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SUBSTANCE ABUSE
Anne Cristine D. Guevarra, MD
Child Psychiatry Rotator
behaviors
Epidemiology
Approximately one of five adolescents have used
marijuana or hashish
Approximately one third of adolescents have used
cigarettes by age 17 years
By 13 years of age, 1/3 of boys and almost of girls
have tried alcohol
By 18 years of age, 92% of males and 73% of females
reported trying alcohol, and 4% reported using alcohol
daily
Of high school seniors, 41% reported using marijuana;
2% reported using the drug daily
Nicotine
Nicotine is one of the most addictive substances known; it
Nicotine
Psychoactive agent of tobacco
Agonist at the nicotinic subtype of Ach receptors in the
CNS
25% of inhaled nicotine reaches the bloodstream
Half-life: 2 hours
Nicotine Toxicity
Low dose: nausea,
vomiting, salivation,
pallor, weakness,
abdominal pain,
diarrhea, dizziness,
headache, increased
blood pressure,
tachycardia, tremor,
and cold sweats
concentrate,
confusion, and sensory
disturbances,
decreased REM
Pregnancy: increased
incidence of LBW and
Persistent pulmonary
hypertension
Griesler, P.C., et al. Comorbid psychiatric disorders and nicotine dependence in adolescence.
Addiction 106(5):10101020, 2011
Nicotine Dependence Linked to Higher Rates of Mental Disorders Among Teens, March 2012, NIDA.
Drinking
Follows adult demographic drinking patterns
Whites >> other groups
Roman Catholics least likely nondrinkers
More than 1/3 of adolescents are treated in pediatric
Alcohol
72.5% of high school students had tried at least one alcoholic drink
24.2% reported an episode of heavy drinking in the month preceding
the survey
39% of adolescents have used alcohol before 8th grade
70% at 8th grade
A significant problem for 10 20% of adolescents
Ages 13 -17 years, 3 million problem drinkers
300,000 with alcohol dependence
Gap between male and female alcohol consumers is
narrowing
Mechanism of Action
no single molecular target
Enhanced: ion channel activities associated with the
Alcohol
May diminish hippocampal brain volume
Compromised cognitive function, especially attention
CIWA-Ar
The Clinical Institute Withdrawal
Assessment for Alcohol measures 10
categories of symptoms, with a range
of scores in each. The maximal score
is 67.
Minimal-to-mild withdrawal symptoms
result in a total score below 8;
moderate withdrawal symptoms
(marked autonomic arousal), in a total
score of 8 to 15; and severe withdrawal
symptoms, in a total score of more
than 15.
High scores are predictive of seizures
and delirium.
Marijuana
most widely used drugs by young people in developed
Marijuana
Short-term effects:
impairment in memory and learning
distorted perception
diminished problem-solving ability
loss of coordination
increased heart rate
anxietyand panic attacks
Withdrawal symptoms:
Insomnia
Irritability
Restlessness
drug craving
depressed mood
nervousness followed by anxiety, tremors, nausea, muscle twitches
Increased sweating, myalgia, and general malaise
Marijuana
Short-term effects: of the active ingredient in marijuana,
Marijuana
Withdrawal syndrome begins 24 hours after the last use,
Marijuana
Risks:
Motor vehicle accidents
Impaired respiratory function
Increased risk of cardiovascular disease
Increased risk for psychotic symptoms and disorders
Cocaine
The annual cocaine use reported by high school seniors
Cocaine
Sniffed, snorted, injected, smoked
Crack is the term given to cocaine after it has been
paranoid thinking.
There is immediate risk of death secondary to cardiac
arrest or from seizures followed by respiratory arrest.
Cocaine
In contrast to stimulants used to treat ADHD, such as
Objectives
To compare three groups of Brazilian psychoactive
293
Crack cocaine
126
Powder cocaine
319
Non-cocaine PAS
Findings
Crack and powder cocaine users were significantly
Opiods
A survey of 7,374 high school seniors found that 12.9%
depression
opioid overdose as a primary diagnosis
inspect the patient's body for needle tracks in the arms, legs,
Heroin
Heroin, a derivative of morphine, is produced from a poppy
plant.
Usually appears as a white or brown powder that can be
snorted, but more commonly, it is used intravenously.
Withdrawal symptoms:
Restlessness
muscle and bone pain
Insomnia
Diarrhea
Vomiting
Cold flashes with goose bumps
Kicking movements
Smyth, B. et al. Years of potential life lost among heroin addicts 33 years after treatment.
Preventive Medicine 44(4):369-374, 2007
Reduced Longevity Among Male Heroin Abusers, 1962-1997, June 2008, NIDA.
Crystal Methamphetamine
Crystal methamphetamine, or ice, was at a relative low
Club Drugs
MDMA, GHB, Rohypnol, and ketamine.
GHB, Rohypnol (a benzodiazepine), and ketamine (an
3,4-Methylenedioxymethamphetamine
(MDMA)
The popularity of MDMA has increased over the last
3,4-Methylenedioxymethamphetamine (MDMA)
MDMA is a derivative of methamphetamine, a synthetic
Gamma-Hydroxybutyrate (GHB)
Gamma-hydroxybutyrate, a club drug, has been found in
Ketamine (Ketalar)
Ketamine, another club drug, was found recently to have
Flunitrazepam (Rohypnol)
Flunitrazepam (Rohypnol), a third club drug, has been
Club Drugs
Primarily depressants and can be added to drinks without
Anabolic Steroids
Despite reported knowledge of the risks of anabolic
Mode of Action
from cholesterol
eugonadal male: physiological dosages of
Inhalants
The use of inhalants in the form of glue, aerosols, and
paint thinner, fingernail polish removers, and cleaning and lighter fluids are being used
by juveniles for the deliberate induction of intoxication
Sniffing provides a chemical escape from reality which is more adaptable, and
therefore more readily accepted, by young children than are such other intoxicating
practices as alcohol ingestion or the use of narcotic drugs.
Among sniffers as among all juveniles apprehended by the police, there is a great
preponderance of boys over girls, and the majority are in their early "teens,. Although
some are as young as 7 to 8 years of age. Although sniffers usually had prior histories
of scholastic under achievement, intelligence per se bore little positive relation to
the adoption of the habit.
In some studies, but not in others, sniffers of toluene have been found to have an
Genetic Factors
The concordance for alcoholism is reportedly higher
Psychosocial Factors
Among adolescents, substance use, particularly marijuana use, is
Comorbidity
higher in relatives of youth with depression and anxiety
disorders
mood disorders are common among those with
alcoholism
strong link between early antisocial behavior, conduct
disorder, and substance abuse
Early intervention with children who show early signs of social deviance
and antisocial behavior may conceivably impede the processes that
contribute to later substance abuse.
to the user
recurrent substance use in the face of obvious impairment in
school or work situations
recurrent substance use despite resulting legal problems
recurrent substance use despite social or interpersonal problems.
Treatment
Effective screening and identification
Brief intervention motivational interviewing, with the
20032004 GSHS
18.9% of surveyed students were
13 years old or younger when they
had their first drink of alcohol;
23.6% drank alcohol in the past
30 days; and 24.3% had
engaged in heavy drinking.