DRUG ABUSE

GROUP MEMBERS:AHMAD ABID ABAS [2]

AHMAD ASYRAF MOHAMAD [3]AHMAD DANIAL AHMAD FUAD [5]

AHMAD FARABI AB MANAF [7]ADIBA MD ZAIN [8]

ADIBAH ABDUL JABAR [9]KHAIREZA KHAIRUDIN [10]

ASIF AMRI HUSSIN [11]

BY:ASIF AMRI BIN HUSSIN(07-5-11)

OVERVIEWDrugs have been part of our culture since the

middle of the last century. Popularized in the 1960s by music and mass media, they invade all aspects of society.

An estimated 208 million people internationally consume illegal drugs

The most commonly used illegal drug is marijuana. According to the United Nations 2008 World Drug Report, about 3.9% of the world’s population between the ages of 15 and 64 abuse marijuana.

DEFINITION OF DRUG ABUSEThere is several ways to define the term drug

abuse but the main concept is about the non permissive consumption of certain substance i.e drug that can give certain effects to an individual in which the chronic use of that substance may lead to physical and psychological dependence.

This term can be define as the use of either licit or illicit drug outside or beyond the permitted medical practice or medical justification.

STATISTICS OF DRUG ABUSE IN MALAYSIADrug abuse has been the most complex social

problem faced by the country. The community involvement with drugs was

not bounded by age and involved all groups either poor, rich, professionals, labourers, public servants or students.

The National Drug Agency (ADK) has, through its efforts, registered more than 300,000 addicts in its drug fight. However, just like the iceberg, the numbers are only what is seen above the surface.

Some local studies have suggested there are an estimated three to four addicts who are not registered with the ADK for every one that is.

Hence the potential numbers of addicts in Malaysia is quite staggering, a possible one million addicts in our country of 25 million, or 4% of the populace!

The following graph and chart is obtained from the National Anti Drug Agency(NADA) from January to June 2011.

This map shows the Malaysia and it’s states.

The following table illustrates the number of drug abuse in Malaysia by states from January to June 2011 and

the differences in the number for the same period during 2010.

This table shows the number of drug abuser in Malaysia from January to June 2011 and the differences of the

numbers in the same months from the last year.

•The table above clearly illustrates the number of drug abuser in Malaysia from January-June 2011 according to gender.•As we can see there is decrease in number of drug abuser in 2011 compared to the number of drug abuser in same period of the last year.•However,nearly 99% of the drug abuser are male while female contribute just nearly 2% of drug abuser in Malaysia.

•The chart above shows the age of drug abuser when they were detected by the authority.•From this chart it is clear that most of the drug abuser came from the youth which comprise of about 79% of total drug abuser in Malaysia from January to June 2011.

The table above shows the number of drug abuser according to the job and the differences

in number compared to 2010 statistics.

The previous slide is the number of drug abuser according to the type of drugs abused by them.

As we can see the most commonly abuse drug in Malaysia is of the opiate group of drug.

It comprises about 67% from the total drug abused in Malaysia.

Then it is followed by marijuana which also known as ganja in Malaysia.

It is abused by nearly 17% of the drug abuser in Malaysia.

FACTORS ASSOCIATED WITH DRUG ABUSE

by:AHMAD DANIAL BIN AHMAD

FUAD,5

INTRODUCTION1. Drug abuse is not just the problem of the

individual. 2. Factors that contribute to drug abuse come

from all levels.3. From the individual's predisposition to

addiction to the economy of their environment

genetici. Susceptibility does not mean inevitability Biological differences It may be harder for people with certain genes to quit

once they start.  Factors that make it harder to become addicted also may

be genetic. Example:an individual may feel sick from a drug that

makes other people feel good.

ii. There is no single addiction gene Scientists will never find just one single addiction gene. Susceptibility to addiction is the result of many

interacting genes. Social and environmental factor contribute to risk of

addiction

iii. When addiction runs in family Researchers construct pedigrees of large families with

addiction as a first step to understanding the disease Not every addict will carry the same gene, and not

everyone who carries an addiction gene will exhibit the trait

The A1 allele of the dopamine receptor gene DRD2 is more common in people addicted to alcohol or cocaine

