Dr CLalremruati District Consultant National Tobacco Control Programme DRUG PSYCHOACTIVE SUBSTANCE Eng thil pawh kan lakluh a kan khawvel hmuh dan te ID: 929956
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Slide1
Signs & SymptomsMyths & Misconceptions
Dr. C.Lalremruati
District Consultant
National Tobacco Control Programme
Slide2DRUG / PSYCHOACTIVE SUBSTANCE
Eng
thil pawh kan lakluh a, kan khawvel hmuh dan te, rilru sukthlek te, kan chezia leh nunphung te, leh kan awm dan ti danglam thei hi Ruihhlo( Drugs/ Psychoactive Substance)Chung thil chu dan phal emaw phal loh ani thei. Mahse tih chhunzawm zel chakna leh a lova awm theih lohna a thlen thin
-
2
-
Slide3Substance use disorderUSE Disorders
(
E.g. The ingestion of alcohol or other drugs without the experience of any negative consequences)
AbuseDependenceINDUCE Disorders(Continuous use of a substance despite NOT being prescribed or recommendedMaladaptive pattern of use resulting in physical, mental, social, legal harmContinued use in spite of negative consequences)IntoxicationWithdrawal3
Slide4Terminology Dependence
Drug taken in
larger amounts or over longer periodPersistent desire or unsuccessful efforts to cut downA great deal of time is spent in: obtaining the drug using the drug recovering from its effects Important social, occupational, or recreational activities given up or reduced Continued use despite harmToleranceWithdrawalAddiction - older term, still used (physical & psychological)-4-
Slide5Type of substancesMental & behavioral disorders due to…
(F10) use of
alcohol
(F11) use of opioids(F12) use of cannabinoids(F13) use of sedatives or hypnotics(F14) use of cocaine(F15) use of other stimulants,including caffeine(F16) use of hallucinogens(F17) use of tobacco(F18) use of volatile solvents(F19) multiple drug use and use of other psychoactive substances5
Slide6DSM IV TRSubstance-related disorders
4.1
Alcoho
l-related disorders4.2 Amphetamine (prescribed drug,ADHD, narcolepsy) related disorders4.3 Caffeine-related disorders4.4 Cannabis-related disorders4.5 Cocaine-related disorders4.6 Hallucinogen-related disorders4.7 Inhalant-related disorders4.8 Nicotine-related disorders4.9 Opioid-related disorders4.10 Phencyclidine (PCP, angel dust) related disorders4.11 Sedative-, hypnotic-, or anxiolytic-related disorders4.12 Polysubstance-related disorder4.13 Other (or unknown) substance-related disorder6
Slide7RUIHHLO HNATHAWH DAN
Physical and Physiological (
Taksa
bung hrang hrang a khawih buai dan)Pyschological (Rilru leh ngaihtuahna lam a khawih buai dan)Social (an khawsakna leh khawsak dan a nghawng)Economic (eizawnna emaw chhungkaw sum pai a khawih pawi dan)
Slide8First Marijuana Use, (Percent of Initiates)
1.5%
67%
5.5%<12 12-1718-25>25Addiction is a Developmental Disease:It Starts Early26%
Slide9When Reading Emotion…Adults Rely More on the Frontal Cortex
While Teens Rely
More
on the AmygdalaSource: Deborah Yurgelon-Todd 2000.
Slide10Rats Exposed to Nicotine in AdolescenceSelf-Administer More Nicotine Than Rats First Exposed as Adults
Sources: Collins et al, 2004, Levin et al, 2003, NIDA Notes v19.2
Slide11Source: Adapted from Volkow et al., Neuropharmacology, 2004.
Drive
Saliency
Memory ControlNon-Addicted BrainNO GOAddicted BrainDriveMemoryControlGOSaliency Why Can’t Addicts Just Quit?
Because Addiction Changes Brain Circuits
Slide12COMORBIDITY
Example: SMOKING EPIDEMIOLOGY
normal population: 23%
alcoholism: 90%+ other addictions: 90%+ schizophrenia: 85% depression: 80%
Slide13Factors influencing drug abuse and dependencePharmacological & physiochemical properties of drugs
Personality & Psychiatric disorder - increased risk associated with schizophrenia, BPAD, depression, ADHD.
Genetic factors (that influence metabolism and the effects of drugs)
Slide14Why do some people become
addicted while others do not?
