Transcript Drug Addiction Part 3

Drug Addiction
Part 3
Karen Revere
Kian Eftekhari
Will Hiesinger
Risk of Addiction
Ever Used (%) Dependence (%) Risk
(%)
Tobacco
75.6
24.1
*31.9
Cocaine
16.2
2.7
16.7
Heroin
1.5
0.4
23.1
Alcohol
91.5
14.1
15.4
Cannabis
46.3
4.2
9.1
Source: Anthony et al, 1994.
Courtesy of Charles A. Dackis, MD
Complications of Cocaine Use
Cerebrovascular Disorders
i.e. Ischemic or Hemorrhagic strokes
-Hemorrhage occurs about twice as frequently as ischemia.
-Hemorrhagic manifestations may be intraparenchymal or subarachnoid
hemorrhage.
-Hemorrhage may occur within seconds of cocaine use or may lag cocaine
use by as long as 12 hours. In many cases, it occurs within a few minutes.
-Ischemic strokes are likely due to vasospasm, vasculitis, or due to the
procoagulant effect of the drug.
-Most cocaine-induced strokes occur in patients younger than 50 years.
The image was obtained 79 minutes
from the sudden onset of right-sided
weakness and numbness. T2weighted imaging and FLAIR show
the lesion as an area of increased
signal intensity with a periphery of
signal loss (arrows C) and a
surrounding rim of increased signal
intensity, most likely due to
vasogenic edema encasing the
hematoma. CT obtained seven hours
from symptom onset shows a left
thalamic hematoma. Linfante, I,
Lilnas, RH, Caplan, LR, Warach, S,
Stroke 1999; 30:2263. Copyright ©
1999 Lippincott Williams and Wilkins.
So, why is this bad?
…because you DIE.
Hypertensive intracerebral hemorrhage
-The 30-day mortality from ICH ranges from 35 to 52 percent and one-half of
these deaths occur within the first two days.
-Only a small number of patients function independently after the event.
Neuropsychiatric
complications
-Neuropsychiatric complications occur in
about 40% of cocaine users.
-Psychiatric disturbances include:
depression, suicidal ideation, paranoia,
violent antisocial behavior, catatonia,
and auditory or visual hallucinations.
-A moderate proportion of addicts
develop panic attacks.
-The paranoid symptoms are more
severe and develop more rapidly with
continuous use of cocaine.
Seizure
-Seizures occur in about 3% of cocaine users.
-The majority of seizures are single, generalized, induced by intravenous or
crack cocaine
-Seizures are one of the few complications of cocaine use in which a direct
relationship with dose has been shown.
-All routes of administration are associated with seizures, and seizures can
be induced in some persons by small quantities of cocaine.
Cocaine use is associated with a variety of
movement disorders: "crack dancers"
-Stereotyped behaviors
-Acute dystonic reactions (sustained, often painful muscular spasms, producing
twisting abnormal postures)
-Choreoathetosis (brief, irregular contractions with twisting and writhing
movements) and akathisia (extreme sensation of restlessness)
-Buccolingual dyskinesias ("twisted mouth" or "boca torcida")
-Exacerbation of Tourette's syndrome
Not Just the Brain
Treatment
-Treatment for cocaine addiction occurs primarily in the outpatient
setting, and involves psychosocial treatment.
-Rates for long-term abstinence are less than 50 percent.
-Buprenorphine may be helpful for patients who are co-addicted to
opiates.
-Disulfiram, topiramate, tiagabine, and modafinil have shown some
promise for cocaine abstinence.
-Peer group self-help programs (such as Cocaine Anonymous) improve
outcomes.
Reduced D2 Binding in Cocaine Dependence
One of the most
interesting findings in
cocaine research . . . .
Raclopride binds D2
receptors in the nucleus
accumbens…
D2 is also seen with morbid
obesity, and addiction to alcohol,
heroin & methamphetamine
Courtesy of Charles A. Dackis, MD
Modafinil Promotes Cocaine Abstinence
Modafinil is a Dopamine enhancing drug
P lac ebo
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
1
2
3
M odafinil
4 Study
5 Week
6
7
8
Longitudinal GEE models showed a significant main effect for cocaine abstinence in
the modafinil group (odds ratio = 2.41, 95% CI 1.09-5.31, p = 0.03)
Courtesy of Charles A. Dackis, MD
Dackis et al.. Neuropsychopharmacology 2005