Week 12:

Potential Abuse and Etiology of

Psychotropic Substance Abuse
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Noh Amit

NNNC 6042 Psychopharmacotherapy_Sem II 2019/2020

2 Outline

1. Potential psychotropic drug abuse

2. Etiology of psychotropic substance abuse

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Despite the side effects, tend to be abused

 Mania
 Euphoria
 Hallucination
 Relaxation

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4 Potential psychotropic drugs abuse

 Despite their effectiveness to relieve anxiety, panic attacks, behavioral disorders and other
conditions can cause physical or psychological dependence
 If the medication as part of a professional treatment program, the chances of becoming
addicted are minimal compared to the potential benefits
 Concern related to the side effects of any psychiatric medication, including its addictive
potential.
 Never stop taking a medication or reduce the dose without talking to doctor first.

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 Not all psychiatric drugs are addictive; in fact, the majority of medications used to treat
mood disorders, anxiety disorders or psychotic conditions do not have a high abuse
potential.
 If patients take a psychotherapeutic drug for a certain period of time, patients may
experience unpleasant or dangerous side effects if patients stop taking the drug suddenly.
 Over time, patients may need higher doses of the drug to manage the symptoms. However,
this does not necessarily mean that patients are “addicted.”

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 If patients have a history of substance abuse, patients may be justifiably concerned about
whether a new psychiatric medication will trigger addictive behaviors.
 When patients seek treatment at a facility that specializes in Dual Diagnosis rehab,
patients’ therapists will be able to help them select medications that will allow them to
recover safely.

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Which psychotropic drugs are addictive?

 Some of the medications used to treat psychiatric disorders have a high abuse potential and
should be used with caution to avoid chemical dependence and addiction.
 These medications include tranquilizing medications in the benzodiazepine family
(lorazepam/Ativan, alprazolam/Xanax, clonazepam/ Klonopin, diazepam/Valium), which
are sometimes prescribed to relieve the symptoms of generalized anxiety disorder or panic
disorder.

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 When benzodiazepines are taken for short periods of time or used strictly on an as-needed
basis according to a doctor’s orders, they can be an effective part of patient’s treatment
program.
 However, when patients take more than the recommended dose or take these drugs too
often, patients can become addicted to their medication.
 The American Academy of Family Physicians notes that for people with a history of
substance abuse, antidepressants, anticonvulsants, anti-hypertensive medications and
neuroleptic drugs (for reduction in confusion and agitation and tend to normalize
psychomotor activity) may be a safer alternative than benzodiazepines.

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 Amphetamine-based drugs used to treat ADHD have the potential to be abused. When used
appropriately, medications like Ritalin and Adderall can focus attention in people with this
behavioral disorder.
 But according to The Clinical Advisor, these medications are often misused recreationally
for their stimulatory effects.
 Addiction itself is a chronic condition that requires intensive professional treatment. If
patients have a psychiatric disorder combined with substance abuse — or a Dual Diagnosis
— patients need support from professionals who can help you recover from both
conditions.

NNNC 6042 Psychopharmacotherapy_Sem II 2019/2020

10 Potential psychotropic drugs abuse among
college students (Tai et al., 2015)
 Many college students suffer from mental illness… the potential for misuse always is
present

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 Misuse of psychotropic drugs is prevalent among college students. A study of 14,175

students from 26 campuses reported that 14.7% of students taking a psychotropic are doing
so without a prescription, including stimulants (52.6%), anxiolytics (38.4%), and
antidepressants (17.4%). Another study states that more than one-third of responders
reported misuse of >1 class of medication
 Psychotropic misuse is concerning because it increases the risk of adverse events.
 Students misuse medications, including stimulants, benzodiazepines, and antidepressants,
for a variety of reasons, such as study enhancement, experimentation, intoxication, self-
medication, relaxation, and stress management.
 One survey reported that >70% of students taking a psychotropic medication took it with
alcohol or another illicit drug [drugs interaction and additive effect]

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 However, <20% of those using a psychotropic medication with alcohol or other illicit
drugs told their health care provider(s), making it impossible for clinicians to predict a
patient’s risk of drug− drug interactions and subsequent adverse events.
 Additionally, additive effects could occur and changes in a patient’s presentation could be
caused by a reaction to a combination of medications, rather than a new symptom of
mental illness.

