MM20705

• In Malaysia, 300,000 registered as drug addicts in 2006
• The number of drug addicts rises every year, so it's a problem in Malaysia especially many problematic drug users are not registered & the real figure is x4 more
• Possibly 4% of the population are drug addicts
• Reasons why people take drugs

  • Pleasurable (most common reason)
  • Easier to socialise to others/ mingle easily
  • Help people forget about their problems
  • Some people have never developed better ways in dealing with their stress
  • In some circles, taking drugs make you more socially acceptable
  • Some are just addicted and is hard for them not to take drugs
• Recreational drugs act on


  Reward pathway of brain - mesolimbic dopaminergic pathway
• Recreational drugs stimulate


  D2 receptors (found in nerve endings) in the nucleus accumbens leading to pleasurable feeling
• Pharmacology of different drugs

  • Amphetamines - stimulates D2 receptors directly
  • Cocaine - prevents uptake of monoamines, especially dopamines
  • Alcohol - allosteric modulator of GABA A
  • Opiods - mu receptor
  • Nicotine - nicotine acetyl choline receptor
  • Cannabis - cannabinoid receptors (found all over the brain & in many peripheral areas)
• Social problems caused by substance misuse

  • Aggression & violence
  • Child neglect & other forms of abuse
  • Unemployment
  • Homelessness
  • Driving under influence of substance
  • Addiction is expensive, it can lead to crimes & prostitutions
• Psychological process of addiction

  1. Pre-contemplation: The pt does not believe they have a problem at all

  2. Contemplation: they believe they have a problem, but don't do anything about it

  3. Ready for action: they want to do something about it & are about to stop

  4. Action: the person is actively doing something about it / They have stopped completely, but they know if they take the substance again they would relapse / Many relapse & go back to pre-contemplation. It takes them many attempts to stop before they can stop for good

  5. Maintenance: After they completely stop, they need to sustain their progress & prevent relapse

  6. Relapse: Relapse is a return to the addictive behaviour after a period of abstinence. It is considered a normal part of the recovery process and provides an opportunity to learn and strengthen the commitment to change
• Effects of excess alcohol

  • Mental health problems: Depression, anxiety, insomnia
  • Cognitive problems: poor coordination and reaction time, poor memory, irritability, increased aggressiveness
  • Large amounts of alcohol leads to: Dementia, fits, delirium tremens, & Wernike-Korsokoff syndrome
  • Wernicke's encephalopathy: Dt thiamine deficiency which causes degeneration of mamillary bodies & medial dorsal nucleus of thalamus. Needs urgent treatment or it may progress to Korsakoff Syndrome
  • Delirium tremons: A dangerous condition that can be fatal, due to severe form of alcohol withdrawal occurring 1-4 days after stopping or cutting down
  • Liver problems: Fatty liver, Cirrhosis, Liver failure, Hepatocellular carcinoma
  • Effects on heart & blood vessels: High blood pressure, Stroke, Cardiomyopathy
  • Cancer: Breast cancer (women), Mouth & throat cancer (people that drink hard liquor)
• Effects of methamphetamine

  • Agitation & violence
  • Depression & anxiety
  • Fatigue
  • Paranoia
  • Intensive craving for the drug
  • Neurotoxicity
  • Damage in dopaminergic & serotinergic neurones
  • Cognitive deficits in chronic users
• Effects of heroin

  • Euphoria & apathy
  • Dysphoria
  • Agitation or retardation
  • Impaired judgement
  • Pupillary constriction
  • Drowsiness or coma
  • Impairment in attention or memory
• Heroin base does not dissolve in water
• Heroin is taken intravenously
• Problems with heroin withdrawal

  • Dysphoria
  • Nausea & vomiting
  • Diarrhoea
  • Muscle aches
• Treatments for substance misuse

  • Harm reduction: Needle exchanges, Teach clients how to inject properly, Hand-out free condoms + sex education, Prevent drunk driving & drug driving, Support the spouse, Treatment of comorbidity, e.g. mental health problems
  • Biological treatment: Alcohol dependence people are given benzodiazepines + thiamine & multivitamins (prevents Wernike-Korsikoff's syndrome)
  • Psychological treatment: Cognitive behavioural therapy, Motivational enhancement therapy, Alcoholics anonymous
  • Social treatments: Support spouse, Consider any children in the family
• Methadone/buprenorphine programme for heroin dependency
• Shooting galleries in Switzerland showed a 70% reduction in heroin use