Journal of Mind and Medical Sciences Volume 2 | Issue 1 Article 4 2015 Current Concepts on Drug Abuse and Dependence Daniela Luiza Baconi Carol Davila University of Medicine and Pharmacy, [email protected] Anne-Marie Ciobanu Carol Davila University of Pharmacy and Medicine Ana Maria Vlăsceanu Carol Davila University of Medicine and Pharmacy Oana Denisa Cobani St. John Emergency Hospital Carolina Negrei Carol Davila University of Medicine and Pharmacy See next page for additional authors Follow this and additional works at: http://scholar.valpo.edu/jmms Part of the Medicine and Health Sciences Commons Recommended Citation Baconi, Daniela Luiza; Ciobanu, Anne-Marie; Vlăsceanu, Ana Maria; Cobani, Oana Denisa; Negrei, Carolina; and Bălălău, Cristian (2015) "Current Concepts on Drug Abuse and Dependence," Journal of Mind and Medical Sciences: Vol. 2 : Iss. 1 , Article 4. Available at: http://scholar.valpo.edu/jmms/vol2/iss1/4 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. Current Concepts on Drug Abuse and Dependence Authors Daniela Luiza Baconi, Anne-Marie Ciobanu, Ana Maria Vlăsceanu, Oana Denisa Cobani, Carolina Negrei, and Cristian Bălălău This review article is available in Journal of Mind and Medical Sciences: http://scholar.valpo.edu/jmms/vol2/iss1/4 JMMS 2015, 2(1): 18- 33. REVIEW Current concepts on drug abuse and dependence Daniela Luiza Baconi1, Anne-Marie Ciobanu2, Ana Maria Vlăsceanu1, Oana Denisa Cobani3, Carolina Negrei1, Cristian Bălălău4 1 Carol Davila University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Toxicology 2 Carol Davila University of Medicine and Pharmacy, Faculty of Pharmacy, Medicines Control 3 St. John Emergency Hospital, Bucur Maternity, Bucharest 4 Carol Davila University of Medicine and Pharmacy, Faculty of General Medicine, St. Pantelimon Hospital Corresponding author: Daniela Luiza Baconi, e-mail: [email protected] Running title: Drug abuse and dependence Keywords: addiction, drug abuse, psychoactive substances www.jmms.ro 2015, Vol. II (issue 1): 18- 33. Date of submission: 2014-10-15; Date of acceptance: 2014-12-11 Abstract Drug addiction is a complex disease characterized by compulsive and uncontrollable desire to seek and consume the drug. In time, drug-related terminology has undergone many changes, arising from the deepening of the mechanisms of action, but also about the need for a greater precision in the definition. Drug dependence can be assigned not only to pharmacological effects of the drugs of abuse, but also to their interaction with each particular neurological and psychological constitution. The research on the neurobiological mechanisms of addiction processes allows both a better understanding of current pharmacotherapy and the development of new treatment strategies in drug abuse and dependence. In this review we intend to present the current concepts related to drug abuse and dependence. Drug abuse and dependence Introduction In 1957, the WHO Expert Committee on Drug Dependence defined habituation. This term is closely related to another one as old, but widely used today: addiction – the behaviour distinguished primarily by a conscious, intense desire for the drug and a tendency to relapse due to persistence of attitudes clearly established in the early stages of addiction. In 1964, the WHO Expert Committee replaced the terms addiction and habituation with "drug dependence" which has been redefined in 1969. In this definition the compulsive use of a drug for its psychological effects is the only feature, both necessary and sufficient to define the drug dependence. DSM-5 (Diagnostic and Statistical Manual), published by the American Psychiatric Association, combines the DSM-IV criteria for substance abuse and substance dependence into single “substance use disorders”, specific to each substance of abuse, within a new "Addictions and related disorders" category. ICD-10 (The 10-th Revision of the International Classification of Diseases and Health Problems), is edited by WHO and defines “dependence syndrome”. ICD 10 replaced the term "physical dependence" with “neuroadaptation”. Also, the term "abuse" is considered relatively ambiguous and replaced with more specific term "hazardous use" or "harmful use". ICD 11, planned for 2017, includes “disorders due to substance use” under the category “Mental and behavioural disorders”. Deepening of the molecular mechanisms of drug abuse and addiction has shown that psychological and physical dependence are not the only component of long-term drug dependence; in addition to positive and negative reinforcement, conditioning