Transcript Addiction and Drug Abuse

Addiction and Drug
Abuse
By
S.Bohlooli, PhD
Cultural Consideration
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Licit or Illicit ?!
Resultant criminal activity leads to make an
agent considered as illicit.
Activity like: robbery, prostitution and other
antisocial activity.
•Drug Misuse
A drug might be used for a
wrong indication, or wrong
dosage, and or too long period
•Drug Abuse
 abuse might be construed as any
use of drug for non medical
purpose
substance dependence (addiction)
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cluster of symptoms indicating that the
individual continues use of the substance
despite significant substance-related problems.
PHYSICAL AND PSYCHOLOGICAL
DEPENDENCE
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Physical dependence is a state that develops
as a result of the adaptation (tolerance)
produced by a resetting of homeostatic
mechanisms in response to repeated drug use.
Psychological dependence is manifested by
compulsive drug seeking behavior in which the
individual uses the drug repetitively for
personal satisfaction often in the face of
known risks to health
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Tolerance is the most common response to repetitive use of the
same drug and can be defined as the reduction in response to
the drug after repeated administrations
Types of Tolerance
•Innate (preexisting sensitivity or insensitivity)
•Acquired
Pharmacokinetic (dispositional or metabolic)
Pharmacodynamic
Learned tolerance
Behavioral
•Conditioned
Acute tolerance
Reverse tolerance (sensitization)
Cross-tolerance
Origins of Substance Dependence
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Agent (drug)
Host (user)
Environment
Agent (drug)
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Availability
Cost
Purity/potency
Mode of administration:
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Chewing (absorption via oral mucous membranes)
Gastrointestinal
Intranasal
Subcutaneous and intramuscular
Intravenous
Inhalation
Speed of onset and termination of effects
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Pharmacokinetics: combination of agent and host
Host (user)
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Heredity
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Innate tolerance
Speed of developing acquired tolerance
Likelihood of experiencing intoxication as
pleasure
Psychiatric symptoms
Prior experiences/expectations
Propensity for risk-taking behavior
Environment
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Social setting
Community attitudes
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Peer influence, role models
Availability of other reinforcers (sources of
pleasure or recreation)
Employment or educational opportunities
Withdrawal Syndrome
Withdrawal signs and symptoms occur when
drug administration in a physically dependent
person is abruptly terminated.
 Withdrawal symptoms have at least two
origins:
(1) removal of the drug of dependence,
(2) central nervous system hyperarousal due to
readaptation to the absence of the drug of
dependence.
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VII. Co-administration/Coabuse
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Many of these drugs are used in combination with
other drugs from one or more categories.
 Alcohol is used, for example, with almost
everything else.
 Smoking (nicotine intake) is prevalent in patients
using other drugs.
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Be aware of the possibility of combination of drugs
when treating intoxication, withdrawal or overdose,
each drug will require a specific treatment.
Neurobiology of Abused Drugs
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Many drugs acts through G protein coupled
receptor (dopamine, opioid and cannabinoid)
Chloride Ion channel associated with GABA
(benzodiazepines)
Excitatory amino acid receptors
(phencyclidine)
I. Animal Studies
A)
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Drug-self administration
Drugs as reinforcers
animals.
High correlation with
human dependence
liability.
in
Morphine/Heroin
Self-Administration
II. Brain Reward System
Changes in brain function => Reward=> Craving
Involve the Dopaminergic System
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Mesolimbic pathway:Ventral tegmental area
(VTA), medial forebrain bundle, nucleus
accumbens and the prefrontal cortex.
Nigrostriatal pathway: Sustantia nigra, striatum.
 Mesocortical pathway: VTA, cingulate and
frontal CTX.
 Tubero-Infundibular: Arcuate N. in
hypothalamus.
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THE DOPAMINERGIC SYSTEM
THE MESOLIMBIC DOPAMINERGIC REWARD PATHWAY
Tyrosine
Tyrosine
L-DOPA
DA
Dopamine Synapse
Dopamine Reuptake System
Alcohol consumption
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Sedation
Relief of anxiety
Slurred speech
Ataxia
Impaired judgment
Disinhebited behavior
Alcohol Withdrawal Syndrome
Alcohol craving
Tremor, irritability
Confusion
Visual hallucinations
Nausea
Sleep disturbance
Fever, profuse
sweating
Tachycardia
Tachycardia
Hypertension
Nausea, diarrhea
Dilated pupils
Sweating
Perceptual distortion
Seizures (12 to 48 hours after last drink)
Severe agitation
Delirium tremens (rare in uncomplicated
withdrawal)
Benzodiazepine Withdrawal Symptoms
Following moderate dose usage
Anxiety, agitation
Increased sensitivity to light and sound
Paresthesias, strange sensations
Muscle cramps
Myoclonic jerks
Sleep disturbance
Dizziness
Following high-dose usage
Seizures
Delirium
Nicotine Withdrawal Syndrome
Irritability, impatience, hostility
Anxiety
Dysphoric or depressed mood
Difficulty concentrating
Restlessness
Decreased heart rate
Increased appetite or weight gain
Clinical aspect of opioid use
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Rush: an orgasm like reaction
Euphoria
Feeling of tranquility and sleepiness
Opioid Withdrawal
SYMPTOMS
SIGNS
Regular Withdrawal
Craving for opioids
Pupillary dilation
Restlessness, irritability
Sweating
Increased sensitivity to pain
Piloerection ("gooseflesh")
Nausea, cramps
Tachycardia
Muscle aches
Vomiting, diarrhea
Dysphoric mood
Increased blood pressure
Insomnia, anxiety
Yawning
Fever
Protracted Withdrawal
Anxiety
Insomnia
Drug craving
Cyclic changes in weight, pupil
size, respiratory center sensitivity
CNS stimulants
Clinical aspects of stimulants
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Rush
Mental alertness
Marked euphoria
Delusion (bugs are crawling under skin!)
Spree use ( up to 4000 mg /day amphetamine)
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Lack of food
Lack of sleep
Cocaine Withdrawal Symptoms and Signs
Dysphoria, depression
Sleepiness, fatigue
Cocaine craving
Bradycardia
Clinical effect of marijuana
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Being high
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Euphoria
Uncontrollable laughter
Alteration of time sense
Depersonalization
Sharpened vision
Late: becoming relaxed, experience of introspective and
dream-like effect
Difficulty in concentration and thinking
Marijuana Withdrawal Syndrome
Restlessness
Irritability
Mild agitation
Insomnia
Sleep EEG disturbance
Nausea, cramping
Drugs Kill the Brain