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INTRODUCTION

According to the American Psychiatric Association, substance use disorder (SUD) is a

complex condition in which there is uncontrolled use of a substance despite harmful

consequences. People with SUD have an intense focus on using a certain substance(s) such as

alcohol, tobacco, or illicit drugs, to the point where the person's ability to function in day-to-day

life becomes impaired. People keep using the substance even when they know it is causing or

will cause problems. The most severe SUDs are sometimes called addictions. People with a

substance use disorder may have distorted thinking and behaviors. Changes in the brain's

structure and function are what cause people to have intense cravings, changes in personality,

abnormal movements, and other behaviors. When someone has a substance use disorder, they

usually build up a tolerance to the substance, meaning they need larger amounts to feel the

effects. According to the National Institute on Drug Abuse, people begin taking drugs for a

variety of reasons, including: To feel good — feeling of pleasure, “high” or "intoxication." To

feel better — relieve stress, forget problems, or feel numb. To do better — improve performance

or thinking. Curiosity and peer pressure or experimenting. People with substance use and

behavioral addictions may be aware of their problem but not be able to stop even if they want

and try to. The addiction may cause physical and psychological problems as well as interpersonal

problems such as with family members and friends or at work.

There are two groups of substance-related disorders: substance-use disorders and

substance-induced disorders:

Substance-use disorders The DSM-5-TR recognizes substance-related disorders resulting from

the use of 10 separate classes of drugs; Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants,

Opioids, Sedatives, Hypnotics, or anxiolytics, Stimulants (including amphetamine-type

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substances, cocaine, and other stimulants) and Tobacco. are patterns of symptoms resulting from

the use of a substance that people continue to take, despite experiencing problems as a result. Its

essential features are a cluster of cognitive, behavioral and physiological symptoms indicating

that an individual continues using the substances despite significant substance-related problems.

These substances can be prescription and non-medical drugs. The specific manifestations and

treatment of intoxication and withdrawal vary by the substance or substance class.

Substance-induced disorders: substance induced disorders refer to the immediate effects of

substance use, called intoxication; and the immediate effects of discontinuing a substance, called

substance withdrawal.

Substance Intoxication occurs when a person develops a reversible set of symptoms due to the

recent use of (or exposure to) a substance. Symptoms of substance intoxication will vary

according the substance. Intoxication occurs because chemical substances (such as drugs)

directly affect the central nervous system. This leads to behavioral and/or psychological effects.

Substance intoxication applies to all classes of drugs except tobacco. Typically, clinicians

diagnose substance intoxication when someone arrives in an emergency room under the

influence of alcohol or another drug.

Substance withdrawal is diagnosed based upon the behavioral, physical, and cognitive

symptoms that occur due to the abrupt reduction or cessation of substance use. Like substance

intoxication, these symptoms vary according to each specific substance. Symptoms of mood,

anxiety, and psychotic disorders may all be induced as a result of alcohol and other drug use or

withdrawal. For example, alcohol use and withdrawal can induce symptoms of depression or

anxiety, manic symptoms can be induced by intoxication with stimulants, steroids, or

hallucinogens; and psychotic symptoms can be induced by withdrawal from alcohol, or

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intoxication with amphetamines, cocaine, cannabis, LSD, or PCP . Other disorders that may

result from alcohol use include substance-induced delirium, amnestic disorder, dementia, sexual

dysfunction, and sleep disorder.

Substance use disorders generally involve behavior patterns in which people continue to use a

substance (for example, a recreational drug) despite having problems caused by its use.

The substances involved tend to be members of the 10 classes of drug that typically cause

substance-related disorders:

Alcohol

Antianxiety and sedative drugs

Caffeine

Cannabis (including marijuana and synthetic cannabinoids)

Hallucinogens (including LSD, phencyclidine, psilocybin, 3,4-methylenedioxymethamphetamine

[MDMA])

Inhalants (such as paint thinner and certain glues)

Opioids (including fentanyl, morphine, and oxycodone)

Stimulants (including amphetamines and cocaine)

Tobacco

Other (including anabolic steroids and other commonly abused substances)

The specific manifestations and treatment of intoxication and withdrawal vary by the substance

or substance class.
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The common terms "addiction," "abuse," and "dependence" are too loosely and variably defined

to be very useful in systematic diagnosis; "substance use disorder" is more comprehensive and

has fewer negative connotations.

Physiologic Effects of Substance Use

These substances all directly activate the brain's reward system and produce feelings of pleasure.

The activation may be so strong that people intensely crave the substance. They may neglect

normal activities to obtain and use the drug. These substances also have direct physiologic

effects, including; Intoxication, Withdrawal, Substance-induced mental health disorders

Intoxication: Intoxication refers to the immediate and temporary effects of a specific drug.

