Alcohol and substance abuse is common now and on the increase, especially among the young adults.

1. ALCOHOL AND SUBSTANCE
ABUSE
Dr Opadotun O.A
Family medicine Resident
Babcock University Teaching Hospital

2. The following are commonly
abused in this environment
except
A. Alcohol
B. Tramadol
C. Methamphetamine
D. Marijuana
E. Caffeine

3. The region with the highest
A. Southwest
B. Northwest
C. Northeast
D. Southeast
E. Southsouth

4. The following are true except
A. Cocaine most widely used illegal
drug.
B. Marijuana is a gateway drug
C. Men should drink no more than 21 units
of alcohol per week
D. Pregnant women: the exact amount that
is safe is not known

5. Risk factors for substance abuse
include
A. Peer pressure
B. Low self esteem
C. Dysfunctional family
D. Old age

6. Outline
 Introduction
 Magnitude of alcohol and substance abuse
 Substances commonly abused
 Causes of Alcohol and Substance use
Disorder
 Health effects of alcohol & substance abuse
 Tools for assessing alcohol and substance
use disorders.
 Intervention strategies
 Recommendation
 Conclusion
 References

7. Alcohol abuse
 Use of alcoholic beverages to excess, either at once
("binge drinking") or as a regular practice.
◦ For some individuals-children or pregnant women, for
example-almost any amount of alcohol use may be legally
considered "alcohol abuse," depending on local laws.
 The Diagnostic and Statistical Manual of Mental
Disorders IV (DSM-IV) (psychiatric diagnosis)
describes alcohol abusers as those who drink despite
recurrent social, interpersonal, health and legal
problems as a result of alcohol use.
◦ It is differentiated from alcohol dependence by the lack of
symptoms such as tolerance and withdrawal.
7

8. Substance Abuse
• Substance abuse refers to the overindulgence in
and dependence of a drug or other chemical leading
to effects that are detrimental to the individual's
physical and mental health, or the welfare of others.
• Substance abuse refers to the use of substances in a
manner outside socio-cultural conventions.
• There are on-going debates as to the exact distinctions
between substance abuse and substance dependence
8

9. Substance Abuse (Cont’d)
◦ Current practice standard distinguishes between the two by
defining substance dependence in terms of physiological and
behavioral symptoms of substance use, and substance abuse in
terms of the social consequences of substance use
 The disorder is characterized by a pattern of continued
pathological use of a medication, non-medically indicated
drug or toxin, which results in repeated adverse social
consequences related to drug use, such as failure to meet
work, family, or school obligations, interpersonal conflicts,
or legal problems.
 Substance abuse may lead to addiction or substance
dependence. Medically, physiologic dependence requires
the development of tolerance leading to withdrawal
symptoms.
9

10. Substance Abuse (Cont’d)
◦ Both abuse and dependence are distinct from addiction
 Addiction involves a compulsion to continue using the
substance despite the negative consequences.
 May or may not involve chemical dependency.
◦ Dependence almost always implies abuse
 but abuse frequently occurs without dependence, particularly
when an individual first begins to abuse a substance.
◦ Dependence involves physiological processes
 while substance abuse reflects a complex interaction between
the individual, the abused substance and society.
10

11. Intro Cont’d…
 Substance dependence, also known
as drug dependence, is a
maladaptive state that develops from
repeated drug administration and
which results in withdrawal symptoms
upon cessation of drug use.
 Alcohol, marijuana, and tobacco use is
prevalent among population aged 15-
24 years

12. Magnitude of Alcohol and
Substance Abuse Cont’d …
 Williams, (2016) maintained that, over
6 million bottles of codeine are sold on
a daily basis in the North-West part of
the country. He also said that due to
the rise in drug addiction, young
people make use of cough syrups to
make themselves high. National Drug
Law Enforcement Agency (NDLEA)
report of 2010 also shows that over
11% of people in the North-West zone
use drugs.