is a significant component in support the drug dependence. The common feature for the addictive drugs is that they have a positive reinforcement ("reward") action associated with mesolimbic dopaminergic pathway activation. Discussion Drug addiction has been conceptualized as a complex and chronic relapsing mental disorders characterized by compulsive drug seeking, the lack of capacity to limit the consumption, the emergence 19 Drug abuse and dependence of a withdrawal syndrome during cessation and the use despite the awareness of the harmful consequences (1, 2). According to American Society of Addiction Medicine (ASAM), addiction is a primary chronic disease of brain reward, motivation, memory and related circuits, characterized by inability to consistently abstain, impairment in behavioural control, craving, diminished recognition of the significant behavioural problems and in interpersonal relationships and also dysfunctions of the emotional response (3). Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can lead to disability or premature death. Usually, addiction represents the syndrome manifested by a particular behaviour in relation to the use of a substance or a class of psychoactive substances, purchasing and consumption of which is the priority; in advanced stages, the compulsive behaviour becomes obvious. Compulsion is a behavioural disorder characterized by an irresistible effusion to perform some acts to which the subject cannot resist, without finding his inner peace. In usual terms, drugs are illegal substances or diverted from legal use; however, some specialists do not hesitate to name drugs other substances or products (e.g. alcohol, tobacco), legal and relatively well integrated social. Psychoactive substance is defined as any substance which alters perception, behaviour, motor or cognitive functions (4). It is emphasized that the term psychoactive does not necessarily imply dependence-producing. Together with its equivalent, psychotropic drug, the term psychoactive substance is descriptive for the whole class of substances, licit and illicit, of interest to drug policy. Some authors refer to psychotropic the drugs used primarily in the treatment of mental disorders (sedatives, anxiolytics, antidepressants, neuroleptics), while others apply the term to substance with abuse susceptibility, because of the effects on disposition or consciousness (stimulants, hallucinogens, sedative-hypnotics, alcohol). In the context of international control of drugs, psychotropic substances are 20 Drug abuse and dependence those set out in the Convention on Psychotropic Substances (1971). In line with the socio-legal status of substances used, consumption of psychoactive substances can be classified into 3 categories (Figure 1). Figure 1 Classification of the psychoactive substances use Illegal use of psychoactive substances refers to drugs themselves, while the legal consumption concerns psychoactive substances not subject to legislative control (e.g. caffeine, nicotine, alcohol). The therapeutic use refers to the administration of psychoactive substances with prescription. In this context, it is important to distinguish between tolerance and physical dependence phenomena or "rebound" effect and addiction. Tolerance and physical dependence are physiological adaptations conditions and does not imply compulsory abuse or addiction. The compulsion phenomenon, an obsessive seeking and use of the substance is usually seen in addiction behaviour (5, 6). Classification of the psychoactive substances. Substances of abuse are often classified by type of action on the central nervous system (CNS) and/or class to which they belong in terms of chemical structure. Louis Lewin classified the psychoactive abuse substances in five psychopharmacological groups (7, 8): 21 Drug abuse and dependence Euphorica: euforic and narcotic substances that induce a state of physical and mental well: opium and opium compounds (morphin); cocaine) Phantastica: hallucinogenic substances of vegetable origin (mescal buttons, Cannabis) Inebriantia: substances that produce a first excitation followed by depression (alcohol, ether, chloroform) Hypnotica: sleep producing substances (chloral hydrate, barbiturates) Excitantia: substances that cause mental stimulation; substances from plants that produce general stimulation without impairment of consciousness (caffeine, tobacco, betel etc.) In 1967, Jean Delay has proposed the psychiatric classification criteria for the substances acting on the central nervous system (CNS). He introduced the general term psychotropic