1. Diabetes & Heart Care Clinic Dr.R.Ravindranath M.D. Consultant in Cardiac & Diabetic Care H2, Turnbulls Road , 1st Cross street, On Chamiers road (Next to Canara Bank) Nandanam, Chennai – 600 035 Phone : Clinic 24355368 Residence 42112244 Mobile 9381047102 Alcohol and Drug Abuse

3. Types of Alcohol Uses Manufacture Kind Solvent for nitrocellulose, ethyl cellulose, lacquer, urea-formaldehyde, urea-melamine plastics. Diluent of hydraulic fluids, extractant of drugs. By fermentation of starch or sugar. Also by synthesis, using ethyl alcohol or acetylene. Butyl (n-butanol) Solvent for lacquers, resins, coatings, films, waxes. Also as brake fluid, in manufacture of propionic acid, plasticizers. As a coproduct of air oxidation of propane and butane mixtures. Normal propyl Solvent for oils, gums, alkaloids, resins. Making acetone, soap, antiseptic solutions. By hydration of propylene from cracked gases. Also as by-product of certain fermentation processes. Isopropyl (isopropanol) Solvent for products such as lacquers, paints, varnishes, glues, pharmaceuticals, explosives. Also as 'building block' in making high-molecular-weight chemicals. By fermentation of sugar, starch, or waste sulfite liquor. Synthesis from ethylene or acetylene. Direct hydration of ethylene. Ethyl (grain alcohol, ethanol) Solvent for fats, oils, resins, nitrocellulose. Manufacture of dyes, formaldehyde, antifreeze solutions, special fuels, plastics. By destructive distillation of wood. Also by synthesis from hydrogen and carbon monoxide under high pressure. Methyl (wood alcohol, methanol)

4. Principally in perfumes. By synthesis from benzene and ethylene oxide. Phenylethyl Intermediate in making chemicals used in nylon manufacture. Stabilizer and homogenizer of soaps, synthetic detergents. Solvent. By catalytic hydrogenation of phenol. By catalytic air oxidation of cyclohexane. Cyclohexanol In foods, pharmaceuticals, in chemical manufacture. Conditioning agent in paper, textiles, glue, cosmetics. Source of alcohol in resin manufacture. By reduction of sugar, usually corn sugar, with hydrogen. Sorbitol In synthetic resins. As tetranitrate in explosives. Also as drug for treatment of heart disease. By condensation of acetaldehyde and formaldehyde. Pentaerythritol In alkyd resins, explosives, cellophane. Tobacco humectant. From treatment of fats in soapmaking. Synthetically, from propylene. By fermentation. Glycerol (glycerin; 1-, 2-, 3-propanetriol) Air disinfectant and dehumidifier. Production of resins, plasticizers. Coproduct in manufacture of ethylene glycol. Triethylene glycol Solvent for dyes, resins. Antileak agent. In gas drying. Softening agent in adhesive printing inks. As coproduct in manufacture of ethylene glycol. Diethylene glycol Deicing fluid, antifreeze, brake fluid. In production of explosives. Solvent for stains, oils, resins, enamels, inks, dyes. By oxidation of ethylene to glycol. Also by hydrogenation of methyl glycolate made from formaldehyde and methanol. Ethylene glycol Solvent for many natural and synthetic resins. Diluting brake fluids, printing inks, lacquers. In medicinal products. By fractional distillation of fusel oil, a coproduct of ethyl alcohol manufacture by fermentation. Amyl (pentyl) In perfume making. As wetting agent in detergents. Solvent for drugs and cleaning compounds. By hydration of isobutylene, derived from petroleum cracking. Tertiary butyl In making other chemicals such as methyl ethyl ketone. Solvent in nitrocellulose lacquers. Production of brake fluids, special greases. By hydration of 1-butane, formed in petroleum cracking. Secondary butyl Solvent for castor-oil-base brake fluids. Substitute for n-butyl alcohol in making urea resins. By synthesis from carbon monoxide and hydrogen at high pressure, then distillation from products formed. Isobutyl

7. Brief description of alcoholic beverages Wines are made from a variety of fruits, such as grapes, peaches, plums or apricots. The most common wines are produced from grapes. The soil in which the grapes are grown and the weather conditions in the growing season determine the quality and taste of the grapes which in turn affects the taste and quality of wines. When ripe, the grapes are crushed and fermented in large vats to pro- duce wine. Beer is also made by the process of fermentation. A liquid mix, called wort, is prepared by combining yeast and malted cereal, such as corn, rye, wheat or barely. Fermentation of this liquid mix produces alcohol and car- bon dioxide. The process of fermentation is stopped before it is completed to limit the alcohol content. The alcohol so produced is called beer. It contains 4 to 8 per cent of alcohol.