13. Magnitude of Alcohol and
Substance Abuse Cont’d …
 From the record of drugs abuse in
Nigeria, the Northwest has a statistics
of 37.47% of the drug victims in the
country, while the Southwest has been
rated second with 17.32%, the south-
East is been rated third with 13.5%,
North-central has 11.71%, while the
North-east zone has 8.54% of the
drug users in the country (Akannam,
2016).

14. continues…
 NAFDAC said that drug abuse is the
excessive, maladaptive or addictive
use of drugs for NON –MEDICAL
PURPOSE.
 In Kano, 37% of the population are
drug abusers
 2/3 of American youths try drug
abuse before they finish from High
School and 90% try alcohol!

15. Causes of Alcohol and
Substance Use Disorder.
As a general rule, the greater the number
of risk the person experience the greater
the likelihood of drug use problems
occurring.
I. Individual factors which includes; low
self-esteem, poor self control, inadequate
social coping skills, sensation seeking,
depression, anxiety and stressful life
events.
II. Being Young: The adolescent is
constantly struggling to define and affirm
his/her identity. In the cause of the
process, adolescent often start
experimenting as part of their search for

16. Causes Cont’d…
III. Genetic factors: Genetic
predisposition accounts for half of the
risk in the development of alcohol
dependence. Adolescent with a positive
family history of alcohol problems are at
greater risk of developing alcohol
problems than their peers with negative
family histories.
IV. The family: Family dysfunction,
ineffective family supervision, criminality
and drug use in the family.

17. V. Gender: Being male (worldwide,
more males use alcohol and drugs than
females).
VI. . Mental Health: Research has
demonstrated that there is a high
incidence of drug abuse in
psychiatric patients as well as a high
incidence of mental disorders among
alcoholics and drug abusers. Also
teenagers with ADHD, conducts
disorders are especially at risk .

18. Causes Cont’d …
VII. Peer Network: Social interaction
with friends and peers may provide
opportunity for alcohol or drug use in
adolescent or may encourage or
support this type of behaviour.
VIII. Social/ Environmental Milieu:
Situations where there are few or no
jobs opportunity for the teeming youths
have been associated with alcohol and
illicit drug use.

31. Types of Alcohol and Substance Abuse
• Alcohol:
▫ Social acceptability makes alcohol one of the most abused
substances.
▫ Because access to alcoholic beverages is convenient,
alcohol abuse affects a large population.
• Cocaine:
▫ Cocaine addiction can be detrimental to the substance
abuser because it drains all aspects of his life. (financial,
family and emotional issues).
• Lysergic Acid Diethylamide (LSD):
▫ LSD can be a drug of choice for individuals wanting to
escape the reality of life.
▫ Many addicts choose LSD because it is undetectable in drug
tests. 31

32.  Marijuana:
◦ A common, inexpensive drug that is usually inhaled is marijuana.
◦ Also referred to as pot, stone, guff, igbo, ganja, etc.
◦ Unlike other substances, marijuana is not as physically addictive.
◦ Viewed as a gateway drug to other substances.
 Prescription Drugs:
◦ The most common prescription drugs that are known to be abused
◦ are sedatives, opioids and tranquilizers; narcotic painkillers and stimulants.
◦ Prescription substance abuse is on the rise and affects teens as well as adults.
◦ Prescription drugs are usually found by the addict initially in the home.
 OTC drugs:
◦ Over the counter medicines are actually another common substance abuse.
◦ It's more common because it's easily obtainable.
32

33. .
 Coffee:
◦ Coffee is part of most morning addiction.
◦ Coffee may be considered something that one can get addicted to but it isn't as
harming as the other substances.
◦ Caffeine is a drug easily acceptable, readily affordable, and of course perfectly
legal.
◦ Drinking coffee gives an extensive high and once one comes down from the huge
amount of energy one had, there is a crash.
◦ So then one goes back to coffee which gives another artificial high.
◦ The only reason it is not considered a drug is because it's something almost half
of the population enjoy.
◦ If drunk just because it has become routine or out of habit then there is an
addiction to coffee
33

