14.

DRUG ABUCE AND DEPENDENCE

The average physician is likely to encounter many patients exhibiting behavior al or

medical complications of licit or illicit drug use, but the relationship or the symptoms to
drugs often goes unrecognized.
Tolerance is a homeostatic process in which the body adapts to the presence of a drug.
Withdrawal symptoms occur when regular users abruptly stop using the drug and
characterize physical dependence.
RECOGNITION
The diagnosis of drug abuce or dependence is basically a clinical disorder. Physicians
must use all the available information and must be alert to the signs of drug abuse in order
to avoid unwittingly prescribing medication that perpetuates the dependence ( e.g.: asking
for a specific medication).
SEDATIVES are CNS depressants and may produce abuse, tolerance and physical
dependence.
PATTERNS OF ABUCE :
1. One is produced by taking PRESCRIPTION SEDATIVES without proper concern
for their potential to produce dependence. These drugs are the most widely
prescribed and have legitimate uses .
2. The second involves DELIBERATELY USING SEDATIVES to obtain a “ HIGH”
as a form of disinhibition or release.
ABSTINENCE SYNDROME. The withdrawal symptom varies in onset,duration and
severity depending on each drug’s dose and duration of action.
STIMULANTS
E.g. : 1 Cocaine – which is available at low prices and high doses may cause delusions or
hallucinations. Effects can be acute (tachycardia, hypertension, hyperthermia) or chronic
(ulceration or perforation of nasal septum).
2 Dextroamphetamine –with an pleasant effect prescribed for weight reduction and
attention defcit disorder.
OPIOIDS
E.g. : morphine, heroin, codeine and methadone
The withdrawal is generally not life-threatening and it has been compared with a severe
case of the “flu”.
CANNABIS (marijuana and hashish)
Cannabis is not a single drug,but a complex preparation containing many biologically
active chemicals. It has a therapeutic potential in several illnesses such as glaucoma,
convulsive seizures, asthma , muscle spasticity and the antiemetic effect.
HALLUCINOGENS include LSD (the most potent), PCP, MDMA that produce distortion
in perception or thinking as a primary effect.
INHALANTS- chemicals that are volatile at room temperatures and that produce
perceptible changes in brain function when are inhaled ( toluene-airplabe glue- , gasoline,
kerosene). The toxic effects on several organ systems are cardiac arrtythmias, bone
marroe depression, damage to liver, kidney and nerves.

THE TREATMENT OF DRUG DEPENDENCE involves 4 stages : acknowledging the

problem, detoxification, pharmacotherapy and psychotherapy.