The lecture has been given on May 10th, 2011 by Dr. Hazhar.

1. Substance(drug) abuse disorders- general part I Substance(drug) abuse disorders- general part I

2. Substance abuse: It is a persistent use of one or more psychoactive substance. Dependence (addiction): untreated, persists and progresses, it ends in dependence: craving, tolerance, withdrawal symptoms, social and personal decline.medical complications .

3. Craving: a strong and an irresistible desire. Tolerance: more amount of the drug to obtain the same effect (dose escalation). Physical dependence: withdrawal syndrome. Psychological dependence: urge to use the drug, thinks about it, likes it and he can not abstain.

4. Personality factors: Predisposition to experiment with both licit and illicit drugs is more likely in those with sensation-seeking or impulsive behaviour traits, and in extroverts rather than in introverts. Herditary factors: alcoholic father. Age: Adolescence and puberty

5. How abused drugs affect the brain? primary neurotransmitter:glutamatestimulatory ,gamma amino butyric acid(GABA) inhibitory, appropriate balance . Secondary transmitters:dopamine, serotonin, noradrenalin, acetylcholine, endogenous opiates, emotion to the primary processes. All drugs act by interfering with these neurotransmitters.

6. Types according to the ICD-10: Alcohol, opiates, cannabinoids, sedatives (benzodiazepines and barbiturate), Stimulants (caffeine, amphetamine),cocaine, hallucinogens, nicotine , volatile substances (adhesives, aerosols, fuel gases, paints,multiple

7. 1.Risk route of use: infection (hepatitis ,HIV), increased rate of brain entry,opiateintox. respiratory depression 2.Risk of the drug itself. 3.Addictiveness : opiates,cocaine. A. pleasure.b. physical suffering of abstinence.c.the psychological suffering, drug to relieve symotoms. 4. Ease of stopping.

8. Management 1. precontemplation stage: there is no recognition of a need for treatment. 2. contemplation stage: treatment is being considered, the patient is helped to clarify his views and to build his motivation to change. 3 .Decision and action stage

9. Therapy 1. medical complications: 2. Treatment primary psychiatric disease if present. 3. Psychotherapy, motivational interviewing, psycho education client-centered therapy, cognitive behavior therapy. 4. Pharmacological , detoxification maintenance Therapy: aversion , anti-craving

10. 4.Sociotherapy, family and marital therapy. 5. Occupational therapy. 6. Stress management and relaxation treatment. 7.Relapse prevention. 8. Self-help group