34. • Cigarette:
▫ Cigarettes consist of nicotine, tar and carbon
monoxide.
▫ Nicotine is a drug equivalent to cocaine and heroin.
 It alters the brain and a person's mood.
▫ Tar is a substance that damages the lungs.
▫ Carbon monoxide is a gas which is poisonous.
34

35. Amphetamines:
 (Speed, uppers, dexies, bennies).
◦ Can be swallowed, inhaled, or injected.
◦ Swallowed or snorted, these drugs hit users with a fast high,
making them feel powerful, alert and energized.
◦ Uppers pump up heart rate, breathing, and blood pressure,
and they can also cause sweating, shaking, headaches,
sleeplessness, and blurred vision.
◦ Prolonged use may cause hallucinations and intense paranoia.
◦ Amphetamines are psychologically addictive.
◦ Users who stop using them report that they experience various
mood problems such as aggression and anxiety and intense
cravings for the drugs.
35

36.  Cocaine and Crack: (Cocaine -Coke, snow, blow, nose candy, white, big C,;
Cracks -Freebase, rock)
◦ Cocaine is inhaled through the nose or
injected. Crack is smoked.
◦ Cocaine is a stimulant that rocks the central nervous
system, giving users a quick, intense feeling of power
and energy.
◦ Snorting highs last between 15 and 30 minutes;
smoking highs last between 5 and 10 minutes.
◦ Cocaine also elevates heart rate, breathing rate, blood
pressure, and body temperature.
◦ Snorting can put a hole inside the lining of the nose.
36

37. ◦ First-time users-even teens-of both cocaine
and crack can stop breathing or have fatal
heart attacks.
◦ Using either of these drugs even one time can
kill.
These drugs are highly addictive, and as a
result, the drug, not the user, calls the shots.
◦ Even after one use, cocaine and crack can
create both physical and psychological
cravings that make it very, very difficult for
users to stop.

38. • Cold and Cough Medicines (DXM): (triple C,
candy, DM, drex, red devils, robo, rojo,
skittles,tussin,velvet, vitamin D)
▫ Several over-the-counter cough and cold medicines
contain the ingredient dextromatorphan (also called
DXM).
▫ If taken in large quantities, these over-the-counter
medicines can cause hallucinations, loss of motor
control, and “out-of-body” (or disassociative)
sensations.
▫ Cough and cold medicines, which come in tablets,
capsules, gel caps, and lozenges as well as syrups,
are swallowed.
▫ DXM is often extracted from cough and cold38

39. ▫ Small doses help suppress coughing, but larger
doses can cause fever, confusion, impaired
judgment, blurred vision, dizziness, paranoia,
excessive sweating, slurred speech, nausea,
vomiting, abdominal pain, irregular heartbeat,
high blood pressure, headache, lethargy,
numbness of fingers and toes, redness of face,
dry and itchy skin, loss of consciousness,
seizures, brain damage, and even death.
▫ Sometimes users mistakenly take cough syrups
that contain other medications in addition to
dextromethorphan.
▫ High doses of these other meds can cause
serious injury of death.
▫ People who use cough and cold medicines and
DXM regularly to get high can become
psychologically dependent upon them.
•

40. • Marijuana: (Pot, weed, blunts, chronic, grass,
reefer, herb, ganja, igbo, stone, etc)
▫ Marijuana also elevates heart rate and blood
pressure.
▫ Some people get red eyes and feel very sleepy or
hungry.
▫ The drug can also make some people paranoid or
cause them to hallucinate.
▫ Marijuana is as tough on the lungs as cigarettes-
steady smokers suffer coughs, wheezing, and
frequent colds.
▫ Those who use marijuana can become
psychologically dependent upon it to feel good, deal
with life, or handle stress. 40

41. ▫ The most widely used illegal drug.
▫ A stronger form of marijuana called hashish
(hash) looks like brown or black cakes or
balls.
▫ Marijuana is often called a gateway drug
because frequent use often leads to the use
of stronger drugs.
▫ Marijuana is typically smoked in cigarette
(joints), hollowed out cigars (blunts), pipes
(bowls), or water pipes (bongs).
▫ Some people mix it into foods or brew it as a
tea, or with alcohol (combine).
▫ Affects mood and coordination.
▫ Users may experience mood swings that
range from stimulated or happy to drowsy or

