SUBSTANCE USE DISORDERS DR ANDREA BODROGI AWAKENINGS FOUNDATION

SUBSTANCE USE DISORDERS DR. ANDREA BODROGI AWAKENINGS FOUNDATION BLUE POINT DRUG CONSULTING CENTRE

ADDICTION IS A BRAIN DISEASE BEYOND A REASONABLE DOUBT

Neurotoxicity AIDS, Cancer NEUROTOXICITY AIDS Mental illness CANCER MENTAL ILLNESS Homelessness Crime Violence Health care Productivity Accidents

HOWEVER… ADVANCES IN SCIENCE HAVE REVOLUTIONIZED OUR FUNDAMENTAL VIEWS OF DRUG ABUSE AND ADDICTION, SHOWING US THAT: ► ABUSE IS A PREVENTABLE BEHAVIOR ► ADDICTION IS A CHRONIC, RELAPSING BRAIN DISEASE

WHY ADDICT BRAIN IS NOT ABLE TO STOP? NOT ADDICTED BRAIN CONTROL EXIST CONTROL DOESN’T EXIST DELIBERATION OF STIMULI AND RESPONSE NO DELIBERATION INHIBITORY POWER FUNCTIONS INHIBITORY POWER DOESN’T FUNCTION

Biology/genes Biology/ Environment Interactions Environment

REWARD SYSTEM

WHY DO PEOPLE TAKE DRUGS ? To feel good Most abused drugs produce intense feelings of pleasure This initial sensation of euphoria is followed by other effects which differ with the type of drug used To feel better To lessen: anxiety worries fears depression hopelessness

BASIC CONCEPTIONS • Psychoactive substance: compound that can alter one’s state of mind • Reinforcer: that causes pleasant or stops unpleasant conditions

ABUSE Maladaptive use of the substance /It interferes with the person’s life, causes harm in social functioning, in family life, health, etc. /

ADDICTION Compulsive behavioural pattern of seeking drugs consumption of drugs Characterized by strong dsesire towards the drugs, and strong tendency to the relapse after the withdrawal

TOLERANCE The dose of the drug has to be increased in order to reach the desired effect Level of tolerance effect of drug develops ------------effect of drug doesn’t develop

DEPENDENCE Two types - physical dependence psychological dependence

PSYCHOLOGICAL DEPENDENCE • Drug use is needed for keeping well • Craving in the absence of drug

PHYSICAL DEPENDENCE When the substance use is reduced or ceased withdrawal symptoms develop lack of withdrawal symptoms Level of dependence --------------withdrawal symptoms

CATEGORIES OF DRUGS CNS Depressants Alcohol Sedatives, hypnotics, and anxiolytics Opiates Heroin Meperidine Codeine Hydromorphone Stimulants Amphetamines Methylphenidate Cocaine Cannabis Hallucinogens Designer Drugs Inhalants

ALCOHOL VS. OTHER DRUGS We know that alcohol impairs the brain and results in addiction with repeated use in the same way as other drugs Psysical and psychological dependence First sign of psysical dependence: Predelirium: trembling, sweating

NEUROPSYCHIATRIC DISORDERS DUE TO ALCOHOL CONSUMPTION Delirium tremens Alcoholic hallucinosis Alkoholic delusive disorder Alcoholic personality changes Alcohol-induced Persisting Dementia Wernicke’s encephalopathy Korsakoff syndrome

DELÍRIUM TREMENS Most severe form of alcohol withdrawal At 15 % of Alcoholic persons Untreated delirium has a mortality rate of 20 % Occurs after prolonged and heavy alcohol consumption at cease or reduction of alcohol use Provoking factors can often be seen (fever, internal disturbance)

SYMPTOMS OF DELIRIUM Psychic, vegetative, somatic symptoms Dsiturbance of consciousness, Desorientation Hallucinations (visual, tactile etc. ) Psychomotor agitation Trembling, sweating Hypertension, fever Increased pulse rate, inversion of sleeping Epileptic attacs

TREATMENT OF DELIRIUM Prevention Benzodiazepines Ensure fluid and electrolite ballance High calorie, high-carbohydrate diet suplemented by multivitamins Treatment of Brain oedema Cardial support Treatment of internal disorders, infections, etc.

ALCOHOLIC HALLUCINOSIS After prolonged and heavy drinking After alcohol-abuse, or cease of alcohol consumption

ALCOHOLIC HALLUCINOSIS Symptoms: Hallucinations Clear consciousness, kept orientation Severe anxiety Persecutory delusions Delusions of reference Altered behaviour by the Psyichotic contents Suicadial danger

ALKOHOLIC DELUSIVE DISORDER Delusions of jealousy (most often) Persecutory Reference

ALCOHOLIC PERSONALITY CHANGES Slowly progressing chronic psychic distrubance involving all parts of personality after prolonged alcohol consumption

SYMPTOMS • • Changeable mood, Superficial emotions, Bursts of anger Superficial attachment to the family Lack of inhibitions, Lack of ethic Decreased critical sense, confused consciousness Irritability, Agressivity Decreased adapting to the society Decreased judgement Deterioration of intellectual functions

