SUBSTANCE USE DISORDER

dr. Hartati Kurniadi SpKJ (K),MHA

= SIDE EFFECT OF DRUG ABUSE =
Substance abuse
OD
death
invalid
intox
traffic accident
fight
Criminal acts
DO or loss of job
Financial Problems
Marital
problem
Divorce
Criminal acts
Imprison
Imprison
Dep
tolerance Needs more rupiahs
Financial Problem
abstinence
Other medical complications :
Depends on type of drugs
Life- threatening (alc., sedative
Amph)
Hospitalization
Not life threatening
(others)
THE QUICKEST WAY TO THE
BRAIN
METHOD
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 MINUTES
15 - 30 MINUTES
20 - 30 MINUTES


DRUGS & THEIR NEURO
TRANSMITTERS
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

Illegal drug

- Amphetamine

- MDMA

- Cocaine

- Flunitrazepan
- Marijuana
- Opiates


OPIAT
OPIAT INTOXICATION
EUPHORIA

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 WITHDRAWAL
MILD WITHDRAWAL MORE SEVERE

DYSPHORIC MOOD, ANXIETY, NAUSEA
AND RESTLESSNESS VOMITING
LACRIMATION OR RHINORRHEA MUSCLE ACHES
PUPILLARY DILATATION SEIZURES
PILOERECTION (IN MEPERIDINE
SWEATING WITHDRAWAL)
HYPERTENSION ABDOMINAL CRAMPS
TACHYCARDIA HOT AND COLD FLASHES
FEVER SEVERE ANXIETY
DIARRHEA
INSOMNIA
YAWNING

THE OPIATE FAMILY
Opium poppy
Opium
Morphine Codein Thebaine
Heroin Hydromophone Dihydrocodeine Oxycodone Etorphine
GANJA
C A N N A B I S INTOXICATION
EUPHORIA
DEPERSONALIZATION
DEREALIZATION
SENSATION OF SLOWED
TIME
IMPAIRED COORDINATION
SILLY OR INAPPROPRIATE
AFFECT OR LAUGHING
AMOTIVATION
CONJUNCTIVAL INJECTION
INCREASED APPETITE
DRY MOUTH

TACHYCARDIA
PERCEPTUAL
DISTURBANCES
PSYCHOSIS, 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 WITHDRAWAL
NOTE : NO DSM CATEGORY
INSOMNIA
NAUSEA
IRRITABILITY AND
RESTLESSNESS
YAWNING
CHILLS
DIARRHEA
INFREQUENT
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

1. MALADAPTIVE BEHAVIORAL CHANGES ( e.g. EUPHORIA
OR HYPERVIGILANCE);
2. TACHYCARDIA OR BRADYCARDIA;
3. PUPILLARY DILATATION;
4. HYPER OR HYPOTENSION;
5. PERSPIRATION OR CHILLS;
6. NAUSEA OR VOMITING;
7. WEIGHT LOSS;
8. PSYCHOMOTOR AGITATION OR RETARDATION;
9. MUSCULAR WEAKNESS, RESPIRATORY DEPRESSION,
CHEST PAIN, CARDIAC DYSRHTHMIAS;
10. CONFUSION, SEIZURES, DYSKINESIA, OR COMA
COCAINE WITHDRAWAL
OCCURS 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

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

AMPHETAMINE WITHDRAWAL
OCCURS 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/HYPNOTIC
INTOXICATION
DYSARTHRIA
ATAXIA
IMPAIRED ATTENTION OR MEMORY
AMNESIA (BLACKOUTS)
NYSTAGMUS
STUPOR OR COMA
AFFECTIVE LABILITY
DELIRIUM OR HALLUCINOSIS MAY
BE PRESENT

SEDATIVES/HYPNOTIC
WITHDRAWAL
AUTONOMIC INSTABILITY (DIAPHORESIS,
ELEVATED HEART RATE, ELEVATED BP,
ANXIETY )
TREMOR
N/V
INSOMNIA
PSYCHOMOTOR AGITATION
DELIRIUM WITH VISUAL, AUDITORY, OR TACTILE
HALLUCINATIONS
GENERALIZED TONIC-CLONIC SEIZURES
IRRITABILITY

= 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 better
Stained fingers
Yellow teeth
< Wrinkles
No more stale breath
= SMOKING =
STOP ?
BANK ACCOUNT: >>

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



NICOTINE WITHDRAWAL
1. DYSPHORIA OR DEPRESSED MOOD
2. INSOMNIA
3. IRRITABILITY, FRUSTRATION OR ANGER
4. ANXIETY
5. DIFFICULTY CONCENTRATING
6. BREATHLESSNESS
7. DECREASED HEART RATE
8. INCREASED APPETITE OR WEIGHT GAIN
ALKOHOL
ALKOHOL
Gol. 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


DYSARTHRIA
ATAXIA
IMPAIRED ATTENTION OR MEMORY
AMNESIA (BLACKOUTS)
NYSTAGMUS
STUPOR OR COMA
AFFECTIVE LABILITY
DELIRIUM OR HALLUCINOSIS MAY
BE PRESENT
ALCOHOL WITHDRAWAL
AUTONOMIC INSTABILITY (DIAPHORESIS,
ELEVATED HEART RATE, ELEVATED BP,
ANXIETY)
TREAMOR
N/V
INSOMNIA
PSYCHOMOTOR AGITATION
DELIRIUM WITH VISUAL, AUDITORY, OR TACTILE
HALLUCINATIONS
GENERALIZED TONIC-CLONIC SEIZURES
IRRITABILITY

ALCOHOL
Social 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 alkohol
20 hari stop alkohol
30 hari stop alkohol