SUBSTANCE USE AND ADDICTIVE DISORDERS

SUBSTANCE USE & ADDICTIVE DISORDERS

NUGGETS a short animation

Watch

• What can you say about the video?

• How does it represent addiction?

TOPICS TO DISCUSS

SUBSTANCE-RELATED DISORDERS

Substance Use Disorders

• a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

MORE

MORE

Criteria 1-4 — Impaired control over substance Criteria 5-7 — Social impairment Criteria 8-9 — Risky use of the substance Criteria 10-11 — Pharmacological criteria

Diagnostic Criteria for Substance Use Disorders

Criterion A: Impaired Control over substance

Taking the substance in larger amounts or for longer than what was originally intended Persistence to cut down or regulate substance use but attempts are failing Spending a lot of time getting, using, or recovering from use of the substance. Cravings and urges to use the substance.

Criterion B: Social impairment

Criterion A: Impaired Control over substance

Not managing to do what you should at work, home, or school because of substance use. Continuing to use, even when it causes problems in relationships. Giving up important social, occupational, or recreational activities because of substance use.

Taking the substance in larger amounts or for longer than what was originally intended Persistence to cut down or regulate substance use but attempts are failing Spending a lot of time getting, using, or recovering from use of the substance. Cravings and urges to use the substance.

Criterion C: Risky use of the substance

Using substances again and again, even when it puts you in danger. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

Criterion D: Pharmacological criteria

Criterion C: Risky use of the substance

Needing more of the substance to get the effect you want (tolerance). Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Using substances again and again, even when it puts you in danger. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

10

11

Severity & Specifiers of Substance Use Disorders

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe = 6 or more symptoms

Substance-Induced Disorders

• are a type of substance-related disorder that involves problems caused by the direct effects of a substance

INTOXICATION

WITHDRAWAL

MORE

Substance/Medication-Induced Mental Disorders

• refer to depressive, anxiety, psychotic, or manic symptoms that occur as a physiological consequence of the use of substances of abuse or medications. It may occur during active use, intoxication or withdrawal

MORE

Features of Substance/Medication-Induced Mental Disorders

Environment

Genes/Family history of addiction

Sleep problems

Chronic pain

CAUSES

CAUSES

Financial difficulties

Divorce or the loss of a loved one

Long-term tobacco habit

Lack of parental attachment in childhood

Relationship issues

Statistics about Substance Use in the Philippines

Statistics of Substance consumption in the Philippines

Statistics of Substance consumption in the Philippines

TREATMENT

attend a detox program

counseling

psychotherapy and medications

ALCOHOL-RELATED DISORDERS

Alcohol Use Disorder

• occurs when people who have consistent issues with alcohol continue to drink to excess

MORE

• the state of drunkenness that people experience after drinking alcohol
• results as the amount of alcohol in your bloodstream increases
• The higher the blood alcohol concentration is, the more impaired you become

Alcohol Intoxication

MORE

Diagnostic Criteria

• Criterion C
• At least 1 of the following signs or symptoms developing during, or shortly after, alcohol use:

Nystagmus

Slurred speech

Impairment in attention or memory

Incoordination

Unsteady gait

Stupor or coma

Alcohol Withdrawal

• occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced
• It can occur within several hours to four or five days later

Diagnostic Criteria

• if a person exhibits two or more symptoms from the list of 11 criteria, they are diagnosed as having an alcohol use disorder, with classifications of mild, moderate, and severe

COMPLICATIONS/IMPACT

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, such as drowning
• Relationship problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes or being the victim of a crime
• Legal problems or problems with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
• Increased risk of attempted or completed suicide

COMPLICATIONS/IMPACT

Impact on your health

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, such as drowning
• Relationship problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes or being the victim of a crime
• Legal problems or problems with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
• Increased risk of attempted or completed suicide

• Liver disease
• Digestive problems
• Heart problems
• Diabetes complications
• Neurological complications
• Weakened immune system
• Increased risk of cancer

Statistics of Alcohol consumption in USA

TREATMENT

Medication

Cognitive Behavioral Therapy (CBT)

Dialectical Behavioral Therapy (DBT)

Motivational Interviewing

CAFFEINE-RELATED DISORDERS

Caffeine

• a naturally occurring stimulant used to boost wakefulness and alertness. It is found in coffee, tea, cola, cocoa, guarana, yerba mate, and over 60 other products.

