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Drug Dependence and

Alcoholism

MRS. MEERA PRASAI

Assistant Professor
Department of Community Medicine

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Contents

 Definition – Drug, Drug abuse, dependence, addiction

 Criteria of Drug addiction
 Difference between Dependence and Addiction
 Dependence producing drugs
 Common used drug
 Alcohol, Alcoholism
 Symptoms of drug addiction
 Factors associated with a high risk of drug abuse
 Prevention- Legal, Educational, Community approach.
 Rehabilitation
 Treatment 3
Drug

 Any substance that, when taken into the

living organism, may modify one or
more of its functions. ( WHO)

 Drug abuse- Self administration of a

drug for non medical reasons, in
quantities and frequencies which may
impair in individual’s ability to
function effectively, and which may
results in social, physical or4

emotional harm.
Types of Drug Abuse

 Too much – at one time

 Too long – Pethidine
 Wrong use- Phenobarbitone
 Wrong combination – Barbiturate and
Alcohol
 Wrong Drug- Brown Sugar ( derivatives
of heroin)
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Drug Dependence

A state, psychic and sometimes also physical,

- Resulting from the interaction between a
living organism and drug,
- Characterized by behavioral and other
responses
- Always include a compulsion to take the
drug on a continuous or periodic basis
- In order to experience its psychic effects,
- and sometimes to avoid the discomfort of
its absence. 6
Drug addiction
A state of periodic or chronic intoxication
detrimental to the individual and society
produced by repeated intake of habit
forming drugs.

Criteria for Drug addiction

Psychological dependence :
Compulsion
Physical dependence : withdrawal
symptoms
Development of tolerance : Tendency
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to increase dose.
Difference between Dependence
and Addiction
 Drug dependence can define by the
effects that the drug has on you.

 The presence of withdrawal symptoms

when a person stops using a drug.

 Dependence is characterized by the

symptoms of tolerance and withdrawal.
While it is possible to have a physical
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dependence without being addicted.

Cont..
 Withdrawal symptoms vary based on
the substance being used.

 Addiction is neurological. Diagnosable

medical condition.

 Marked by a change in behavior caused

by the biochemical changes in the brain
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Difference cont..

 Substance use becomes the main

priority of the addict, regardless of the
harm they may cause to themselves or
others.

 An addiction causes people to act

irrationally when they don’t have the
substance.

They are addicted to in their system.

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Addiction as a disease-

 1956 – Addiction was declared a

disease by the American Medical
Association.
 Is a Primary disease.
A Progressive disease
 The disease is Terminal
A Permanent disease
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Dependence Producing Drugs
 Opioids- Narcotic analgesics.
- Psychic dependence.
- Heroin, morphine, codeine.
- Worst type of addiction by Heroin. Craving

 Cocaine-CNS stimulant.
- Superman drugs, Tactile hallucination

 Cannaabinoids- Psychic dependence.

- Plant- Bhang, Hashish or Charas.
- Relaxation, Euphoria
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Dependence Producing Drugs
cont..
 Caffeine and other stimulant-
Coffee, Tea

 Hallucinogens- Psychotogenic
- LSD, 20-25mcg disturbances.
- Pseudo hallucinations- Alters the
normal perception, colours are heard
and music becomes palpable
- No physical dependence 13
Dependence Producing Drugs
cont..
Volatile substance- CNS Depressants.
- Glue, Petrol, Ether,
- Euphoria, Confusion, Ataxia.
 Psychoactive substance- Stimulant,
depressants, opiates and hallucinogens

 Hypnotics , Sedative, Tranquillizer-

Alcohol

 Tobacco
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Common use Drugs
1. Amphetamines and cocaine
2. Barbiturates
3. Cannabis- charas/bhang/ganja
4. Heroin
5. LSD(Lysergic acid diethylamide)
6. Alcohol
7. Tobacco
8. Caffeine
9. Volatile solvents 15
16
Alcoholism

 Alcohol- a drug may be classified as a

sedative, tranquillizer, hypnotic or
anesthetic, depending upon the
quantity consumed.

 Patternof drinking which is harmful to

the individual or to his / her family.

 Onlydrug whose self-induced

intoxication is socially acceptable.
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 Alcoholism is a disease and alcohol is
a disease agent. Alcohol use
disorder.

 Effects on central nervous

system(CNS). Produce psychic
dependence from mild to strong.

 Physical dependence develops slowly.

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Alcoholism cont..