VULNERABILITY
14
Slide15VULNERABILITY TO ADDICTIONVulnerability = Susceptibility= Proneness
Vulnerability
(Potential risk) = Hazard x 1/Preparedness (Coping capacity)
Hazard = Nature and NurturePreparedness (Coping capacity) = Mental, Physical, Social, Religious, etc.15
Slide1616
Slide17There’s a
Big
Biological / Genetic
Contribution to Drug Abuse and Addiction…….Overlapping with Environmental Influences that Help Make Addiction a Complex Disease.17
Slide18Biology/genes
Environment
Biology/
EnvironmentInteractions18
Slide19Research Study Conducted Under Project HIMNA-MADAT
Slide20Slide2121Classification of Psychoactive Drugs
b. Stimulant
Cocaine
ATS (meth,estacy)TobaccoCannabis a. DepressantAlcoholOpioids (codane, morphine, heroin)Sedative – hypnotics (diazepam,alprazolam)Volatile solventsCannabis c. HallucinogenLSDCannabis
Slide22Drugs hnathawh dan
Depressant
– an
taksa khawl, a bikin thluak hnathawh a ti muang, a ti zawi. Chuti chung chuan a tir lamah phurna a awm fo bawkStimulant – anmahni a ti phur a, an hah har a, muthilh a ti harsa a, chaw ei peih lohna a thlenHallucinogen – An thil hmuh emaw hriatna (sense) a khawih danglam
Slide23Withdrawal symptomsUsually opposite of acute effects
Depressants: withdrawal-excitation
Stimulants: withdrawal-lethargy/’crash’
23
Slide24Alcoholic beverages24
Slide2525
Slide26Alcohol: Psychological effects
Alcohol is a brain depressant.
In small amounts it relieves anxiety
it may also give a sense of strength and result in boisterous behaviourIt heightens the mood prior to intake, be it sadness or happinessImpairs judgement and performance -26-Effects of alcohol
Slide27Alcohol withdrawal: mildAnxietyRestlessness
Insomnia
Tremors
CravingPalpitation Sweating Breathlessness 27
Slide28Alcohol withdrawal: severeSevere Alcohol Withdrawal: “Delirium Tremens”
All features of mild withdrawal
Disorientation (unawareness of self and surroundings – time, place and person)
Hallucinations Seizures (fits – ‘rum fits’)Can be fatal28
Slide29Alcohol related physical problems
GIT –
oesophagitis
, gastritis, reflux, m-w tears, varices, pancreatitis, portal HT, ca’sLiver – hepatitis, fatty liver, cirrhosis, haemochr, hepatic Ca, hepatic encephalopathyCardiovascular – arrythmias, cardiomyopathy, coronary/cerebrovascular disease, hypertensionMetabolicEndocrine e.g. pseudocushings, hypogonadism, infertility, low libido/impotenceMusculoskeletal e.g. gout, fractures, osteoporosisHaematological e.g. anaemia, thrombocytopaeniaRespiratory Dermatological e.g. spider naevi, palmar erythema, eczema, worsening psoriasis
Slide30Alcohol – Neurological problems
Amnesic
(
Korsakoff’s) syndrome & Wernicke’s encephalopathyCerebellar degenerationCentral pontine myelinosisDementia, amnesia/blackouts etcFetal alcohol syndrome
Slide31Opoids31
Slide32Heroin (Smack)32
Slide33Opioids: Psychological effects
The effects differ widely between new and dependent users
-
33-New users Who is not in pain an unpleasant reaction / vomitingWho has pain or anxiety some reliefDependent users Short lived in-tense experience – “rush”A state of profound euphoria A dreamlike state lasting longer
Slide34Opioid withdrawal
Very distressing, but never fatal !
Opening of all holes !
Watering from eyes, noseVomitingLoose motionsBodyache / painAnxiety, restlessness, insomnia34
Slide35Cannabis (Bhang, Charas
, Ganja, Hashish)
35
Slide36Cannabis products Bhang (leaves)
Ganja (dried flowering stem of the plant)
Charas
/ Hashish (extracted from the resin covering the plant)Hashish Oil (extracting THC using chemical methods)-36-OralSmokedSmokedSmoked
Slide37Cannabis: Psychological effects
A dreamy state with an increased tendency to fantasize
State of euphoria, well being and enjoyment
Generally followed by a period of drowsinessPerceptual and sensory distortionsCan prolong reaction time and impair coordination Sounds and colours may become more intense Restlessness, fear and even panic may spoil the experience (“bad trip”)There may be driven activity (subject knows that one’s activities are meaningless, yet is unable to control them)-37-
Slide38Cannabis withdrawalNon specific
General discomfort
Intense craving
Anxiety, restlessness38
Slide39Sedative – hypnotics Valium,
Avil
, Cough Syrups
39
Slide40Sedative – hypnotics & other pharmaceuticalsMedications for:
Sleep (Diazepam)
Allergy (
Promethazine, pheniramine)Pain (Pentazocine, Propoxyphene)Cough (Codiene)Diarrhea (Diphenoxalate)Anesthesia (Ketamine)-40-General brain depressantsOpioid like actions Hallucinogen
Slide41Cocaine and other stimulants
41
Coca leaf and cocaine powder
Slide42Amphetamine Type Stimulants (ATS)
-
42
-
Slide43Stimulants: Psychological effectsImmediately after smoking the drug or injecting it- extremely pleasurable ‘rush’ or ‘flash’.
