Drug dependence

Drug Abuse
Drug dependence
• Is a state (psychic/physical) in which the user has a desire to continue
the drug either to experience its effects or to avoid the discomfort of
its absence.
• Classification:
• 1. Psychic dependence:
• It is seen in the form of compulsive
• Repeated drug taking for personal satisfaction
• It is a condition characterized 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.
• E.g. Heavy cigarette smoking
• 2. Physical dependence
• 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 is produced after a prolonged use of drug
and if the drug is abruptly discontinued, it produces intense
physiological disturbances known as withdrawal or abstinence
syndrome.
Drug Tolerance
• After repeated use of drug, a larger dose is needed to produce the
same effect indicating that tolerance has developed in the individual
for that drug.

• A person needs a large dose of the drug for the same effect.

• E.g. Persons who are dependent on morphine may at times need 200
times the usual dose of morphine for euphoric effect.
• Drug misuse:
• It can be defined as use of drugs in conditions for which they are not
required or in improper dosage schedule.
• Drug addiction:
• Drug addiction is a state of periodic or chronic intoxication produced
by the repeated consumption of a drug.
• Its characteristics include:
• 1. An overpowering desire or compulsion to continue taking the drug
and to obtain it by any means
• 2. A tendency to increase the dose.
• 3. Psychic/physical dependence on the effects of the drugs.
• Drug habituation:
• It is a condition resulting from the repeated consumption of a drug.
• Its characteristic
• 1. A desire but not a compulsion to continue taking the drug for the
sense of well-being
• 2. Little or no tendency to increase the dose
• 3. Presence of psychic dependence but absence of physical
dependence and hence of an abstinence syndrome.
• Drug abuse
• It is defined as the consumption of a drug repeatedly to produce
profound effect on mood and feeling of well being.
• Although they are not required for the patient for a particular disease.
But they are given apart from medical need or in unnecessary
quantities.
The drugs of abuse can be classified as follows:
• 1. Drugs used or present in commonly used beverages:
• A) Caffeine in tea, coffee and cold drinks. No serious harm is caused to
user by repeated consumption.
• B) Nicotine is taken in a number of different forms of tobacco e.g. for
smoking, for chewing and internasal administration.
• While tobacco consumption is not claimed to bring any benefit to
user, it has been clearly established that this is the cause of many
chronic ailments in heavy consumption.
• Ethyl alcohol
• Heavy and repeated consumption of alcohol leads to both
dependence and tolerance
• 2. prescribed drugs like morphine, meperidine, barbiturates and
amphetamine are to be used only on doctor’s prescription
• But a quite a few persons, who have an easy reach to the drug, i.e.
doctors, nurses and pharmacist tend to misuse these drugs and thus
become dependent on them.
• Banned drugs:
• 1. Heroin is the most dangerous drug because of its addiction liability
which includes both psychological and physical dependence
components.
• It is for this reason that the manufacture, sale and distribution of this
drug is banned.
• 2. Cocaine is obtained from plant sources and is also highly addicting.
Treatment aspects:

• Drug abuse treatment has two major steps:

• 1. Detoxification
• 2. Rehabilitation of the patient
Detoxification
• It is done by stopping the drug and treatment is done for withdrawal
symptoms
• It takes 10-21 days and can be done either by providing in – patient
services or by out- patient services
• Detoxification is followed by rehabilitation treatment because
otherwise relapses are very common.
Rehabilitation
• It is a long-term treatment
• It depends upon the patient’s need after detoxification.
• Various therapies like psychotherapy, family therapy, behavior therapy
and group therapy are tried during this treatment.
• Some important drugs of abuse and their treatment are discussed
below
Narcotic Analgesics (opiates, morphine,
heroin and pethidine)
• Complication
• Constipation, swelling of hands, feet, scalp, eyelids, pin point pupils,
impotence in male, pulmonary edema causes physical disability
• Withdrawal symptoms
• These symptoms begin 8 hrs after the last dose, rhinorrhea, crying,
sweating are seen.
• At 24-28 hrs nausea, vomiting, diarrhea, hypertension, fever,
sometimes cramps are observed.
Treatment
• It involves pharmacological or psychological methods or combination
of both.
• 1. Psychological : Dose is reduced and social counselling is done.

• 2. Pharmacological: Patients are given gradually increasing oral dose

of methadone, when heroin is withdrawn, 30 mg of methadone is
usually a safe and effective dose.
• 2. General depressants:
• A) Alcohol:
• It causes physical disability, impaired occupational adjustment,
• As tolerance increases, person consumes more alcohol.

• Complication:
• Malabsorption, gastritis, cirrhosis (hepatic cell damage), chronic
diarrhea, delirium, tremors
• Withdrawal symptoms:
• Withdrawal symptoms vary from hangover to delirium tremors, After
6-8 hrs, withdrawal symptoms are sweating, insomnia, headache,
muscle twitching, tachycardia, diarrhea.
• These symptoms reduce after 40-50 hrs. After 2 -3 days,
hallucinations, disorientation followed by delirium occurs.
Treatment
• To overcome deficiencies give vitamin B complex especially thiamine
and nicotinic acid
• Sedatives like Chlordiazepoxide, diazepam may be given.
• Drugs like disulfiram (antabuse) in dose 0.5 gm/day is given
• (This medication is used along with counseling and support to treat 
alcoholism. 
• Disulfiram works by blocking the processing of alcohol in the body.
This causes you to have a bad reaction when you drink alcohol.)
• B) barbiturates:
• Patient start using barbiturate for insomnia and progressively increase the
dose

• Complication: It leads to impairment of psychomotor function, altered

sleep pattern in children.

• Withdrawal symptoms: start after around 36 hrs. It includes nausea,

vomiting, weakness, anorexia, insomnia, weight loss, hypotension,
anxiety
• Treatment:
• Non-substitutive treatment is recommended.
• Withdrawal of drug over 10 days to three weeks.

4. Central nervous system stimulants:

Amphetamine, cocaine
• Complication:
• Psychosis, hallucination, anxiety.
• Cocaine produces psychological dependence.

• Withdrawal symptoms:
• Patients on withdrawal schedule should be initially warned about the
depression that may follow and last for a few weeks.
• Treatment:
• Sympathomimetic stimulation may be counteracted by haloperidol or
other depressing drugs in treating subjects with history of IV self
administration of amphetamine or cocaine.
• Hospitalisation is necessary for proper medical supervision.
• Tricyclic antidepressants like desipramine is indicated for along
standing depression.
• Psychological treatment is also recommended.
Questions
• 1. Define drug dependence
• 2. Distinguish between drug addiction and drug habituation
• 3. Write any three drugs, which cause drug addiction?
• 4. What are the reasons for drug abuse? How drug addicts are
treated?
• 5. Write short notes on: a. Addictive drugs b. Drug abuse
• 6. what do you understand by the term drug dependence, drug abuse
and addictive drugs? Describe the treatment and complication
involved in it.
• 7. Discuss withdrawal symptoms of narcotic analgesic and its
treatment methods
• 8. What are hallucinogens, write in detail about its withdrawal
symptoms and treatment measures.