Caffeine Intoxication

• a dose of caffeine that’s well over 250 mg can cause caffeine intoxication - a condition in which an individual may feel nervous, restless, excited, twitchy and flushed

CAUSES

Signs and Symptoms of Caffeine Intoxication

• Palpitations, agitation, tremor, insomnia are common signs of caffeine intoxication.

• Other symptoms can include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, and gastrointestinal complaints, which can occur with low doses (<200mg) in children, the elderly, or caffeine-naive individuals.

• Sensory disturbances (e.g. - ringing in the ears and flashes of light) can occur with high doses of caffeine.

• Criterion B: At least 5 of the following signs or symptoms developing during, or shortly after caffeine use:

Restlessness

Nervousness

Insomnia

Diagnostic Criteria

Gastrointestinal disturbance

Diuresis

Muscle twitching

Rambling flow of thought and speech

Tachycardia or cardiac arrhythmia

Caffeine Withdrawal

• a withdrawal syndrome that occurs after the abrupt cessation/termination of (or substantial reduction in) prolonged daily caffeine use.

SIGNS & SYMPTOMS

• Criterion B: Abrupt cessation of or reduction in caffeine use, followed within 24 hours by at least 3 of the following signs or symptoms:

Headache

Diagnostic Criteria

Marked fatigue or drowsiness

Dysphoric mood, depressed mood, or irritability

Difficulty concentrating

Flu-like symptoms (nausea, vomiting, or muscle pain/stiffness)

PREVENTION

decrease the incidence of caffeine withdrawal by using caffeine daily or only infrequently (e.g. - using no more than 2 days in a row)

gradually reducing caffeine over a period of days or weeks can also decrease the incidence and severity of caffeine withdrawal

low intensity yoga to relieve withdrawal symptoms such as headache, fatigue, and muscle pain

Statistics of Caffeine Consumption in USA

Statistics of Caffeine Consumption in USA

CANNABIS-RELATED DISORDER

Cannabis Use Disorder

• a substance use disorder characterized by a problematic pattern of cannabis (marijuana) use leading to clinically significant impairment or distress

CAUSES

SYMPTOMS

Diagnostic Criteria

Cannabis Intoxication

• occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - impaired motor coordination, sensation of slowed time, impaired judgment, social withdrawal, euphoria, anxiety) that develops during, or shortly after ingestion of cannabis

Diagnostic Criteria

TREATMENT

Symptomatic management

Cognitive Behavioral Therapy (CBT)

Dialectical Behavioral Therapy (DBT)

Motivational Interviewing

Cannabis Withdrawal

• a withdrawal syndrome that develops after the termination of or substantial reduction in heavy and prolonged cannabis use

Diagnostic Criteria

TREATMENT

Detoxification center

Inpatient rehabilitation center

Support groups and therapy

Statistics of Cannabis Consumption in USA

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _ _ _ _

HALLUCINOGEN

HALLUCINOGEN-RELATED DISORDERS

Disclaimer: The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Substance Abuse Prevention (CSAP), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the Philippines Department of Health (DOH).

Hallucinogen-Related Disorders

• a group of substance-related disorders involving the ingestion of drugs classified broadly as hallucinogens

MORE

MORE

Short-Term Effects of Hallucinogens

The short-term effects of hallucinogens typically begin within 20 to 90 minutes of taking substances. These effects may be brief, lasting around 15 minutes in some cases. In other cases, these short-term effects may last as long as 12 hours. Common short-term effects include:

more

Long-Term Effects of Hallucinogens

According to the National Institute on Drug Abuse, these effects are rare.

• visual disturbances
• hallucinations
• flashbacks
• persistent psychosis
• mood changes
• paranoia
• disorganized thinking

Therapeutic Uses

Psychedelic therapy is a type of treatment that utilizes psychedelic substances such as LSD, psilocybin, and ketamine in a controlled setting under the supervision of a therapist.

