SUBSTANCE USE

DISORDER
INTRODUCTION
 Psychoactive substance including alcohol,
cannabis etc have been consumed in different
societies.
 Social and traditional use has created more social
and health problems.
 The prevalence of persons consuming illicit
substance is progressively increasing and the age
of initiation is decreasing.
LICIT SUBSTANCES
 Tobacco
 Alcohol

Illicit substance
 Opiates
 Cannabis
 Cocaine
 Hallucinogens
 COMMONLY USED SUBSTANCE
 Alcohol

 Opioids :
 Codeine- derivate of opium.
 Heroin (brown sugar/smack)
 Opium (afim)- made of poppy opium.

 Cannabis : Ganja, chares, bhang, marijuana

 Cocaine :Stimulant extracted from leaves of coca

plant
 COMMONLY USED SUBSTANCE

 Hallucinogens e.g. LSD[lysergic acid

diethylamide], Dhaturo.

 Sedative and hypnotics e.g. Barbiturates

[ secobarbital , amobarbital ]

 Other stimulant e.g. caffeine, nicotine, volatile

substance.
 ICD 10 CRITERIA
F10-19 Mental and behavioural disorder due
to psychoactive substance use.
 F 10 : Mental and behavior disorders due to use of alcohol.
 F 11 : Mental and behavioral disorders due to use of
opioids.
 F 12 : cannabinoids.
 F13 : Sedatives /hypnotics.
 F 14 : cocaine.
 F 15 : other stimulants including caffeine.
 F 16 : hallucinogens.
 F 17 : tobacco
 F 18 : volatile solvents.
 F 19 : multiple drug use and other psychoactive
DEFINITION
 Substance abuse is a psychoactive drug use of any
class or type, used alone or in a combination ,that
poses significant hazards to health.

(Bennet & Woolf 1991)

DEFINITION
Dependence –
 A compulsive or chronic requirement.

 The need is so strong as to generate distress (either

physical or psychological) if left unfulfilled
DEPENDENCE SYNDROME
A. Three or more must occur for at least 1 month
1. A strong desire to take the substance.
2. Impaired capacity to control substance taking
behavior.
3. A physiological withdrawal state when substance
use is reduced or ceased
4. Evidence of tolerance
5. Pre-occupation with substance use as manifested
by important alternative pleasure or interests
being given up.
CONTD….
6. Persistent substance use despite clear evidence of
harmful consequences.
SUBSTANCE DEPENDENCE
Physical dependence :

 Physical dependence occur when drug user body

become resistant to particular drug

 without drug the user may experience symptoms

of mild discomfort to convulsion.
PSYCHOLOGICAL DEPENDENCE
 It means when there is an overwhelming desire to
repeat the use of a particular drug to produce
pleasure or avoid discomfort.(Hermes,1993)

 It can be extremely powerful ,producing intense

craving for a substance as well as its compulsive
use.
CONTD…
Tolerance :
 It is defined as the need for increasingly larger or
more frequent doses of a substance in order to
obtain the desired effects originally produced by a
lower dose.
1. Substance intoxication :
It is a transient condition following the
administration of psychoactive substance, resulting
in disturbance in level of consciousness, cognition,
perception, behaviour or other physiological
function..

This is associated with high blood level of drug.

2.SUBSTANCE
WITHDRAWAL
 It is the development of substance specific
behavioral change, physiological and cognitive
changes, that is due to cessation or reduction in
heavy and prolonged substance use.(APA 2000)
ICD 10 CRITERIA
Withdrawal state
1. The development of a substance-specific
syndrome caused by the cessation or reduction in)
heavy and prolonged substance use.
2. The substance-specific syndrome causes clinically
impairment in social, occupational, or other
important areas of functioning.
3. The symptoms are not caused by a general
medical condition and are not better accounted for
by another mental disorder.
STIMULANT
 act on brain to produce excitation, increase
alertness, aggressiveness and decreased food
intake.

 For e.g. cocaine, nicotine, caffeine.

DEPRESSANT
 act to decrease CNS functioning.
 Produces calming and relaxing effect.
 E.g. alcohol, opioids.
HALLUCINOGENS
 drug that produce perceptual disturbance
involving any sensory modality [ vision, hearing,
smell , touch, taste].

 E.g. LSD[lysergic acid diethylamide], Dhaturo.

PREDISPOSING FACTORS
Biological factors

 Genetics– familial transmission is seen.

