Content

Historical highlights. Terminology. Etiology, Level of

PAS use, Effects, Biomolecular aspects, Signs of
possible PAS use , Diagnosis, Symptoms of usage,
Abstinence and Intoxication, Management , Prognosis
Referal

Kaplan HI., Sadock BJ., Comprehensive Textbook of Psychiaty

vol. I, 7th. Ed., Lippincot, Williams & Wilkins, Baltimore, 2000.
Diagnosis and Statistical Manual of Mental Disorder , 4 th. Ed.,
American Psychiatric Association, Washington DC, 1994.
Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di
Indonesia III , cetakan 1, DirJen YanDik DepKes RI, Jakarta.
Kaplan HI. Sadock BJ., Synopsis of Psychiatry , Behavioral
Sciences / Clinical Psychiatry 8 th. Ed., Williams & Wilkins,
Baltimore, 1998.
Undang-undang Narkotika & Psikotropika , cetakan kedua . Sinar
Grafika , Jakarta 1999
Historical Hightlights

Used since ancient time  rituals,

socialization, recreation .
INDONESIA
Opiate ordonance 1927
Import, distribution, usages
regular opiate distribution for personal
consumption ( old Chinese people )
Brisbane ordonance
Terminology

Psychoactive substance (PAS)

a substance when ingested acts on
the mind
SUBSTANCES:

PPDGJ III , ICD 10

DSM IV
 Dependence syndrome

 Tolerance

 Withdrawal syndrome
Inter-relation of PAS, the individual person and
the enviroment
Characteristics
PAS : effect , accessibility
Person : high risk, curiousity ,peer solidarity ,
identity, escapism, misuse  abuse
Environment : family disharmony, authority crisis,
norm - value changes, morale & religiousities 
forced by peers, less facililities for youth
activities, less employment and education
facilities.
High rik individuals  Potential user

Easily disappointed  aggressive,

instant gratification ,
bored easily  depresive
risk taking behaviour
psychosexual problems
personality disturbance
lower intelligence
• Physically and mentally healthy
• Socially well adjusted
• Honest
• Responsible
• Able to handle severe / acute stress
• Able to fulfill leisure time
• Rationale expextations
Level of PAS
Use
dependence Treatment &
rehabilitation
abuser
user
situational

occational intervention

experimental
Promotion &
Non High risk prevention
user
Low risk promotion
Physical  the substance, ingredients and
method of usage
- pulmonary & respiratory system
- Cardiovascular - GI tract
- dermatologic - urinary tract
- haemopoetic - endocrine
- bone & muscle - nervous system
- other (AIDS)
HIV infection

 Flulike syndrome after 3 -- 6 weeks

becoming infected
 Seroconversion 6 -- 12 weeks,
6 -- 12 month
(Elisa , Western blot )
 HIV  AIDS 8 -- 11 years
Psychological 
several kind of mental and behavioural
problems due to PAS use

Social 
disturbance of produtivty and social live
 Alcohol  amphetamine
 halucinogen  opiate
 cocaine  cannabis
 sedatives / hypnotics
 designer amphetamines ( e.g. ecstasy )
 Achievement ( work , academic ) 
 irritable
 Socialization 
 Dicipline 
 No sense of responbility
 Stealing , cheating , dishonest
 Not well groomed
 Use to be alone in certain “special” places
 Use to wear sun glasses, longleeves shirt
Diagnosis

 PPDGJ III / ICD 10

 DSM IV
Dependence Syndrome

1. A strong desire or sense of compulsion to take

the substance
2. Difficulties in controlling substance taking
3. A physiological withdrawal state
4. Evidence of tolerance
5. Progressive neglect of alternative pleasure or
interests because of PAS use
6. Persisting with substance use despite clear
evidence of overtly harmful consequences
Symptoms of Usage , Abstinence
& Intoxication

