DRUG / SUBSTANCE ADDICTION
1.05.2020 1 Drug / Substance
Drug: Substances or products used to alter or examine physiological systems and pathological conditions, or to prevent the occurrence of a disease. They show pharmacological activity.
Addictive substance: They are products that show pharmacological activity but are not used as drugs and have the potential to create addiction.
1.05.2020 2 Drug / Substance Addiction
Feeling the delightful psychic effects of the substance resulting from an interaction between a psychoactive substance/drug and CNS,
To prevent the appearance of withdrawal symptoms when the substance is not found or discontinued,
It is a behavioral disorder characterized by continued use of the substance despite the psychic and physical ill effects.
1.05.2020 3 Addiction criteria
To increase the dosage and duration of use
Failure to reduce or discontinue to use
Excessive time spent on obtaining, using, or getting rid of its effects
Symptoms of poisoning or withdrawal
Neglect of social and professional activities
1.05.2020 4 Addiction criteria
Continue to use despite the substance's bad effects.
Development of significant tolerance to substance.
Frequent use of the substance to get rid of withdrawal symptoms.
1.05.2020 5 Gradually increasing amount of substances despite problems.
Unsuccessful attempts to quit.
Spending so much time in supplying, consuming or quitting a substance.
Reducing or leaving social, vocational or leisure activities.
An addict is a person who has at least three of the following list within 12 months.
1.05.2020 6 Features of addictive substances / drugs
‘Psychotropic’ Psychoactive’
Psychic stimulation or depression.
Perception, temperament and behavior disorder.
Mental and motor dysfunction are observed.
1.05.2020 7 Addictive substances / drugs
Euphoria (enjoyment)
Rewarding effect
Reinforcer effect
Psychic (psychological) addiction may occur.
Physical (physiological) addiction may occur. Abstinence syndrome
Sleep disturbance, insomnia
Hyperactivity
Increased sensitivity to pain
Increased sympathetic activity (tremor etc.) 1.05.2020 8 Rewarding/Promoting effetcs
The positive effects of the drug on mental state and behavior encourage the desire to use the drug / substance again. The unpleasant effects that occur when not used also force the person to take drugs / substances.
Anxiety
Discomfort, ailment
Tachycardia
Other symptons related with abstinence
1.05.2020 9 Tolerance
Tolerance occurs to most addictive substances / drugs
Morphine
Amphetamine
Barbiturades
Volatile solvent
Alcohol-tobacco
Hashish
Cocaine
Khat 10 Tolerance
For Morphine
Tolerance develops for analgesic effect.
No tolerance was observed for myosis
For Cocaine
Tolerance to euphoria, sympathomimetic and cardiovascular effects develops.
Tolerance to psychotic effects (anxiety, paranoid behavior, stereotypical movements, visual and tactile hallucinations) does not develop.
1.05.2020 11 Cross tolerance
If tolerance to one of the drugs in the same pharmacological group has developed, tolerance will develop against other drugs in that group.
Diazepam-Nitrazepam-Medazepam
Cross-tolerance can also occur between drug groups and substances.
Alcohol-Barbiturades-Benzodiazepines-Other hypnosedatives
1.05.2020 12 Psychic addiction
It is seen in all drug/substance addictions.
* Psychic craving against medicine and unhappiness when it can't get it
* drug seeking behavior
If there is only psychic addiction, withdrawal syndrome does not occur when the drug is stopped (hashish, LSD, Khat).
1.05.2020 13 Physical addiction
It is the psychic and somatic symptoms that occur as a result of the reduction, discontinuation or administration of the pharmacological antagonist.
It usually accompanies psychic addiction.
It is a separate event from psychic addiction.
Withdrawal syndrome occurs when the drug is stopped.
1.05.2020 14 Abstinence syndrome
It encourages the drug to be taken again.
The severity of withdrawal syndrome indicates the degree of physical addiction.
