Signs Symptoms Myths Misconceptions Dr C Lalremruati District

Signs & Symptoms Myths & Misconceptions Dr. C. Lalremruati District Consultant National Tobacco Control Programme

DRUG / PSYCHOACTIVE SUBSTANCE �Eng thil pawh kan lakluh a, kan khawvel hmuh dan te, rilru sukthlek te, kan chezia leh nunphung te, leh kan awm dan ti danglam thei hi Ruihhlo( Drugs/ Psychoactive Substance) �Chung thil chu dan phal emaw phal loh ani thei. Mahse tih chhunzawm zel chakna leh a lova awm theih lohna a thlen thin -2 -

Substance use disorder • USE Disorders (E. g. The ingestion of alcohol or other drugs without the experience of any negative consequences) 1. Abuse 2. Dependence • INDUCE Disorders � (Continuous use of a substance despite NOT being prescribed or recommended � Maladaptive pattern of use resulting in physical, mental, social, legal harm � Continued use in spite of negative consequences) 1. Intoxication 2. Withdrawal 3

Terminology �Dependence �Drug taken in larger amounts or over longer period �Persistent desire or unsuccessful efforts to cut down �A great deal of time is spent in: � obtaining the drug � using the drug � recovering from its effects �Important social, occupational, or recreational activities given up or reduced �Continued use despite harm �Tolerance �Withdrawal �Addiction - older term, still used (physical & psychological) -4 -

Type of substances �Mental & behavioral disorders due to… 1. (F 10) use of alcohol 2. (F 11) use of opioids 3. (F 12) use of cannabinoids 4. (F 13) use of sedatives or hypnotics 5. (F 14) use of cocaine 6. (F 15) use of other stimulants, including caffeine 7. (F 16) use of hallucinogens 8. (F 17) use of tobacco 9. (F 18) use of volatile solvents 10. (F 19) multiple drug use and use of other psychoactive substances 5

DSM IV TR Substance-related disorders � 4. 1 Alcohol-related disorders � 4. 2 Amphetamine (prescribed drug, ADHD, narcolepsy) related disorders � 4. 3 Caffeine-related disorders � 4. 4 Cannabis-related disorders � 4. 5 Cocaine-related disorders � 4. 6 Hallucinogen-related disorders � 4. 7 Inhalant-related disorders � 4. 8 Nicotine-related disorders � 4. 9 Opioid-related disorders � 4. 10 Phencyclidine (PCP, angel dust) related disorders � 4. 11 Sedative-, hypnotic-, or anxiolytic-related disorders � 4. 12 Polysubstance-related disorder � 4. 13 Other (or unknown) substance-related disorder 6

RUIHHLO HNATHAWH DAN • Physical and Physiological (Taksa bung hrang a khawih buai dan) • Pyschological (Rilru leh ngaihtuahna lam a khawih buai dan) • Social (an khawsakna leh khawsak dan a nghawng) • Economic (eizawnna emaw chhungkaw sum pai a khawih pawi dan)

Addiction is a Developmental Disease: It Starts Early First Marijuana Use, (Percent of Initiates) 67% 26% 5. 5% 1. 5% <12 12 -17 18 -25 >25

When Reading Emotion… Adults Rely More on the Frontal Cortex While Teens Rely More on the Amygdala Source: Deborah Yurgelon-Todd 2000.

Rats Exposed to Nicotine in Adolescence Self-Administer More Nicotine Than Rats First Exposed as Adults Sources: Collins et al, 2004, Levin et al, 2003, NIDA Notes v 19. 2

Why Can’t Addicts Just Quit? Addicted Brain Non-Addicted Brain Control Saliency Drive NO GO Saliency Memory Drive GO Memory Because Addiction Changes Brain Circuits Source: Adapted from Volkow et al. , Neuropharmacology, 2004.

