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Addiction and Drug Addiction and Drug AbuseAbuse
ByBy
S.Bohlooli, PhDS.Bohlooli, PhD
Cultural ConsiderationCultural Consideration
Licit or Illicit ?!Licit or Illicit ?! Resultant criminal activity leads to make an Resultant criminal activity leads to make an
agent considered as illicit.agent considered as illicit. Activity like: robbery, prostitution and other Activity like: robbery, prostitution and other
antisocial activity.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)
cluster of symptoms indicating that the individual continues use of the substance despite significant substance-related problems.
PHYSICAL AND PSYCHOLOGICAL DEPENDENCE
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
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
Agent (drug) Host (user) Environment
Agent (drug) Agent (drug) AvailabilityAvailability CostCost Purity/potencyPurity/potency Mode of administration:Mode of administration:
Chewing (absorption Chewing (absorption viavia oral mucous membranes) oral mucous membranes) GastrointestinalGastrointestinal IntranasalIntranasal Subcutaneous and intramuscularSubcutaneous and intramuscular Intravenous Intravenous Inhalation Inhalation
Speed of onset and termination of effectsSpeed of onset and termination of effects Pharmacokinetics: combination of agent and hostPharmacokinetics: combination of agent and host
Host (user)Host (user) HeredityHeredity
Innate toleranceInnate tolerance Speed of developing acquired toleranceSpeed of developing acquired tolerance Likelihood of experiencing intoxication as Likelihood of experiencing intoxication as
pleasurepleasure Psychiatric symptomsPsychiatric symptoms Prior experiences/expectationsPrior experiences/expectations Propensity for risk-taking behaviorPropensity for risk-taking behavior
EnvironmentEnvironment
Social settingSocial setting Community attitudesCommunity attitudes
Peer influence, role modelsPeer influence, role models Availability of other reinforcers (sources of Availability of other reinforcers (sources of
pleasure or recreation)pleasure or recreation) Employment or educational opportunitiesEmployment 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.
VII. Co-administration/Co-VII. Co-administration/Co-abuseabuse
Many of these drugs are used in combination with Many of these drugs are used in combination with other drugs from one or more categories.other drugs from one or more categories. Alcohol is used, for example, with almost Alcohol is used, for example, with almost
everything else.everything else. Smoking (nicotine intake) is prevalent in patients Smoking (nicotine intake) is prevalent in patients
using other drugs.using other drugs.
Be aware of the possibility of combination of drugs Be aware of the possibility of combination of drugs when treating intoxication, withdrawal or overdose, when treating intoxication, withdrawal or overdose, each drug will require a specific treatment. each drug will require a specific treatment.
Neurobiology of Abused DrugsNeurobiology of Abused Drugs
Many drugs acts through G protein coupled Many drugs acts through G protein coupled receptor (dopamine, opioid and cannabinoid)receptor (dopamine, opioid and cannabinoid)
Chloride Ion channel associated with GABA Chloride Ion channel associated with GABA (benzodiazepines)(benzodiazepines)
Excitatory amino acid receptors Excitatory amino acid receptors (phencyclidine)(phencyclidine)
I. Animal StudiesI. Animal Studies
A)A) Drug-self administrationDrug-self administration Drugs as reinforcers in Drugs as reinforcers in
animals.animals. High correlation withHigh correlation with
human dependencehuman dependence
liability.liability.
Morphine/HeroinMorphine/Heroin
Self-AdministrationSelf-Administration
II. Brain Reward SystemII. Brain Reward SystemChanges in brain function => Reward=> CravingChanges in brain function => Reward=> Craving
Involve the Dopaminergic SystemInvolve the Dopaminergic System Mesolimbic pathway:Ventral tegmental area Mesolimbic pathway:Ventral tegmental area
(VTA), medial forebrain bundle, nucleus (VTA), medial forebrain bundle, nucleus accumbens and the prefrontal cortex.accumbens and the prefrontal cortex.
Nigrostriatal pathway: Sustantia nigra, Nigrostriatal pathway: Sustantia nigra, striatum.striatum.
Mesocortical pathway: VTA, cingulate and Mesocortical pathway: VTA, cingulate and frontal CTX.frontal CTX.
Tubero-Infundibular: Arcuate N. in Tubero-Infundibular: Arcuate N. in hypothalamus.hypothalamus.
THE DOPAMINERGIC SYSTEMTHE DOPAMINERGIC SYSTEM
THE MESOLIMBIC DOPAMINERGIC REWARD PATHWAY
Dopamine Synapse
DA
L-DOPA
Tyrosine
Tyrosine
Dopamine Reuptake System
Alcohol consumption Alcohol consumption
SedationSedation Relief of anxietyRelief of anxiety Slurred speechSlurred speech AtaxiaAtaxia Impaired judgmentImpaired judgment Disinhebited behaviorDisinhebited behavior
Alcohol Withdrawal Syndrome
Alcohol craving Confusion
Tremor, irritability Visual hallucinations
Nausea Fever, profuse sweating
Sleep disturbance Tachycardia
Tachycardia Nausea, diarrhea
Hypertension Dilated pupils
Sweating Severe agitation
Perceptual distortion
Seizures (12 to 48 hours after last drink)
Delirium tremens (rare in uncomplicated withdrawal)
Benzodiazepine Withdrawal SymptomsFollowing 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 useClinical aspect of opioid use
Rush: an orgasm like reactionRush: an orgasm like reaction EuphoriaEuphoria Feeling of tranquility and sleepinessFeeling of tranquility and sleepiness
Opioid WithdrawalSYMPTOMS 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
AnxietyInsomniaDrug craving
Cyclic changes in weight, pupil size, respiratory center sensitivity
CNS stimulantsCNS stimulants
Clinical aspects of stimulantsClinical aspects of stimulants
RushRush Mental alertnessMental alertness Marked euphoriaMarked euphoria Delusion (bugs are crawling under skin!)Delusion (bugs are crawling under skin!) Spree use ( up to 4000 mg /day amphetamine) Spree use ( up to 4000 mg /day amphetamine)
Lack of foodLack of food Lack of sleepLack of sleep
Cocaine Withdrawal Symptoms and Signs
Dysphoria, depression
Sleepiness, fatigue
Cocaine craving
Bradycardia
Clinical effect of marijuanaClinical effect of marijuana
Being highBeing high EuphoriaEuphoria Uncontrollable laughterUncontrollable laughter Alteration of time senseAlteration of time sense DepersonalizationDepersonalization Sharpened visionSharpened vision Late: becoming relaxed, experience of introspective and Late: becoming relaxed, experience of introspective and
dream-like effectdream-like effect Difficulty in concentration and thinkingDifficulty in concentration and thinking
Marijuana Withdrawal Syndrome
Restlessness
Irritability
Mild agitation
Insomnia
Sleep EEG disturbance
Nausea, cramping
Drugs Kill the Brain