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Definition

  • The World Health Organization defines psychotropic substances as any substance that affects mental processes, such as cognition and emotion
  • Psychotropic substances are classified into three main categories:
    • Stimulants
    • Depressants
    • Hallucinogens

How do psychotropic substances affect the functioning of the brain?

  • Most psychotropic substances affect the reward circuitry in the brain by immersing it in dopamine (chemical messenger). Dopamine mutations in the brain reward circuit because unhealthy and abnormal enjoyable activities, causing people to repeat their use behavior over and over again.
  • Over time, the brain adapts to the extra dopamine, reducing the height (euphoria) a person feels compared to the height he felt when he first took the psychotropic substance - an effect known as "endurance."
  • Tolerance: causes increased doses to be forced overtime and repeated abuse, in an attempt to achieve the same high dopamine, and may lead to loss of control and overdoses that may lead to death

Depressants\Drugs:

Are substances that work to inhibit the work of the central nervous system and the signals that are transmitted from and to the brain, and accordingly the speed of the heartbeat and breathing decreases, of the most.

Important types:

  1. 1. Alcoholic drinks:
    • Short term alcohol consumption can lead to many problems, such as:
      • Nausea
      • Consistency and reaction ability damaged
      • Blurred vision
      • heaviness of the tongue
      • Vomiting
      • Headache
      • Unconsciousness
    • In the long run, excessive consumption of alcohol may lead to health problems, such as:
      • Digestive disorders
      • Increased risk of pancreatitis and ulcers
      • Severe liver damage
      • Damage to the brain and nervous system
      • Confused thinking and memory loss
      • Hormonal performance affected
      • Increased risk of heart disease and stroke
      • Increased risk of developing cancer of the digestive system, pharynx, esophagus, liver, as well as breast cancer in women.
    • On the sensory level, excessive alcohol intake increases: anxiety, anger and depression, as well as negatively affects social performance in the family or at work
    • Alcoholism is treated by treating alcohol withdrawal symptoms in specialized centers and under the supervision of a doctor.
    • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends in order for him to recover and begin to recover and return to his normal life.
  2. 2. Opioids (heroin, morphine, codeine, etc.)
    • Heroin:
      • It is considered one of the most addictive and most addictive opiates
      • It affects the brain and makes it secrete chemicals that lead to feelings of euphoria, happiness and relaxation, and heroin like other drugs completely reduces the feeling of pain
      • Heroin has many damages to the body, including in the short term, that is, immediately after taking the dose, and in the long term, with long-term use.
      • Short-term side effects include: shortness of breath, lack of focus, loss of pain, physically or even psychologically, and also persistent itching that is difficult to control
      • As for the long-term illnesses of the addict, such as: heart disease, transmission through the use of needles (injections), especially AIDS and hepatitis C virus, pneumonia, blood clots, liver disease, convulsions.
      • The risk of death due to an overdose
      • Heroin addiction is treated by treating symptoms of heroin withdrawal at specialized centres and under the supervision of a doctor.
      • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends in order for him to recover and begin to recover and return to his normal life
  3. 3. Opioid-like-acting substances (Tramadol / Tramal):
    • Tramadol:
      • Tramadol is used for moderate to severe pain relief. Tramadol is similar to codeine in terms of its ability to relieve pain, but the risk of addiction to it or inhibition of breathing is low compared to codeine.
      • Tramadol is also used to relieve pain in cancer patients, but after using Tramadol in treatment for several weeks, it is often necessary to replace it with one of the most powerful narcotic pain relievers.
      • Tramadol abuse for non-medical purposes in high doses and for long periods leads to addiction.