42.  Inhalants: Inhalants are substances that are sniffed
or “huffed” to give the user an immediate rush or
high.
◦ They include household products like glues, paint
thinners, dry cleaning fluids, gasoline, felt-tip
marker fluid, correction fluid, hair spray, aerosol
deodorants, and spray paint.
◦ Inhalants are breathed in directly from the original
container (sniffing or snorting), from a plastic bag
(bagging), or by holding an inhalant-soaked rag in
the mouth (huffing).
42

43. ◦ Inhalants make one feel giddy and confused,
as if one were drunk.
◦ Long time users get headaches, nosebleeds,
and may suffer the loss of hearing and sense
of smell.
◦ Inhalants are the most likely of abused
substances to cause severe toxic reaction and
death.(even from one use)
◦ Inhalants can be very addictive.
◦ Those who use inhalants can become
psychologically dependent upon them to feel
good, deal with life or handle stress

44. • Liver health and alcohol:
▫ Liver induces enzyme (alcohol dehydrogenase)
that break down alcohol and burns it as fuel.
▫ But alcohol exhausts the liver's ability to do this
and too much too often can damage it
permanently.
▫ Given a chance, the liver can repair a lot of
damage.
▫ This is why it's important to drink sensibly and
have non-drinking days as well as not drinking too
much at any one time.
44

45. • Cancer:
▫ After smoking, drinking alcohol is the second biggest
risk factor for cancers of the mouth and throat.
▫ Drinking and smoking together carries the highest
risk of all.
▫ People who develop cirrhosis of the liver (often
caused by too much drink) can develop liver cancer.
▫ Women who drink more than three drinks a day
increase their risk of breast cancer.
• Mental health problems:
▫ There is a link between drinking too much alcohol and
mental health problems.
▫ Heavy long-term drinking also risks problems with
memory loss.

46.  Alcohol
 We drink, we feel different.
 We stop drinking and sooner or later we feel 'normal' again.
 Alcohol affects the brain like an anaesthetic.
 One of the very first anaesthetics used in medicine – ether – is alcohol-
based.
 As with anaesthetics, the more alcohol take the more of our brain it shuts
down.
The stages of intoxication
 Stage 1 (Social lubricant): After one or two drinks (1-3 units), there is
talkativeness, heart rate speeds up a little, gives an 'up' feeling.
 (This is the effect that people refer to when they say alcohol makes them
feel more sociable).
 The 'warm feeling', or flushes, is caused by alcohol in the blood making
small blood vessels in the skin expand, allowing more blood to flow closer to
the surface and lowering blood pressure at the same time.
46

47. • Stage 2 (Giddiness):
▫ After a couple more drinks (4-6 units) there is light
headedness, co-ordination and reaction times are
impaired, ability to make decisions is also slowed down
due to alcohol acting on nerve cells all around the body
and making them work more slowly.
• Stage 3 (Sober):
▫ Another few drinks (7-9 units), reaction times are much
slower, vision becomes blurry and speech is slurred.
▫ Drinking more than eight units at a time seriously
overloads the liver.
▫ If self is taken care of in the days to come, it should
repair itself but for tomorrow a hangover is sure.
47

48. • Stage 4 (Unfriendliness):
▫ Drinking more than 10 units, staggering, and accidents are
commonplace.
▫ This amount of alcohol will be affecting cells all over the
body.
▫ In an effort to rid itself of the poison, the body tries to pass
the alcohol out mixed with water in our urine.
▫ This is why alcohol makes one visit the rest room a lot and
is the cause of the dehydration that gives morning-after
headaches.
• Stage 5 (Unconscious or dead):
▫ Drinking more than 30 units (that's about twelve pints of
strong lager) is enough to knock most people out.
▫ It is a short step to heart failure and breathing slowing to a
stop.
▫ Even when people are already unconscious, alcohol in the
stomach can continue to be absorbed and can reach lethal
levels.
▫ People can also be sick and suffocate on their vomit.
▫ For these reasons, it's crucial never to leave very drunk
people on their own.