Increased expression of the Mpdz gene results in mice experiencing less severe withdrawal symptoms from sedative-hypnotic drugs such as barbiturates

Mice bred to lack the cannabinoid receptor gene Cnr1 have a

reduced reward response to morphine.Mice bred to lack the serotonin receptor geneHtr1b are more attracted to cocaine and alcohol

Mice bred to lack the β2 subunit of nicotinic cholinergic receptors have a reduced reward response to cocaine

Mice with low levels of neuropeptide Y drink more alcohol, whereas those with higher levels tend to abstain

Fruit flies mutated to be unable to synthesize tyramine remain sedate even after repeated doses of cocaine

Mice mutated with a defectivePer2 gene drink three times more alcohol than normal

Non-smokers are more likely than smokers to carry a protective gene, CYP2A6, which causes them to feel more nausea and dizziness from smoking

Alcoholism is rare in people with two copies of the ALDH*2 gene variation

Mice with the Creb gene "knocked-out" are less likely to develop morphine dependence.

OTHER FACTORSI. SEX Men are twice as likely to have problems

with drugs.II. DRUG Cause temporary,pleasurable feelings DependentIII.Mental condition Anxiety,depression and other mental

conditions

IV. Environment Peer pressure Lack of parental guidance and supervisionV. Economy Unemployed Laid off to CEOs in big corporations

conclusion1. Just because you are prone to addiction

doesn't mean you're going to become addicted. It just means you've got to be careful.

2. There are many ways that genes could cause one person to be more vulnerable to addiction than another.

CLASSIFICATIONS OF DRUG ABUSE

Cannabinoids and hallucinogens

By:Ahmad Asyraf bin Mohamed (3)

CannabinoidsAny chemical that activates the body’s

cannabinoid receptors.Most commonly understood through the use

of the Cannabis plant, marijuana (a dry, shredded green and brown mix of flowers, stems, seeds, and leaves)

Arguably the most controversial and commonly abused drug.

Mechanism of actionThe main active chemical in marijuana is

delta-9-tetrahydrocannabinol (THC), a cannabinoid.

It acts on the cannabinoid receptors, namely the:CB1 (Primarily found in CNS neurons)

CB2 (Primarily found in PNS immune cells)

When cannabinoids bind to receptors they inhibit adenylyl cyclase activity and activate the Mitogen-activated protein (MAP) kinase pathway in neurons and cells heterologously expressing CB1 and CB2 receptors.

EffectsPsychoactive

alteration of conscious perception, euphoria, feelings of well-being

20-30% users experiences panic attacksmarked distortions in the perception of

time and space depersonalization and derealization

More effectsSomatic effects increase heart rate, dry mouth(cotton

mouth), reddening of the eyesreduction in intra-ocular pressure muscle relaxation

WithdrawalOccurs in long term abuserSymptoms:

irritability, sleeplessness, decreased appetite, anxiety, and drug craving

It starts 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation.

HallucinogensHallucinogens are a diverse group of drugs

that cause an alteration in perception, thought, or mood

most hallucinogens do not consistently cause hallucinations!

Examples:LSD (acid), MDMA(ecstasy), etc.

Tablets of MDMA

Mechanism of actionLSD binds to most serotonin receptor subtypes

except for 5-HT3 and 5-HT4The psychedelic effects of LSD are attributed to its

strong partial agonist effects at 5-HT2A receptors. MDMA inhibits the vesicular monoamine

transporter, which results in increased concentrations of serotonin, norepinephrine, and dopamine in the cytoplasm, and induces their release by reversing their respective transporters through a process known as phosphorylation.

Effects of LSDKnown as “trip” experience of radiant colors, eidetic

imagery, altered sense of time.Visual effects, as movement of static surface,

after images, intensification of colours.

Effects of MDMADiminished fear, anxietyMood lift with subsequent euphoriaMild psychedeliahyperactivityIncreased energy and enduranceIncreased alertness

Adverse effectsAnxiety and paranoiaDepressionIrritabilityFatigueImpaired attention, focus, and concentration

Withdrawal symptomsdepression anxiety schizophrenia impaired memory lessened attention span mental confusion  psychological dependence suicidal thoughts

References http://drugabuse.gov/infofacts/hallucinogens.

htmlhttp://emedicine.medscape.com/article/29375

2-overview#a0104http://en.wikipedia.org/wiki/Hallucinogen

AMPHETAMINES ADDICTION

By : ADIBAH ABDUL JABAR (9)

IntroductionAmphetamines and amphetamine-related drugs are

central nervous system stimulants.The past decade has seen a marked increase in the

popularity of amphetamines use, particularly methamphetamine in Malaysia.