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13 1. Stimulants
 Stimulants have the highest rate of diversion; 61.7% of college students prescribed
stimulants have shared or sold their medication.
 The most common reason for stimulant misuse was to enhance academic performance
 RISKS:
 It is critical to ascertain the route of drug administration, because non-oral routes,
including crushing then snorting or injecting, are associated with additional health
concerns, such as accidental death or blood-borne illnesses.
 Cardiac adverse effects of stimulants include hypertension, vasospasm, tachycardia, and
dysrhythmia; psychiatric and other effects include serotonin syndrome, hallucinations,
anxiety, paranoia, seizures, tics, hyperthermia, and tremor.

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 The risk of switch to mania might not be apparent to those who prescribe
stimulants or to young people who take non-prescribed stimulants for academic
enhancement or to achieve medication-induced euphoria.
 Adolescent stimulant use is associated with symptoms of early-onset bipolar
disorder in patients who have attention-deficit/ hyperactivity disorder (ADHD)
and undiagnosed bipolarity.
 Diversion could occur through sharing medications or selling them to friends and
family.

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 Risk factors for misuse of stimulants include: heavy alcohol use,

previous illicit drug use, white race, fraternity or sorority
membership, low GPA, increased hyperactivity symptoms, and
attendance at a competitive college or university.

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16 2. Benzodiazepines
 Misuse of benzodiazepine is a significant component of prescription drug abuse
and often occurs with other medications and alcohol.
 Additional methods of misuse include increased dosage and non-oral routes of
administration.
 Common characteristics of benzodiazepine abusers include: young age, male sex,
personality characteristics of impulsivity and hopelessness, and abuse of other
drugs, including cocaine and methadone.
 Benzodiazepines are prescribed for their anxiolytic and hypnotic properties and
students could use these drugs with other agents to augment the euphoric effects
or diminish withdrawal symptoms.

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 Patients taking benzodiazepines for anxiety might self-medicate with alcohol,

which increases sedation and depression, and can contribute to the risk for
respiratory depression.
 Misuse of benzodiazepines can result in cognitive and psychomotor impairment
and increase the risk of accidents and overdose.
 Although overdose with monotherapy is rare, the risk increases when a
benzodiazepine is used with alcohol or another respiratory depressants, such as
opioids, because combination use can produce additive effects.

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 It is important to avoid prescribing benzodiazepines to patients who have a

history of significant substance abuse and consider using alternative, non-
addictive agents, such as selective serotonin reuptake inhibitors, or non-
pharmaceutical treatment when such patients present with an anxiety disorder.
 The risk of adverse effects of benzodiazepines can be reduced by limiting the
dosing and the duration of the treatment, and by using longer-acting rather than
the more addictive, shorter-acting, agents.

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19 3. Antidepressants
 Despite the relative absence of physically addictive properties, antidepressants
from most classes are abusable agents sought by young people for non-medical
use.
 monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, serotonin-
norepinephrine reuptake inhibitors, and bupropion as the antidepressants most
likely to be misused for their amphetamine-like euphoric effects or serotonin-
induced dissociative effects (a disruption of cognitive and motor processes, can
be viewed as a continuum ranging from excessive daydreaming and memory
problems to more severe forms of depersonalization or derealization disorders)
 compared with other drug classes discussed (in this article), the rate of
antidepressant misuse is relatively low among college students.

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 Persons with depression are at increased risk of alcoholism compared with the
general population. This combination can increase depressive symptoms and
sedation, and decrease coordination, judgment, and reaction time.
 Excessive alcohol use can increase the risk of seizures in patients taking
antidepressants such as buproprion.
 avoid prescription of bupropion in patients who are at risk of binge drinking, and
give careful consideration to providing alternative therapies for them.
 Hypertensive crisis (a severe increase in blood pressure that can lead to a stroke)
could occur if MAOIs are combined with certain types of alcoholic beverages
containing tyramine, including some wines and draft beer.