 Children of alcoholics are three times more likely
than other children to become alcoholics (Harvard
Medical School, 2001)

 Biochemical factors- role of dopamine have been

implicated in cocaine, alcohol and Opoid
dependence.
PREDISPOSING FACTORS
 drugs of abuse (rewards) have been shown to
activate dopaminergic pathway, also known as the
mesolimbic dopamine pathway, causing an
increase in dopamine levels

 Alcohol may produce endorphin ( brain’s “feel-

good” chemicals) :Alcohol produce morphine-like
substances in the brain that are responsible for
alcohol addiction.
PSYCHOLOGICAL FACTORS
 fixation at the oral stage of
psychosexual development

 Sadock and Sadock (2003) state,

“Anxiety in people fixated at the
oral stage may be reduced by
taking substances, such as alcohol,
by mouth.”

 Alcohol may also serve to increase

feelings of power and self-worth in
these individuals.
Personality factors
 Person with low self esteem
 Depression
 Inability to relax
 Inability to communicate effectively
 Anti social personality
 Sense of inferiority
 Poor impulse control
 Low self-esteem
 Inability to cope with the pressures of
living and society (poor stress
management skills)
Personality factors

 Loneliness
 Desire to experiment, a sense of adventure
 Pleasure-seeking
 Machoism
 Sociocultural factors
 Social learning : modeling ,imitation
 Children learn from parents
 Peer influence
 Drinking for group cohesiveness
 Cultural and ethnical influences
 Urbanization
 Unemployment
 Poor social support
 Effects of television and other mass media
 Occupation: substance use is more common in
chefs,barmen,salesmen, actors, entertainers, army
personnel, journalists, medical personnel, etc.
 Easy Availability of Drugs

 Psychiatric disorders :Substance use disorders are more

common in depression, anxiety disorders, personality
disorder (especially antisocial personality) and
occasionally in schizophrenia.
ALCOHOL ABUSE AND DEPENDENCE
 Alcohol is a clear colored liquid with a strong
burning taste.

 The rate of absorption of alcohol into the blood

stream is more rapid than its elimination.

 Absorption of alcohol into the blood stream is

slower when food is present in the stomach.

 A small amount is excreted through urine .

ALCOHOL ABUSE AND
DEPENDENCE
 Alcohol is a natural substance formed, by the
fermentation of grains and fruits.

 Fermenting is a chemical process whereby yeast

acts upon ingredients in the fruits/grains, creating
alcohol.

 Alcohol exerts a depressant effect on the

CNS,resulting in behavioral and mood changes.
ALCOHOL ABUSE AND DEPENDENCE

 A concentration of 80 to 100mg of alcohol per 100

ml of blood is considered intoxication.

 A person with 200mg to 250mg will be toxic--

sleepy, confused and his thought process will be
altered.

 If blood level is 300mg/100 ml of blood the person

may lose consciousness.

 A concentration of 500 mg /100 ml is fatal.

ALCOHOL ABUSE AND DEPENDENCE

 Alcoholism is also known as ‘ alcohol dependence’

that include the four component;
1. Craving

2. Loss of control

3. Physical dependence: Body become resistance to

drug and without drug the user may experience
symptoms of mild discomfort to convulsion.

4. Tolerance
PROCESS OF DEVELOPMENT
OF ALCOHOLISM
 Experimentation- due to peer pressure and
curiosity

 Recreational- Gradually starts in functions like

marriage, parties , conference but occasionally.

 Relaxation- Now whenever they want to relax they

use alcohol like during week days. They gradually
increase in frequency.
PROCESS OF DEVELOPMENT
OF ALCOHOLISM
 Compulsive- now they start drinking almost daily
or drinking heavily for a period of time for
pleasure or to avoid discomfort of withdrawal
symptoms.
PATTERN OF USE / ABUSE
Phase 1 : pre alcoholic phase
 Use of alcohol to relieve everyday stress and
tensions of life.
 It acts as a positive reinforcement
 As a child, the individual may have observed
parents or other adults drinking alcohol and
enjoying the effects.
 The child learns that use of alcohol is an
acceptable method of coping with stress
 Tolerance develops
Phase 2 : the early alcoholic phase
 Begins with blackouts-amnesia

 Now alcohol is no more a source of pleasure.

 rather alcohol is required by the individual.

 Common behaviors include secret drinking, preoccupation

with drinking and maintaining the supply of alcohol, rapid
gulping of drinks, and further blackouts.

 The individual feels enormous guilt and becomes very

defensive about his or her drinking. Excessive use of denial
and rationalization is evident.