8. Brief description of alcoholic beverages Whisky is made by distilling the fermented juice of cereal grains such as corn, rye or barley. Scotch whisky was originally made in Scotland. The word "Scotch" has become almost synonymous with whisky of good quality. Rum is a distilled beverage made from fermented molasses or sugarcane juice and is aged for at least three years. Caramel is sometimes used for colouring. Brandy is distilled from fermented fruit juices. Brandy is usually aged in oak casks. The colour of brandy comes either from the casks or from caramel that is added. Gin is a distilled beverage. It is a combination of alcohol, water and various flavours. Gin does not improve with age, so it is not stored in wooden casks. Liqueurs are made by adding sugar and flavouring such as fruits, herbs or flowers to brandy or to a combination of alcohol and water. Most liqueurs contain 20-65 per cent alcohol. They are usually consumed in small quantities after dinner.

9. Types of alcoholic beverages

10. Common local brews in the South-East Asia Region Arrack is a distilled beverage, obtained from paddy or wheat. Jaggery, sugar or sugarcane is added to either of these two cereals and boiled with water. This is allowed to ferment, after which it is distilled. This beverage con- tains about 50- 60 per cent of alcohol. Toddy is obtained from the flowers of a coconut or palm tree. A white liquid, with a sweetish taste, oozes out of these flowers. When consumed fresh, this juice has no intoxicating effect. This liquid is collected and allowed to ferment. At times, yeast is added to hasten the process. The fermented juice has an alcohol content of approximately 5-10 per cent.

13. Signs of Alcoholism As alcohol levels increase with more drinking, there is poor control of muscles, poor coordination, double vision, flushing of the face, bloodshot eyes, and vomiting. Behavior varies greatly. It is hard to predict what an intoxicated person will do next. He/she may cry bitterly, show unexplained happiness, change moods rapidly, or just pass out. NOTE: “Passing out” or “falling asleep” can be a warning sign that the person is actually in a dangerous alcohol coma. Shipmates may assume the person is safely asleep, when he/she may actually be in a life-threatening coma. Take care to monitor a shipmate’s condition and make certain he is breathing and responsive. Get immediate help if you suspect alcoholic coma. This could save a life. Serious intoxication results when a large amount of an alcoholic beverage is taken over a relatively short period of time (or for a longer period of time, when alcohol intake exceeds alcohol excretion). Memory is commonly lost for the events while intoxicated. Symptoms are drowsiness that can progress rapidly to coma; slow snoring breathing; blueness of the face, lips, and fingernail beds; involuntary passage of urine or feces; dilated pupils; and rapid weak pulse. A suspected alcoholic stupor or coma represents a medical emergency. Obtain immediate help via radio

14. Alcohol Withdrawal Alcohol withdrawal occurs when a physiologically dependent person abruptly stops using alcohol. Physiologic dependence can develop after prolonged and heavy drinking. For example, consider a crew member who drinks alcohol regularly while in home port. When this crew member goes to sea and suddenly stops drinking, he/she may experience withdrawal within a day or two. Thus, withdrawal is most common early in a voyage. Alcohol withdrawal can be a life-threatening emergency. Symptoms include increased sweating and pulse (greater than 100/min), hand tremor, insomnia, nausea or vomiting, hallucinations or illusions, agitation, anxiety, and grand mal seizures. The patient is distressed by the symptoms. Alcohol withdrawal is diagnosed when the symptoms are due to the cessation of alcohol and not due to another medical or psychiatric disorder. Alcohol withdrawal can advance to withdrawal delirium, called delirium tremens or “DTs”. DT’s include a disturbance of consciousness and a change in cognition. DT’s usually occur within 24 to 72 hours of stopping alcohol intake; however they may occur as much as a week after.

28. Drug Abuse

29. What is Medicine ? Medicine (Latin medicus, “physician”), the science and art of diagnosing, treating,and preventing disease and injury. Its goals are to help people live longer, happier, more active lives with less suffering and disability. Medicine goes beyond the bedside of patients. Medical scientists engage in a constant search for new drugs, effective treatments, and more advanced technology. In addition, medicine is a business. It is part of the health care industry, one of the largest industries in India, and among the leading employers in most communities.

35. Types of Drugs Drugs can be categorized in many ways, hard or soft, uppers or downers, addictive or non-addictive, most harmful or least harmful, legal or illegal. However, we think a useful way of categorizing drugs is by dividing them into three categories based on the effect they achieve: STIMULANTS... They increase the activity of the central nervous system ( examples include Alkyl Nitrites, Amphetamines, Anabolic Steroids, Cocaine & Crack, Caffeine, Ecstasy and Tobacco ). DEPRESSANTS... They reduce the activity of the central nervous system ( examples include Alcohol, Barbiturates, Benzodiazepines, Heroin and Solvents ). HALLUCINOGENS... They alter perceptions of reality and may result in hallucinations ( examples include LSD, Cannabis and Magic Mushrooms ).