Intoxication impairs the person's mental function and judgment and may alter mood. Depending

on the drug, the person may feel a sense of excitement or an exaggerated feeling of well-being

(or euphoria), or the person may feel calmer, more relaxed, and sleepier than usual. Many drugs

impair physical functioning and coordination, leading to falls and vehicle crashes. Some drugs

trigger aggressive behavior, leading to fighting. As larger amounts of the drug are used (called an

overdose), adverse effects become more obvious, with serious complications and sometimes risk

of death. Tolerance means that people need more and more of the drug to feel the effects

originally produced by a smaller amount. People can develop tremendous tolerance to drugs such

as opioids and alcohol.

Withdrawal: Withdrawal refers to symptoms that develop when people stop taking a substance

or take significantly less than usual. Withdrawal causes various unpleasant symptoms that differ

depending on the substance involved. Withdrawal from some drugs (such as alcohol or
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barbiturates) can be serious and even life threatening. Most people who experience withdrawal

know that taking more of the substance will reduce their symptoms. Whether withdrawal occurs

depends only on the substance and how long it is used, not whether the person has a substance

use disorder, is using the substance recreationally, or the substance is illegal. Some prescription

drugs, particularly opioids, sedatives, and stimulants, can result in withdrawal symptoms even

when taken as prescribed for legitimate medical reasons and for relatively brief periods (less than

1 week for opioids). People who have withdrawal symptoms were previously termed physically

dependent upon the substance. However, "dependence" has negative connotations suggesting

illicit drug use, so doctors prefer to avoid this terminology.

Substance-Induced Mental Health Disorders: Substance-induced mental health disorders are

mental changes produced by substance use or withdrawal that resemble psychiatric disorders

such as depression, psychosis, anxiety and OCD. For a mental health disorder to be considered

substance induced, the substance involved must be known to be capable of causing the disorder.

Substances can be members of the 10 classes of drug that typically cause substance-related

disorders: Alcohol, Antianxiety and sedative drugs, Caffeine, Cannabis (including marijuana and

synthetic cannabinoids), Hallucinogens (including LSD, phencyclidine, and psilocybin),

Inhalants (such as paint thinner and certain glues), Opioids (including fentanyl, morphine, and

oxycodone), Stimulants (including amphetamines and cocaine), Tobacco. Other (including

anabolic steroids and other commonly abused substances)

But many other substances can cause mental health disorders. Common examples include

anticholinergic drugs and corticosteroids, which may cause temporary symptoms of psychosis.
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In addition, the mental health disorder should;

 Appear within 1 month of intoxication with or withdrawal from the substance cause

significant distress or impair functioning

 Not have been present before use of the substance

 Not occur only during acute delirium caused by the substance

 Not last for a substantial period of time.

Recreational drug use has exsisted in one form or the other for centuries. People have used

drugs for a variety of reasons including;

 To alter or enhance mood

 As part oof religious ceremonies

 To gain spiritual enlightenment

 To enhance performance

Recreational uses of drugs: People who take drugs recreationally may take them

occasionally in relatively small doses, often without doing themselves harm. That is, users do not

develop drug withdrawal and drug does not physical harm them (at least in the short term).

Drugs usually considered recreational include; opium, alcohol, nicotine, marijuana, caffeine,

hallucinogenic mushroom and cocaine. Many recreational drugs are considered natural because

they are close to their plant origin. Recreational drugs can be taken by mouth, inhaled or

injected.

On the other hand, people can use drugs and it will can cause mental health disorders,

though these mental disorders can exist without the influence of any drug. Such mental disorders

as psychosis, anxiety, OCD, depression etc.

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Substance/medication-induced psychotic disorder: also known as toxic psychosis, alcohol-

induced psychosis, and drug-induced psychosis, is the diagnostic name for a specific mental

health condition where an individual experiences hallucination, delusions, or both within a

month of using or withdrawing from prescription drugs, illegal drugs, and/or alcohol. This

psychosis is merely a symptom, not a condition in and of itself. It is typically very temporary,

resolving in a couple of hours or days at most. However, it is a very serious symptom that often

requires emergency medical intervention.

Symptoms of substance/medication-induced psychotic disorder: disorder include

experiencing delusions, hallucinations, or both. Individuals experiencing these symptoms may or

may not have insight into whether their delusions and/or hallucinations are real.

While it can be difficult to differentiate substance/medication-induced psychotic disorder

from schizophrenia spectrum and other psychotic disorders, there are some key factors to note.

With substance/medication-induced psychosis

 Symptoms begin within a month of using or withdrawing from drugs, alcohol, or both.

 There are no psychosis-related symptoms noted prior to the substance use or withdrawal.

 Symptoms typically last for under a month.

 Symptoms usually diminish after withdrawal.

 Individuals typically don't experience disorganized speech or behavior, or reduced

emotional expression, which are common symptoms in schizophrenia spectrum and other

psychotic disorders.

Substance or medication-induced anxiety disorder: is the diagnostic name for anxiety or panic

attacks that are caused by alcohol, drugs, or medications. The transient feelings of anxiety or
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panic that can happen spontaneously during intoxication or withdrawal from alcohol or drugs.

