{"id":329,"date":"2020-02-16T10:45:52","date_gmt":"2020-02-16T05:15:52","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=329"},"modified":"2020-02-16T10:45:52","modified_gmt":"2020-02-16T05:15:52","slug":"drug-dependence","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/drug-dependence\/","title":{"rendered":"Drug dependence"},"content":{"rendered":"\n

Drug dependence<\/strong><\/p>\n\n\n\n

Repeated administration of certain drugs may induce a habit and dependence.<\/p>\n\n\n\n

If the habit-forming agent is not made available to the habitu\u00e9, he develops withdrawal symptoms characterized by psychic\/physical disturbances like headache, restlessness & emotional upset and\/or convulsions & vasomotor collapse.<\/p>\n\n\n\n

WHO definition <\/strong>\u00e0<\/strong>,<\/strong> \u2018A state, psychic & sometimes also physical, resulting from the interaction between a living organism & a drug, characterized by behavioral & <\/strong>other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects & sometimes to avoid the discomfort of its absence<\/strong>.<\/p>\n\n\n\n

Tolerance may or may not be present. A person may be dependent on more than one drug\u2019. Withdrawal of a drug can precipitate a drug withdrawal syndrome.<\/p>\n\n\n\n

Drug dependence is of 3 type:<\/p>\n\n\n\n

  1. Psychic<\/u><\/strong>: A condition in which a drug produces \u2018a feeling of satisfaction & a psychic drive that require periodic or continuous administration of the drug to produce pleasure or to avoid discomfort\u2019, is called psychic dependence.<\/li>
  2. Physical<\/u><\/strong>: In the case of physical dependence, the body achieves an adaptive state that manifests itself by intense physical disturbances when the drug is withdrawn (withdrawal syndrome).<\/li>
  3. Combined<\/u><\/strong>.<\/li><\/ol>\n\n\n\n

    Drugs causing dependence<\/strong> include<\/p>\n\n\n\n

    • Opioids<\/u><\/strong>:<\/strong> Morphine, Heroin, Pethidine (Psychological + Physical)<\/li>
    • CNS Stimulants<\/u><\/strong>:<\/strong> Amphetamjines, Methylphenidate, Caffeine, Nicotine, Cocaine<\/li>
    • CNS Depressants<\/u><\/strong>:<\/strong> Ethyl alcohol,  Barbiturates, Benzodiazepines, Methaqualone<\/li>
    • Hallucinogens<\/u><\/strong>:<\/strong> Lysergic acid diethylamide (Only Psychological), Phencyclidine, Cannabinoids,<\/li><\/ul>\n\n\n\n

                   Psilocybine, Psilocin, Dimethyl tryptamine,<\/p>\n\n\n\n

      Role of Dopamine<\/strong><\/p>\n\n\n\n

      • Primary neurotransmitter of the reward circuit in the brain.<\/li>
      • It regulates movement, emotion, cognition, motivation, and feelings of pleasure.<\/li>
      • Natural Rewards like food, water, coitus, nurturing etc. cause a release of dopamine, and are associated with the reinforcing nature of these stimuli.<\/li>
      • Nearly all addictive drugs, directly or indirectly, act upon the brain\u2019s reward system by flooding the circuit with dopamine.<\/li>
      • On drug abuse, dopamine secretion can increase from 2 to 10 folds. Thus, addictive drugs are perceived by the brain as being very rewarding, this can lead to repetitive behavior (reinforcement).<\/li><\/ul>\n\n\n\n
        \"\"<\/figure>\n\n\n\n
        1. Opioids<\/strong><\/li><\/ol>\n\n\n\n

          Overdose \u00e0 Accidental, suicidal or seen in drug abusers<\/p>\n\n\n\n

          S\/S: respiratory depression, cyanosis, fall in BP and shock, miosis, flaccidity, stupor, coma, death due to respiratory failure<\/p>\n\n\n\n

          Treatment:<\/p>\n\n\n\n

          Respiratory support, maintenance of BP, gastric lavage<\/p>\n\n\n\n

          Specific antidote: Naloxone 0.4-0.8 mg i.v.<\/strong><\/p>\n\n\n\n

          Opioid Dependence<\/u><\/strong><\/p>\n\n\n\n

          Most individuals with Opioid Dependence have significant levels of tolerance.<\/p>\n\n\n\n

          Withdrawal is associated with marked drug seeking behaviour<\/p>\n\n\n\n

          Physical manifestations \u00e0 lacrimation, sweating, yawning, anxiety, fear, restlessness, mydriasis, tremor, insomnia, abdominal colic, diarrhoea, rise in BP, palpitation, rapid weight loss<\/p>\n\n\n\n

          Treatment:<\/p>\n\n\n\n

          1. Substitution therapy with methadone<\/li>
          2. Clonidine: \u03b12<\/sub> agonist acts on presynaptic receptors & inhibit release of NE<\/li>
          3. Naltrexone + Clonidine: naltrexone induces withdrawal which is overcome by clonidine, then naltrexone is used for maintenance<\/li>
          4. Cannabinoids<\/strong><\/li><\/ol>\n\n\n\n