      • Tramadol addiction is one of the most common types of drug addiction in the world
      • The appearance of tramadol symptoms in people who are not known to take tramadol for a therapeutic purpose is an indication of tramadol addiction, among the most important of these symptoms:
      • Narrowing pupils
      • Change in appetite for food
      • Loss of focus
      • Slow speech
      • Sleeplessness and irregular sleep
      • Also a serious symptom of tramadol addiction: that the patient suffers from seizures without a history of epilepsy, occurring because tramadol affects the receptors for serotonin and noradrenaline, which in turn increases the secretion of neurotransmitters.
      • Tramadol addiction is treated by treating its withdrawal symptoms, in specialized centres and under the supervision of a doctor.
      • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends so that he recovers and begins to recover and return to his normal life.
  4. Inhalants and volatile substances (glue, gasoline, dyes):
    • Often young people fall victim to addiction to this type of narcotic substance, due to their ignorance of its seriousness and toxicity and its spontaneous presence in many societies, and its use in many daily purposes, some people smell these substances and then fall into their addiction without imagining Never the magnitude of the toxicity and the severe damage caused by these substances
    • There is a small percentage of adults or the elderly who intentionally add these substances, and sometimes this happens spontaneously due to the nature of their work as workers for workshops, factories and craftsmen
    • Some dentists or anaesthetists may also fall into this type of addiction as a result of their continuous use of these substances.
    • The most important types are volatile solvents and toxic gases
    • Volatile solvents: This type of solvent is usually found in the writing correctors, in addition to the liquid spray paints that fill the lighters, in addition to shoe polishing materials, gum, thinner, nail polish removers, gasoline, hairspray, and alcohol.
    • Toxic gases: such as chloroform, ether, helium, which is used in refrigeration devices such as refrigerators and air conditioners, and nitrous oxide gas, which is called laughter gas, in addition to propane gas, butane (lighters gas, ignition gas)
    • Signs appearing on people abusing inhalers:
      • His clothes, body, and breaths may have a smell of thick or intoxicating chemicals.
      • His skin is red and inflamed around his nostrils.
      • Bleeding frequently from the nose or the area around his nose or mouth may look inflamed.
      • Inhalers may lose their interest in eating, leading to weight loss.
      • His skin is almost pale blue, and his eyes are always red and teary as the pupil expands.
      • You find him heavy talking very slowly, unnaturally, and lost his ability to coordinate and move without balance.
      • In addition to the physical signs of inhalation addiction that appear as physical or behavioral symptoms.
      • Inhaler abusers may have an abnormally large variety of markers or nail polish bottles without any evidence of use of these objects for their specific purposes.
    • Impact of Inhalants abuse:
      • Initially a tonic.
      • Trance.
      • Absence of braking.
      • Reducing anxiety.
      • Increased self-confidence.
      • After that or with higher doses, loss of consciousness and concentration occurs - lack of estimation of distances and time. The effect begins immediately after inhalation and ends after 15-30 minutes.
      • Complications
      • Decreased pulse and breathing - headache - nausea - heavy talk - lack of muscle tone - sensitivity around the nose and mouth of the inhaler (the kidney).
      • Death due to cardiac arrest, asphyxia, or central nervous system inhibition - a loss of falsehood or heart that causes death.
      • Spray can cause ossification, death, pneumonia, and forgetfulness, absence of focus, liver, kidney, and medulla damage.
    • Inhalation addiction is treated by treating its withdrawal symptoms, in specialized centres and under the supervision of a physician.
    • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends so that he recovers and begins to recover and return to his normal life

