DRUG DEPENDENCE

Drug dependence is a state in which the user has a desire to continue the
drug either to experience its effects or to avoid the discomfort of its
absence.
It is classified as
1) PSYCHIC DEPENDENCE : It is seen in the form of compulsive and
repeated drug taking for personal satisfaction . It is a condition
characterised by an emotional or mental drive to continue taking a drug
for which the user feels it is necessary to maintain his sense of well
being.
2) PHYSICAL DEPENDENCE : It occurs when withdrawal of dug
produces symptoms that are opposite to those sought by the user . It is a
state which comes itself with intense physical disturbances when the
administration of the drug is suspended.

WITHDRAWAL OR ABSTINENCE SYNDROME

When physical dependence has been induced during the prolonged use
of a drug , and if the dug is abruptly discontinued or when its actions are
diminished by the administration of a specific antagonist , then physical
dependence manifests itself as an intense physiological disturbances
called the withdrawal or abstinence syndrome.
DRUG DEPENDENCE AND ITS TREATMENT
1) Narcotic analgesics (morphine)
It is used in severe pain due to its CNS depressant properties.
Withdrawal symptoms : The person develops intense desire for the
drug ,lethargy and weakness. After 12 hrs , yawning,lacrimation ,
perspiration,rhinorrhoea,tremors and anorexia . The peak of the
withdrawal symptom is reached after 48 hrs and is characterised by
fever,rise in blood pressure,increase in heart rate,dilation of previously
constricted pupils and abdominal cramps.
Treatment :
Pschycological : Dose is reduced and social counselling is done.
Pharmacological : Patients are given gradually increasing oral dose of
methadone,when heroin is withdrawan,30mg methadone is usually a
safe and effective dose.
2) General depressants
a) Alcohol
Withdrawal symptoms : It vary from hangover to delirium tremors.
After 6-8 hrs, withdrawal symptoms are
sweating,insomnia,headache ,muscle
twitching,tachycardia,diarrhoea.these symptoms reduce after 40-50
hrs. After 2-3 days , hallucinations , disorientation followed by delirium
tremors.
Treatment :
1)To overcome deficiencies give vitamin B complex especially thiamine
and nicotinic acid.
2)Sedatives like chlordiazepoxide,diazepam may be given.
3)Drugs like disulfiram(antidote) in dose 0.5g/day and metronidazole are
given.

2) Bariturates :
Withdrawal symptoms : Symptoms start after around 36hrs. It includes
nausea,vomitting,weakness,anorexia,insomnia,weightloss,hypotension,
anxiety,muscle twitching.
Treatment :
Gradual withdrawal of drug over 10 days to 3 weeks.
3) Hallucinogens :
These are drugs which act on CNS to produce a state of perception of
objects with no reality eg:LSD,mescaline.
Withdrawal symptoms : Depress the CNS,psychotic complications like
schizophrenia ; their effect other than CNS are pupil dilation,
tachycardia,increased body temperature , pulse rate and respiratory rate.
Treatment :
1)Psychotherapy
2)Antianxiety and sedative drugs can be used.
3)Psychotic reaction like schizophrenia may be treated with drug like
chlorpromazine.
4) Central nervous system stimulants
These agents for eg:-cocaine,amphetamine,stimulate the CNS.
Withdrawal symptoms : They produce the psychological dependence.
Fatigue,tremor,depression and GI disturbances.
Treatment :
Toxic manifestations of chronic stimulant abuse,exhibited as psychotic
reactions,can be treated with phenothiazines or antipsychotic agents such
as haloperidol . If the severe amphetamine withdrawal symptoms occur
in the form of depression , they can be treated with tricyclic
antidepressants . For psychological treatment , it is advisable to admit in
the hospital where patient can be observed in a better way.