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Drug abuse (dependence)

Definitions:

Substance abuse and dependence refers to any continued pathological use of

a medication, non medically indicated drug (called drugs of abuse)

They normally are distinguished as follows:

Substance abuse is any pattern of substance use that results in

repeated adverse social consequences related to drug taking, for

example, interpersonal conflicts, failure to meet work, family or school

obligations or legal problems

Substance dependence, commonly known as addiction, is

characterized by physiological and behavioral symptoms related to

substance use, these symptoms include the need for increasing

amounts of the substance to maintain desired effects, withdrawal if

drug-taking ceases, and a great deal of time spent in activities relatedto substance use.

WHO described dependence as a syndrome includes:

1. A compulsion to use the drug, usually during attempts to stop consumption

2. The wish to cease drug use although intake continues

3. Adaptive changes in the nervous system leads to tolerance and withdrawal

symptoms

4. Drug intake to relieve withdrawal symptoms

5. Priority to drug seeking

On this ground, dependence means that the person becomes in continuous need for

the drug, stoppage of administration leads to:

a) Withdrawal symptoms (physical dependence): It is a serious characteristic

illness occurs on withdrawal of the drug due physical dependence which

could be stopped by administration of the drug

b) Desire to the euphoria: (craving): it is due to psychological dependence on

the effect of the drug

Tolerance:

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It is a tendency to increase the dose of the drug because the repetition with

the same dose has progressively less effect and the dose needs to be

increased to obtain the same effect

Progressive increase of the dose leads to failure of the proper feeding

resulting in physical deterioration then stop working then forced to do

anything to get the drug then moral deterioration

Cross tolerance:

Ability of one drug to suppress manifestations of physical dependence produced

by another (substitution therapy)

Causes of substance dependence:

They are not well established but three factors are believed to contribute tosubstance-related disorders:

Genetic factors

Psychopathology

Social learning

1- Genetic factors:

In genetic epidemiological studies of alcoholism , the probability of

identical twins both exhibiting alcohol dependence was significantly

greater than with fraternal twins thus suggesting a genetic componentin alcoholism

It is unclear whether the genetic factor is related to alcoholism directly

or it is linked to other psychiatric disorders that are known to be

associated with substance abuse

2- Psychopathology

They include antisocial personality disorder, bipolar disorder, depression,

anxiety disorder and schizophrenia

3- Social environment:

In this model, drug taking is essentially a socially learned behavior. Local

social norms determine determine the likelihood that a person is exposed to

the substance and whether continued use is reinforced. For example,

individuals may by observing family or peer role models learn that substance

use is normal.

Clinical presentation of drug dependence in general:

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a. Due to dependence

Withdrawal symptoms

Craving

b. Due to tolerance: Physical deterioration

Moral deterioration

c. Due to acute toxicity

Overdose

Synergism or potentiation with other drugs

Adultration and foreign substance

d. Due to infective disease

Viral hepatitis

AIDS

General management of dependence:

a. Treating the physical dependence by withdrawal

Appropriate withdrawal is preferrd in treatment of all types of drug

dependence except morphine and barbiturates

b. Treating the psychological dependence by rehabilitationc. Follow-up

Dependence producing drugs:

a. Stimulants:

Natural: coffee, tea and cocaine

Synthetic: amphetamine and methamphetamine

b. Depressants: hypnotics, tranquillizers

c. Hallucinogens

d. Euphoriants

Opium or morphine and heroine dependence

Gradual physical deterioration

Gradual moral deterioration

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Injection marks

Miosis, constipation, loss of appetitie and euphoria

Severe withdrawal syptomps

Gradual withdrawal is needed in treatment, may be relieved by barbituratesand tranquillizers

Barbiturate dependence

Physical deterioration

Mental deterioration

Severe withdrawal sypmtoms

Gradual withdrawal is needed in treatment

Gradual withdrawal may be relieved by tranquillizers

Alcohol dependence

Physical deterioration

Mental deterioration

Jealous husband syndrome: the person becomes jealous with excessive

sexual desire and impotence at the same time

Coarse tremors in the lips and hands

Pachymeningitis hemorrhagica (chronic subdural hematoma)

Appropriate withdrawal is preferred

Antabuse (disulfiram): alcohol dehydrogenase inhibitor. If alcohol is taken

during administration of antabuse, a disturbance occurs in alcohol

metabolism. It stops at acetaldehyde stage, the accumulation of

acetaldehyde leads to undesirable effects (tachycardia, palpitation and

vomiting). This will make the patient hates alcohol.

Amphetamine dependence

Action:

Stimulation of cerebral cortex

Stimulation of reticular formation

Suppression of appetite

Physical deterioration

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Mental deterioration

Personality changes (suicide or homicide)

Abrupt withdrawal

Cocaine dependence

Physical deterioration

Mental deterioration

Cocaine bug: the patient feels as if insects are creeping under the skin

Moral deterioration

Sexual perversion

Increase aggressiveness