COMORBIDITY Example: SMOKING EPIDEMIOLOGY normal population: 23% alcoholism: 90%+ other addictions: 90%+ schizophrenia: 85% depression: 80%

Factors influencing drug abuse and dependence �Pharmacological & physiochemical properties of drugs �Personality & Psychiatric disorder - increased risk associated with schizophrenia, BPAD, depression, ADHD. �Genetic factors (that influence metabolism and the effects of drugs)

VULNERABILITY Why do some people become addicted while others do not? 14

VULNERABILITY TO ADDICTION �Vulnerability = Susceptibility= Proneness �Vulnerability(Potential risk) = Hazard x 1/Preparedness (Coping capacity) �Hazard = Nature and Nurture �Preparedness (Coping capacity) = Mental, Physical, Social, Religious, etc. 15

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There’s a Big Biological / Genetic Contribution Big to Drug Abuse and Addiction… …. Overlapping with Environmental …. Overlapping with Influences that Help Make Addiction a Complex Disease. 17

Biology/genes Biology/ Environment Interactions Environment 18

Research Study Conducted Under Project HIMNA-MADAT

Classification of Psychoactive Drugs a. Depressant 1. Alcohol 2. Opioids (codane, morphine, heroin) 3. Sedative – hypnotics (diazepam, alprazolam) 4. Volatile solvents 5. Cannabis b. Stimulant 1. Cocaine 2. ATS c. Hallucinogen 1. LSD 2. Cannabis (meth, estacy) 3. Tobacco 4. Cannabis 21

Drugs hnathawh dan • Depressant – an taksa khawl, a bikin thluak hnathawh a ti muang, a ti zawi. Chuti chung chuan a tir lamah phurna a awm fo bawk • Stimulant – anmahni a ti phur a, an hah har a, muthilh a ti harsa a, chaw ei peih lohna a thlen • Hallucinogen – An thil hmuh emaw hriatna (sense) a khawih danglam

Withdrawal symptoms �Usually opposite of acute effects �Depressants: withdrawal-excitation �Stimulants: withdrawal-lethargy/’crash’ 23

Alcoholic beverages 24

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Alcohol: Psychological effects Effects of alcohol �Alcohol is a brain depressant. �In small amounts it relieves anxiety �it may also give a sense of strength and result in boisterous behaviour �It heightens the mood prior to intake, be it sadness or happiness �Impairs judgement and performance -26 -

Alcohol withdrawal: mild �Anxiety �Restlessness �Insomnia �Tremors �Craving �Palpitation �Sweating �Breathlessness 27

Alcohol withdrawal: severe Severe Alcohol Withdrawal: “Delirium Tremens” �All features of mild withdrawal �Disorientation (unawareness of self and surroundings – time, place and person) �Hallucinations �Seizures (fits – ‘rum fits’) �Can be fatal 28

Alcohol related physical problems �GIT – oesophagitis, gastritis, reflux, m-w tears, varices, pancreatitis, portal HT, ca’s �Liver – hepatitis, fatty liver, cirrhosis, haemochr, hepatic Ca, hepatic encephalopathy �Cardiovascular – arrythmias, cardiomyopathy, coronary/cerebrovascular disease, hypertension �Metabolic �Endocrine e. g. pseudocushings, hypogonadism, infertility, low libido/impotence �Musculoskeletal e. g. gout, fractures, osteoporosis �Haematological e. g. anaemia, thrombocytopaenia �Respiratory �Dermatological e. g. spider naevi, palmar erythema, eczema, worsening psoriasis

Alcohol – Neurological problems �Amnesic (Korsakoff’s) syndrome & Wernicke’s encephalopathy �Cerebellar degeneration �Central pontine myelinosis �Dementia, amnesia/blackouts etc �Fetal alcohol syndrome

Opoids 31

Heroin (Smack) 32

Opioids: Psychological effects The effects differ widely between new and dependent users New users • Who is not in pain an unpleasant reaction / vomiting Dependent users • Short lived in-tense experience – “rush” • A state of profound euphoria • Who has pain or anxiety some relief • A dreamlike state lasting longer -33 -

Opioid withdrawal Very distressing, but never fatal ! �Opening of all holes ! • Watering from eyes, nose • Vomiting • Loose motions �Bodyache / pain �Anxiety, restlessness, insomnia 34

Cannabis (Bhang, Charas, Ganja, Hashish) 35

Cannabis products �Bhang (leaves) �Ganja (dried flowering stem of the plant) �Charas / Hashish (extracted from the resin covering the plant) �Hashish Oil (extracting THC using chemical methods) Oral Smoked -36 -

Cannabis: Psychological effects �A dreamy state with an increased tendency to fantasize �State of euphoria, well being and enjoyment �Generally followed by a period of drowsiness �Perceptual and sensory distortions �Can prolong reaction time and impair coordination �Sounds and colours may become more intense �Restlessness, fear and even panic may spoil the experience (“bad trip”) �There may be driven activity (subject knows that one’s activities are meaningless, yet is unable to control them) -37 -