Types :Amphetamines – group substances including

predominantly amphetamine and methamphetamine.

Ecstasy- group substances – including MDMA (3, 4-Methylenedioxymethamphetamine ) and its analogues.

Effects of abuse1. Short term loss of appetite, rapid breathing and

heartbeat, high blood pressure, and dilated pupils

fever, sweating, headache, blurred vision, and dizziness (high dose)

flushing, pallor, very rapid or irregular heartbeat, tremors, loss of coordination, and collapse (very high dose)

death

feeling of well-being, great alertness and energy.

talkative, restless, and excited, and sense of power and superiority

paradoxically, in children these drugs frequently produce a calming effect and were often prescribed for hyperactivity.

2. Long term effectsshort-term effects are exaggeratedvarious illnesses related to vitamin

deficiencies and malnutritionmore prone to illnessamphetamine psychosis - a mental

disturbance very similar to paranoid schizophrenia

kidney damage, lung problems, strokes, or other tissue injury may result

3. Effects of ecstasyusers feel happy, relaxed and loving that last

for 3-5 hoursdecreases appetite and the need for sleepmood swings, short-term memory loss,

inability to concentrate and significant reduction in mental abilities

poor health

Withdrawal symptomsdue to tolerance to some effectsbecome psychologically or physically

dependentfatigue, long but troubled sleep, irritability,

intense hunger, and moderate to severe depression, which may lead to suicidal behaviour

fits of violence may also occurthese disturbances can be temporarily

reversed if the drug is taken again

Tobacco and InhalantsAhmad Abid Abas 2

TobaccoMechanism

1) Enter bloodstream -> Stimulates adrenal glands -> adrenaline -> Stimulates CNS -> ↑BP,Respiration,HR.2) Lead to released of glucose -> Suppressed insulin excretion -> chronically elevated blood glucose.3) Increase level of Dopamine.4) Addiction results from long term brain changes.

Tobacco Withdrawal Symptoms from Addicted User

- Irritability- Attention difficulties- Sleep disturbances- Increase appetite- Powerful cravings for tobacco

Adverse Effects on Health

Tobacco Free Initiative (WHO)

WHO response In 2008, WHO introduced a package of tobacco control

measures to further counter the tobacco epidemic and to help countries to implement the WHO Framework Convention. Known by their acronym MPOWER :

1)Monitor tobacco use and prevention policies2) Protect people from tobacco use3)Offer help to quit tobacco use4)Warn about the dangers of tobacco5)Enforce bans on tobacco advertising, promotion and

sponsorship6)Raise taxes on tobacco.

Malaysian Smoking Cessation Programme and Smoke-Free Air Laws

Inhalants –Who’s Huffing Now(glue and gums sniffing)-(whippets,poppers,snappers)

Inhalants are volatile substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect.

Types : Volatile Solvents (paint thinners and removers, dry-cleaning fluids,

degreasers, gasoline, glues)

Aerosols (spray paints, deodorant and hair sprays)

Gases (ether, chloroform, halothane, and nitrous oxide )

Nitrites (cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl (butyl) nitrite )

Inhalants (Mechanism affect brain)

Hypoxia -> damage cells throughout body -> e.g Brain hypoxia (hippocampus) -> inability to learn new things and carry simple conversations.

Long term used will break down myelin -> muscle spasm and tremors -> difficulty with basic action like walking,talking etc.

Acting like CNS depressant similar to alcohol-> initial excitation then disinhibition,agitation.