49.  Large amount of alcohol can lead to
alcoholic cardiomyopathy, commonly
known as "holiday heart syndrome."
 Chronic heavy alcohol consumption
impairs brain development, causes brain
shrinkage, dementia, physical
dependence, increases neuropsychiatric
and cognitive disorders and causes
distortion of the brain chemistry.

50. ▫ One of the organs most sensitive to the toxic
effects of chronic alcohol consumption is the
brain.
▫ In France approximately 20% of admissions to
mental health facilities are related to alcohol
related cognitive impairment most notably
alcohol related dementia.
▫ Alcoholic liver disease is a major public
health problem.
▫ Alcohol misuse is a leading cause of both
acute pancreatitis and chronic
pancreatitis.69,70
▫ The International Agency for Research on
Cancer, IARC, (Centre International de
Recherche sur le Cancer) of the World
Health Organization has classified alcohol as
carcinogenic to humans.
▫

51.  Sleep:
◦ Chronic use of alcohol use to induce sleep can lead to
insomnia.
◦ Frequent moving between sleep stages occurs, with
awakenings due to headaches and diaphoresis.
◦ Stopping chronic alcohol abuse can also lead to profound
disturbances of sleep with vivid dreams.
◦ Chronic alcohol abuse is associated with NREM stage 3
and 4 sleep as well as suppression of REM sleep and
REM sleep fragmentation.
◦ During withdrawal REM sleep is typically is exaggerated
as part of a rebound effect.
51

52. Alcohol withdrawal syndromes
Uncomplicated alcohol withdrawal
syndrome
 Occurs 4–12hrs after the last alcoholic drink.
 Features—coarse tremor, sweating,
insomnia, tachycardia (pulse >100), nausea
and vomiting, psychomotor agitation, and
generalized anxiety.
 Occasionally, transitory visual, tactile, or
auditory hallucinations or illusions.
 There may be increasing craving for alcohol
both in itself and as a relief from withdrawal
symptoms.
 Symptoms increase in severity in rough
proportion to the habitual alcohol
consumption, peaking at 48hrs and lasting 2–
5 days, with symptoms being more prolonged
in heavier drinkers.

53. Alcohol withdrawal syndrome with
seizures
• In 5–15% of cases withdrawals are
complicated by grand mal seizures
occurring 6–48hrs after the last drink.
• If seizures occur only during withdrawal
they do not signify the development of
idiopathic epilepsy.
• Predisposing factors: previous history of
withdrawal seizures, idiopathic epilepsy,
history of head injury, hypokalaemia.

54. Delirium tremens
 Acute confusional state secondary to
alcohol withdrawal.
 A medical emergency requiring inpatient
medical care.
 Occurs in 75% of episodes of
withdrawal. Onset 1–7 days after the last
drink with a peak incidence at 48hrs.
 Risk is increased by severe dependence,
comorbid infection, and preexisting liver
damage.
 In addition to the features of
uncomplicated withdrawal there is:

55.  Clouding of consciousness.
 Disorientation.
 Amnesia for recent events.
 Marked psychomotor agitation.
 Visual, auditory, and tactile
hallucinations (characteristically of
diminutive people or animals—
‘Lilliputian’ hallucinations).
 Marked fluctuations in severity hour by
hour, usually worse at night.
 In severe cases: heavy sweating, fear,
paranoid delusions, agitation,

56.  suggestibility, raised temperature,
sudden cardiovascular collapse.
 Reported mortality of 5–10%. It is most
risky when it develops unexpectedly and
its initial manifestations are
misinterpreted (e.g. in a patient not
known to be alcohol-dependent
developing symptoms post-operatively).
 Differential diagnosis: hepatic
encephalopathy, head injury, pneumonia,
acute psychotic illness, acute
confusional state with other primary
cause.