Stimulants

  • They work by stimulating the central nervous system with an increase in the rate of major vital functions such as heartbeat, body temperature, and blood pressure.
  • Its dangerous effect includes many organic symptoms (such as loss of appetite) and other nervous and psychological (such as anxiety and seizures and hallucinations), of the most important types
  • Cathion (Khat)
  • Cocaine, crack cocaine
  • amphetamines (Captagon), methyl amphetamine (crystal myth)
  • Among its most serious complications: severe addiction (may occur from the first dose), high risk of heart attacks, strokes, epileptic seizures and hysteria.
  • Doping addiction treatment should be carried out in specialized centers and under the supervision of a physician, because of the serious withdrawal symptoms it causes.
  • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends in order for him to recover and begin to recover and return to his normal life

Hallucinogens

  • They are substances that lead to hallucinations!
  • hallucinations are defective auditory perception (auditory hallucinations), visual (visual hallucinations), or sensory (sensory hallucinations)
  • Hallucinogenic substances include: -
  • LSD
  • Mescaline
  • Cannabis (marijuana / hashish):
    • Cannabis and marijuana are extracted from the cannabis plant, but there is a difference between cannabis and marijuana in terms of the method of extraction, shape, color and concentration of the active substance.
    • Hashish: It is a gum substance found in the hemp plant stem and extracted from it.
    • Marijuana: It is extracted from the flower and leaves above the cannabis plant, is harvested and dried completely, removing any seeds or stems and then grinding them. Usually marijuana is green or gray.
    • Cannabis: Cannabis is used through smoking, as the addict adds it to tobacco and smokes it, and sometimes it is chewed or added to certain foods.
    • Marijuana: The method of using marijuana differs from cannabis only when it is added to the "bong" water pipe and smoked, and it may be boiled with hot water to make tea.
    • Hashish is an Arabic name that is traded among users with the same name and there are no other common names.
    • Marijuana: Unlike cannabis, there are brand names that include (Ganga, herb, Mary Jane).
    • The difference between cannabis and marijuana appears in the place of presence, where cannabis is spread more in the Arab countries and the Middle East and Afghanistan, China, and India solve the list of countries that produce cannabis drug, but it is forbidden to use, use and trade in it is considered an illegal act.
    • Marijuana is found in European countries and Uruguay, America, Spain and the Netherlands are among the most permitted countries in agriculture and not for use, but there are some states in America where cultivation and use are permitted.
    • Side effects:
      • Both cannabis and marijuana leave the same side effects on the general health of the abuser as the addictive THC active substance affects the hemp receptors in the brain and causes a change in the nervous system functions, and that effect appears within minutes of taking, but the marijuana differs in that it causes the accumulation of tar Ali lung, which leads to lung cancer.
    • Common symptoms of taking it include:
      • Relaxation and euphoria.
      • Sagacity and indifference.
      • Increased appetite.
      • Defective estimation of distances and time.
      • Lung and breathing problems.
      • Heart rate disorder.
      • Poor focus and memory.
      • Anxiety
      • Increased sensation
    • Long-term use of cannabis and marijuana can lead to schizophrenia, depression, hallucinations and paranoia.
    • Dangers: The difference between cannabis and marijuana appears in the concentration of the drug, as cannabis is more dangerous than marijuana because it contains 400 chemicals and the percentage of the active substance THC in it ranges between 20% - 60%.
    • As for marijuana: marijuana leaves an addictive effect less severe than cannabis, and the percentage of narcotic within it ranges between 10% - 20%.
    • Treatment of cannabis / marijuana addiction should be done in specialized centers and under the supervision of a physician, due to the withdrawal symptoms and psychological complications.
    • Patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends so that he recovers and begins to recover and return to his normal life.
  • magic mushrooms
  • Treatment of hallucinogen addiction should be carried out in specialized centers and under the supervision of a physician, as it causes serious withdrawal symptoms.
  • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends in order for him to recover and begin to recover and return to his normal life.

Controlled Prescription drugs

  • These are drugs used for medical purposes in specific doses and under medical supervision, but in case of misuse they cause mental effects and lead to addiction and health complications
  • Taking these drugs without a prescription or for symptoms other than treatment is a crime punishable by law!
  • the most important types:
    • analgesic / narcotic drugs (morphine, codeine)
    • sedative / psychiatric drugs (Xanax, Rivotril)
    • Neurological drugs (Kimadrin, Lyrica, Neurontin)
    • Anabolic drugs (Ritalin, Adderall)
  • Treatment of medical drug addiction should be carried out in specialized centers and under the supervision of a physician, as it causes serious withdrawal symptoms.
  • The patient must undergo an integrated treatment program, follow the doctor’s instructions, and support family and friends in order for him to recover and begin to recover and return to his normal life.

New drugs / synthetic and synthetic drugs:

  • In recent years, we have noticed a marked change in the patterns of abuse among young people and adolescents, and their tendency to use different types of drugs and new psychotropic substances.
  • According to UNODC sources, there is an increase in the emergence of new types of psychotropic substances, with 483 new substances registered at the end of 2015.
  • They are narcotic drugs and psychotropic substances, pure or prepared (laboratory)
  • Not subject to international control under the 1961 Drug Convention or the 1971 Convention on Psychotropic Substances
  • But it poses a public health threat!
  • The name does not mean that it is new inventions
  • Some of them were discovered 40 years ago, but they have recently appeared and spread in the global markets with new forms and names!
  • There are several categories of new psychotropic substances, the most important of which are:
    • Synthetic cathiones (beneficial)
    • Synthetic hemp semi-synthetic (Spice, K2, Chronicle)
    • ketamine, pheniclidine (PCP)
    • Material of plant origin (Kratom)
  • • According to the United Nations Office on Drugs and Crime: the threat of new psychotropic substances has become a global phenomenon that has spread to more than 90 countries
  • There are many types of these substances discovered daily!
  • Therefore, it was necessary to be careful and not to use any drugs or preparations of unknown ingredients and without medical advice, and even the substances that they promote as herbs and natural analgesics, care must be taken not to use them without being subject to the examination and control of the authorities Local

Tobacco and e-smoking products

  • Smoking is one of the most important causes of diseases, deaths and poverty around the world, with deaths amounting to 7 million deaths annually due to direct smoking, and 1.2 million deaths due to involuntary smoking, according to the statistics of the World Health Organization.
  • Smoking is considered a gateway to the world of addiction, and studies have shown that adolescent smokers are three times more likely to use psychotropic substances than non-smokers (WHO)
  • Electronic cigarettes and similar smoking devices are also harmful as conventional cigarettes, because they contain the same active substance "nicotine", which has direct damages to the heart, brain, and blood vessels and leads to addiction!
  • Its use also stimulates addictive behavior and encourages non-smokers to try it out thinking (wrongly) that it is less harmful than traditional smoking!

