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