 Person is pre occupied with drinking and maintaining the

CONTD..
Phase 3 : the crucial phase
 Individual has lost the control
 Clear evidence of physiological dependence
 Binge drinking
 Drinking is the total focus
 Individual is ready to lose anything to maintain the
addiction.
CONTD…
Phase 4 :the chronic phase
 Emotional and physical symptoms.
 Emotional symptoms is evidenced by profound
helplessness and self- pity
 Impairment in reality testing may result in
psychosis.
 Life-threatening physical manifestations may be
evident
 Abstain from alcohol results in a terrifying
symptoms that include hallucinations, tremors,
convulsions, severe agitation and panic.
 Depression and ideas of suicide are present.
 MEDICAL AND SOCIAL
COMPLICATIONS OF ALCOHOL
DEPENDENCE

 At low doses alcohol produces relaxation, less

concentration, drowsiness and slurred speech and
sleep.

 Chronic use results in multisystem physiological

impairments.
 MEDICAL AND SOCIAL
COMPLICATIONS OF ALCOHOL
DEPENDENCE
 Gastrointestinal complication of alcohol e.g. liver disease,
gastritis, ulcer.

 Peripheral neuropathy [damage to your peripheral nerves,

often causes weakness, numbness and pain, usually in your
hands and feet]

 Alcoholic myopathy [muscle weakness]

 Wernicke’s encephalopathy[ serious neurologic disorder

resulting due to thiamine deficiency characterized by
 ophthalmoplegia(paralysis or weakness of the eye muscles),
 ataxia[lack of voluntary coordination of muscle], and
 confusion.
 MEDICAL AND SOCIAL
COMPLICATIONS OF ALCOHOL
DEPENDENCE
 Korsakoff's psychosis [Wernicke encephalopathy causes
brain damage in lower parts of the brain called the thalamus
and hypothalamus].
 gross memory disturbance.
 Other symptoms include:
 Disorientation
 Confusion
 Poor attention span and distractibility
 Impairment of insight

 Alcoholic cardiomyopathy [weakens and thinning the heart

muscle]
CONTD…
 Protein malnutrition
 Vitamin deficiency disorder
 Esophagitis
 Gastritis
 Pancreatitis
 Alcoholic hepatitis
 Cirrhosis of liver
 Leukopenia : an abnormal reduction of circulating
white blood cells.
 Thrombocytopenia : decreased platelets count
 Sexual dysfunction
CONTD….
 Psychological complication like guilt feelings,
depression, worthlessness , decreased self
confidence.
 Alcoholic hallucinosis
 Alcoholic psychosis
 Alcohol related other psychiatric disorder like
depression ,anxiety.
 Suicidal attempts
CONTD….
 Financial complication
 Social : looked down in the society ,
 Familial : loss of respect, frequent quarrels
 Occupational :sick leave ,deterioration of job
performance ,loss of job.
 Legal involvement in illegal activities, arrests due
to drunken driving.
CONTD….
 Accidents or injuries
 Alcoholic breath
 Loss of interest in activities and hobbies
 Bloodshot eye
 Feeling a need or compulsion to drink
 Keep alcohol with oneself everywhere
 ALCOHOL DEPENDENCE

1. Acute intoxication
2. Withdrawal syndrome
3. Alcohol induced amnestic disorders
4. Alcohol induced psychiatric disorders
 Acute intoxication:
 develops during or shortly after alcohol ingestion.

 characterized by clinically significant maladaptive behavior

or psychological changes, e.g.
 mood lability,
 impaired judgment,
 slurred speech,
 incoordination,
 unsteady gait,
 Nystagmus(eyes make repetitive, uncontrolled
movements).
 inappropriate sexual or aggressive behavior,
 impaired attention and memory finally resulting in
stupor or coma
ALCOHOL INTOXICATION(ICD10)
F10.0
Intoxication usually occurs at blood alcohol levels between
100 to 200 mg/dl .
A. General criteria must be met
B. Dysfunctional behavior as evidenced by at least one of
the following
 Argumentativeness
 Aggression
 Liability of mood
 Impaired attention
 Impaired judgment
 Interference with personal functioning
CONTD…
C. At least one of the following signs must be
present
 Unsteady gait
 Difficulty in standing
 Slurred speech
 Decreased LOC
 Flushed face
 Withdrawal syndrome