Coming soon

  • El Kashef, A., Zoubeidi, T., Thomas, R.A., Al Hashmi, H., Lee, A.J., Tar-Ching, A., Osman, O.T., Blair, I, El Arabi, H.F., Al Ghaferi, H. (2013). A profile of patients with substance use disorders and treatment outcomes: A 10-year retrospective study from the National Rehabilitation Center. International Journal of Prevention and Treatment of Substance Use Disorders, 1, 86-108. 
  • Elarabi, H., Hajal, S., Salas, S. and Wanigaratne, S. (2013).  Training alone is not enough: The outcome of a training needs analysis with the nurses working in an addiction treatment centre in Abu Dhabi, United Arab Emirates.  Drug and Alcohol Review, 32 (supplement 1), 2 – 74.  
  • Elarabi, H., Al Hamedi, F. and Wanigaratne, S. (2013).  Rapid Analysis of Knowledge Attitudes and Practices towards substance addiction across different target groups in Abu Dhabi City, United Arab Emirates.  International Journal of Prevention and Treatment of Substance Use Disorders, 1:1, 78-101.
  • Al Ghaferi, H., Osman, O.T., Matheson, C., Wanigaratne, S. and Bond, C. (2013). Substance misuse in Arabic countries: the need for published research. International Journal of Prevention and Treatment of Substance Use Disorders, 1, 9-14. 
  • Elarabi, H., Al Ozaibi, N., Shawky, M., Wanigaratne, S., Salas, S., Al Hamedi, F., Al Maskari, B., Al Marzooqi, S., Al Khaja, A. and Al Ghaferi, H. (2014). Transforming a residential substance dependence program: Experience from the National Rehabilitation Centre, United Arab Emirates. Mental Health and Substance Use: Dual Diagnosis, 7 (4), 353-362.
  • Al Marzouqi, A., Matheson, C., Al Hashmi, H., Thomas, R.A., Lee, A.J., Bond, C., Al Ghaferi, H. and Elkashef, A. (2014).  Current practices and attitudes of family physicians towards substance use disorders in the Emirate of Abu Dhabi: a cross-sectional survey in primary care.  International Journal of Prevention and Treatment of Substance Use Disorders, 2, 84 - 97. 
  • Al Ghaferi, H. (2014).  The Evolution of the National Rehabilitation Centre Abu Dhabi.  Alcohol and Alcoholism, 49 (1), 11-12. 
  • Alhyas, L., Elarabi, H., El-Kashef, A., Wanigaratne, S., Almarzouqi, A., Alhosani, A and Al Ghaferi, H. (2015). Parents’ Perceptions and Beliefs on Adolescence and Substance Use: A Preliminary Qualitative Study in Abu Dhabi, United Arab Emirates (UAE).  Journal of Child and Adolescent Behavior, 3:2, 1-6, doi:10.4172/2375-4494.1000195.
  • Alhyas, L., Al Ozaibi, N., Elarabi, H., El-Kashef, A., Wanigaratne, S., Al Marzouqi, Al Hosani, A. and Al Ghaferi, H. (2015). Adolescents’ perceptions of substance use and factors influencing its use: a qualitative study in Abu Dhabi, United Arab Emirates (UAE). Journal of the Royal Society of Medicine, 6 (2), 1-12, DOI: 10.1177/2054270414567167.
  • Alblooshi, H., Hulse, G.K., Elkashef, A., Al Hashmi, H., Shawky, M., Al Ghaferi, H., Al Safar, H. and Tay, G.K. (2016). The pattern of substance use disorders in the United Arab Emirates in 2015: results of a National Rehabilitation Centre cohort study. Substance Abuse Treatment, Prevention and Policy, 11:19.
  • Doran, C.M. (‎2016)‎. Preliminary estimates of the economic implications of addiction in the United Arab Emirates. EMHJ-Eastern Mediterranean Health Journal, 22 (‎10)‎, 749 - 755. World Health Organization. Regional Office for the Eastern Mediterranean. https://apps.who.int/iris/handle/10665/260160.
  • Alhassan, A.E.A. (2017). New Psychoactive Substances: “Chemical Chameleons” That Evade Detection and Legalizations. International Journal of Emergency Mental Health and Human Resilience, Vol. 19, 3. 1-4.
