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Alcoholism & Drug DependenceDr. Rahul NetragaonkarAssociate Professor

DrugDrug is defined as "any substance that, when living organism, may modify one or more of its functions" (WHO).Drug abuse"Drug abuse" is defined as self administration of a drug for non-medical reasons, in quantities and frequencies which may impair an individual's ability to function effectively, and which may result in social, physical, or emotional harm.Drug dependence"Drug dependence" is described as a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterized by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. A person may be dependent upon more than one drugsDrug abuse is an intense desire to obtain increasing amounts of a particular substance. Drug dependence is the body's physical need, or addiction, to a specific agent. Over the long term, this dependence results in physical harm and behavior problems which causes tolerance and cross tolerance. Thus, it creates a vicious cycle.ProblemThe non-medical use of alcohol and other psychoactive drugs has become a matter of serious concern in many countries. Alcohol abuse is a more or less universal problem, the incidence of drug abuse varies from place to place. An estimated 12-20 million people smoke marijuana in the US. 30-50 per cent of all high school students had made marijuana an accepted part of life.

CONSUMPTION OF VARIOUS DRUGS

Why do so many Teenagers start down this potentially Dangerous path ?

Agent factors- Dependence producing drugs

1. Alcohol2. Opioids (Heroin)3. Cannabinoids (Marijuana)4. Sedatives or hypnotics5. Cocaine6. Other stimulants including caffeine7. Hallucinogens8. Tobacco9. Volatile solvents10. Other psychoactive substances, and drugs fromdifferent classes used in combination

Legal drugs are not necessarily safer. A study in 2010 asked drug-harm experts to rank various illegal and legal drugs. Alcohol was found to be the most dangerous.It is believed that drug abuse only harms the user but this graph clearly depicts that it not just harms the person but destroys the whole family ,his profession, and life.Amphetamines are synthetic drugs,drugs, structurally similar to adrenaline. In medical practice, they are used to treat obesity, mild depression, narcolepsy and certain behaviour disorders in children. The ordinary therapeutic dose is 10-30 mg a day These drugs act on the central nervous system. They produce mood elevation, elation, a feeling of well-being and increased alertness and a sense of heightened awareness.Superman" drugs. The use of these drugs results in psychic dependence. With large doses, such dependence, is often rapid and strong. AMPHETAMINES AND COCAINE: CocaineCocaine is derived from the leaves of the coca plant. It was formerly used in medical practice as a potent local anaesthetic. Cocaine is a central nervous stimulant. It produces a sense of excitement, heightened and distorted awareness and hallucinations. Unlike amphetamines, it produces no tolerance. There is a 'no physical dependence; no withdrawal symptoms', per se. The chewing of coca leaves is a very common practice in Bolivia and Peru in South America.BARBITURATESBARBITURATES: If amphetamines stimulate, barbiturates sedate. They are a major ingredient in sleeping pills. The drug-users generally prefer short-acting barbiturates such as pentobarbital and secobarbital to long acting ones.The addiction to barbiturates is one of the worst forms of suffering. It leads to craving, or both physical and psychic dependence.CANNABISCANNABIS: Most widely.used drug today is Cannabis, which is a very ancient drug obtained from the hemp plants - Cannabis sativa, C. indica and C. americana.The resinous exudate from the flowering tops of the female plant contains most of the active ingredients - called hashish or charas. The dried leaves and flowering shoots are called bhang; The resinous mass from the small leaves and brackets of inflorescence is called Ganja. Alcohol: Our Most Primitive IntoxicantEgyptBarley beer is probably the oldest drink in the world with its origin in Egypt prior to 4200 BCChina7000 BC - the production of a prehistoric mixed fermented beverage of rice, honey and fruit (neolithic village of Jiahu in Henan province)2000 BC- unique cereal beverages (Shang and Western Zhou Dynasties)HEROINHEROIN: Heroin, morphine, codein, methadone, pethidine are narcotic analgesics. Addiction to heroin is perhaps the worst type of addiction because it produces craving. With narcotics generally psychic dependence is strong and tends to develop early. Tolerance to narcotics also occurs rapidly, making it necessary to take increasing doses of the drug to achieve the same effect.LSD(Lysergic acid diethylamide)LSD: (LSD) was synthesized in 1938 by Hoffmann in Switzerland. LSD is a potent psychotogenic agent. Although amounts as low as 20-25 may produce subjective disturbancesOral doses in the range of 100-250 are usually required to effect intense depersonalization. LSD alters the normal structuring of perception. ALCOHOL By pharmacological definition, alcohol is a drug and may be classified as a sedative, tranquillizer, hypnotic or anaesthetic, depending upon the quantity consumed. Of all the drugs, alcohol is the only drug whose self-induced intoxication is socially acceptable. It is not a "stimulant" as long believed, but a primary and continuous depressant.Alcohol produces psychic dpendance of varying degrees from mild to strong. Physical dependence develops slowly.Alcoholism is a disease and alcohol a "disease agent" which causes acute and chronic intoxication, cirrhosis of the liver, toxic psychosis, gastritis, pancreatitis, cardiomyopathy and peripheral neuropathy. Also, evidence is mounting that it is related to cancer of the mouth, pharynx, larynx and oesophagus.Further, alcohol is an important etiologic factor in suicide, automobile and other accidents, and injuries and deaths due to violence. The health problems for which alcohol is responsible are only part of the total social damage which includes family disorganization, crime and loss of productivity.TOBACCOTobacco is in legal use erywhere in the world yet it causes far more deaths than all other psychoactive substances combined. About 3 miliion premature deaths a year (6 per cent of the world total) are already attributed to tobacco smoking. Tooacco isresponsible for about 30 per cent of all cancer deaths in developed

