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Drug Use Disorders

Mental health

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Bright Kumwenda
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15 views22 pages

Drug Use Disorders

Mental health

Uploaded by

Bright Kumwenda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Drug Use and

Drug Use Disorders


A. Introduction
B. Learning objectives
C. Key actions
1. Establish communication and build trust
2. Conduct assessment
3. Plan and start management
4. Link with other services and supports
5. Follow up
Introduction

• What legal and illegal drugs are commonly used in your


community?

• Why do people use drugs?

• Should people be forced to have treatment?


Drug use management is important

• Drug use happens in almost all communities

• Drug use is associated with substantial health and social


problems
– Drug use can lead to harm and dependence
– Intensive cannabis use may result in psychotic disorders
– Injecting drug users have high rates of HIV and Hepatitis C

• Non-specialist clinicians can assess, manage or refer people


with drug use problems
• You can make a difference
Drugs we will cover

• Cannabis

• Opioids
• Benzodiazepines
• Stimulants
• Other drugs
Cannabis
Cannabis
• Local names: Any suggestions?

• Is obtained from cut and dried upper leaves, flowers


and stems of cannabis plant

• Main psychoactive ingredient is delta-9-


tetrahydrocannabinol (THC)

• Is prepared and smoked as a cigarette or in a pipe;


taken as tea or eaten in cakes or as relish.
Effects of cannabis 1
• Cannabis use may have short term effects (on task
performance, short term memory, effects on cardiovascular
and respiratory system) or long term effects (on the endocrine
system, Central nervous system, immune system).

• Cannabis intoxication: Nausea, headaches, altered


concentration, analgesia, red conjunctivae, delayed
responsiveness, and normal pupil size

• Long term use: self-neglect, poor hygiene, anxiety, and


psychosis

• Cannabis withdrawal: mood swings, weight loss, nausea,


racing thoughts, anxiety, restlessness, anxiety and muscle
cramps - usually lasts about one to two weeks
8
Effects of cannabis 2
• Medical consequences of cannabis use
– decreased in sperm count, and testosterone and
luteinizing hormones
– pulmonary complications because cigarettes are
made without filters

• THC is fat soluble and excreted slowly. Casual users


may have a positive urine test for 5-10 days and
chronic users for up to 30 days
Opioids
Benzodiazepines
Stimulants
ICD 10 classification 1
Common terms used in assessment:
• Intoxication: a condition that follows the administration of a
psychoactive substance and results into the disturbance of the
level of cognition, consciousness, perception, judgment, affect or
behaviour or any psychophysiological functions and responses.

•Withdrawal: a syndrome of withdrawal like signs and symptoms


that are sometimes experienced by abstinent alcohol or opiate
dependent individuals that are previously exposed to stimuli
associated to drug use.
ICD 10 classification 2

• Hazardous use/harmful use: a pattern of substance


use that increases the risk of harmful consequences
for the user
• Dependence: a cluster of behavioural, cognitive, and
physiological phenomena that may develop after
repeated drug use. (e.g. strong desire to use drug,
impaired control, increased tolerance, physical
withdrawal
• Psychotic disorder

mhGAP-IG base course - field test version 1.00 – May 2012 14


Relationship between drug abuse and mental illness

Dual diagnosis – substance abuse and psychiatric


illness
What is it?
•Patients have both a substance use disorder and another major
psychiatric disorder. Examples include a cannabis-dependent
patient with panic disorder and an alcoholic patient with major
depression.
•The term is used to highlight the difference between such
patients and patients with a single diagnosis; patients with a
dual diagnosis have special diagnosis and treatment needs.

.
Relationship between drug abuse and mental illness

Is dual diagnosis common?


• Yes. Dual diagnosis is extremely common and often
unrecognized.
• Of patients with a substance use disorder,
approximately 50% have at least one other
psychiatric disorder, most commonly a mood or
anxiety disorder.
• Conversely, almost 30% of patients with other
psychiatric disorders also have a history of substance
abuse
Relationship between drug abuse and mental illness
What are the causes of dual diagnosis?
•Psychopathology may serve as a risk factor for addictive
disorders or may affect the course of an addictive disorder
•There may be familial (genetic) links between certain
psychiatric disorders and substance use disorders.
•Psychiatric symptoms may develop in the course of chronic
intoxication with an abused substance.
• Psychiatric disorders may emerge as a consequence of
substance use and persist after remission.
•Sometimes the occurrence of both disorders in the same
individual is pure coincidence.
Management overview

• Manage associated health problems – physical and


mental
• Brief interventions

• In people who are dependent, management of


withdrawal
Management
• Acute substance induced psychotic disorders are
usually short lived and should be treated like any
other
• However antipsychotic medication may be
discontinued after 3 to 6 months
• People with schizophrenia often continues to use
cannabis to self-medicate their chronic (residual)
symptoms
• Drug users often face discrimination by the health
system because of their continued use
Brief Interventions for people with
harmful/hazardous drug use
• The brief intervention technique is the same as in the
alcohol use module.

• Do you remember the components of a brief


intervention
– State the results of the assessment
– Ask about other substance use
– Assess motivation to change
– State the recommendation to cut down or quit
What would you do at follow up?

• Re-assess drug use and its impact on the person’s life


• Explore the person’s motivation to change their pattern of
drug use
• Continue to provide brief interventions

• Provide or refer for dependence treatment if necessary


Key messages

• Health care providers can make a difference

• Treat associated health conditions

• Provide brief interventions to reduce hazardous/harmful


substance use and to stop drug use in those with drug
dependence.

• Refer for further treatment if there is no improvement

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