 Rapidlyabsorbed from stomach. Within

2-3 minutes of consumption, detected in
blood. Maximum concentration reached
about 1 hour.

 Binge drink- consume a large amount

of alcohol in a short period of time-high
risk.

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 Blood alcohol level- 0.10% means
that there are 0.10 gm of alcohol for
every 100 ml of blood.

 In
USA 0.08 is legally intoxicated. Above
0.40 are potentially fatal.

 Nepal-0.08 ([Link])
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 Alcoholic- a person who habitually
lacks self control with regard to the use
of alcoholic beverages to the extent
that health, social or economic
functioning is substantially impaired.

 Types of Alcohol use-

a) Social
b) Problem
c) Alcoholic
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Problems statement
 Alcoholand cannabis have been used for
centuries.

 6.8% of adults engage in heavy episodic

drinking. Equivalent to 1.1 millions adults
*Source- [Link]>2019>Alc..

 Cultural factors are more important.

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 Genetic factors- small contribution
 Alcohol producing industries - Large
France, Italy, Portugal
 Rare among Muslim and Jews.
 Availability of alcohol
 Cheaper
the price the higher the
consumption.
 More in Urban than Rural.

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The Effects of Alcohol
 Hereditary and congenital- Children of at
least one biologic parent, incidence is twice.

 Inflammatory damage- liver cirrhosis

 Sugar levels- Hypoglycemia or

hyperglycemia because liver and pancreas
not functioning well.

 Digestive and endocrine system-

Malnutrition, Pancreatitis
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Effects cont..
 Central nervous system- Depressant
- Slurred speech, coordination is more
difficult of brain and body.
- Hard to balancing- never drive after
drinking.
-Numbness of feet and hands
-Difficult to create long term memory,
ability to think
-Permanent brain damage can lead to
Wernicke- Korsakoff syndrome. 27
Effects cont..
 Dependency

 Circulatory system- Heart disease,

high blood pressure, stroke, heart
failure, low RBC and anemia.

 Immune system- develop pneumonia

or tuberculosis, risk for several types of
cancer, including mouth, breast, and
colon. 28
The effect cont..
 Sexual and reproductive health-

• Erectile dysfunction
• Pregnant women- fetal alcoholic
syndrome disorder(FASD).
•Women who drinks heavily stop
menstruating and develop infertility.

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Effect
 Other conditions-
- Learning difficulties,
- Long term health issues,
- Skeletal and muscle systems- thinner
bone and risk of fracture, muscle
weakness, cramping and atrophy.
- Suicide, automobile and other accidents
- Family disorganization, crime and loss
of productivity
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
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Symptoms of Drug Addiction

 Lossof interest in sports and daily

routine.
 Loss of appetite and body weight
 Unsteady gait, clumpsy movements,
tremor
 Reddening and puffiness of eyes,
unclear vision
 Fresh,
numerous injection marks on
body and blood stains on cloths 32
Symptoms cont..
Nausea, vomiting and body pain
Drowsiness or sleeplessness, lethargy
Acute anxiety, depression, profuse
sweating
Change mood, temper, tantrums
Depersonalization and emotional
detachment
Presence of needles, syringe and
strange packets at home and 33

Impaired memory and concentration .

Factors Associated with High
Risk of Drug Abuse

 Unemployment
 Living away from home
 Migration to cities
 Relaxed parental control
 Alienation from family
 Leaving school early
 Broken homes, parent families.
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High risk of Drug Abuse cont.-
 Large urban environments.
 Areas
where drugs are sold, traded or
produced
 Certain
occupation-tourism, drug
production
 Areas with high rates of crime
 Areas where there are drug using
gangs
 Areas where delinquency is common
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Prevention
Legal approach-
Prohibition of the sale of tobacco
products to minors.

Prohibition of smoking in schools,

hospitals, and public places.

Prohibition of cigarette advertising.

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Legal Approach cont..

Establishment of mandatory public

health education.

Health warning on cigarette packet.

Frequent examine of alcohol

consumption by traffic police.

Penalty and punishment for drunken

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driving
Prevention cont.

Educational approach-
- Program for school children.

- Public information campaign on

electronic media.

- Clear and unambiguous message.

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Community approach -
Alternative activities.
- Community group activities. Mother’s
group

- Establishment of groups for sport and

athletics, music, religion.

- Non government organization play a

crucial role. 39
Treatment
 Identification
of drug addicts and
motivate for detoxication.

 Detoxication require hospitalization.

 Post detoxication counselling and follow

up.

