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
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