Unfortunately, the same drugs that many people use to try and boost their confidence, help

them relax, and lower their inhibitions are the ones most prone to causing substance-induced

anxiety disorder or panic attacks. In some cases, people don't even realize that it is alcohol,

drugs, or medications that are causing anxiety because they only associate those substances

with feeling good. To be diagnosed with Substance/Medication-Induced Anxiety Disorder, the

symptoms must be causing considerable mental distress or significantly disrupting the person’s

life, including employment, social life, or another major aspect of their existence.

Symptoms include; edginess, worrisome thoughts, agitation, restlessness, sleep disruption, or

lack of focus. Other common signs and symptoms include rapid heart rate, difficulty breathing,

increased blood pressure, and excessive sweating.

Substance/medication-induced obsessive- compulsive disorder: is the diagnostic name for

drug-induced OCD. Obsessive-compulsive behavior is a group of seemingly uncontrollable and

repetitive behaviors that are driven by obsessions. Obsessions are unwanted thoughts, urges or

images that intrude on an individual's consciousness. They are associated with compulsive

behaviors which are actions that the person feels compelled to carry out often in response to,

and in an effort to control an obsession. These behaviors can be body-focused, for example,

picking at one's own skin, or pulling out one's own hairs. Although substance-induced OCD is

rare, the consequences can be severe.

The compulsions rarely have any realistic connection to the obsessions they are

designed to neutralize or prevent. Rather, they form a ritualistic behavior that is designed to
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reduce anxiety but ultimately worsen the overall condition. While some people with obsessive

compulsive disorders are aware that the beliefs that are part of their obsessions are probably

not true, some are less certain, and others are convinced that they actually are true, to the

point where their beliefs are delusions. In some cases, almost immediately. There is even a

category "with onset during intoxication," which means that the obsessive compulsive episode

actually begins when the individual is high on the drug. It can also occur during withdrawal,

during which severe mental problems are common; repetitive, intrusive thoughts and

compulsive behaviors associated with OCD and other related disorders can result from

exposure to a variety of medications and substances.

The symptoms of substance or medication-induced OCD are similar to those of pure OCD.

According to the DSM-V, a diagnosis is given only when OCD symptoms reach levels beyond

what is expected during drug use or toxin exposure and withdrawal. The symptoms and criteria

considered when making a diagnosis for substance or medication-induced OCD include:

 Severe, intrusive obsessive thoughts and/or compulsive behaviors (i.e. obsessive

checking, hand washing, skin picking, hair pulling, repetitive rituals)

Key factors to note about substance induced OCD

 Symptoms begin within one month of drug or medication use, or upon withdrawal from

a substance or medication known to cause OCD anxiety symptoms

 Symptoms are not due to a pre-existing OCD or related disorder that occurred prior to

substance exposure
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 Effects of OCD symptoms cause significant anxiety and distress, impairing functioning in

everyday life

 Medication or substance-induced OCD is most commonly associated with people who

abuse alcohol or drugs but can occur in anyone.

 Physicians must find that no other medical condition is causing the symptoms. Further,

the diagnosing medical professional must distinguish the symptoms from those of

delirium, dementia, psychotic disorders, or typical substance withdrawal.

Management of substance induced psychosis in African setting

Generally in Nigeria, due to high cost of primary healthcare and the relative affordability of

traditional alternative re-invented the resort to traditional remedies by both the rich and poor.

Here the psychiatric patient is taken to a mental home. Their methodology include that of

traditional/orthodox approach which include; some sort of sacrifice, prayers and the use of

herbs, tree saps, leaves and back. Their approach could be seen as bio-psychology and religio-

pychology is very prominent in the eastern part of Nigeria. (O’Connor1995). The latter

emphasizes the medicinal values of herbs and herbal mixtures while the former involves the

use of incantations, invocation of spiritual forces, including pouring of libations, as well as

sacrifices. Both of these techniques are complementary and are in use in the present day

mental homes services.

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Management of substance induced psychosis in Asian societies

According to Yongping, substance abuse is a dysfunction of the Heart-Spirit. “… desire comes

from the Heart and belongs to the Spirit. When desire is abnormal, or out of control, it becomes

pathological, therefore uncontrollable desire is a dysfunction of the Spirit.”

Acupuncture treatment: is a treatment in which thin needdles are inserted into the body. The

aim is to balance the life forces known as Qi that are responsible for different health issues.
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K. (2004). Prevalence and co-occurrence of substance use disorders and independentmood
and anxiety disorders: Results from the national epidemiologic survey on alchohol and
related conditions . Archieves of general psychiatry, 61(8),807-816.
Hartney, E. (2019). DSM 5 criteria for substance use disorders. verywellmind. com https://www.
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National Institutes of Health. (2008). Understanding drug abuse and addiction.
Tinsley, J. A. (2011). Assessment and treatment of substance use disorders. Focus, 9(1), 3-14
World Health Organization. (2021). The state of the health workforce in the WHO African
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American Psychiatric Association. (2020, December). What is a substance use disorder?
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing.
Furnham, A., & Wong, L. (2007). A cross-cultural comparison of British and Chinese beliefs
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Acupuncture treatment: Zusanli (ST36), Xuehai (SP10), Geshu (BL17), Shenmen (HT7)