Phencyclidine Use Disorder

• The disorder is given to people who are experiencing problems as a result of using a group of substances called phencyclidines, or substances which are pharmacologically similar to them, such as ketamine
• Phencyclidine is also known as angel dust
• a drug used for its mind-altering effects

Diagnostic Criteria

A pattern of phencyclidine (or a pharmacologically similar substance) use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:1. Phencyclidine is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control phencyclidine use. 3. A great deal of time is spent in activities necessary to obtain phencyclidine, use the phencyclidine, or recover from its effects. 4. Craving, or a strong desire or urge to use phencyclidine. 5. Recurrent phencyclidine use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to phencyclidine use; phencyclidine-related absences, suspensions, or expulsions from school; neglect of children or household).

Diagnostic Criteria

6. Continued phencyclidine use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the phencyclidine (e.g., arguments with a spouse about consequences of intoxication; physical fights). 7. Important social, occupational, or recreational activities are given up or reduced because of phencyclidine use. 8. Recurrent phencyclidine use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by a phencyclidine). 9. Phencyclidine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the phencyclidine. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the phencyclidine to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the phencyclidine

Severity & Specifiers

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe = 6 or more symptoms

Prevalence

• The prevalence of phencyclidine use disorder is unknown.
• Approximately 2.5% of the population reports having ever used phencyclidine.

Causes

• The exact cause of substance use disorder is not known.
• A person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.
• Risk and Prognostic Factors
• Culture-Related Diagnostic Issues
• Gender-Related Diagnostic Issues

Effect

Associated Feature for Supporting Diagnosis

Diagnostic Markers

Statistics of Hallucinogen consumption

TREATMENT

Inpatient Treatment Programs

Drug abuse Treatment

Motivational Interviewing

Outpatient Treatment Programs

Cognitive Behavioral Therapy (CBT)

Other Hallucinogen Use Disorders

• The "Other" in the title distinguishes the hallucinogens causing the disorder from phencyclidine and pharmacologically similar substances, which has its own disorder, known as phencyclidine use disorder.

Diagnostic Criteria

A pattern of phencyclidine (or a pharmacologically similar substance) use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:1. The hallucinogen is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control hallucinogen use. 3. A great deal of time is spent in activities necessary to obtain the hallucinogen, use the hallucinogen, or recover from its effects. 4. Craving, or a strong desire or urge to use the hallucinogen. 5. Recurrent hallucinogen use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to hallucinogen use; hallucinogen-related absences, suspensions, or expulsions from school; neglect of children or household).

Diagnostic Criteria

6. Continued hallucinogen use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the hallucinogen (e.g., arguments with a spouse about consequences of intoxication; physical fights). 7. Important social, occupational, or recreational activities are given up or reduced because of hallucinogen use. 8. Recurrent hallucinogen use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by the hallucinogen). 9. Hallucinogen use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the hallucinogen. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the hallucinogen to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the hallucinogen. Note: Withdrawal symptoms and signs are not established for hallucinogens, and so this criterion does not apply.

Severity & Specifiers

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe = 6 or more symptoms

Prevalence

Diagnostic Markers

• Of all substance use disorders, other hallucinogen use disorder is one of the rarest.
• Rates are higher in adult males (0.2%) compared with females (0.1%)
• Rates are highest in individuals younger than 30 years, with the peak occurring in individuals ages 18–29 years (0.6%) and decreasing to virtually 0.0% among individuals age 45 and older.

TREATMENTS

Causes

• The exact cause of substance use disorder is not known.
• A person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors.
• Risk and Prognostic Factors
• Culture-Related Diagnostic Issues
• Gender-Related Diagnostic Issues

Statistics of Other Hallucinogens consumption

Phencyclidine Intoxication

• a diagnosis that must be suspected clinically so that the appropriate tests are ordered for confirmation. PCP intoxication shares many features with overdoses of cocaine, amphetamines, anticholinergic agents, hallucinogens, and withdrawal from benzodiazepines.

Diagnostic Criteria

Within 1 hour, two (or more) of the following signs or symptoms: *Note: When the drug is smoked, “snorted,” or used intravenously, the onset may be particularly rapid. 1. Vertical or horizontal nystagmus. 2. Hypertension or tachycardia. 528 Substance-Related and Addictive Disorders 3. Numbness or diminished responsiveness to pain. 4. Ataxia. 5. Dysarthria. 6. Muscle rigidity. 7. Seizures or coma. 8. Hyperacusis.

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-6 symptoms
• No Comorbid PUD

Prevalence

• Use of phencyclidine or related substances may be taken as an estimate of the prevalence of intoxication.
• Approximately 2.5% of the population reports having ever used phencyclidine.