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21 Potential psychotropic drugs abuse among
students
 The psychotropic drugs and prisoners population

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22 Etiology of psychotropic substance abuse—
Kuhar (1998) *
 The etiology of drug use represents a complex interplay of personality, genetic,
environmental, and cultural influences on behavior that are difficult to dissect or
treat as independent forces.
 Causes and correlate of substance abuse
 Involving several factors that may appear independently or in combination with
other such factors
 (Book: Handbook of Drug Use Etiology: Theory, Methods, and Empirical
Findings, 2010, Chapter 5: Etiology)

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 Etiological studies conducted on population samples have focused on drug use;

those conducted on clinical samples, especially those concerned with familial
factors, have tended to focus on the etiology of drug abuse and dependence.
 Two general categories of variables have been examined—risk factors and
protective factors
 Research has focused primarily on risk factors associated with drug use rather
than on abuse and dependence.
 Risk factors are related to the probability of an individual's developing a disease
or to vulnerability, which is a predisposition to a specific disease process 

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 Before a factor is labelled a risk factor, it has to satisfy the following conditions: the
risk factor must be statistically associated with the disease; the risk factor must
precede the onset of disease; and the observed association must not be spurious/false. 
 Protective factors are variables that are statistically associated with reduced likelihood
of drug use.
 In statistical terms, a protective factor moderates the relationship between a risk factor
and drug use or abuse, or it buffers the impact of risk factors on the individual.
 When the protective factor is present, it is assumed that there will be considerably less
drug use or abuse than would otherwise be expected, given the risk factors that are
also present.

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 Biological Factors
 Genetic Vulnerability
 Physiological Vulnerability
 Psychosocial Factors
 Personality Traits
 Psychopathology

 (Book: Handbook of Drug Use Etiology: Theory, Methods, and Empirical Findings,
2010, Chapter 5: Etiology)

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 Contextual Factors
 Familial Factors
 Peer Factors
 Sociocultural or Environmental Factors

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 Biological Factors —Genetic Vulnerability. Examples on twin studies and/or

Adoption Studies.
 Physiological Vulnerability — Neurochemical system impairment and heightened
susceptibility to a drug because of biologically determined responsiveness) and
examples of Metabolic Variations, Biochemical Markers
 Psychosocial Factors — Studies of psychosocial risk factors. Examples on
Personality Traits, and Psychopathology.
 Contextual Factors —Factors external to the individual and arising in the social
(family setting or peer group) or broader environment. Examples on Familial
Factors, Peer Factors, and Sociocultural or Environmental Factors.

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28 Additional note
 The etiology or cause of substance related disorders has been identified as
involving several factors that may appear independently or in combination with
other such factors.
 There is evidence that genetic factors play a role in both dependence and abuse.
 Other causal theories cite the use of drugs as a means to cover up or get relief
from other problems related to mental illness, stress, issues involving
relationships, self-esteem and work, and others.
 Thus the using behavior is also looked at as a possible symptom of other issues or
problems (Kinney, 2003).

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 The behavioral and biological view— is when the processes experienced become
associated with drug use and its pleasant effects. When the feelings produced by
drugs are pleasurable, it increases the likelihood of future use.
 Drugs of abuse stimulate the "pleasure pathway" in the brain (mesolimbic
dopamine system). This can be direct stimulation by drugs such as cocaine and
amphetamines, or indirect stimulation by drugs such as heroin and alcohol—
reinforcing pleasure is a result of its effects on GABA neurotransmitters (Kinney
2003; Carroll, 2000).

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 Reinforcement— Drug use is negatively reinforcing when it provides escape from

negative feelings. The process of use may be called tension reduction or self-
medication.
 Some drugs produce this effect by enhancing activity of the GABA
neurotransmitters, which reduce the anxiety/fear responses.
 Increased use or levels of use have been noted among people who have
experienced traumas such as physical or sexual abuse.

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 The behavioral view also suggests that –using to avoid unpleasant withdrawal
symptoms (Kinney 2003; Carroll, 2000).

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 The biological view

 States there is a difference between children of alcohol dependent
parents and those of non-dependent parents with respect to genetic predisposition
and/or biochemical factors.

 Children of alcohol dependent parents are four times more likely than children of
non-dependent parents to develop substance dependence, regardless of whether
they are raised by their biological or adoptive (Kinney 2003; Carroll, 2000).

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 This indicates that some may have a biological vulnerability to substance

dependence relating to an enhanced sensitivity to rewarding effects of drugs.
 The presence of the gene does not mean an individual will definitely become
chemically dependent just like the absence of the gene does not mean that an
individual would not become dependent with sufficient use over time (Kinney
2003; Carroll, 2000).

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 that the brain adjusts after use, so it has less of some key neurotransmitter in the
system and the need for more influences continued substance use (Kinney 2003;
Carroll, 2000).

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Additional critical reading:

 Psychiatric Drugs Are More Dangerous than You Ever Imagined:
https://www.youtube.com/watch?v=luKsQaj0hzs

 Anticpsychotic and side effects: https://www.youtube.com/watch?v=3J1swiS7uJo

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