Enhanced mood and body movement, euphoria
Increased respiration
Increased heart rate, blood pressureInsomniaReduced appetite-43-
Slide44LSD
(Lysergic acid diethylamide)
44
Slide45Tobacco45
Tobacco use reduce life span (7-10yrs)
Tobacco kills around 6 million people each year
Direct tobacco use results to 5 million deaths (WHO)
Slide46Volatile solvents (Inhalants)46
Slide47Stimulant withdrawalLethargy
Hypersomnia
/ sleepiness
Fatigue / sad moodCravingAnhedonia (inability to feel pleasure)47
Slide48RUIHHLO TITE LAN CHHUAH DANTuizawng leh
rilru
puthmang inthlakthlen hi chu tleirawlte zia ve reng a nih lain, heng a hnuaia tarlante erawh hi chu chik zualin ngaihven ila:thian kawm duhzawng sikul/class kal loh, examnaa tih chhiat zuala thil neih leh thiltih sawithat vak duh lohnasum hman dan sawi tha duh lothil rimna chi leh rimtui hman nasat – thil dang rim thahna atan Thinchhiat uchuak, rilru puthmang danglam thut thutMutdan leh ei /in lama danglamna te Thil pakhatah rilru an pe reng thei loChaw ei mumal lo, vun dang, luak leh ringawt thin, Haihawt em emSawi ngai tul lova sawi nawn sawi nawnIntifai an thatchhe tial tialHnar/hmai bawr hiah neuh neuhRihna tlahniam leh a dangte. Bathroom/room ah a inkhung rei zual em
Slide49Ruihhlo hmansual
tir
theitu leh hmansual tiawlsam theitu (Causative and Risk Factors)Chhungkuaa ruihhlo hmangsual awm vangChhungkua boruak zir loh vangThiante nawrna (Peer Pressure)Rilru lam harsatna engemaw ber an neih sa inHarsatna an neih chhawk nana an hmanin Chak lohna engemaw bik an neihinSource: National Institute on Drug Abuse (NIDA)
Slide50Substance use disorders (Addiction)
Indirect suicide???
50
Slide51The usual drug-use ‘career’From ‘softer
’ to ‘
harder
’ drugs-51-TobaccoCharas / GanjaHeroin / SmackInjection TidigesicAlcohol
Slide52Relationship between tobacco dependence and alcohol dependence Correlation between Tobacco Dependence and Alcohol Problem Severity
Fagerstrom
AUDITCorrelation Coefficient1.000.238**Sig. (2-tailed)..001**Correlation is significant at <.01 level
Slide53MythFactYou can stop using drugs anytime
Withdrawal sickness, believing you must have drugs, and being around people who use can make stopping drug use difficult. But there are people and programs that can help
You have to use drugs for a long time before they can really hurt you
Drugs can cause the brain to send the wrong signals to the body. This can make a person stop breathing, have a heart attack or go into a coma. This can happen the first time the drug is used If you only buy drugs from friends, you'll get the pure stuffBecause drugs are illegal, no one can know what is really in them
Slide54MythFactTeenagers are too young to get addicted
Addiction can happen at any age. Even unborn children can get addicted because of their mother's drug use
If you're pregnant and use drugs, your body protects the baby
Drugs affect an unborn child as much or more than the mother. Drug use during pregnancy can cause the baby to die or be born too early. It can damage the baby's mind and bodyIf you smoked pot on the weekend, you'd be fine by MondayThe effects of pot (marijuana) can last for up to 3 days. It impairs memory, reflexes and coordination
Slide55MythFact If you get drunk, coffee will sober you up
Once alcohol is in the bloodstream, only time will make a person sober
Snuff and chewing tobacco are safe because there's no smoke
Smokeless tobacco can cause mouth and throat cancer, high blood pressure and dental problems. It can also lessen the senses of taste and smell and can cause bad breath Sniffing glue gives an instant rush. There isn't time for it to hurt youInhalants enter the blood and go through the body in seconds. Sniffing larger amounts can cause a heart attack or death from suffocation because inhalants replace oxygen in the lungs
Slide56MythFactPot isn't as bad for you as cigarettes
Marijuana smoke has more cancer causing chemicals than tobacco
Drugs relieve stress. They help deal with problems
Drugs only make people forget and not care about their troubles. When the drug wears off, the problem is still there As soon as a person feels normal, all the drug is out of the body Long after the effects of the drug stop being felt, the drug can still be in the body. For example, cocaine can be found in the body up to one week and marijuana up to 3 months after a single use
Slide57SUPPORT SYSTEMSSELF
FAMILY
&
SOCIETY Can help in copingIn social activities – YMA, MHIP, MUP etcIn Religious activities – KTP, Pavalai etc
Slide58Baseline survey on extent & pattern of Drug use in Mizoram (SWD)
Slide59Note: The 1st
drug use is tobacco & solvents and progressively move on to alcohol and cannabis and so on..