1.05.2020 15 Abstinence syndrome
Anxiety, dysphoria, sleep disturbance
Drug seeking, concentration impairment
Lacrimation, rhinore
Hyperpyrexia, sweating
Irritability, overeating
Seizures
Delirium
Mortality1.05.2020 in some cases 16 Addiction types (WHO)
1- Morphine (Heroin, 5- Amphetamin phentanyl, codeine) 6- Cocaine 2- Alcohol 7- Hashish/Marihuana 3- Barbiturades 8- Halusinogen / Psychedelic (hypnotics, 9- Khat tranquilizing) 10- Volatile solvent 4- Tobacco
1.05.2020 17 Very Strong Addicitive Substance
o Morphine (Psy/Phys) o Heroine (Psy/Phys) o Cocaine (Psy/Phys?) o Nicotine (tobacco) (Psy/Phys)
1.05.2020 18 Strong Addicitive Substance
o Alcohol (Psy/Phys) o Barbiturades (Psy/Phys) o Volatile solvents (Psy/Phys) o Amphetamins (Psy/Phys)
1.05.2020 19 Medium Strong Addicitive Substance
o Benzodiazepines (Psy/Phys) o Metaqualon (Psy/Phys) o Glutetimid (Psy/Phys)
1.05.2020 20 Weak Addicitive Substance
LSD (Psy)
Mescaline (Psy)
Hashish (Psy)
Caffeine (Psy)
1.05.2020 21 Morphine type addiciton
Strong psychic addiction
Physical addiction and tolerance
Develops Abstinence syndrome
Morphine
Heroin (diethylmorphine-lipophilic)
Oxicodon
Codeine
Meperidine
1.05.2020 22 Psychic effects
Euphoria
Lethargy and sedation
Stupor (= numbness, drowsiness)
Analgesia
1.05.2020 23 Abstinence syndrome
Yawning, lacrimation
Runny nose, sneeze
Restlessness, tremor, sweating
Anxiety, sleep disturbance, anorexia
Vomiting, diarrhea, dehydration
‘Cold turkey’
Heart and breathing acceleration
Abdominal and muscle cramps 1.05.2020 24 Cocaine - effects
Cocaine is obtained from leaves of Erythroxylon coca plant.
Euphoria
CNS stimulation
Increnet of heartbeat
Hypertension, arryhtms
Increment of sexual activity
1.05.2020 25 Cocaine – Effects of in chronic use
Various infections
Skin abscess
Nasal septum perforation
Epileptic seizures
Migraine
Tics
1.05.2020 26 Hallucinogen/Psychodelics
LSD (Lisergic acid diethylamide)
Psilocin, psilocibin
DMT, DET (triptamin derivatives)
Mescaline
Biperidene (Akineton®)
Phencyclidine (PCP; angel dust)
1.05.2020 27 LSD / Effects
Hallucination
Impairment of time perception ability
Visiul impairment
Thinking difficulties
Sympathetic hyperactivity
Use: Oral route
1.05.2020 28 Cannabis/Esrar (hashish; cannabis)
Marijuana, Hashish oil Active stuff: Cannabinoidler- 11 derivatives
delta-9-tetrahydrocannabinol (THC) (psychoactive + antiemetic)
Oral administration Inhalation route in the cigarette
1.05.2020 29 Cannabis/Effects Lethargy, sedation Euphoria, uncontrollable laughing Disappearance emotional exhaustion (disinhibition) Decrement in psychomotor performance
Use by oral or inhalation Strong psychic addiction Abstinence symptoms (low grade): Anxiety, depression, sleep distubances, anorexia, irritability1.05.2020 , tremor, sweating, nausea, restlessness30. Synthetic cannabinoids
Illegal products such as «Bonsai» and «Jamaika» .
These products are marketed under names such as “legal highs, herbal highs, designer drugs, party pills”.
They are available in the form of powder, christal, tablet, capsule, liquid, cannabis cigarette, mixed cigarette, herbal mixture, products impregnated on blotter paper.
