DRUG ADDICTION DRUG ADDICTION AND ALCOHOLISMAND ALCOHOLISM

Yard. Doç. Dr. N. Berfu AkbaşYard. Doç. Dr. N. Berfu Akbaş

Yeditepe ÜniversitesiYeditepe Üniversitesi

Psikiyatri Anabilim DalıPsikiyatri Anabilim Dalı

DEPENDENCE:DEPENDENCE: A maladaptive pattern of substance use, leading to clinically A maladaptive pattern of substance use, leading to clinically

significant impairment or distress, manifested by TOLERANCE, significant impairment or distress, manifested by TOLERANCE, WITHDRAWAL, PERSISTANT DESIRE, a great time and activity WITHDRAWAL, PERSISTANT DESIRE, a great time and activity spent, social activities given up, use is continued despite spent, social activities given up, use is continued despite knowledge of harms.knowledge of harms.

ABUSE:ABUSE: recurrent substance use in a failure to fulfill recurrent substance use in a failure to fulfill major role obligations, use in situations physically major role obligations, use in situations physically hazardous, recurrent legal problems, continued use hazardous, recurrent legal problems, continued use despite social and interpersonal problemsdespite social and interpersonal problems

INTOXICATION:INTOXICATION: the development of a reversible the development of a reversible substance-specific syndrome due to recent substance-specific syndrome due to recent exposure ( clinicaly significant maladaptive exposure ( clinicaly significant maladaptive behavioral or psychological changes on central behavioral or psychological changes on central nervous system )nervous system )

WITHDRAWAL:WITHDRAWAL: the development of a reversible the development of a reversible substance-specific syndrome due to the cessation of substance-specific syndrome due to the cessation of substancesubstance

ALCOHOL RELATED DISORDERSALCOHOL RELATED DISORDERS

%0.05 in blood: thought, judgment, restraint loosened%0.05 in blood: thought, judgment, restraint loosened% 0.1 : voluntary motor actions clumsy% 0.1 : voluntary motor actions clumsy% 0.3 : confusion and stupor% 0.3 : confusion and stupor

0.5 promil: 0.5gr alcohol in 1lt blood: %0.063 alcohol0.5 promil: 0.5gr alcohol in 1lt blood: %0.063 alcohol

Intoxication:Intoxication: inappropriate behaviour, mood lability, inappropriate behaviour, mood lability, impaired judgement, slurred speech, incoordination, impaired judgement, slurred speech, incoordination, nystagmus, impaired attention amd memory, comanystagmus, impaired attention amd memory, coma

Withdrawal:Withdrawal: autonomic hyperactivity, hand tremor, autonomic hyperactivity, hand tremor, insomnia, nausea-vomitting, hallusinations, illusions, insomnia, nausea-vomitting, hallusinations, illusions, psychomotor agitation, anxiety, grand mal seizurespsychomotor agitation, anxiety, grand mal seizures

Delirium TremensDelirium Tremens: Alcohol ıntoxication delirium, mortal : Alcohol ıntoxication delirium, mortal %20. ın 1 week after alcohol cessation. %20. ın 1 week after alcohol cessation. Hallusinations, delusions, tachycardia, diaphoresis, Hallusinations, delusions, tachycardia, diaphoresis, fever, hypertension, hyperexcitability or lethargyfever, hypertension, hyperexcitability or lethargy

Wernicke-Korsakoff SydromeWernicke-Korsakoff Sydrome:: alcohol-induced alcohol-induced persisting amnestic disorder. Thiamine deficiency.persisting amnestic disorder. Thiamine deficiency.

WernickeWernicke’’s Encephalopaty: alcoholic encephalopaty, s Encephalopaty: alcoholic encephalopaty, ataxia, confusion, nystagmus, gaze palsy, anisocoria. ataxia, confusion, nystagmus, gaze palsy, anisocoria. Reversible if treated, if notReversible if treated, if not→ Korsakoff→ Korsakoff’’s Sydrome: s Sydrome: chronic amnestic sydrome.chronic amnestic sydrome.

Marciafava-Bignami Syndr: demyelination of corpus Marciafava-Bignami Syndr: demyelination of corpus callosum, optic tracts, cerebellar peduncles.callosum, optic tracts, cerebellar peduncles.