Inhalants (symptoms of intoxication)

slurred speech, lack of coordination, euphoria, and dizziness. - > lightheadedness, hallucinations, and delusions.

lose the ability to learn new thingsmuscle spasms and tremors Long term -> mood swings,anergic,severe

brain damage,

Inhalants (withdrawal symptoms)Anxiety,depression,aggressivenessHeadache,tremors,nausea,loss of appetiteHallucinations

Adverse Effect on Health‘Sudden Sniffing Death’Disturbed consciousness and apneaHearing lossPeripheral Neuropathies or limb spasm

From to

DepressantRelaxation,Lowered inhibitions,Reduced intensity of physical sensationsdigestive upsets, Body heat loss, reduced muscular coordination

Passing out,loss of body control, stupor,Severe depression of respirationpossible death.(Effects are exaggerated when used in combination with alcohol –synergistic effect).

• Amnesia,• confusion,• drowsiness,• Personality changes

Development of Tolerance• Moderate

• (DSM-IV) requires 2 or more of the following characteristics to be present for diagnosis

• autonomic hyperactivity (eg, sweating, pulse rate >100); • increased hand tremor; • insomnia; • nausea or vomiting;

• transient visual, tactile, or auditory hallucinations or illusions;

• psychomotor agitation; • anxiety; • grand mal seizures.

Beer

Hard Liquor

Wine

Development of Tolerance• Moderate

After a few drinks:    feel more relaxed, reduced concentration & slower reflexes.

•  A few more drinks:    fewer inhibitions, more confidence, reduced coordination, slurred speech, intense moods

• Still more drinks:    Confusion, blurred vision, poor muscle control. 

• More still:    Nausea, vomiting, possible incontinence, poor respiration, a fall in blood pressure, sleep. 

• Even More:    Possibly coma or death. 

The severity of alcohol withdrawal depends on various factors including•age, •genetics, •degree of alcohol intake •length of time the individual has been misusing alcohol• number of previous detoxifications.

• Mild to moderate psychological symptoms:

• Feeling of jumpiness or nervousness• Feeling of shakiness• Anxiety• Irritability or easily excited• Emotional volatility, rapid emotional

changes• Depression• Fatigue• Difficulty with thinking clearly

• Mild to moderate physical symptoms:• headache - general, pulsating• Sweating, especially the palms of the hands or the face• Nausea and vomiting• Loss of appetite• Insomnia, sleeping difficulty• Paleness• Rapid heart rate (palpitation)• Eyes, pupils different size (enlarged, dilated pupils)• Skin, clammy• Abnormal movements• Tremor of the hands• Involuntary, abnormal movements of the eyelids

• Severe symptoms:• A state of confusion and hallucinations (visual)

-- known as delirium tremens• Agitation• Fever• Convulsions (which may result in death)• “Black outs" -- when the person forgets what

happened during the drinking episode

• A toxicology screen refers to various tests to determine the type and approximate amount of legal and illegal drugs a person has taken.

• How the Test Is Performed• blood or urine sample. • However, it may be done soon after

swallowing the medication, using stomach contents that are obtained through gastric lavage or after vomiting.

A blood toxicology screen can determine the presence and level (amount) of a drug in your body.

Urine sample results are usually reported as positive (substance is found) or negative (no substance is found).

• HOW LONG AFTER USAGE CAN DRUGS BE DETECTED

• There is no simple answer to this question, because it depends on

• substance itself • dosage, • frequency of abuse• individual rates of drug metabolism

and excretion• sensitivity of the particular test carried

out

DRUGSDURATION OF DETECTION IN URINE:

Alcohol up to 1 dayAmphetamines (including MDMA, MDA)

1-3 days

Barbiturates 1-3 daysBenzodiazepines 1-3 daysCannabis up to 14 daysCocaine 1-3 daysCodeine 1-2 daysCyclizine 1-2 daysDihydrocodeine 1-2 daysHeroin (morphine) up to 1 dayMethadone 1-3 days6-MAM up to 1 day

• http://emedicine.medscape.com/article/290585-clinical

• http://www.kickoff.net.au/Alcohol.html

• http://health.nytimes.com/health/guides/tes/toxicology-screen/overview.html

• http://www.toxlab.co.uk/dasguide.htm#SENSITIVITIES

• http://alcoholism.about.com/cs/withdraw/a/aa030307a.htm

PRINCIPLE AND METHODSOF TREATMENT

BY:ADIBA MD ZAIN [8]

PRINCIPLES OF EFFECTIVE TREATMENTAddiction is a complex but treatable disease.No single treatment is appropriate for everyone.Attends to multiple needs of the individual, not

just his or her drug abuse.Treatment for an adequate period of time is

critical.Counseling and other behavioral therapies are

the most commonly used.Medications are an important element of

treatment for many patients, especially when combined with counseling and other behavioral therapies.