CAUSE

DiAGNOSTIC MARKERS

Treatment/Management

• Supportive Care
• Sedation
• Medication
• Physical Restraints

Other Hallucinogen Intoxication

• Disorders caused by other hallucinogens include:
• Behavioral or psychological effects occurring after ingestion of a hallucinogen (other than PCP).

Diagnostic Criteria

Two (or more) of the following signs developing during, or shortly after, hallucinogen use: 1. Pupillary dilation.2. Tachycardia. 3. Sweating. 4. Palpitations. 5. Blurring of vision. 6. Tremors. 7. Incoordination.

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate / Severe = 4-6 symptoms
• No Comorbid PUD

Prevalence

• The prevalence of other hallucinogen intoxication may be estimated by use of those substances. In the United States, 1.8% of individuals age 12 years or older report using hallucinogens in the past year. Use is more prevalent among younger individuals, with 3.1% of 12- to 17-year-olds and 7.1% of 18- to 25-year-olds using hallucinogens in the past year, compared with only 0.7% of individuals age 26 years or older. Twelve-month prevalence for hallucinogen use is more common in males (2.4%) than in females (1.2%), and even more so among 18- to 25-year-olds (9.2% for males vs. 5.0% for females). In contrast, among individuals ages 12–17 years, there are no gender differences (3.1% for both genders).

Suicide Risk

Hallucinogen Persisting Perception Disorder

• a post- hallucinogen intoxication disorder encompassing a range of mostly visual perceptual disturbances that occur within a certain time frame after cessation of drug use.

Diagnostic Criteria

Following cessation of use of a hallucinogen, the reexperiencing of one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (e.g., geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, intensified colors, trails of images of moving objects, positive afterimages, halos around objects, macropsia and micropsia). The symptoms in Criterion A cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to another medical condition (e.g., anatomical lesions and infections of the brain, visual epilepsies) and are not better explained by another mental disorder (e.g., delirium, major neurocognitive disorder, schizophrenia) or hypnopompic hallucinations

Causes of HPPD

• Researchers and doctors do not yet have a solid understanding of who develops HPPD and why.

Development and Course

PREVALENCE

Available treatment options

HPPD has no recognized medical treatment.

Some people do not need treatment.

A 2021 review of HPPD suggests certain medications may help treat HPPD, but those studies are limited. Antiseizure and epilepsy medications like clonazepam (Klonopin) and lamotrigine (Lamictal) are sometimes prescribed.

How to cope with HPPD?

GUESS THE PICTURE

_ _ _ _ _ _ _ _

INHALANT

INHALANT-RELATED DISORDER

Inhalants commonly used include

• Solvents (such as paint thinners and degreasers).
• Gases (such as whipping cream aerosols).
• Nitrites (such as a prescription medicine called amyl nitrite).

• Chemical odours on clothing or breath
• Empty containers or discarded soaked rags or clothing hidden in the trash
• Red eyes, irritability, frequent headaches, drunk appearance, and slurred speech
• Personality changes
• Nausea or loss of appetite
• Sores around the mouth

Signs of use

How Inhalants Are Used

Effects

When inhalants are breathed, they cause alcohol-like effects:

• slurred speech, lack of coordination, and dizziness.
• A person can become light-headed and may have hallucinations and delusions. The effects last only a few minutes.
• After heavy use of an inhalant, a person may have a headache and feel drowsy for several hours.
• A person who inhales the substance can lose consciousness and die.

Effects

Long-term health problems, such as brain, liver, kidney, blood, or bone marrow damage, can occur from inhaling some substances. Long-term use of inhalants also causes:

• Weight loss.
• Muscle weakness and lack of coordination.
• Disorientation and inattentiveness.
• Irritability and depression.

Inhalant Use Disorder

• a psychiatric condition that applies to the deliberate use of inhalants, not to the accidental inhalation of toxic or psychoactive substances, even if they are the same substances that are people inhale when they have inhalant use disorder, and even if they produce identical effects.