 In persons who have been drinking heavily

over a prolonged period of time, any rapid
decrease in the amount of alcohol in the body
is likely to produce withdrawal symptoms
 ALCOHOL WITHDRAWAL(ICD10)
F10.3
 It occurs within 4 to 12hrs cessation /reduction of
alcohol
A. The general criteria must be met
B. Any three of the following signs must be present
 Tremor of the tongue, eyelids.
 Sweating
 Nausea and vomiting
 Tachycardia
 Hypertension
CONTD…
 Psychomotor agitation
 Headache
 Insomnia
 weakness
 Hallucinations
 convulsions
 Withdrawal syndrome
Simple withdrawal syndrome:
 It is characterized by mild tremors, nausea, vomiting,
weakness, irritability, insomnia and anxiety.

Delirium tremens:
 occurs usually within 2-4 days of complete or
significant abstinence from heavy alcohol drinking.
 course is short, with recovery within 3-7 days.
 characterized by:

• disordered mental activity, with clouding of

consciousness and disorientation in time and place
• Poor attention span
 Withdrawal syndrome

Delirium tremens:
• hallucinations usually visual or tactile hallucinations
• shouting and evident fear
• Gross tremors in hands
• Autonomic disturbances such as sweating, fever,
tachycardia, raised blood pressure, pupillary dilatation
• Dehydration with electrolyte imbalances
• disturbed sleep-wake pattern or insomnia
• Blood tests reveal impaired liver function
Alcohol- induced amnestic disorders
Chronic alcohol abuse associated with thiamine (vitamin
'B') deficiency is the most frequent cause of amnestic
disorders.
This condition is divided into:
a)Wernicke’s Encephalopathy
b) Korsakoff' s syndrome
 Alcohol- induced psychiatric disorders
a) Alcohol-induced dementia:
 long term complication of alcohol abuse
 global decrease in cognitive functioning
 decreased intellectual functioning and memory.

b) Alcohol-induced mood disorders: Excess drinking may

induce persistent depression

c) Suicidal behavior

d) Alcohol-induced anxiety disorder

e)Pathological jealousy: delusion that the partner is
being unfaithful.
f) Alcoholic seizures (rum fits)
g). Alcoholic hallucinosis
i) Alcoholic psychosis
 DIAGNOSIS
 History of alcohol use
 Clear harmful physical/social consequences
 Urine test
 Blood test for alcohol-200mg/dl intoxication
 Liver function test
MANAGEMENT
Assess the problem
Alcohol if is related to stress or family problems.

 Screening of the patient

 CAGE can be used

Have you ever cut down on alcohol?

Have you ever been annoyed by peoples criticism?
Have you ever felt guilty about drinking?
Have you ever need eye opener drink?
MANAGEMENT
1. Detoxification--Treatment of withdrawals

 cessation of the substance of abuse and

administration of specific medication
CONTD…..
 Benzodiazepines are the choice of drug.
 Diazepam 20 to 40 mg / chlordiazepoxide 40 to 80
mg
 The dose is gradually tapered off over next 7 to 10
days.
 In case of severe withdrawal symptoms
 Inj Diazepam 10 to 20 mg every 30 to 60 mts till
the patient is sedated or the symptoms subside.
CONTD…..
 VITAMIN B CONTAINING 100 MG OF
THIAMINE SHOULD BE ADMINISTERED
TWICE DAILY FOR 3 TO 5 DAYS
NSG MANAGEMENT
 Close monitoring of withdrawal symptoms.
 Vital signs
 Check Loc
 Orientation to time ,place and person.
 Prevent injury
 maintaining fluid and electrolyte balance,
 strict monitoring of vitals.

Close observation is essential, especially during the

first five days.
2.MAINTENANCE PHASE
 Deterrent agent (Disulfiram)
 Available form 250 to 500 mg/tab
 Initial dose :500 mg for 1st 2 weeks
 Maintenance dose :250 mg
 Dose 1-2 tabs /day
 It inhibits the activity of a particular enzyme
Aldehyde dehyogenase in the body.
 2.MAINTENANCE PHASE

 In the absence of enzyme Aldehyde dehyogenase

there will be accumulation of acetaldehyde
 This will cause lot of unpleasant symptoms if a
person takes alcohol.
 This is called DER( disulfiram-ethanol reaction )
 Pt experiences nausea, vomiting, headache ,redness,
flushing, fall in BP , and even coma.
SIDE EFFECTS
 Drowsiness
 Gastric irritation
 Hepatotoxicity
 Peripheral neuropathy
 Skin reactions
 Psychosis
 Optic atrophy( decrease in size or wasting away of
a part or tissue)
PRECAUTIONS
 Informed consent
 LFT
 Ophthalmology check up
 Ask for numbness/tingling
 Should not be given to impulsive and persons
suffering from psychiatric illness.
PATIENT EDUCATION

 Education about s/s of DER

 Explain that DER can occur with alcohol intake

even in small doses.