1. Opiate
Symptoms of Usage , Abstinence &
Intoxication

2. Cannabis
 Symptoms of Usage , Abstinence
& Intoxication

3. Sedative - hypnotic
Symptoms of Usage , Abstinence
& Intoxication

4. Alcohol
Symptoms of Usage , Abstinence
& Intoxication

5. Amphetamine
Symptoms of Usage , Abstinence
& Intoxication

6. Cocaine
Symptoms of Usage , Abstinence
& Intoxication

7. Inhalants
Symptoms of Usage , Abstinence
& Intoxication

8. Hallucinogens
Management Security approach

Basic principles
Supply
abuse
Needs

Prosperity approach
Promotion
education Treatment
prevention rehabilitation

NEEDS 
2 major goals of treatment

 Complete abstinence

 Physical, psychiatric and

psychosocial well - being
 Adequate psychosocial
supports are very important for
changes of behaviour

 urine drug screens

Treatment

1. By laws
UU no. 5 1997 (Psikotropika)
UU no. 22 1997 (Narkotika)
2.1. Potential users
2.2. Users
2. 1. Potential users
 Prevention (parent, families,teachers, tutors)
 develop alternate activities

2. Users
 Physical, psychological, social.
 Treatment & rehabilitation are not separate
 Long - term
 Need broad cooperation
Treatment phases

1. Initial, 1- 3 days (in patient)

2. Detoxification and treatment for medical
complications , 1- 3 weeks (in patient)
3. Stabilization , 3- 9 months
4. Preparation for reintegration to the
community , 3 - 12 months
5. Resocialization , approx. 3 years.
treatment

Opiate

 Education
 Methadone
 Naltrexone
 Psychotherapy
treatment

Cannabis

 Amotivational syndrome
 Abstinence & suport 
education
 Psychotherapy,
 Antianxiety, antidepressant
treatment

Sedative - hypnotic
 Withdrawal
 Overdose
treatment

Alcohol
 Psychotherapy
 Behaviour therapy
 Pharmacotherapy
 treatment

Amphetamine & cocaine

• Very difficult to remain abstinent 

powerfully reinforcing & induces craving
• Psychotherapy
• Antipsychotic
• Anticraving
treatment

Inhalant
 Short lived  cease or change to
another substance
 Counselling, education about PAS
 DA antagonist
treatment

Hallucinogens
 Talking down
 DA antagonist, bzd.
Referals

 Early phases  GPs

 Advance phase  Psychiatric facilities
 Acute intoxication (emergency situation)
& medical complications 
General hospital : ER, ICU.
 Psychiatric symptom 
Psychiatric facilities
 Treatment facilities

 Mental hospital, Psychiatric departements

 10 % of bed capacities
 RSKO ( Jakarta )
 Police facilities ( Pamardi Siwi , Jakarta )
 Religion - based facilities
 Social wellfare facilities (Lembang , Parung)
 Rehabilitation centers
Prognosis
Remission specifiers
 Early partial remission
 Early full remission
 1 month --  12 months , no dependence
 Sustained partial remission
 Sustained full remission
 12 months , no dependence
Alcohol

 20 % spontaneous remission
 no antisocial personality
 no other PAS use
 general life stability
 joining full course of initial rehabilitation 
60 % chance for  1 year abstinence
Amphetamine

 25 % have unfavorable outcomes in

daily living affairs (family, work, drug use)
Cannabis
Those who does not understand the
intellectual reasons for addressing a
substance abuse problem has a little
motivation to stop .
Hallucinogens
Lifetime character of hallucinogen
abuse : bell curve
Inhalants
Low prevalence in adulthood , associated
with increased risk for future diagnosis of
antisocial personality disorder and other PAS
use disorder
Opiate
 Relapse rate : high
 relapse mostly at the first 3 month ,
2 out of 3 patients relapse within
6 months.
 33 % of those with 3 years
abstinence , eventually relapsed
 Death rate 1 - 3 % / year.
 Sedative - hypnotics

10 months -- 6 years follow up ,

45 -- 70 % no longer taking bzd.