Diagnostic Criteria

• problematic pattern of use of a hydrocarbon-based inhalant substance leading to clinically significant impairment or distressas manifested by two or more symptoms from a list of 11 criteria, occurring within a 12-month period

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate / Severe = 4-6 symptoms

Prevalence

• About 0.4% of Americans ages 12–17 years have a pattern of use that meets criteria for inhalant use disorder in the past 12 months. Among those youths, the prevalence is highest in Native Americans and lowest in African Americans.

DiAGNOSTIC MARKERS

Signs of Inhalant Use Disorder

• Speech is mumbled or slurred.
• Reactions are uncontrolled.
• The person experiences a “high.”
• Absence of motor skill control.
• Drunk-like appearance.
• Vomiting and stomach upset.
• Emotionally and physically calm.
• Hallucinating.
• Lack of appetite.
• Rash.
• Pupils are dilated.
• Person has a chemical smell like paint.
• Blemishes or imprints around the nose and mouth

TREATMENT

Group Therapy

Family Therapy

Counseling

12 step program

Detox

Hospitalization

Inhalant Intoxication

• produces a syndrome similar to alcohol intoxication, consisting of dizziness, incoordination, slurred speech, euphoria, lethargy, slowed reflexes, slowed thinking and movement, tremor, blurred vision, stupor or coma, generalized muscle weakness, and involuntary eye movement (APA, 2000)

Diagnostic Criteria

Two (or more) of the following signs or symptoms developing during, or shortly after, inhalant use or exposure: 1. Dizziness. 2. Nystagmus. 3. Incoordination. 4. Slurred speech. 5. Unsteady gait. 6. Lethargy. 7. Depressed reflexes. 8. Psychomotor retardation. 9. Tremor. 10. Generalized muscle weakness. 11. Blurred vision or diplopia. 12. Stupor or coma. 13. Euphoria.

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate / Severe = 4-6 symptoms
• No Comorbid

Prevalence

• The prevalence of actual episodes of inhalant intoxication in the general population is unknown, but it is probable that most inhalant users would at some time exhibit use that would meet criteria for inhalant intoxication disorder.

TREATMENT

Cognitive behavioral therapy

Family counseling

Motivational interventions

Activity and engagement program

Support groups and 12-step programs

Statistics of Inhalant Addiction and Abuse

GUESS THE PICTURE

_ _ _ _ _ _

OPIOID

OPIOID-RELATED DISORDER

Opioid-Related Disorders

• Opioids, sometimes called narcotics, are medications prescribed by doctors to treat persistent or severe pain. They are used by people with chronic headaches and backaches, by patients recovering from surgery or experiencing severe pain associated with cancer, and by adults and children who have gotten hurt playing sports or who have been seriously injured in falls, auto accidents, or other incidents

SIDE EFFECTS

There are many types of prescribed opioids that are known by several names, including

• Codeine
• Fentanyl
• Hydrocodone
• Oxycodone
• Oxymorphone
• Morphine

How are opioids taken?

Opioid Use Disorder

About 2.1 million Americans had opioid use disorder in 2016.

• OUD is defined in the DSM-5 as a problematic pattern of opioid use leading to clinically significant impairment or distress.
• OUD was previously classified as Opioid Abuse or Opioid Dependence in DSM-IV.
• OUD has also been referred to as "opioid addiction."

Diagnostic Criteria

A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. Opioids are often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use. 3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. 4. Craving, or a strong desire or urge to use opioids. 5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.

Diagnostic Criteria

6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. 7. Important social, occupational, or recreational activities are given up or reduced because of opioid use. 8. Recurrent opioid use in situations in which it is physically hazardous. 9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of an opioid. Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision. 11. Withdrawal, as manifested by either of the following: a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal, pp. 547–548). b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms. Note: This criterion is not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe: 6 or more symptoms

EFFECTS

TREATMENT

Medication

Medication-assisted treatment

Three FDA-approved medications

Self Help Programs

Opioid Intoxication

• a condition in which you're not only high from using the drug, but you also have body-wide symptoms that can make you ill and impaired.

DIAGNOSTIC CRITERIA

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate/Severe = 4-6 symptoms

CAUSE

TREATMENT

Emergency Medical Treatment

Naloxene

Oxygen Support

Opioid Withdrawal

If you stop or cut back on these drugs after heavy use of a few weeks or more, you will have a number of symptoms. This is called withdrawal.

