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Understanding Drug Dependence and Abuse

This document discusses various topics related to drug dependence and addiction. It defines key terms like drug abuse, tolerance, physical dependence, and addiction. It also covers classes of drugs of abuse and factors that influence drug abuse. The document discusses treatment of drug addiction and highlights the high relapse rate. It provides details on tolerance, physical dependence, withdrawal symptoms, and medical interventions for opioid and CNS depressant addiction.

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Dessy Kusumadewi
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74 views23 pages

Understanding Drug Dependence and Abuse

This document discusses various topics related to drug dependence and addiction. It defines key terms like drug abuse, tolerance, physical dependence, and addiction. It also covers classes of drugs of abuse and factors that influence drug abuse. The document discusses treatment of drug addiction and highlights the high relapse rate. It provides details on tolerance, physical dependence, withdrawal symptoms, and medical interventions for opioid and CNS depressant addiction.

Uploaded by

Dessy Kusumadewi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

Drug Dependence

Blanton, March 10, 2004

Drug Abuse
Illicit designation varies with culture
Illicit designation varies over time Licit US drugs currently include caffeine, tobacco, and alcohol

Drug Abuse
Significant Morbidity and Mortality

Economic Drain Legal Drugs most commonly misused

Drugs of Abuse Trends of use and disuse Trends of societal acceptance and nonacceptance
Legalization/decriminalization of marijuana- medical pot

Terminology
Drug Abuse- use outside accepted norms
Compulsive use- preoccupation with drug

Psychological Dependence- need for drug to maintain feeling of well being


Physical Dependence- changes that result in withdrawal if drug is stopped Tolerance- drug loses effectiveness

Terminology
Addiction: physical, psychological dependence, tolerance
uncontrollable obsession to obtain and use drug

Classes of Drugs of Abuse


-Opioids -CNS Depressants -CNS Stimulants -Nicotine -Cannabinoids -Psychedelics -Arylcyclohexylamines -Inhalants

Factors in Drug Abuse


Drug: effects, availability, price User: heredity, psychiatric disorders, risk-taking behavior Environment: social setting, peers

Treatment of Drug Addiction High Relapse Rate- CRAVING Success---> Long term treatment Supportive and/or Psych therapy AA and NA

Tolerance

Dispositional- pharmacokinetic

Pharmacodynamic- functional
Behavioral- learned Cross- similar class- substitute Degree- dose, frequency, duration

Physical Dependence
Not a single mechanism Linked to Tolerance and Adaptation Three Conditions: -Sufficient Dose -Sufficient Frequency -Sufficent Duration Withdrawal in Absence of Drug

Intensity of Withdrawal

Degree of Cellular Adaptation Half-life of the drug

Cross- Dependence
Clinical use of drugs from the same class as the drug of addiction- to reduce withdrawal:
methadone for heroin benzodiazepines for ethanol

Opiate Addiction

Significant # of health care professionals


stress easy access to pharmaceutical grade opiates

Opiate Addiction
Opiate Effects intensely pleasurable feelings
IV Heroin Rapid Tolerance- 100x dose increase Short t1/2 grade of heroin

Opiate Withdrawal- Signs


craving mydriasis restlessness sweating pain sensitivity gooseflesh nausea vomiting cramps diarrhea muscle aches blood pressure dysphoria yawning insomnia fever

Opiate Addiction Intervention Methadone Substitution titrated downward over time Clonidine for autonomic symptoms

Opiate Addiction Intervention Methadone: long half-life


Heroin
Methadone
0 6 12 18 24

High Normal Sick

Hours

Opiate Addiction Intervention


Acetylmethadol

Buprenorphine-

partial agonist

Naltrexone-

antagonist

CNS Depressant Addiction


Cognition and Psychomotor Performance
Overdosage--> Respiratory Arrest

Tolerance to Psychic and Motor Effects, but not to respiratory depression

CNS Depressant Withdrawal

Must be treated Risk of fatal status epilepticus Ethanol and Barbiturates- more dangerous than Benzodiazepines

Concluding Remarks Polysubstance Abuse Underreporting of alcohol and nicotine use


Shame in admission of illicit drug abuse

Study Guide

1) Understand tolerance and physical dependence. 2) Contrast opioid and CNS depressant withdrawal symptoms. 3) Contrast medical management of withdrawal from opioid and CNS depressants.

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