1. SUBSTANCE USE
DISORDERS
Niharika Thakkar
Child Guidance Centre and
Department of Behavioural Sciences and Mental
Health,
Sahyadri Hospitals ltd, Pune

2. What are Substances??
•Alcohol
•Opioids
•Cannabinoids
•Sedatives/Hypnotics
•Cocaine
•Caffeine
•Hallucinogens http://learn.genetics.utah.edu/content/addiction/drugs/ab
•Tobacco
•Volatile solvents

3. How to identify?
 Self report data
 Analysis of blood, urine etc
 Presence of drug samples
 Clinical signs and symptoms (Disturbances in
levels of consciousness, perception, affect,
behavior, psycho-physiological functions and
responses)
 Informant history
 Comorbidity with other psychotic disorders

4. Acute
Intoxication
 Small doses of substance
produce disproportionately
severe intoxication effect
 Causes behavioural
disinhibition
►Recovery is usually
complete ..Funny Anti Smoking Commercial - EPIC
SPOOF.flv

5. Harmful Use
 Pattern of Use
 Abusing the Substance
 Binging

6. Dependence Syndrome
 Strong desire or compulsion
 Difficulty in controlling in terms of onset,
termination or levels of use
 Withdrawal state
 Evidence of tolerance
 Neglect of alternative pleasures
 Persistent use inspite of
consequences

7. Tolerance
 Increased
doses
required
- Alcohol and
opiate-
dependent
individuals
take daily
doses
sufficient to
incapacitate
or kill non-
tolerant
users

8. Withdrawal State
 Indicator of Dependence
Syndrome
 Repeated prolonged high dose
 Onset and Course is time
limited
 Physical symptoms
 Psychological disturbances:
Anxiety, Depression & Sleep
disorders

9. Withdrawal State with Delirium
 Delirium tremens:
 Short lived
 Occasionally life threatening
 Toxic-confusional state with accompanying
somatic disturbances: Insomnia,
tremulousness and fear
 Clouding of consciousness, vivid
hallucinations and illusions affecting any
sensory modality, delusions, agitation,
automatic over activity.
http://learn.genetics.utah.edu/content/addiction/drugs/abuse.html

10. Psychotic Disorder
 During or immediately after
psychoactive substance use
 Vivid hallucinations
 Misidentifications
 Delusions or ideas of reference
 Psychomotor disturbances
 Abnormal affect : Fear to ecstasy
 Immediately or in 48 hours (or late onset)
 Resolves within a month and fully within 6
months

11. Amnesic Syndrome
 Chronic impairment in memory
 Remote memory lost, immediate memory
preserved
 Disorientation
 Confabulation
 Personality changes
Korsakov’s syndrome ..Requiem for a Dream.flv

12. Residual and Late onset Psychotic
Disorder
 Beyond the period during which psychoactive
substance related effect might reasonably be
assumed to be operating
 Not always reversible: Dementia
 Not to be confused with Withdrawal state
 Negative history: Rule out acute and transient
psychotic disorders
 Flashbacks

14. Guess the Celebrity??

16. Articles
 SUBSTANCE ABUSE IN INDIA, Ahmad Nadeem, Bano
Rubeena, Agarwal V.K., Kalakoti Piyush
 Tobacco use in India: prevalence and predictors of
smoking
and chewing in a national cross sectional household survey
M Rani, S Bonu, P Jha, S N Nguyen, L Jamjoum