            Obtained from Cannabis indica<\/em> (marijuana)<\/p>\n\n\n\n

            Various forms in which it is used:<\/p>\n\n\n\n

            1. Bhang derived from dried leaves, taken orally<\/li>
            2. Ganja derived from dried female inflorescence, smoked<\/li>
            3. Charas resinous extract from flowering tops and leaves, smoked with tobacco (hashish)<\/li><\/ol>\n\n\n\n
              • Most important active principle is\u0394<\/strong>9<\/sup><\/strong> tetrahydrocannabinol (<\/strong>\u0394<\/strong>9<\/sup><\/strong> THC)<\/strong><\/li><\/ul>\n\n\n\n

                Cannabis Dependence<\/strong><\/p>\n\n\n\n

                • Individuals with dependence have compulsive use & generally do not develop physiological dependence.<\/li>
                • Chronic use leads to tolerance<\/li>
                • Withdrawl symptoms \u2013 mild<\/li>
                • Interferes with family, school, work or recreational activities. (amotivational syndrome)<\/li>
                • Persistent use despite physical (e.g chronic cough d\/t smoking) or psychological (e.g excess sedation d\/t repeated use of high doses)<\/li>
                • Supportive treatment suffice in withdrawal state.<\/li><\/ul>\n\n\n\n
                  • Hallucinogens<\/strong><\/li><\/ul>\n\n\n\n

                    Affect thought, perception and mood at low doses with minimal effects on memory & orientation<\/p>\n\n\n\n

                    Produce shape and color distortion, depersonalization, hallucination, slowing of time perception, sense that colors are heard & sounds are seen<\/p>\n\n\n\n

                    • Hallucinogens may continue to be used despite the knowledge of adverse effects (e.g., memory impairment while intoxicated; “bad trips,\u201c which are usually panic reactions; or flashbacks)<\/li>
                    • Bad trips require medical attention in form of talking down\/reassurance.<\/li>
                    • Severe agitation may respond to diazepam (20 mg orally)<\/strong><\/li>
                    • Nicotine and tobacco<\/strong><\/li><\/ul>\n\n\n\n

                      Spending a great deal of time in using the substance is best exemplified by chain-smoking. (time to procure is minimal)<\/p>\n\n\n\n

                      Giving up important social, occupational, or recreational activities (in searching smoking-restricted areas)<\/p>\n\n\n\n

                      Continued usage despite medical problems like bronchitis, COPD d\/t smoking.<\/p>\n\n\n\n

                      • Combination of psychological and pharmacological treatment<\/li>
                      • Nicotine replacement therapy: transdermal patch, chewing gum, inhalers, nasal spray, lozenges<\/li>
                      • Bupropion, Clonidine<\/li>
                      • Rimonabant : CB1receptor inverse agonist improves abstinence rates and reduces the weight gain but high frequency of depressive and neurologic symptoms<\/li>
                      • Varenicline : partially stimulates nicotinic receptors – reducing craving and preventing most withdrawal symptoms.<\/li><\/ul>\n\n\n\n
                        • Alcohol (ethanol)<\/strong><\/li>
                        • Acts through several cellular mechanisms<\/li>
                        • Ionotropic receptors:<\/li><\/ul>\n\n\n\n

                                 GABAA <\/sub>\u2013 enhances GABA mediated inhibition,<\/p>\n\n\n\n

                                      <\/sub>NMDA (glutaminergic) – inhibition<\/p>\n\n\n\n

                                 5-HT3<\/sub> – activation<\/p>\n\n\n\n

                          • Ion channel: Kir3\/GIRK<\/li>
                          • Transporter: (equilibrative nucleoside transporter, ENT1, related to adenosine uptake)<\/li>
                          • Not known which target is responsible for DA release<\/li><\/ul>\n\n\n\n
                            \"\"<\/figure>\n\n\n\n
                            • Anti-craving agents<\/li>
                            • Naltrexone: interferes with alcohol induced reinforcement by blocking opioid receptors<\/li>
                            • Acamprosate : NMDA receptor antagonist –  normalize the dysregulated neurotransmission associated with chronic ethanol intake<\/li>
                            • Fluoxetine: used occasionally<\/li><\/ul>\n\n\n\n
                              • Amphetamines dependence treatment<\/strong>
                                • Behaviour therapy: aversion therapies like sub threshold electric shock or emetic like apomorphine<\/li><\/ul>
                                  • Psychotherapy<\/li><\/ul>
                                    • Group therapy e.g. alcoholics anonymous, narcotic anonymous<\/li><\/ul>
                                      • Detoxification: Gradual tapering of drug that has caused dependence or sudden withdrawal of drug followed by substitution therapy<\/li><\/ul>
                                        • Specific drug therapy e.g. Disulfiram<\/li><\/ul>
                                          • Correction of nutritional deficiencies<\/li><\/ul>
                                            • Community treatment and rehabilitation <\/li><\/ul><\/li><\/ul>\n\n\n\n
                                              \"\"<\/figure>\n","protected":false},"excerpt":{"rendered":"

                                              Drug dependence Repeated administration of certain drugs may induce a habit and dependence. If the habit-forming agent is not made available to the habitu\u00e9, he develops withdrawal symptoms characterized by psychic\/physical disturbances like headache, restlessness & emotional upset and\/or convulsions & vasomotor collapse. WHO definition \u00e0, \u2018A state, psychic & sometimes also physical, resulting from[…]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/329"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=329"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/329\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=329"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=329"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=329"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}