1.05.2020 31 Toxic effects
Euphoria Nausea, vomiting,
Increased curiosity sweating
Over empathy Agitation, confusion
Social interaction Respiratory depression
the sedation Acute renal failure
Hypothermia, analgesia, Hypokalemi to catalepsy and immobility acidosis
Acute MI 1.05.2020 32 ECSTASY (EXTACY)
It was used as an adjunct in psychotherapy in the 1970s.
It started to be used by addicts in the 1980s.
They resembles to the amphetamis as chemical structure.
Chemical name: MDMA (3,4-methylenedioxy methyl amphetamine)
1.05.2020 33 Ecstacy
Ecstasy is available in the form of white, brown, pink or yellow tablets or capsules. Ecstasy causes the release of substances called dopamine and noradrenaline in the brain. Ecstasy also leads to release of serotonin. It can cause hyperthermia, dehydration and arrhythmia in the heart.
1.05.2020 34 AMPHETAMIS and derivatives
Metamphetamine (Methedrin,‘speed’, ‘crystal’)
Dietilproprion
Phenthermine
Phenmetrazine
Chlorfentermine
Phenfluramine
1.05.2020 35 Pharmacological effects
Euphoria
Increased energy, attention and concentration
High self-confidence
Decrement of starving and tiredness
Exibition of sexual desires
Increment of systemic blood pressure
Hypereactivity, restlessness, anxiety
1.05.2020 36 Volatile substance addiciton
Liquid general anesthetics (ether, chloroform)
Gasoline, gasoline of lighther
Benzol and toluene (vehicle of adhesive substance) Thinner
Carbon tetrachloride
LPG (liquid petrol gase) and other volatile solvents
1.05.2020 37 Psychic effects
Inhalation in amounts without losing consciousness, can create a state of euphoria and relaxation, similar to alcohol intoxication.
1.05.2020 38 Thinner
Legal substances/products.
Cheap and easy to find
Therefore, it is frequently used by the poor and young people.
%90 toluene + %9 ethylacetate + <%1 benzol
1.05.2020 39 Secondary diseases
AIDS (Acquired Immun Deficiency Syndrome)
Liver-kidney diseases
Anxiety-depression
Psychosis
Cancer
Permanent brain damage
1.05.2020 40 Treatment
There is no rational and definitive treatment for drug/substance addiction.
Treatment
Isolation
Detoxification
Rehabilitation
1.05.2020 41 Treatment (alcohol addiction)
Disulfiram (Antabus® tablet) Inhibits aldehyde dehyrogenase and causes nausea.
Oral administration.
Uses in motivated persons.
No alcohol comsuption during therapy.
Acamprosate (Campral® tablet) (analog of GABA)
Oral administration.
Uses in motivated persons
No alcohol comsuption during therapy.
Naltrexone1.05.2020 (opioid-alcohol addiction therapy) 42 Treatment
Methadone (replacement treatment of opioid addiciton)
Buprenorfin + Naloxon (replacement treatment of opioid addiciton) ® Suboxon sublingual tablet Buprenorfin+Naloxon (2 /0,5 mg)
Naltrexon (opioid-alcohol addiction therapy) ® Nalplant Implant Pellet (1000 mg naltrexone) ® Ethylex film coated tablet 50 mg
1.05.2020 43 Treatment
Antidepressants (SSRIs)
Benzodiazepines (in various addiciton type)
Diazepam
1.05.2020 44 Nicotine addiction therapy
Varenicline (partial nicotinic agonist)
Bupropion (antidepresan like effect)
Nicotine replacement treatment (NRT)
Gum (Nicorette® Gum, 2 mg) 8-12 gum/day .
Lozenge (Niquitin® pastil 2/4 mg)
Sublingual tablet (Nicorette® SL tablet, 2 mg)
Flaster (Nicorette® Transdermal flaster, 2 mg)
1.05.2020 45