TOBACCOSMOKINGNONSMOKINGCIGARETTES,CIGARS,BIDISKHAINI,TOBACCO LEAFSNUFF

NICOTINA PALATIERYTHROLEUKOPLAKIALEUKOPLAKIA

SQUAMOUS CELL CARCINOMAPassive smoking

Passive smoking can give rise to other potentially fatal diseases such as heart disease and stroke, Per capita consumption of tobacco is decreasing slowly in developed countries. By contrast, per capita tobacco consumption is rising in many developing countries among both men and women. Because of the long delay between the cause and full effect, people tend to misjudge the hazards of tobacco. When a generation of young adults begin to smoke, they do not witness the high morbidity and mortality

26Host factors

Pleasure, Peer pressureDesire to experiment, Sense of adventure, Wish for self-knowledge, Desire to escape. Minor discomforts Social and psychological maladjustmentThe average age of drug users has decreased considerably in recent years.

Symptoms of drug addiction

Loss of interest in sports and daily routine;Loss of appetite and body weight;Unsteady gait, clumpsy movements, tremors;Reddening and puffiness of eyes, unclear vision;Slurring of speech;Fresh, numerous injection marksNausea, vomiting and body pain;Drowsiness or sleeplessness, lethargy and passivity;Acute anxiety, depression, profuse sweating;Changing mood, temper, tantrums;Depersonalisation and emotional detachment;Impaired memory and concentration; andPresence of needles, syringes and strange packetsEnvironmental factors

UnemploymentLiving away from homeMigration to citiesRelaxed parental controlAlienation from familyEarly exposure to drugsLeaving school earlyBroken homes; oneParent familiesLarge urban environments certain occupations (tourism, drug production or sale)Prevention

Legal approach : Prohibition of the sale of tobacco products to minors; Restriction on the sale of cigarettes from automatic vending machines; Prohibition of smoking in schools and other places frequented by young people;Prohibition of smoking in public; Educational approach Educational programmes for school children and publicInformation campaigns on electronic media. Community approachSocial, economic, cultural, political factors

TreatmentIdentification of drug addicts and their motivation for detoxicationDetoxication (requires hospitalization)Post-detoxication : counselling and follow-up (based on clinic and home visits) Rehabilitation.Simultaneously with medicalRehabilitationThe rehabilitation of former drug user, regardless of age, is in most cases a long and difficult process. Relapses are very frequent. Success of the treatment necessitates the adoption of mature and realistic attitude by the local community and the avoidance of panic, moral condemnation and discrimination.Facilities for vocational training and sometimes the provision of sheltered work opportunities are useful in rehabilitation and help to prevent relapse.

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