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

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