Development and Course

Diagnostic Criteria

Three (or more) of the following developing within minutes to several days after Criterion A: 1. Dysphoric mood.2. Nausea or vomiting. 3. Muscle aches. 4. Lacrimation or rhinorrhea. 5. Pupillary dilation, piloerection, or sweating. 6. Diarrhea. 7. Yawning. 8. Fever. 9. Insomnia.

TREATMENT

Medications

Cognitive Behavioral Therapy

Spiritual Counseling

12 Step Program

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _

SEDATIVES

SEDATIVE, HYPNOTIC, OR ANXIOLYTIC-RELATED DISORDER

Sedative

• a drug that has a calming effect and therefore relieves anxiety, agitation, or behavioral excitement by depressing the central nervous system

Hypnotics

• a drug that helps induce and sustain sleep by increasing drowsiness and reducing motor activity

Anxiolytic

• a drug used in the treatment of anxiety, mild behavioral agitation, and insomnia

Sedative, Hypnotic, or Anxiolytic Use Disorder

• a substance use disorder characterized by frequent consumption of substances including benzodiazepines, other drugs like benzodiazepines, carbamates, barbiturates, and hypnotics similar to barbiturates regardless of the significant complications related to the use of these substances.

Diagnostic Criteria

A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use. 3. A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects. 4. Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic. 5. Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor work performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic-, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household). 6. Continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g., arguments with a spouse about consequences of intoxication; physical fights).

Diagnostic Criteria

7. Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use. 8. Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use). 9. Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic. 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the sedative, hypnotic, or anxiolytic. Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics (refer to Criteria A and B of the criteria set for sedative, hypnotic, or anxiolytic withdrawal, pp. 557–558). b. Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as alcohol) are taken to relieve or avoid withdrawal symptoms. Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision

Specify current severity

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe: 6 or more symptoms

DIAGNOSTIC MARKERS

Treatment

CAUSE

Sedative, Hypnotic, or Anxiolytic Intoxication

• occurs when there is a clinically significant problematic behavioural or psychological change (e.g. - inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning) that develops during, or shortly after ingestion of substances under this category.

Diagnostic Criteria

One (or more) of the following signs or symptoms developing during, or shortly after, sedative, hypnotic, or anxiolytic use: 1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in cognition (e.g., attention, memory). 6. Stupor or coma.

Treatment

Sedative, Hypnotic, or Anxiolytic Withdrawal

• a withdrawal syndrome that occurs after a marked decrease in or cessation of intake after several weeks or more of regular use of substances under this category.

RISK FACTORS

Diagnostic Criteria

Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) sedative, hypnotic, or anxiolytic use described in Criterion A: 1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm). 2. Hand tremor. 3. Insomnia. 4. Nausea or vomiting. 5. Transient visual, tactile, or auditory hallucinations or illusions. 6. Psychomotor agitation. 7. Anxiety. 8. Grand mal seizures.

Treatment

TREATMENTS IN THE PHILIPPINES

TREATMENTS IN THE PHILIPPINES

TREATMENTS IN THE PHILIPPINES

TREATMENTS IN THE PHILIPPINES

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _

ANSWER: STIMULANT

STIMULANT- RELATED DISORDERS

Stimulant-Related Disorders

• Stimulant use disorder
• Stimulant intoxication
• Stimulant withdrawal

Disorders that result from abuse of a class of medications known as stimulants, which include drugs such as amphetamines, methamphetamine, and cocaine.

MOST WELL-KNOWN STIMULANTS

Medical use stimulants

Substance Use Disorders

• captures a range of problems associated with the use of a wide variety of stimulant drugs, including meth, cocaine, and amphetamines, but not including caffeine or nicotine.

DIAGNOSTIC CRITERIA

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

The stimulant is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects. Craving, or a strong desire or urge to use the stimulant.

DIAGNOSTIC CRITERIA

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

Recurrent stimulant use resulting in a failure to fulfill major role obligations at work,school, or home. Continued stimulant use despite having persistent or recurrent social or interper-sonal problems caused or exacerbated by the effects of the stimulant. Important social, occupational, or recreational activities are given up or reduced be-cause of stimulant use. Recurrent stimulant use in situations in which it is physically hazardous.

The stimulant is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects. Craving, or a strong desire or urge to use the stimulant.