57. • Wernicke-Korsakoff syndrome:
▫ Wernicke-Korsakoff syndrome is a manifestation
of neuronal degeneration 2 thiamine deficiency,
usually as a secondary effect of chronic alcohol
abuse.
▫ Wernicke's encephalopathy: acute onset of triad
1.) Acute confusional state 2.) Occular signs
(opthalmoplegia CNVI, nystagmus 3.) Ataxic
gait, Associated features of peripheral
neuropathy
▫ Due to poor intake, reduced absorption, impaired
hepatic storage of Vit B1
57

58. ▫ Tx: high potent parenteral Vit B1,
watch out for allergic reaction
 Avoid carbohydrate load until thiamine
replacement is complete (i.e. do not
rehydrate with glucose solutions prior
to thiamine).
▫ Treat immediately diagnosis is made
or strongly suspected, treat all those at
high risk prophylactically

59. Korsakoff syndrome
 Clinical features Absence or
significant impairment in the ability to
lay down new memories, together with
a variable length of retrograde
amnesia. Working memory ,
procedural and emotional memory is
unimpaired. Confabulation for the
episodes of amnesia may be
prominent.
 Other neuropsychological deficits
associated with ARBD may be seen.

60.  Most commonly due to thiamine
deficiency, secondary to heavy alcohol
use. Rarer causes are head injury, post-
anaesthesia, basal/temporal lobe
encephalitis, carbon monoxide
poisoning, and thiamine deficiency
secondary to other causes.
 It should be remembered that Korsakoff
syndrome is not invariably preceded by
Wernicke encephalopathy, and can
present in a ‘chronic’ form.
 Tx: Continue oral thiamine replacement
for up to 2yr.

61. Mental health effects
▫ High rates of major depressive disorder occur in
heavy drinkers and those who abuse alcohol.
▫ Alcohol misuse is associated with a number of
mental health disorders and alcoholics have a
very high suicide rate.
▫ A study of people hospitalised for suicide
attempts found that those who were alcoholics
were 75 times more likely to go on to successfully
commit suicide than non-alcoholic suicide
attempters.
▫ About 33 percent of suicides in the under 35s are
due to alcohol or other substance misuse.

62. • This is significantly higher than the
increased risk of psychotic disorders seen
from cannabis use making alcohol abuse a
very significant cause of psychotic
disorders.
• Prominent hallucinations and/or
delusions are usually present when a
patient is intoxicated or recently
withdrawn from alcohol.
• Alcohol dependence relates directly to cravings
and irritability.
• Also alcohol use is a significant predisposing
factor towards anti-social behaviour in children.

63. • Depression, anxiety and panic disorder are disorders
commonly reported by alcohol dependent people.
• Psychosis is secondary to several alcohol-related
conditions including acute intoxication and withdrawal
after significant exposure.
• Chronic alcohol misuse can cause psychotic type
symptoms to develop, more so than with other drugs of
abuse.
• Alcohol abuse has been shown to cause an 800%
increased risk of psychotic disorders in men and a
300% increased risk of psychotic disorders in women
which are not related to pre-existing psychiatric
disorders.
63

64. • Whilst alcohol initially helps social phobia
or panic symptoms, with longer term
alcohol misuse can often worsen social
phobia symptoms and can cause panic
disorder to develop or worsen, during alcohol
intoxication and especially during the alcohol
withdrawal syndrome.
• This effect is not unique to alcohol but can
also occur with long term use of drugs which
have a similar mechanism of action to alcohol
such as the benzodiazepines which are
sometimes prescribed as tranquillisers to
people with alcohol problems.
64

65. What is a unit of alcohol?
• One unit of alcohol is 10ml (1cl) by
volume, or 8g by weight, of pure alcohol.
• A more accurate way of calculating units is
as follows: The percentage alcohol by
volume (% abv) of a drink equals the
number of units in one litre of that drink.
• For example: Strong beer at 6% abv has six
units in one litre.
• If one drinks half a litre (500ml) - just under
a pint - then one has had three units.65