37. Cannabis Smoked - mixed with tobacco Concentrated syrupy liquid varying in color from clear to black Hash Oil Hashish Oil Smoked or eaten Brown or black cakes or balls Hash Hashish Taken orally Soft gelatin capsules THC Tetrahydrocannabinol Smoked or eaten Like dried parsley, with stems and/or seeds; rolled into cigarettes Pot, Reefer, Grass, Weed, Dope, Ganja, Mary Jane, or Sinsemilla Marijuana How is it used? What does it look like? What is it called? Type

39. Inhalants Vapors inhaled Cans of aerosol propellants, gasoline, glue, paint thinner Solvents Hydrocarbons Vapors inhaled Aerosol paint cans Aerosol sprays or cleaning fluids Chloro hydrocarbons Vapors inhaled In small bottles Rush, Bolt, Bullet, Locker Room, and Climax Butyl Nitrite Vapors inhaled Clear yellowish liquid in Poppers or Snappers Amyl Nitrite Vapors inhaled Small 8-gram metal cylinder sold with a balloon or pipe propellant for whipped cream in aerosol spray can Laughing gas or Whippets Nitrous Oxide How is it used? What does it look like? What is it called? Type

41. Cocaine Smoked White to tan pellets or crystalline rocks that look like soap Crack, rock, freebase Crack cocaine Inhaled, injected White crystalline powder Coke, Snow, Nose Candy, Flake, Blow, Big C, Lady, White, and Snowbirds Cocaine How is it used? What does it look like? What is it called? Type

43. Other Stimulants Taken orally, injected Pills or capsules Ritalin, Cylert, Preludin, Didrex, Pre-State, Voranil, Sandrex, and Plegine Additional Stimulants Taken orally, injected, inhaled White powder, pills, rock that resembles a block of paraffin Crank, Crystal meth, Crystal methadrine, and Speed Methamphetamines Taken orally, injected, inhaled Capsules, pills, tablets Speed, Uppers, Ups, Black beauties, Pep pills, Copilots, Bumblebees, Hearts, Benzedrine, Dexedrine, Footballs, and Biphetamine Amphetamines How is it used? What does it look like? What is it called? Type

45. Depressants Taken orally Tablets or capsules Valium, Librium, Miltown, Serax, Equanil, Miltown, and Tranxene Tranquilizers Taken orally Tablets Qualudes, Ludes, Sopors Metha qualone Taken orally Red, yellow, blue, or red and blue capsules Downers, Barbs, Blue Devils, Red Devils, Yellow Jacket, Yellows, Nembutal, Tuinals, Seconal, and Amytal Barbiturates How is it used? What does it look like? What is it called? Type

47. Hallucinogen Chewed or swallowed Fresh or dried mushrooms Magic Mushrooms, 'shrooms Psilocybin Discs - chewed, swallowed, or smoked or Tablets and capsules - taken orally Hard brown discs, tablets, capsules Mesc, Buttons, and Cactus Mescaline and Peyote Taken orally, licked off paper, gelatin, and liquid can be put in the eyes. Colored tablets, blotter paper, clear liquid, thin squares of gelatin LSD, Acid, Microdot, White lightning, Blue heaven, and Sugar Cubes Lysergic acid diethylamide Taken orally, injected, smoked (sprayed on joints or cigarettes) What does it look like - Liquid, white crystalline powder, pills, capsules PCP, Hog, Angel Dust, Loveboat, Lovely, Killer Weed Phencyclidine How is it used? What does it look like? What is it called? Type

49. Narcotics Taken orally, injected Tablets or capsules Percocet, Percodan, Tussionex, Fentanyl, Darvon, Talwin, and Lomotil Others Taken orally, injected White powder, solution, tablets Pethidine, Demerol, Mepergan Meperidine Smoked, eaten, or injected Dark brown chunks, powder Paregoric, Dover's Powder, Parepectolin Opium Taken orally, injected, or smoked White crystals, hypodermic tablets, or inject able solutions Pectoral syrup Morphine Taken orally, injected Dark liquid varying in thickness, capsules, tablets Empirin compound with codeine, Tylenol with codeine, Codeine in cough medicine Codeine Injected, smoked, or inhaled White to dark-brown powder or tar-like substance Smack, Horse, Mud, Brown sugar, Junk, Black tar, and Big H Heroin How is it used? What does it look like? What is it called? Type

51. Designer Drugs Taken orally, injected, or smoked White powder PCPy, PCE Analog of Phencyclidine (PCP) Taken orally, injected, or inhaled White powder, tablets, or capsules MDMA (Ecstasy, XTC, Adam, Essence), MDM, STP, PMA, 2, 5-DMA, TMA, DOM, DOB, EVE Analog of Amphetamines or Methamphetamines (Hallucinogens) Inhaled, injected White powder MPTP (New heroin), MPPP, synthetic heroin Analog of Meperidine (Narcotic) Inhaled, injected White powder Synthetic heroin, China white Analog of Fentanyl (Narcotic) How is it used? What does it look like? What is it called? Type