Treatment plan must be modified as necessary to ensure that it meets patients changing needs.

Many drug–addicted individuals also have other mental disorders.

Medication by itself does little to change long–term drug abuse.

Treatment does not need to be voluntary to be effective.

Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

Assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases.

Provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

There are 3 major areas in the rehabilitation program:

1. Detection and detoxification2. Rehabilitation in an institution3. Supervision in the community and follow-up care

DETOXIFICATIONDetoxification is the process by which the body clears

itself of drugs and is often accompanied by unpleasant and sometimes even fatal side effects caused by withdrawal.

The process of detoxification often is managed with medications that are administered by a physician therefore, it is referred to as "medically managed withdrawal."

Generally considered a precursor to or a first stage of treatment because it is designed to manage the acute and potentially dangerous physiological effects of stopping drug use.

Outpatient Drug Rehabs and Drug Treatment CentersUse a wide range of treatment modalities including:problem-solving group or talk therapy, insight-oriented psychotherapycognitive-behavioral therapy, and 12-step programs.

*more loosely structured *depending on the individual patient's characteristics and

needs.

Inpatient Short-Term Drug Rehabs and Drug Treatment CentersKeep patients up to 30 days in treatment center. Most of these treatment programs focus on: *medical stabilization *abstinence *lifestyle changes

Staff members are primarily medical professionals and counselors trained in drug and alcohol addiction. 

Tends to be less effective in long-term recovery. Intensive but relatively brief residential treatment based on

a modified 12-step approach, talk and group therapy.

Inpatient Long-Term Drug Rehabs and Drug Treatment Centers

Around-the-clock, drug-free treatment in a residential community of counselors and fellow recovering addicts.

Patients generally stay in these programs several months or up to a year or more.  

Greater chance of success provide care 24 hours per day, generally in non-clinical

settings. The best-known residential treatment model is the

therapeutic community (TC)

REHABILITATION CENTER

Prepared By:AHMAD FARABI BIN AB MANAF (7)

PHARMACOTHERAPY FOR ADDICTIVE

DISORDER

usually conducted in specialized settings (e.g., methadone maintenance clinics).

long-acting synthetic opioid(opioid agonist).80–125 mg/d, periodic dose adjustments as

their clinical or subjective tolerance changes. Reduction by a slow taper to minimize discomfort.

prevent opioid withdrawal, block the effects of illicit opioid use, and decrease opioid craving.

semi-synthetic partial opioid agonist(agonist and binds more tightly at the mu-opioid receptor and blocks other opioid from binding to the receptor).

addition of Naloxone to Buprenorphine may further decrease abuse liability while increasing its safety.

eliminates withdrawal symptoms.

long-acting synthetic opioid antagonist.to prevent withdrawal symptoms, individuals

must be medically detoxified and opioid-free for several days before taking naltrexone.

noncompliance is a common problem.best suited for highly motivated patients.

originally marketed as an antidepressant.has mild stimulant effects through blockade

of the reuptake of catecholamines, especially norepinephrine and dopamine.

suppressing tobacco craving, promoting cessation without concomitant weight gain.

partial agonist of nicotinic receptors (alpha-4 beta-2) which thought to be involved in the rewarding effects of nicotine.

blocks the ability of nicotine to activate dopamine.

interfering with the reinforcing effects of smoking, thereby reducing cravings and supporting abstinence from smoking.

blocks opioid receptors that are involved in the rewarding effects of drinking and the craving for alcohol.

reduces relapse to heavy drinking but less effective in helping patients maintain abstinence.

stabilize the chemical balance in the brain that was disrupted by alcoholism, possibly by blocking glutamatergic N-methyl-D-aspartate receptors, while GABA type A receptors are activated.

reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria.

help dependent drinkers maintain abstinence for weeks to months, and more effective in patients with severe dependence.

interferes with degradation of alcohol, resulting in the accumulation of acetaldehyde producing a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol.

compliance is generally poor. Effective in highly motivated patients.

THANK YOU