66. What are the recommended safe limits of alcohol
drinking?
 Men should drink no more than 21 units of alcohol
per week (and no more than four units in any one
day).
 Women should drink no more than 14 units of
alcohol per week (and no more than three units in
any one day).
 Pregnant women: the exact amount that is safe is not
known. Therefore, pregnant women and women
trying to become pregnant should not drink at all.
66

67. • What about alcohol tolerance?
• I can drink more than 10 units and be okay".
• People who regularly drink too much develop a
tolerance to alcohol. This means that more
alcohol can be consumed than is normal,
without the person seeming to suffer the same
effects as outlined above.
• Unfortunately, a tolerance to alcohol does not
protect one from harm.
• Having a high tolerance to alcohol can indicate
that a person drinks too much and the more
one drink, the more damage it will cause.67

68. Tools for Assessing Alcohol
and Substance use Disorders
Adolescents may not recognize that problem drinking
or substance misuse can lead to future medical, legal
and psychosocial problems.
The Family Physician can intervene with screening
and counselling.
Tools recommended for screening all patients for
alcohol intake include:
1. Alcohol Use Disorders Identification Test
(AUDIT) or CAGE mnemonics.
• The Alcohol Use Disorders Identification
Test (AUDIT) is a 10-item screening tool
developed by the World Health Organization
(WHO) to assess alcohol consumption,
drinking behaviors, and alcohol-related
problems.

70. Tools for Assessing Alcohol and
Substance use Disorders Cont’d
…
The minimum score (for non drinkers) is
0 and the maximum possible score is
40. A score of 8 or more indicates a
strong likelihood of hazardous or
harmful alcohol consumption and
identifies mild dependence.

71. Tools for Assessing Alcohol and
Substance use Disorders Cont’d
…C – Have you ever felt you had to cut back on how much you
drink?
A – Have you ever felt annoyed by someone else asking about
your drink?
G – Have you ever felt guilty about your drinking or anything you
did while drinking?
E – Have you ever use alcohol as an eye-opener in the
morning?
Scoring:
A “no” response = 0 point
A “yes” response = 1 point
0-1 point = Negative screen
2-4 points = Positive Screen
A score of 2 and above will prompt more questions
1.) what is the most alcohol you have drunk in a single day
2.) what is the most alcohol you have drunk in a single week

72. Tools for Assessing Alcohol and
Substance use Disorders Cont’d
…
 CAGE – AID (Adjusted to Include
Drugs):
Its screens for alcohol in addition to
drugs.

73. Intervention Strategies
 Non-pharmacologic:
Counselling is an important intervention which
can be offered by the Family
Physician/psychologist.
Five “A’s” Intervention Technique use by
Physicians:
Assess the risk of behaviour for the patient.
Advise the patient on the risk and how to
modify.
Agree come to an agreement with patient on
treatment.
Assist the patient with the treatment plan.
Arrange follow-up or referral to treatment.

74. Intervention Strategies
contd…
Interventions in patients abusing alcohol or
other substances must be tailored to the
patient’s specific needs.
Appropriate treatment programme should have
strong family involvement by improving family
relationship and bonding, total abstinence
goals.
- Demand Reduction: Is concerned with
services which are aimed at discouraging the
abuse of substances by members of the
public. Demand reduction include strategies
such as; prevention, early intervention,
treatment, rehabilitation and after care

75. Intervention Strategies Cont’d
…
– Personal Level: High self esteem with high
degree of motivation, feelings that one is in
control of his/her life, optimism and
willingness to seek support.
– Cognitive Behavioural Therapy (CBT):
Cognitive behavioural therapy are the
mainstay of substance use disorder
treatment. It is based on the assumption that
the learning processes used by patient to
initiate and continue their drug use
behaviours can also be used to reduce or
stop their drug use. CBT is primarily used in
outpatient settings, usually with weekly
individual sessions over several months.

