynocturnal awakeningrestlessness

Most symptoms begin 6 to 12 hours following smoking cessation, peak In 1 to 3 days, and last on average 3 to 4 weeksNicotine 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 illegallyAmphetamines are generally swallowed, injected or smoked. They are also snorted

Methamphetamines is particularly dangerous it is highly addictive and causes psychotic behaviour Amphetamine psychosis

TreatmentChlorpromazine-an antipsychotic, controls hallucination, lowers blood pressure and relieves nauseaEffects 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

OverdoseIf a large amount or a strong batch is taken, it could also cause an overdoseRacing heartbeatPassing outStroke, heart attack and deathSnorting amphetamines can damage the nasal passage and cause nose bleeds.Injecting amphetamines and sharing needles can increase the risk of:Hepatitis BHepatitis CHIV/AIDSTetanus

Long term effectsRegular use of amphetamines may eventually cause:Reduced appetite and extreme weight lossRestless sleepDry mouth and dental problemsRegular colds and fluTrouble concentratingDifficulty breathingMuscle stiffnessAnxiety and paranoiaDepressionHeart and kidney problemsIncreased risk of strokeNeeding to use more to get the same effectDependence on amphetaminesFinancial, work and social problems

INTOXICATION AND OVERDOSEIntoxication 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-threateningMarked 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 a white powder that is more pure with less impurity than cocaine hydrochloride.

Crack 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 hyperreflexiaExamples: 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 TremorsINHALANTS 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 Paint 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 fuelsWithdrawal 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

ALCOHOLIntoxication 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.