 Precautions to avoid alcohol containing substance

preparations such as cough syrups, drops of any
kind and alcohol-containing foods and sauces.

 Advise not to use alcohol based aftershave lotions.

 Any topical applications containing alcohol should

also be avoided.
PATIENT EDUCATION

 Caution patient against taking CNS depressants

medication during disulfiram therapy.

 Instruct patient to avoid driving or other activities

requiring alertness.

 Patients should be warned that the disulfiram-

alcohol reaction may continue for as long as 1 to 2
weeks after the last dose of disulfiram

 Under no circumstance it should be started without

obtaining patient’s consent.
CONTD….
 It should not be given as a means of punishment.

 It is well suited for patients who are well

motivated for leaving alcohol.
MANAGEMENT OF DER
 It is an emergency
 In case of mild hypotension administer I/V fluids
 In severe case Inj Dopamine
 Symptomatic treatment
 Close monitoring
ANTI-CRAVING AGENT
 Acamprosate is thought to reduce the craving that
is experienced by alcohol dependent patients.
 Action : it stabilizes the imbalance in
neurotransmitters which is seen in alcohol
dependency.
 Available form 333mg/tab
 Dose : 2tabs three times daily.
 Acamprosate should not be taken by people with
kidney disorder.
 Allergies to the substance.
CONTD….
 Naltrexon is also found to be effective in reducing
the craving for alcohol.
 Dose : 5omg/day
 Fluoxetin has also shown benefit and can be
preferred in patients with concomitant depression.
Psychological treatment

 Motivational interviewing/Counselling

 Group therapy: Group therapy enables the patients to

observe their own problems mirrored in others and to
work out better ways of coping with them.

 Aversive conditioning: In this technique the client is

exposed to chemically induced vomiting or shock when
he takes alcohol.

 Cognitive therapy: This involves reduction in alcohol

intake by identifying and modifying maladaptive
thinking patterns.
Psychological treatment
 Relapse prevention technique: This technique helps
the patient to identify high-risk relapse factors and
develop strategies to deal with them.

 Cue exposure technique: This technique aims

through repeated exposure to desensitize drug
abusers to drug effects ,and thus improve their
ability to remain abstinent.

 Other therapies include assertiveness training,

counseling, supportive psychotherapy and individual
psychotherapy.
OPIOID ABUSE
 Opioid refers to a group of compounds that
includes opium and synthetic substitutes.
 Opioid is a CNS depressant.
 Opioid exerts both sedative and analgesic effects.
 Opioids induces a sense of euphoria.
 Cause feeling of well being and mental peace
which is described as being like ‘floating on
water’
EXAMPLE OF OPIOID
 Codeine- derivate of opium. Used as painkiller and
cough suppressant. Available in tablets, capsule,
suppositories and solution.

 Heroin (brown sugar/smack)- fine white or brown

powder. Can be eaten, smoked, inhaled or injected.
It is illegal.

 Opium (afim)- made of poppy opium. Dark brown

chunk or powder. Can be eaten or smoked and
injected.
EXAMPLE OF OPIOID
 Methadone - synthetically prepared. It can be
ingested.

 Morphine-Derivative of opium and has been use as

painkiller. It can be injected.
METHODS OF ADMINISTRATION
OF OPIOID DRUGS
 Oral
 Smoked
 I/M
 I/V
PATTERNS OF ABUSE
 Usually obtained with the help of prescription
 Abuse and dependency occurs when the individual
increases the dose.
 Then the individual gets obsessed with obtaining
more drugs.
SECOND PATTERN
 Use the drug for recreational purpose.
 Tolerance develops
 Dependency occurs
 Obsessed to procure the drugs by all means to
maintain the addiction
SIGN AND SYMPTOMS OF
INTOXICATION
Effect on CNS
 Euphoria
 Mood changes
 Drowsiness
 Pupillary constrictions occurs in response to
stimulation of occulomotor nerve
 Depression of the respiratory centers.
 Suppression of the cough centre in the medulla
GI EFFECTS
 Diminishes peristaltic activity
 These effects lead to a marked decrease in the
movement of food
 Thereby constipation and fecal impaction