76. A
B
S
T
I
N
E
N
C
E
AT-
RISK
USE
ABUS
E
DEP
Use - + + +
Consequences - -/+ + ++
Repetition - - + +
Loss of Control - - - +
Preoccupation, Compulsivity
Physical Dependence
Continuum of drug use in patient with alcohol or substance use
disorder

77. Intervention Strategies Contd
 Pharmacologic
Use of medications for the treatment of
alcohol abuse and dependence as well as
substance abuse and dependence. These
medications include:
Alcohol Abuse and Dependence
- Disulfiram(Aversive drugs inhibits
AcetaldehydeLDH)
- Naltrexone(antag effects of endogenous
endorphins)
- Acamprosate(Anti craving drug)

78. Other medications include:
- Anticonvulsants. E.g. Topiramate,
Baclofen and Serotonergic agents.
- Antipsychotics e.g Haloperidol if BZD
fails in the settings of halucinations
and delusions
- Supplements e.g Parenteral vit B,
minerals e.g Mg

79. Intervention Strategies Cont’d
…
Substance Abuse and Dependence
Treatment of intoxication for most substances
is supportive and symptomatic and typically
occurs in inpatient settings.
- Opiates: treatment of opiates overdose
involves administration of naloxone.
- Users of cocaine and amphetamines may
take benzodiazepines to counter the
stimulant effect.
- Treatment of cannabis use: Abstinence and
support which involves hospitalisation and
through careful monitoring. Use of family and
group psychotherapies.

80. Intervention Strategies Cont’d
…
- Nicotine: Patient who smoke should receive
advice and encouragement at every clinic
visit, counselling is an effective way to begin
intervention.
- Pharmacotherapy used in treating tobacco
use and dependence: Tobacco users
attempting to quit should be prescribed one
or more effective first line pharmacotherapies
for tobacco use cessation these include
Nicotine patch, Nicotine gum, Nicotine
lozenges, Nicotine inhaler, Nicotine nasal
spray, Bupropion SR and Varenicline.

81. Recommendation
 Nigerian Government should intensify efforts in
preventing alcohol and substance abuse through
NDLEA (National Drug Law Enforcement
Agency) and other drug controlling groups like
NAFDAC (National Agency for Food and Drug
Abuse Control).
 The government should have a well- defined
comprehensive and realistic policy on control of
drugs. This policy should include establishing a
federal drug control centre, under the auspices of
the ministries of health and internal affairs.
 Public education should be targeted at the
vulnerable segment of society, such as the older
children, adolescent and young adults.

82. Conclusion
 Alcohol and drug abuse is a disorder that is
characterized by a self-destructive pattern of
using a substance that leads to significant
problems and distress.
 Alcohol and substance abuse can be caused
by the interplay of at least one or more
factors.
 Uncontrolled alcohol and drug abuse and its
effect are accompanied by violence, crime,
misbehaviour and hence a threat to society at
large.
 Alcohol and substance abuse is injurious to
the health of the user, as a result has a lot of
social and psychological problems.

83. Further Reading
 Rakel Textbook of Family Practice (6th ed.)
 Rakel RE and Rakel DP. Textbook of Family
Medicine (8th ed.)
 Oxford Handbook of Family Medicine by Bob
Mash (3rd ed.)
 https://en.wikipedia.org/wiki/Substance_depe
ndence
 Akannam, T. (2016). North-West Rank
Highest in Drug Addiction. Nigerian Drug
Statistics by Zone. Retrieved May 5, 20117.
from
http://www.nairaland.com/203955/nigerian-
drug-statistics-zone.

84.  William, TK (2016). Psychoactive substances
and the English language: "Drugs,“ discourses,
and public policy. Contemporary Drug Problems,
 Kaplan and Sadocks. Synopsis of Psychiatric
(10th ed.)
 Alcohol and Substance Abuse by Dr Ndifreke E.
Udonwa
 Alcohol and Substance Abuse in Adolescent by
Dr Bello Abdulrasheed Abdulazeez
 Oxford handbook of Psychiatry (3rd ed.)
 Katzung BG. Basic and Clinical Pharmacology
(10th ed.)

86. Questions???