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Drug abuse & addiction
T. Páleníček
Psychiatrické centrum Praha
3. Lékařská fakulta Univerzity Karlovy
Páleníček,2002
History
• „Primitive cultures“ – Egypt,
indians, chinese …..
• Medical indications, raw material,
shamanic use
• Old continent – canabis, opiats,
mushrooms,
• New continent – mushrooms,
coca, peyotl, ayahuasca
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Today
• Illicit substances (most of them) in most
countries arround the world
• Many new drugs – chemistry
• Purity
• Lost of the traditional consequences of
use – misuse
• New ways of application
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Definitions
• Affects the perception of the reality –
psychotropic effect & addictive Potential
(Presl)
• Any substance, that if gets into the
organism, affects one or more of its
function (pharmacological def.)
• Drug (substance) abuse – psychological
or physical state of servility vis-a-vis the
drug
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Terms
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Use
Abuse
Tolerance
Dependence - physical &
psychic
• Whitdrawal syndrom
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Addiction
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First experience
Recreational use
Abuse
Dependece
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Based on the reward
– drug seeking – aplication of the drug –
effect(reward) – reinforcing effect –
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Neurobiological substrate – DA system (NAC)
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General risks of drug use
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Toxic effects
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Form of application – i.v. - infections
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Loss of control – addiction
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Social consequences - loss of work,
living place, friends
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Changes in mood, personality
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Classification
1. Natural versus synthetic
2. Through the effect
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Sedatives, tranqulisers, hypnotics
Stimulants
Halucinogens
Entactogens
Inhallants
3. Legal versus illegal
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Opiats
1. Morfin, heroin, kodein, buprenorfin …
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Acts through own receptors (µ, κ, σ)
Analgesic effect, euphoria, sedation
Vagotonic effect
Supression of breathing
High addictive potential – physical and
psychological
Tolerance – overdose
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Opiats
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Other sedatives,
tranqulisers, hypnotics
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Benzodiazepines
Barbiturates
Toluen
Alcohol
High addictive potential, physical
dependence (often mixed with
others), live threatening withdrawal
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Stimulants
1. Kokain, crack
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inhibitor of DA and NA reuptake
euphoria, state of high, increased speach,
feeling „ I am the best“
increased locomotion
elevates heart rate, blood presure
snorted, smoked, injected, on genitals
psychological dependece
heart attack, stroke
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Stimulants
1. Amphetamine, methamphetamine
(speed, ice, meth)
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Release of DA
Speed feeling, insomnia, anorexia, increased
speach, stereotyped behaviour
Increased heart rate, blood presure
Snorted, injected, smoked, per os
Psychological dependence
Heart attack, stroke, toxic hepatitis,
neurotoxic, toxic psychosis
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Halucinogens
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Natural – (cannabis), psylocin, mezcal,
ayahuasca, ibogain, muscarin
Synthetic – LSD, DOB, DOM (STP), TMA, DMT,
Ketamine (Special K), PCP (Angel dust)
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Most affect 5-HT system - 5HT2a receptors
Cannabis – CB1 & CB2 receptors
Ketamine, PCP – NMDA antagonists
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Halucinogens
1. Halucinations - tripping
2. Most are not addictive
3. Bad trip, flashbacks, risk of injury,
psychosis
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LSD (acid, trip) – trips, crystal, liquid
DOM, DOB – trips, pills
Ketamine, PCP – white powder
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Cannabis
1. Marijuana, hashish…
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many states of being, often upside-down – stimulation,
sedation, anxiosity, anxiolytic effect, laugh, halucinations,
euforia, taste to eat
anxiety disorders, memory deficits, insulted
spermatogenesis
a lot of terapeutical indications (CB – recptor agonists,
antagonists, natural medicine)
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Entactogens
1. MDMA, MDEA, MDA
2. PMA, PMMA, 4-MTA, 2C-B, 2C-T-7,
MBDB
Entactogen = „the touch within“
producing state of well being, empathy, belonging
to others, feeling of love, peace
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Ecstasy
E, madam, eve, pill, xtc…
1. Ecstasy - MDMA (MDA, MDEA)
2. Ecstasy - tablet (capsule)
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Use of MDMA
• Young people (15 – 30 yrs)
• All social groups
• Connection with parties
• polydrug users
• „recreational users“
• Per os, snorted
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effects
1. Metabolised by (CYP2D6) (cytochrom P450)
2. 5-9% white population is defficient
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Poor metabolisers
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Increased risk of acute toxicity
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Drug-drug interactions (virostatics - ritonavir)
3. Acute effects – release of 5-HT and DA
4. Chronic effects – toxic effects
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effects
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Chronic: neurotoxicity - cognitive defficit, sleep
disorders, parkinsonism???, toxic hepatitis,
teratogenic, imune dysfunction, flashbacks, psychosis
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Risks: serotonin syndrom, stroke, rhabdomyolysis,
acute liver failure
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Neurotoxicity: selective degeneration of 5-HT and DA
axons
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Treatment of addiction
• Motivation
• Decission to stop
• First contact with proffesionals (K-centre,
hospital …)
• Again motivation and testing the decision to
stop
• Detoxification
• Therapy – ambulant, in hospital, in
community
• Susequent care – getting back to society
• Relaps
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Prevence
• Primární – vzdělávání cílové populace
• Sekundární – práce s vyléčenými
(abstinujícími) závislými
• Terciární – minimalizace rizik (harm
reduction, substituční léčba,
testování drog)
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Děkuji vám za pozornost
Páleníček,2002
Serotonergní dráhy
5-HT vlákna vycházejí zejména z mediálních a dorsálních rapheálních
jader a projikují se do řady podkorových i korových oblastí mozku
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rapheální jádra
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hypothalamus
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amygdala, hipocampus
neocortex
caudatum, putamen
thalamus
substantia nigra
neurovaskulární orgány komor
9. mozeček
10. mícha
(upraveno podle Manter and Gatz´s essentials of clinical Neuroanathomy and Neurofysiology, 1992)
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