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