Medical complications of alcohol useMedical complications of alcohol use:: Liver damage, peptic ulcer, pancreatitisLiver damage, peptic ulcer, pancreatitis Peripheral neuropathies, myopathy, hepatocerebral Peripheral neuropathies, myopathy, hepatocerebral

degeneration, cerebellar degeneration, degeneration, cerebellar degeneration, gynecomastiagynecomastia

HT, stroke cardiomyopathy, anemia, electrolyte HT, stroke cardiomyopathy, anemia, electrolyte imbalancesimbalances

Ca of mouth, pharynx, liver, breastCa of mouth, pharynx, liver, breast

Idiosyncratic alcohol intoxicationIdiosyncratic alcohol intoxication: : small amounts, agressionsmall amounts, agression

Pathological jealosyPathological jealosy Alcoholic hallusinosis: auditoryAlcoholic hallusinosis: auditory

AMPHETAMINE-RELATED DISORDERSAMPHETAMINE-RELATED DISORDERS Ice, crystal, speed, XTC, adam, Ice, crystal, speed, XTC, adam,

eve...psychostimulants. eve...psychostimulants. Metamphetamine, ephedrine, Metamphetamine, ephedrine,

pseudoephedrine, pseudoephedrine, MDMA( ecstasy), MDMA( ecstasy), methylphenidatmethylphenidat

A single dose ( 5mg): ıncrease A single dose ( 5mg): ıncrease the sense of well-being, elation, the sense of well-being, elation, euphoria, friendliness, improve euphoria, friendliness, improve attention, increase attention, increase performance, anorexiaperformance, anorexia

Severe hypertension, Severe hypertension, myocardial infarction, myocardial infarction, cerebrovascular infarction, cerebrovascular infarction, ischemic colitis, seizures, coma. ischemic colitis, seizures, coma.

CAFFEINE RELATED DISORDERSCAFFEINE RELATED DISORDERS

A cup of coffee: 100-150mg. Caffeine A cup of coffee: 100-150mg. Caffeine ( methylxanthine)( methylxanthine)

Low doses: + reinforcer, doses > 300mg: Low doses: + reinforcer, doses > 300mg: increased anxiety and mild dysphoria.increased anxiety and mild dysphoria.

Global cerebral vasoconstrictionGlobal cerebral vasoconstriction Intoxication:Intoxication:restlessnessrestlessness,,nervousness, nervousness,

excitement, muscle twitching, cardiac arrhytmiaexcitement, muscle twitching, cardiac arrhytmia Withdrawal: Withdrawal: fatique, drowsiness, anxiety and fatique, drowsiness, anxiety and

depression, nausea and vomittingdepression, nausea and vomitting

CANNABIS-RELATED DISORDERSCANNABIS-RELATED DISORDERS Hashish ( flower), marijuana Hashish ( flower), marijuana

( leaves)( leaves)

(tetrahidrocannabiol- THC)(tetrahidrocannabiol- THC)- Physical dependance is not Physical dependance is not

strongstrong- No respiratory depressionNo respiratory depression Euphoria, sensitivity to external Euphoria, sensitivity to external

stimuli, slows time, motor skill stimuli, slows time, motor skill impairment may last 12 hrs, impairment may last 12 hrs, red eye, tachycardia, increased red eye, tachycardia, increased appetite, hypotension, long appetite, hypotension, long term use; cerebral atrophy, term use; cerebral atrophy, seizures, chromosomal seizures, chromosomal damage, decreased damage, decreased testesterone, testesterone, amotivational amotivational syndromesyndrome

COCAINE-RELATED DISORDERSCOCAINE-RELATED DISORDERS Vasoconstrictive and topical Vasoconstrictive and topical

anesthetic effectsanesthetic effects Dopamine reuptake blockageDopamine reuptake blockage Produces euphoriaProduces euphoria→personality →personality

changes, changes, impulsive behaviour, weight impulsive behaviour, weight

loss, insomnia,nasal loss, insomnia,nasal congestion,congestion,

cerebrovascular(infarcts)cerebrovascular(infarcts) cardiological disorders cardiological disorders

( arritymia, MI, CMP )( arritymia, MI, CMP ) seizures, seizures, crash syndrome ( post crash syndrome ( post

intoxication depression)intoxication depression) formication ( cocaine bugs)formication ( cocaine bugs)

HallucınogensHallucınogens mushrooms( psilocybimushrooms( psilocybi

n), n), mescaline( cactus),LSmescaline( cactus),LSD D

Phencylidine (PCP)Phencylidine (PCP) ““hallucinogen hallucinogen

persisting perception persisting perception disorderdisorder””- “flashbacks”- “flashbacks”

Opioid Related DisordersOpioid Related Disorders: : morphine, heroin, fentanyl, morphine, heroin, fentanyl, codeine, hydrocodonecodeine, hydrocodone

μ receptor *: analgesia, resp. μ receptor *: analgesia, resp. depres., hypothermia, depres., hypothermia, bradycardia, constip.bradycardia, constip.

κ receptor: analgesia, diuresis, κ receptor: analgesia, diuresis, sedationsedation

Σ receptor: analgesiaΣ receptor: analgesia Euphoric high ( rush )Euphoric high ( rush )→ sedation,→ sedation,

Dry mouth, ichy nose, red face, Dry mouth, ichy nose, red face, pinpoint pupils, constipation, pinpoint pupils, constipation, smooth muscle contraction, smooth muscle contraction, respiratory respiratory depression,anaphylactic shock, depression,anaphylactic shock, arrythmia,hyptension, arrythmia,hyptension, hypothermia...hypothermia...