Substance related disorders are an important topic in psychiatry. Substance abuse and dependence are prevalent conditions that are commonly encountered by physicians. It is estimated that 10-15% of the population struggles with substance abuse or dependence, making it a significant public health concern.
In this blog we’ll cover dependence, alcohol, alcohol induced neurocognitive disorders, opioids, cannabis, cocaine, and tobacco.
ICD uses the term Dependence
DSM uses the term substance
Tolerance (Physical dependence)
Increasing amount of substance is required to get the desired effect
E.g.: If someone easily got intoxicated by 2 drinks earlier, would now need 4 drinks to get the same effect as he has become intolerant.
Withdrawal symptoms (Physical dependence)
They are the characteristic symptoms that develop if the substance intake is stopped
E.g.: If someone who has been using alcohol regularly, suddenly stops, he will develop symptoms like tremors, vomiting, nausea, etc.
Tolerance and Withdrawal symptoms are suggestive of Physicsl dependence (The body is dependent on a particular substance)
Hallucinogens (LSD etc.) are not associated with physical dependence.
An intense urge to take the substance which is often difficult to ignore/resist
Inability to control substance taking behavior
The person is not able to stop himself from taking/consuming the substance
Progressive neglect of alternative ways of pleasure
The person will stop doing other activities that he used to do earlier
Continued use despite clear harmful consequence
In Spite of knowing the consequences, he still cannot stop the use
M/C Used/Abused Substance in the World
The symptoms that appear when a person ingests a particular substance
Intoxication symptoms of alcohol depend on Blood Alcohol Concentration (BAC)
30 mg/dl: Legal limit
200-300 mg/dl: Alcoholic blackouts
When alcohol consumption is 200-300 mg/dl, the person will not be able to recall anything the next day
In other words – Anterograde Amnesia – The person was not able to make memories when BAC was 200-300 mg/dl
Alcohol Withdrawal Symptoms
They depend on the duration since the last alcohol intake
Date Rape Drugs: Flunitrazepam, GHB and Ketamine (dissociative amnesia).
Previous year Question
Q. A patient presented with history of visual hallucinations and disorientation. He was a chronic user of alcohol and last intake was a day’s back? what is the likely diagnosis? Alcohol withdrawal delirium? (FMGE Aug 2020)
A. Alcohol withdrawal seizures
B. Alcohol withdrawal Delirium
C. Alcoholic hallucinosis
Q. Freud’s theory of dream work, includes all except? (NEET Jan 2018)
Q. Disulfiram is a type of? (FMGE Nov 2017)
A. Aversion therapy
B. Anticraving therapy
D. Opioid management therapy.
Q. Which of the following drug is known to cause dependence is most commonly abused? (NEET Jan 2020)
Q. Jet black pigmentation of tongue with tactile hallucinations is a feature of? (FMGE June 2018)
Q. Magnan Symptom are associated with which substance? (NEET Jan 2020)
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