Prevention of Substance Abuse

1. Prevention of Substance Abuse COM 116 Fall 2012 MH Rajab

2. Overview • Introduction and definitions • Alcohol as an example • Use, abuse and dependence • Associated health problems • Treatments • Effects including costs to community & society

3. What Constitutes a Substance For this course substance includes: • Tobacco • Alcohol • Drugs (heroin, hashish, cocaine, etc.) We’ll discuss Alcohol as an example. It is the most reported abused substance after tobacco in the KSA(Ref)

4. Why be Concerned with Substance Abuse in my Community? • Substance abuse at any community, e.g., a university, is of major concern, mainly to leadership and the medical establishment. • Substance abuse is a sensitiveissue to confront. • However, all agree if left unchecked or unconfirmed, it may negatively impact, not only students performance for example, but the reputation of the college or university as a whole.

5. Definitions • The origin of the word “Alcohol” is still not determined fully, but is somewhere between the following two explanations: • Al Kohool: the makeup, referring to the use of the distillate in the manufacture of eyeliner. The word kohool is the plural of kohul, which means an eyeliner. • Al Ghaoul: A word exists in Arabic and in English, ghoul, means monster or spirit, and is similar to how we refer to alcohol as “spirits”.

6. The Arabic Origin of the Word The Quran, surah, 37 (AL Saffat) verses 47. • “*لا فِيهَا غَوْلٌ وَلا هُمْ عَنْهَا يُنزَفُونَ” • لا فيها غول أي: ليس فيها من الأضرار الخفية المعروفة في الخمر”

7. Alcohol Use and Abuse • Cultural differences in the use of alcohol. • Any use at all in some cultures vs. too much in others. • Abuse is the pattern of alcohol use, leading to clinically significant impairment or distress with at least one of the following occurring: • Legal problems due to alcohol consumption • Failure to fulfill a major role at work, e.g., exams • Use alcohol in hazard situations, e.g., car accidents • Repeated interpersonal and social problems

8. Alcohol Dependence • A pattern of alcohol use that leads to clinically significant impairment with at least 3 or more of the following six criteria occurring: • Tolerance: need more amount to achieve desired effect • Withdrawal: use alcohol to relieve or avoid withdrawal symptoms • Lack of control, e.g., drinking large amounts • Continue to use despite knowledge of having a recurrent physical or psychological problems related to alcohol • Preoccupation with drinking-related activities

9. Factor Associated w/ Alcohol Dependence • P = G + E + GI, …a theoretical base • Genetic Factors (G): • Alcohol dependence has a familial pattern. • ~ 40-60% of the variance of risk of having alcohol dependence is explained by genetic-related factors. • Environmental Factors (E): • It can happen in persons without a family history • e.g., cultural attitude toward drinking, access to alcohol, stress (exams, bad news, etc.) • GxE: In class discussion

10. Alcohol Dependence: Genetic Factors • In families with history of dependence the risk is 3-4 times higher (medical implications?!) • Closer genetic relationships • Severity of alcohol-related problems in affected relatives

11. Blood Alcohol Concentration (BAC) BAC is affected by the following: • Amount of alcohol consumed at a specific time • Weight • Type and amount of food in the stomach • Gender • Other factors… • FYI: On average, the rate of alcohol metabolism is 8.5 g/hr

12. Epidemiology of Alcohol Use (U.S. Data) • Any alcohol disorder 8.5% • Alcohol abuse 4.7% • Alcohol dependence3.8%

13. Cost to Community or Society (U.S. Data) • Total annual cost to the US society $184.6 billion. • Costs include: • Alcohol abuse and dependence prevention and treatment • Accidents, crimes, fires, etc… • Medical “health” consequences • Research

14. Effects of Chronic Alcohol Use on Body Systems • It affects all body systems, in particular: • Cardiovascular • Increase risk of high blood pressure, stroke, etc. • Gastrointestinal • Stomach and other types of ulcers, etc. • Pancreatitis, etc. • Nervous Systems • Memory impairment, cognitive deficits, etc.

15. Diseases Associated with Alcohol Abuse • Primary diseases include; • Alcohol poisoning • Cardiomyopathy • Alcohol gastritis and liver cirrhosis • Other • Secondary diseases include: • Cancer, heart disease, liver disease, pancreatitis, respiratory disease, metabolic disease, psychiatric

16. Treatment • Biological aspects • Use pharmacotherapy • Cognitive and behavioral aspects • Use psychotherapy

17. Prevention: Screening Instruments • Many screening instruments are available to aid physicians in detecting alcohol problems including: • CAGE questionnaire • Alcohol Use Disorder Identification Test (AUDIT) • Brief Michigan Alcoholism Screening Test (BMAST) • Other * Some questionnaires are self-administered which makes screening process less time-consuming to clinicians

18. Relapse Among Substance-Abuse Patients in Riyadh Dr. N. Al-Nahedh • Substance abuse is an acknowledged problem in Saudi Arabia. • Studied sociodemographics of substance abuse and relapse rates of 160 inpatients at AlAmal Hospital in Riyadh, 1998. • Mean age of was 29.5 yrs, mean duration of abuse 9.5 yrs • Alcohol was used by 23.75% of the patients, • sedatives by 23.12%, • heroin by 18.75%, • hashish (cannabis) by 10.63% and • glue-sniffing by 9.38%. • Some used more than one substance • Age, unemployment, peer pressure and family and social stresses were factors associated with repeat admissions. • The most significant predictors of a patient's relapse were unemployment and social stresses. • More nationwide studies are needed

19. Hypnosis for Smoking Cessation • Elkins, G.R., Rajab, M.H. (2004). Clinical hypnosis for smoking cessation: preliminary results of three-session intervention. International Journal of Clinical and Experimental Hypnosis, 52(1), 73-81. • http://www.hipnosis.org.es/hipnosis_pdf/clinical_hypnosis.pdf

20. References • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Ed. Text Revision (DMS-IV-TR). American Psychiatric Association: Washington, DC; 2000. • Antunes, P. Alcohol Use Disorder. Texas A&M University, College of Medicine, Department of Psychiatry. A lecture presented to second year medical students. 2010. • Cherpitle CJ. Brief screening instruments for alcoholism. Alcohol Health Res World. 1997; 21:348-351. • Schuckit MA. Alcohol and alcoholism. In Braundwald E, Hauser SL, Fauci AS, et al, eds. Harrision’s Principles of Internal Medicine. 15th ed. New York: McGraw-Hill • Elkins, G.R., Rajab, M.H. (2004). Clinical hypnosis for smoking cessation: preliminary results of three-session intervention. International Journal of Clinical and Experimental Hypnosis, 52(1), 73-81. • http://www.emro.who.int/publications/emhj/0502/04.htm • http://thefoodblog.com.au/2009/07/of-arabic-origin-alcohol.html • http://audio.islamweb.net/audio/index.php?page=FullContent&audioid=216616