Cannabis withdrawal Non specific • General discomfort • Intense craving • Anxiety, restlessness 38

Sedative – hypnotics Valium, Avil, Cough Syrups 39

Sedative – hypnotics & other pharmaceuticals Medications for: �Sleep (Diazepam) �Allergy (Promethazine, pheniramine) �Pain (Pentazocine, Propoxyphene) �Cough (Codiene) �Diarrhea (Diphenoxalate) �Anesthesia (Ketamine) General brain depressants Opioid like actions Hallucinogen -40 -

Cocaine and other stimulants Coca leaf and cocaine powder 41

Amphetamine Type Stimulants (ATS) -42 -

Stimulants: Psychological effects �Immediately after smoking the drug or injecting itextremely pleasurable ‘rush’ or ‘flash’. �Enhanced mood and body movement, euphoria �Increased respiration �Increased heart rate, blood pressure �Insomnia �Reduced appetite -43 -

LSD (Lysergic acid diethylamide) 44

Tobacco • Tobacco use reduce life span (710 yrs) • Tobacco kills around 6 million people each year • Direct tobacco use results to 5 million deaths (WHO) 45

Volatile solvents (Inhalants) 46

Stimulant withdrawal �Lethargy �Hypersomnia / sleepiness �Fatigue / sad mood �Craving �Anhedonia (inability to feel pleasure) 47

RUIHHLO TITE LAN CHHUAH DAN Tuizawng leh rilru puthmang inthlakthlen hi chu tleirawlte zia ve reng a nih lain, heng a hnuaia tarlante erawh hi chu chik zualin ngaihven ila: � thian kawm duhzawng � sikul/class kal loh, examnaa tih chhiat zual � a thil neih leh thiltih sawithat vak duh lohna � sum hman dan sawi tha duh lo � thil rimna chi leh rimtui hman nasat – thil dang rim thahna atan � Thinchhiat uchuak, rilru puthmang danglam thut � Mutdan leh ei /in lama danglamna te � Thil pakhatah rilru an pe reng thei lo � Chaw ei mumal lo, vun dang, luak leh ringawt thin, � Haihawt em em � Sawi ngai tul lova sawi nawn � Intifai an thatchhe tial � Hnar/hmai bawr hiah neuh � Rihna tlahniam leh a dangte. � Bathroom/room ah a inkhung rei zual em

Ruihhlo hmansual tir theitu leh hmansual tiawlsam theitu (Causative and Risk Factors) �Chhungkuaa ruihhlo hmangsual awm vang �Chhungkua boruak zir loh vang �Thiante nawrna (Peer Pressure) �Rilru lam harsatna engemaw ber an neih sa in �Harsatna an neih chhawk nana an hmanin �Chak lohna engemaw bik an neihin Source: National Institute on Drug Abuse (NIDA)

�Substance use disorders (Addiction) �Indirect suicide? ? ? 50

The usual drug-use ‘career’ Injection Tidigesic From ‘softer’ to ‘harder’ drugs Heroin / Smack Charas / Ganja Alcohol Tobacco -51 -

Relationship between tobacco dependence and alcohol dependence Correlation between Tobacco Dependence and Alcohol Problem Severity Fagerstrom Correlation Coefficient Sig. (2 -tailed) **Correlation is significant at <. 01 level AUDIT 1. 000 . 238**. . 001

Myth Fact You can stop using drugs anytime Withdrawal sickness, believing you must have drugs, and being around people who use can make stopping drug use difficult. But there are people and programs that can help You have to use drugs for a long time before they can really hurt you Drugs can cause the brain to send the wrong signals to the body. This can make a person stop breathing, have a heart attack or go into a coma. This can happen the first time the drug is used If you only buy drugs from friends, you'll get the pure stuff Because drugs are illegal, no one can know what is really in them

Myth Fact Teenagers are too young to get addicted Addiction can happen at any age. Even unborn children can get addicted because of their mother's drug use If you're pregnant and use drugs, your body protects the baby Drugs affect an unborn child as much or more than the mother. Drug use during pregnancy can cause the baby to die or be born too early. It can damage the baby's mind and body If you smoked pot on the weekend, you'd be fine by Monday The effects of pot (marijuana) can last for up to 3 days. It impairs memory, reflexes and coordination