Slide60Slide61Slide62Second Hand Smoke Exposure Mizoram
Slide63Slide64Slide65Universal women’s helpline2016-17 calls & cases received
Quarter
July-Sept
2016Oct-Dec 2016Jan-Mar2016TotalTotal no. of calls received193397222812Total no. of cases received276356146Total no. of calls attributable to alcohol97199111406(50%)Total no. of cases attributable to alcohol14322874(50.68%)
Slide66Mizoram synod social front booklet no.49
Slide67MLPC Act 2014 Study Group Report in a tarlan danin
:
23.38% (
Hospital pali atanga damlo record an neih) -zu vang19% -alcohol related deaths
Slide68Slide69KTP Rorel Inkhawm
2019 Report
Sl.no
Member thi zat4701Mipa 4282Hmeichhia42
Slide70KAN SUM LEH PAI A NGHAWNG DAN(
Zu
)
MLPC Act hman atanga thla 8 chhungin Govt. Of Mizoram in zu zawrhna atangin Rs.19.44 crore tax a la lutZu kaihhnawih vanga accident thleng vangin Rs.16 lakhs Zu ruih vanga accident inenkawlna senso zat Rs.4.09 croreZu in nasat vanga natna enkawl nan Rs.6.35 croreJudicial cost atan Rs.2.67 croreRs.1.20 crore zu vanga lungin tang te tan sen ral ani bawk
Slide71KAN SUM LEH PAI A NGHAWNG DAN(
Vaihlo
)
NI TINA KAN SUM HMAN RAL ZAT(Mizoram Presbyterian Kohhran Hmeichhe Report 2004)Rs. 8,93,933.35CIGARETTES = ₹ 718/- Per MonthApprox. Figure3,20,000 smokers X ₹ 718 = ₹ 22,97,60,000/-
Slide72NO.1 POSITIONS IN CANCER IN INDIA(INDIA RAMA PAKHATNA KAN NIHNA)
1
Cancer
zawng zawng belhkhawm ah (Mipa & hmeichhe)2Hrawk & hnar cancer/ Nasopharynx Cancer (Mipa & hmeichhe)3Chuap Cancer (Mipa & Hmeichhia)4Pumpui Cancer (Mipa & Hmeichhia)5Chhulhmawr cancer (Hmeichhia)6Thisen cancer chi khat / Myeloid leukemia (Mipa)7Chaw dawt cancer (Mipa)
Slide73THE CIGARETTES AND OTHER TOBACCO PRODUCTS
(PROHIBITION OF ADVERTISEMENT AND REGULATION OF TRADE AND COMMERCE, PRODUCTION, SUPPLY AND DISTRIBUTION) ACT, 2003
Slide74MAIN PROVISIONS OF THE ACT
1
Prohibition of smoking in public places
Sec-42Prohibition of advertisement of cigarettes and tobacco products Sec-53Prohibition of tobacco products to minors saleSec-6(a)4Prohibition of sale of tobacco products near educational institutions Sec-6(b)5Regulation of health warning on tobacco products packs Sec-7
Slide75VAIHLO NGHEI DUH TAN DISTRICT HOSPITAL tin ah
AH OPD HUN CHHUNGA PAN THEIH RENG KAN NI