ContentHistorical highlights. Terminology. Etiology, Level of

PAS use, Effects, Biomolecular aspects, Signs of possible PAS use , Diagnosis, Symptoms of usage,

Abstinence and Intoxication, Management , Prognosis

Referal

Kaplan HI., Sadock BJ., Comprehensive Textbook of Psychiaty vol. I, 7th. Ed., Lippincot, Williams & Wilkins, Baltimore, 2000.

Diagnosis and Statistical Manual of Mental Disorder , 4 th. Ed., American Psychiatric Association, Washington DC, 1994.

Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III , cetakan 1, DirJen YanDik DepKes RI, Jakarta.

Kaplan HI. Sadock BJ., Synopsis of Psychiatry , Behavioral Sciences / Clinical Psychiatry 8 th. Ed., Williams & Wilkins, Baltimore, 1998.

Undang-undang Narkotika & Psikotropika , cetakan kedua . Sinar Grafika , Jakarta 1999

Historical Hightlights

Used since ancient time rituals,

socialization, recreation .

INDONESIA

Opiate ordonance 1927

Import, distribution, usages

regular opiate distribution for personal consumption ( old Chinese people )

Brisbane ordonance

Terminology

Psychoactive substance (PAS) a substance when ingested acts on the mind

SUBSTANCES:

PPDGJ III , ICD 10

DSM IV

Dependence syndrome

Tolerance

Withdrawal syndrome

Inter-relation of PAS, the individual person and the enviroment

Characteristics

PAS : effect , accessibility

Person : high risk, curiousity ,peer solidarity , identity, escapism, misuse abuse

Environment : family disharmony, authority crisis, norm - value changes, morale & religiousities forced by peers, less facililities for youth activities, less employment and education facilities.

High rik individuals Potential user

Easily disappointed aggressive,

instant gratification ,

bored easily depresive

risk taking behaviour

psychosexual problems

personality disturbance

lower intelligence

• Physically and mentally healthy

• Socially well adjusted

• Honest

• Responsible

• Able to handle severe / acute stress

• Able to fulfill leisure time

• Rationale expextations

dependence

abuser

situational

Low risk

High risk

occational

experimental

Treatment & rehabilitation

intervention

promotion

Promotion & prevention

Level of PAS Use

user

Non user

Physical the substance, ingredients and method of usage

- pulmonary & respiratory system

- Cardiovascular - GI tract

- dermatologic - urinary tract

- haemopoetic - endocrine

- bone & muscle - nervous system

- other (AIDS)

HIV infection

Flulike syndrome after 3 -- 6 weeks becoming infected

Seroconversion 6 -- 12 weeks,

6 -- 12 month

(Elisa , Western blot ) HIV AIDS 8 -- 11 years

Psychological several kind of mental and behavioural problems due to PAS use

Social disturbance of produtivty and social live

Alcohol amphetamine halucinogen opiate cocaine cannabis sedatives / hypnotics designer amphetamines ( e.g. ecstasy )

Achievement ( work , academic ) irritable Socialization Dicipline No sense of responbility Stealing , cheating , dishonest Not well groomed Use to be alone in certain “special” places Use to wear sun glasses, longleeves shirt

Diagnosis

PPDGJ III / ICD 10

DSM IV

Dependence Syndrome

1. A strong desire or sense of compulsion to take the substance

2. Difficulties in controlling substance taking

3. A physiological withdrawal state

4. Evidence of tolerance

5. Progressive neglect of alternative pleasure or interests because of PAS use

6. Persisting with substance use despite clear evidence of overtly harmful consequences

Symptoms of Usage , Abstinence & Intoxication

1. Opiate

Symptoms of Usage , Abstinence & Intoxication

2. Cannabis

Symptoms of Usage , Abstinence & Intoxication

3. Sedative - hypnotic

Symptoms of Usage , Abstinence & Intoxication

4. Alcohol

Symptoms of Usage , Abstinence & Intoxication

5. Amphetamine

Symptoms of Usage , Abstinence & Intoxication

6. Cocaine

Symptoms of Usage , Abstinence & Intoxication

7. Inhalants

Symptoms of Usage , Abstinence & Intoxication

8. Hallucinogens

ManagementBasic principles

Supply

Needsabuse

Prosperity approachPromotion education prevention

Treatment rehabilitation

Security approach

NEEDS

2 major goals of treatment

Complete abstinence

Physical, psychiatric and psychosocial well - being

Adequate psychosocial supports are very important for changes of behaviour

urine drug screens

Treatment

1. By laws

UU no. 5 1997 (Psikotropika)

UU no. 22 1997 (Narkotika)

2.1. Potential users

2.2. Users

2. 1. Potential users Prevention (parent, families,teachers, tutors)

develop alternate activities

2. Users Physical, psychological, social.

Treatment & rehabilitation are not separate

Long - term

Need broad cooperation

Treatment phases

1. Initial, 1- 3 days (in patient)

2. Detoxification and treatment for medical complications , 1- 3 weeks (in patient)

3. Stabilization , 3 - 9 months

4. Preparation for reintegration to the community , 3 - 12 months

5. Resocialization , approx. 3 years.

treatment

Opiate

Education Methadone Naltrexone Psychotherapy

treatment

Cannabis

Amotivational syndrome Abstinence & suport education Psychotherapy, Antianxiety, antidepressant

treatment

Sedative - hypnotic

Withdrawal Overdose

treatment

Alcohol

Psychotherapy Behaviour therapy Pharmacotherapy

treatment

Amphetamine & cocaine

• Very difficult to remain abstinent powerfully reinforcing & induces craving

• Psychotherapy

• Antipsychotic

• Anticraving

treatment

Inhalant Short lived cease or change to

another substance Counselling, education about PAS DA antagonist

treatment

Hallucinogens

Talking down DA antagonist, bzd.

Referals

Early phases GPs Advance phase Psychiatric facilities Acute intoxication (emergency situation)

& medical complications General hospital : ER, ICU.

Psychiatric symptom Psychiatric facilities

Treatment facilities

Mental hospital, Psychiatric departements 10 % of bed capacities

RSKO ( Jakarta ) Police facilities ( Pamardi Siwi , Jakarta ) Religion - based facilities Social wellfare facilities (Lembang , Parung) Rehabilitation centers

PrognosisRemission specifiers Early partial remission Early full remission

1 month -- 12 months , no dependence Sustained partial remission Sustained full remission

12 months , no dependence

Alcohol

20 % spontaneous remission no antisocial personality no other PAS use general life stability joining full course of initial rehabilitation 60 % chance for 1 year abstinence

Amphetamine

25 % have unfavorable outcomes in daily living affairs (family, work, drug use)

Cannabis

Those who does not understand the intellectual reasons for addressing a

substance abuse problem has a little motivation to stop .

Hallucinogens

Lifetime character of hallucinogen abuse : bell curve

Inhalants

Low prevalence in adulthood , associated with increased risk for future diagnosis of

antisocial personality disorder and other PAS use disorder

Opiate

Relapse rate : high

relapse mostly at the first 3 month , 2 out of 3 patients relapse within

6 months.

33 % of those with 3 years abstinence , eventually relapsed

Death rate 1 - 3 % / year.

Sedative - hypnotics

10 months -- 6 years follow up ,

45 -- 70 % no longer taking bzd.