Myth Fact If you get drunk, coffee will sober you up Once alcohol is in the bloodstream, only time will make a person sober Snuff and chewing tobacco are safe because there's no smoke Smokeless tobacco can cause mouth and throat cancer, high blood pressure and dental problems. It can also lessen the senses of taste and smell and can cause bad breath Sniffing glue gives an instant rush. There isn't time for it to hurt you Inhalants enter the blood and go through the body in seconds. Sniffing larger amounts can cause a heart attack or death from suffocation because inhalants replace oxygen in the lungs

Myth Fact Pot isn't as bad for you as cigarettes Marijuana smoke has more cancer causing chemicals than tobacco Drugs relieve stress. They help deal with problems Drugs only make people forget and not care about their troubles. When the drug wears off, the problem is still there As soon as a person feels normal, all the drug is out of the body Long after the effects of the drug stop being felt, the drug can still be in the body. For example, cocaine can be found in the body up to one week and marijuana up to 3 months after a single use

SUPPORT SYSTEMS SELF FAMILY & SOCIETY Can help in coping �In social activities – YMA, MHIP, MUP etc �In Religious activities – KTP, Pavalai etc

Baseline survey on extent & pattern of Drug use in Mizoram (SWD)

Note: The 1 st drug use is tobacco & solvents and progressively move on to alcohol and cannabis and so on. .

Second Hand Smoke Exposure Mizoram

Universal women’s helpline 2016 -17 calls & cases received Quarter July. Sept 2016 Oct-Dec Jan-Mar 2016 Total no. of calls received 193 397 222 812 Total no. of cases received 27 63 56 146 Total no. of calls attributable to alcohol 97 199 111 406 Total no. of cases attributable to alcohol 14 32 28 (50%) 74 (50. 68%)

Mizoram synod social front booklet no. 49

MLPC Act 2014 Study Group Report in a tarlan danin: � 23. 38% (Hospital pali atanga damlo record an neih) -zu vang � 19% -alcohol related deaths

KTP Rorel Inkhawm 2019 Report Sl. no Member thi zat 470 1 Mipa 428 2 Hmeichhia 42

KAN SUM LEH PAI A NGHAWNG DAN (Zu) �MLPC Act hman atanga thla 8 chhungin Govt. Of Mizoram in zu zawrhna atangin Rs. 19. 44 crore tax a la lut �Zu kaihhnawih vanga accident thleng vangin Rs. 16 lakhs �Zu ruih vanga accident inenkawlna senso zat Rs. 4. 09 crore �Zu in nasat vanga natna enkawl nan Rs. 6. 35 crore �Judicial cost atan Rs. 2. 67 crore �Rs. 1. 20 crore zu vanga lungin tang te tan sen ral ani bawk

KAN SUM LEH PAI A NGHAWNG DAN (Vaihlo) NI TINA KAN SUM HMAN RAL ZAT (Mizoram Presbyterian Kohhran Hmeichhe Report 2004) Rs. 8, 933. 35 Approx. Figure CIGARETTES = ₹ 718/- Per Month 3, 20, 000 smokers X ₹ 718 = ₹ 22, 97, 60, 000/-

NO. 1 POSITIONS IN CANCER IN INDIA (INDIA RAMA PAKHATNA KAN NIHNA) 1 Cancer zawng belhkhawm ah (Mipa & hmeichhe) 2 Hrawk & hnar cancer/ Nasopharynx Cancer (Mipa & hmeichhe) 3 Chuap Cancer (Mipa & Hmeichhia) 4 Pumpui Cancer (Mipa & Hmeichhia) 5 Chhulhmawr cancer (Hmeichhia) 6 Thisen cancer chi khat / Myeloid leukemia (Mipa) 7 Chaw dawt cancer (Mipa)

THE CIGARETTES AND OTHER TOBACCO PRODUCTS (PROHIBITION OF ADVERTISEMENT AND REGULATION OF TRADE AND COMMERCE, PRODUCTION, SUPPLY AND DISTRIBUTION) ACT, 2003

MAIN PROVISIONS OF THE ACT 1 Prohibition of smoking in public places Sec-4 2 Prohibition of advertisement of cigarettes and tobacco products Sec-5 3 Prohibition of tobacco products to minors sale Sec-6(a) 4 Prohibition of sale of tobacco products near educational institutions Sec-6(b) 5 Regulation of health warning on tobacco products packs Sec-7

VAIHLO NGHEI DUH TAN DISTRICT HOSPITAL tin ah AH OPD HUN CHHUNGA PAN THEIH RENG KAN NI