 Counselling to address emotional40

problems
Treatment
 Rehabilitation to learn new coping skills
and behavior.
 Support groups, including 12 step
programs –Alcohol Anonymous(AA).
Self help program such as Women for
Sobriety
 Medicaltreatment for health problems
associated with alcohol use disorder.
- Benzodiazepams for withdrawal
- Thiamine supplements. 41
Alcoholic Anonymous meeting 42
Treatment cont.
 Medication to help control addiction.
 Medicine to help alcohol use disorder-
Naltrexone
Acamprosate
Disulfiram (Antabuse)
Most important is that the patient
must go on for complete break
with his group, otherwise the
chances of relapse are 100
percent. 43
Rehabilitation

 Long and difficult process.

 Vocational training
 Avoidance
of panic moral
condemnation and discrimination.

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References

 [Link]/alcohol/factsheet
 [Link]/health/alcohol
 [Link]/health/alcoholism/
basics#treat..
 Park’s
test book of Preventive and social
Medicine.- K. Park

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46
MCQs
 1.
Which is the drug cause pseudo
hallucination as colours are heard
and music become palpable?
a. Barbiturate
b. Cocaine
c. Caffeine
d. LSD

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2. What is legally intoxicated Blood
Alcohol Level?

a. 0.08%
b. 0.10%
c. 0.20%
d. 0.40%

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3. What is time taken to reach blood
concentration in highest level in
blood after consumption of
alcohol?

a. 30 minutes
b. 45 minutes
c. 1 hour
d. 2 hour 49
4. Teen Centre Activities is approach to
prevent drug abuse, is what type of
approach for prevention?

a. Legal approach
b. Community approach
c. Education approach
d. Peer group approach

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4. Which of the system is effected
when cirrhosis of lever is seen in
alcoholic patient ?

a. Inflammatory system
b. Digestive system
c. Immune system
d. Circulatory system

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SAQ-
 What is Alcohol ? (1)
 What are its effect on a body?(2.5)
 Whatare preventive measures of drug
dependence? (1.5)

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Answer
Alcohol- Drug, Depressant- Disease
agent
Classified as- Sedative, Tranquillizer,
Hypnotic or Anaesthetic depending upon
the quantity.
- Rapidly absorbed from the stomach and
small intestine.
- It can be detected from blood, within 2-3
minutes of consumption.
- It can be detected in blood- the maximum
concentration is reached about one hour
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after consumption.
Alcoholism cont..

 Effectson central nervous system(CNS).

Produce psychic dependence from mild
to strong.

 Physical dependence develops slowly.

 Rapidlyabsorbed from stomach. Within

2-3 minutes of consumption, detected in
blood. Maximum concentration reached
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about 1 hour.
The Effects of Alcohol
 Inflammatory damage- liver cirrhosis

 Sugar levels- Hypoglycemia or

hyperglycemia because liver and
pancreas not functioning well.

 Digestive and endocrine system-

malnutrition, Pancreatitis

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Effects of Alcohol
 Central nervous system- Depressant
- Slurred speech, coordination is more
difficult of brain and body.
- Hard to balancing- never drive after
drinking.
-Numbness of feet and hands
-Difficult to create long term memory,
ability to think
-Permanent brain damage can lead to
Wernicke- Korsakoff syndrome. 56
The effect cont..
 Sexual and reproductive health-
• erectile dysfunction
• Pregnant women- fetal alcoholic
syndrome disorder (FASD).
• Women who drinks heavily stop
menstruating and develop infertility.

57
Effect
 Other conditions-
- Learning difficulties,
- Long term health issues,
- Skeletal and muscle systems- thinner
bone and risk of fracture, muscle
weakness, cramping and atrophy.
- Suicide, automobile and other accidents
- Family disorganization, crime and loss
of productivity
58


Preventive Measures of Drug Dependence

Legal approach-
Prohibitionof the sale of tobacco
products to minors.

Prohibition of smoking in schools,

hospitals, and public places.

Prohibition of cigarette advertising.

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Legal Approach

Establishment of mandatory public

health education.

Health warning on cigarette packet.

Frequentexamine of alcohol
consumption by traffic police.

Penalty and punishment for drunken

60

driving
Prevention cont.

Educational approach-
- Program for school children.

- Public information campaign on

electronic media.

- Clear and unambiguous message.

61
Community approach -
Alternative activities.
- Community group activities. Mother’s
group

- Establishment of groups for sport and

athletics, music, religion.

- Non government organization play a

crucial role. 62