Psychiatry >
Drug Use & Misuse
“Overuse of Drugs → Abuse patterns causing dependence”
Risk Factors
- Individual factors (gender, age, family) interact with external factors (culture, price, availability, advertising)
- Stress
- Depression
- Anxiety
- Early alcohol or nicotine use
- Emotional & physical abuse
Clinical Presentation
- Acute Intoxication:
- Disturbed consciousness
- Cognition
- Perception
- Affect or behaviour
- Dependence syndrome:
- Use of substance takes on a higher priority than other behaviours that previously had greater value
Investigations
- History
- Suspect if arrested for theft to buy drugs
- Odd transient behaviour
- Hallucinations
- Injection stigmata
- Marked veins
- Hepatitis
Management
- Education:
- Safe injection
- Overdose prevention
- Basic first-aid training
- Offer Hep B immunisation
- Dependence treatment:
- Set realistic goals with aim of helping patient live active and healthy
- Set conditions for acceptable behaviour and treatment withdrawal
- Decrease criminal activity
- CBT
- Family therapy
- AA meetings
- 12 Step programs
- Refer to community substance team for further assistance
- Methadone as part of the transition abstinence (still an Opioid but taken orally and free hence reduced need for crime)
- Other Drugs:
- Disulfiram
- Lifexidine (SE: drowsiness)
- Buprenophine (SE: liver dysfunction)
- Naltrexone (can cause withdrawal reactions)
Complications
- Relapse
- Organ failure
- Interactions with other medications