Cardiovascular effects
 Induces hypotension

Sexual functioning
 Decreases sexual pleasure
 Retarded ejaculation
 Orgasm failure
SIGN AND SYMPTOMS OF
INTOXICATION
Larger amount use may cause
 Apathy
 Hypertension
 Slurred speech
 Impairment of attention and judgement
 Seizure
 Thready pulse
 Respiratory depression
 Bradycardia
 Coma can occour
OPIOID
INTOXICATION(F11.0)
a. General criteria of intoxication must be met
b. There must be dysfunctional behavior, as
evidenced by at least one of the following
1. Apathy and sedation
2. Psychomotor retardation
3. Impaired attention
4. Impaired judgment
5. Interference with personal functioning
CONTD…
c. At least one of the following signs must be present
1. Drowsiness
2. Slurred speech
3. Pupillary constriction
4. Decreased LOC
OPIOID WITHDRAWAL
 Eg : 6 to 12 hrs after last dose
 Increases after 36 to 48 hrs
 They subside within 2 to 6wks
ICD 10 CRITERIA (F11.3)
a. General criteria must be met
b. Any three of the following signs must be present
1. Craving for an opioid drug
2. Rhinorrhea /sneezing
3. Lacrimation
4. Muscle aches
5. Abdominal cramps
6. Nausea vomiting
7. Diarrhea
8. Pupillary dilation
9. Tachycardia
10. Yawning
11. Restless
MANAGEMENT
INTOXICATION
 Provision of adequate ventilation
 Inj Naloxone (bocks or reverses the effects of
opioids, including extreme drowsiness, slowed
breathing, or loss of consciousness).
 Incase of respiratory depression 2mg
 Otherwise 0.1 to 0.4 mg
 If no response 2mg should be repeated every 1to
2minutes up to a total of 10 mg
 Repeat it every 1-2 hr
MANAGEMENT

DETOXIFICATION

 Tab Buprenorphine 2 to 8mg /day

 acts on the opioid receptors and produce the same
effects .
 It is used to satisfy the craving and will help in
controlling the use of illicit substance.
CONTD….
 Buprenorphine is available in sublingual
preparation
 The tab must be placed under the tongue and
allowed to dissolve.
 It dissolves within 2 to 8mts
 The effects begin within 30 to 60 mts and peak
within 2 to 4hrs
SIDE EFFECTS
 Sedation
 drowsiness
 Constipation
 Tolerance
 Liver damage and pregnancy must be ruled out
before starting the medication
PSYCHOLOGICAL METHOD
 Individual psychotherapy
 Behaviour therapy
 Family therapy
 Group therapy

 Rehabilitation
CANNABIS ABUSE
 Cannabis is generic preparation of hemp plant.
 Called ganja, chares, bhang, marijuana
 Can be smoked and ingested(chew or eat)
 Most widely cultivated
 Cannabis is more closely linked with youth culture
 The age of initiation is usually lower than for other
drugs.
 SIGN AND SYMPTOMS OF
INTOXICATION
 Cardiovascular effects
 Tachycardia
 Orthostatic hypotension

 Respiratory effects
 Marijuana is usually smoked and the smoke is
retained in the lungs for the desired effect
 Thereby greater amount of tar is deposited in the
lungs
 Reproductive effect
 Decrease in levels of serum testosterone
 Abnormal sperm count ,motility

 CNS effects
 Feeling of euphoria
 Disorientation
 Depersonalization
 Relaxation
 In higher doses low judgment
 Loss of recent memory
 Heavy usage will cause psychosis
CANNABIS
INTOXICATION(F12.0)
a. General criteria must be present
b. At least one of the following dysfunctional behavior
1. Euphoria
2. Anxiety
3. Paranoid ideation
4. Impaired judgment
5. Impaired Attention
6. Reaction time increased
7. Illusion and hallucinations
8. Depersonalization and derelization
9. Interference in personal functioning
CONTD….
c. At least one of the following signs must be present
1. Increased appetite
2. Dry mouth
3. Tachycardia
CANNABIS
WITHDRAWAL(F12.3)
 No definite diagnostic criteria
 Symptoms and signs usually include
 Anxiety
 Irritability
 Tremor of the outstretched hands
 Sweating
 Muscle aches
 TREATMENT
 Reassurance
 Antipsychotic for psychotic features
 Antianxity for reducing anxiety
 Psychotherapy
 Familytherapy
Individual therapy
Thank you