DIAGNOSTIC CRITERIA

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbatedby the stimulant. Tolerance, as defined by either of the following:a. A need for markedly increased amounts of the stimulant to achieve intoxicationor desired effect.b. A markedly diminished effect with continued use of the same amount of thestimulant. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal, p. 569). b. The stimulant (or a closely related substance) is taken to relieve or avoid with-drawal symptoms.

10

11

DIAGNOSTIC CRITERIA

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbatedby the stimulant. Tolerance, as defined by either of the following:a. A need for markedly increased amounts of the stimulant to achieve intoxicationor desired effect.b. A markedly diminished effect with continued use of the same amount of thestimulant.

11

Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal, p. 569). b. The stimulant (or a closely related substance) is taken to relieve or avoid with-drawal symptoms.

10

NOTE

Severity & Specifiers of Stimulant-Use Disorders

• Severity based on the number of symptom criteria endorsed
• Mild = 2-3 symptoms
• Moderate = 4-5 symptoms
• Severe = 6 or more symptoms

How stimulants are used?

Stimulants can be taken in a number of ways with varying effects. - Prescription stimulants: most commonly available as tablets or capsules intended for oral use. In some cases, people may attempt to crush and snort the pills or dissolve their contents into the water to be injected. - Illicit (illegal) stimulants: in their various forms are typically snorted, smoked, or injected.

NOTE

RISK FACTORS

Environmental (Teenagers)

• Prenatal cocaine exposure
• Postnatal cocaine use by parents
• Exposure to community violence during childhood

(Youths, especially females)

• Living in an unstable home environment
• Having psychiatric condition
• Associating with dealers and users

Temperamental

• Comorbid bipolar disorder
• Schizophrenia
• Antisocial Personality Disorder
• Other Substance Use Disorders
• Impulsivity
• Childhood Conduct Disorder
• Adult Anti-social Disorder

• Heightened alertness and feelings of euphoria.
• Elevate a user’s blood pressure, heart rate, and breathing.
• Heavy use - irregular heartbeat, heart failure and seizures, and death (in some cases).

EFFECTS

MORE INFO

Stimulant Intoxication

Occurs when there is a clinically significant problematic behavioral or psychological change that develops during, or shortly after the use of stimulants.

diagnostic criteria

other signs and symptoms

note

Diagnostic Criteria

Two (or more) of the following signs or symptoms, developing during, or shortly after, stimulant use: 1. Tachycardia or bradycardia. 2. Pupillary dilation. 3. Elevated or lowered blood pressure. 4. Perspiration or chills. 5. Nausea or vomiting. 6. Evidence of weight loss. 7. Psychomotor agitation or retardation. 8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias. 9. Confusion, seizures, dyskinesias, dystonias, or coma.

Recent use of an amphetamine-type substance, cocaine, or other stimulant. Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, use of a stimulant.

The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.

Stimulant Withdrawal

• a withdrawal syndrome that develops within a few hours to several days after the cessation of (or marked reduction in) stimulant use (generally high dose) that has been prolonged.

note

Other Signs and Symptoms

• Stimulant effects: euphoria, increased pulse, blood pressure, and psychomotor activity are most common.
• Depressant effects: sadness, bradycardia, hypotension, and decreased psychomotor activity are less common and generally happen only with chronic high-dose use.
• Intoxication (either acute or chronic): is often associated with impaired social or occupational functioning.
• Severe intoxication or overdose: seizures, cardiac arrhythmias, hyperpyrexia (fever), and death.

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _

ANSWER: TOBACCO

TOBACCO- RELATED DISORDERS

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _

ANSWER: UNKNOWN

OTHER (OR UNKNOWN) SUBSTANCE-RELATED DISORDERS

GUESS THE PICTURE

_ _ _ _ _ _ _ _ _

ANSWER: GAMBLING

NON-SUBSTANCE-RELATED DISORDERS

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Guidance for community-based treatment and care services. (n.d.). Retrieved March 17, 2022, from https://www.unodc.org/documents/southeastasiaandpacific/Publications/2016/CBT_Guidance_Doc_Philippines_5_May_2016_low.pdf Khan, M. (2022, February 22). Substance-induced disorders - mental health disorders. MSD Manual Consumer Version. Retrieved March 16, 2022, from https://www.msdmanuals.com/home/mental-health-disorders/substance-related-disorders/substance-induced-disorders