  • Elrasheed, A., Al Ghaferi, H. and Ali, A.Y. (2017). Assessment of Alcohol Exposure: Testing for Ethylglucuronide (Etg), Ethylsulfate (Ets). International Journal of Emergency Mental Health and Human Resilience, Vol. 19, No.3, pp. 1, ISSN 1522-4821.
  • Saaran, K., Al Ghafri, H., El Rasheed, A., Awadi, A. and Ali, A.Y. (2017). Hepatitis C Infection among Intravenous Drug Users. A Silent Disease in an Invisible Population. International Journal of Emergency Mental Health and Human Resilience, Vol.19, No. 3, 1-4.
  • Al Ghaferi, H., Bond, C. and Matheson, C. (2017). Does the biopsychosocial-spiritual model of addiction apply in an Islamic context? A qualitative study of Jordanian addicts in treatment. Drug and Alcohol Dependence, 172, 14-20.
  • Al-Ghafri, H., El-Rasheed, A., Ali, A.Y. and Al-Mamari, S (2018). Carbohydrate Deficient Transferrin: How reliable is it as a Biomarker for Chronic Alcohol Consumption? International Journal of Emergency Mental Health and Human Resilience, Vol.20, No. 2, pp 1-6 International ISSN 1522-4821.
  • Al Ghafri, H., Elrasheed, A., Alhassan., Yousif Ali, A., Al Mamari, S., Gawad, T., Alawadhi, A., Shawky, M., Hassan, N., Elliott, S. (2018).  A 6-year review of drug trends in the United Arab Emirates from the perspective of the National Rehabilitation Center (NRC), Abu Dhabi.  
  • Journal of Current Topics in Toxicology, vol. 16/2020.
  • ElKashef,A., Alzayani,S., Shawky,M., AlAbri., Littlewood,R., Qassem, T., Alsharqi,A., Hjelmström, P., Abdel Wahab,M., Abdulraheem, M., Adel Alzayed,P. (2019) Recommendations to improve opioid use disorder outcomes in countries of the Middle East. Journal of Substance Use, 24:1, 4-7, DOI: 10.1080/14659891.2018.1489906
  • Elarabi, H., Elrasheed, A., Ali, A., Shawky, M., Hasan, N., Gawad, T.A., Adem, A. and Marsden, J. (2019). Suboxone Treatment and Recovery Trial (STAR-T). Study Protocol for a Randomised Controlled Trial of Opiod Medication Assisted Treatment with Adjunct Medication Management Using Therapeutic Drug Monitoring and Contingency Management. Journal of Addiction, Vol 2019, Article ID 2491063, DOI: 10.1155/2019/2491063.
  • Albalooshi, H., Al Safar, H., Fisher, H.F., Cordell, H., Elkashef,A., AlGhaferi, H.,Shawky, M… Tay, G (2019). Case-control genome wide association study of substance use disorder (SUD) identifies novel variants on chromosome 7p14.1 in patients from the United Arab Emirates (UAE). American Journal of Medical Genetics Part B Neuropsychiatric Genetics. 180(1):68‐79. doi:10.1002/ajmg.b.32708
  • Ghaferi, H., Hasan, N., Elarabi, H.F., Radwan, D., Shawky, M., Al Mamari, S., Abdelgawad, T., Elrasheed, A., Kodera, A., Al Kathiri, H., Wanigaratne, S. (2020). The impact of family engagement in opioid assisted treatment: Results from a randomised controlled trial. International Journal Of Social Psychiatry. DOI: 10.1177/0020764020979026
  • Elarabi, H., Hasan, N., Marsden, J., Radwan, D., Adem, A., Almamari, S., Elrasheed, A. (2020). Therapeutic Drug Monitoring in Buprenorphine/Naloxone Treatment for Opioid Use Disorder: Clinical Feasibility and Optimizing Assay Precision. Pharmacopsychiatry. 2020; doi 10.1055/a-1083-6842
  • https://journals.sagepub.com/eprint/EQAXWTXGMXUZJKMQAPGH/full#articleShare  Container
  • In Press accepted for publication in Addiction. : "Effectiveness of incentivized adherence and abstinence monitoring in buprenorphine maintenance: a pragmatic, randomized controlled trial".