ALCOHOL-INDUCED PERSISTING DEMENTIA • Reason: Direct neurotoxic effect of alcohol and thiamine deficiency Symptoms: • Deterioration of intellectual functions • Impaired memory, Impaired ability of abstraction • Impaired judgement, Impaired problemsolving thinking • Impaired orientation

WERNICKE’S ENCEPHALOPATHY Prolonged and heavy drinking Acute illness Usually starts before the Korsakoff syndrome At 2 -6% of alcoholic patients Reason of the illness: Thiamine (vitamine B 1) deficiency

SYMTPOMS OF WERNICKE’ ENCEPHALOPATHY Ocular motility abnormalities Lateral rectal palsy, gaze palsy Disturbance of consciousness Ataxia

KORSAKOFF SYNDROME Prolonged and heavy drinking Chronic illness, slowly progressing Starts after Wernicke encephalopathy, or without it

SYMPTOMS OF KORSAKOFF SYNDROME Memory disturbance Impaired short term memory, impaired ability of learning (Immediate recall, and long term memory are relatively kept) Patient is not able to memorize even simple informations Reason of the illness: Thiamine (vitamine B 1) deficiency

THIAMINE Reason of thiamine deficiency: • Poor nutrition • Malabsorption • Thiamine is a cofactor for several important enzymes • It’s involved in the conduction of the axon potential along the axon and in synaptic transmission

NEUROPATHOLOGICAL LEASIONS IN WERNICKE – KORSAKOFF SYNDROME • Leasons are simmetrical, Paraventricular • Mamillry bodies, Thalamus, Hypothalamus • Midbrain, Pons, Medulla • Fornix, Cerebellum

Effects and consequences of illegal drug use

EFFECTS OF OPIATE USE -flushing - orgasm sensation in the abdomen - euphoria - calmness

WITHDRAWAL SYMPTOMS OF OPIATES lacrimation rhinorrhea sweating yawning hot and cold flashes insomnia muscle and joint pain nausea abdominal cramps vomiting sever anxiety irritability

EFFECTS OF STIMULANTS elevated mood increasd energy increased alertness transient psychosis decreased appetite autonomic hyperarousal: - tachicardia - elevated blood pressure

EFFECTS OF COCAIN euphoria disinhibition enhanced sens of mastery sexual alartness improved self esteem rush (rapid onset of euphoria) tactile hallucinations (coke bugs)

STIMULANT WITHDRAWAL fatigue depression nightmares headache sweating muscle cramps hunger

HALLUCINOGENS Agents, that induce psychotic-like experiences, hallucinations, perceptual disturbances, feeling of unreality Hallucinogens LSD (lysergic acid diethylamide) peyotle mescaline MDMA

EFFECTS OF HALLUCINOGENS Changes in perception: hallucinations, illusions synthesias (e. g. colors are brighter and more intense or colors may be heared and sounds seen) Emotions become intense and labile Introspection Depersonalisation, Derealization

BAD TRIPS Patient develop marked anxiety and paranoia Flashback: a brief reoccurrence of a drug induced experience that occurs in situations unrelated to taking the drug

CANNABIS • Cannabis derivatives are produced from the hemp Cannabis sativa • The active ingredient is the THC (delta-9 tetrahydrocannabinol) • The illicit psychoactive compound (marijuana) is probably the most widely used drug

EFFECTS - euphoria - drowsiness - feeling of calm - feeling that time has slowed - improved self coinfidence - perceptual distortions - paranoia (suspiciosness) - decreased motor coordinaton

CONSEQUENCES Amotivational syndrome Memory disturbance Marijuana impairs the transfer of material from mediate to long term memory

DESIGNER DRUGS Synthetic drugs produced by underground chemists In chemical structure they are similar to the well known illicit drugs They are technically legal by chemical formulation The sequestered and tested drugs become illegal Not controlled by the United Nations drug control treaties Reported in: Africa, Asia, Australia, Europe, New Zealand, North America

NEW PSYCHOACTIVE DRUGS • Similar effects of the illegal counterpart • Easily obtain instructions of mixing, making, dosing and ingesting synthetic drugs in line (Erowid. org) • Easily obtained as internet is flourushing marketplace • Dangerous and unperdictable side effects because: • More potent, Last longer • Never tested on Humans • No regulatory oversight or quality control • More addictive potential

Ketamine Synthetic Cathinones (Mefedrone) Pheniletilamine New Psychoactive substances Mimic effect to illicit stimulants Synthetic cannabinoids Plant based substances Kartom (UNITED NATIONS OFFICE ON DRUG AND CRIME) Piperazines

CHARACTERISTICS OF NEW PSYCHOACTIVE DRUGS Easy to obtain (At several places the only drug to be obtained) Continuously changing drugs New effects Unpredictable consequences Risk taking behaviour

THERAPY OF ADDICTIVE DISORDERS Connected therapeutic chain from detixification to resocialisation and rehabilitation Aim of treatment: Improve ability to community and social functioning

We Need to Treat the Whole Person! In Social Context

Full recovery is a challenge but it is possible …

In Treating Addiction… We Need to Keep Our Eye on the Real Target Abs tin ence in y t i l a ion ork t c n u F , W ity y l i m a F un m m o and C

Thank you for your attention!