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7/29/2019 5.DRUGDEPENDENCE
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Drug Dependence
Blanton, March 10, 2004
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Drug Abuse
Illicit designation varies with
culture
Illicit designation varies over
time
Licit US drugs currently include
caffeine, tobacco, and alcohol
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Drug Abuse
Signi f icant Morbidity and Mortal i ty
Economic Drain
Legal Drugs most commonly misused
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Drugs of Abuse
Trends of use and disuse
Trends of societal acceptance
and nonacceptance
Legalization/decriminalization
of marijuana- medical pot
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Terminology
Drug Abuse- use outside accepted norms
Compulsive use- preoccupation with drug
Psychological Dependence- need for drug to
maintain feeling of well being
Physical Dependence- changes that result inwithdrawal if drug is stopped
Tolerance- drug loses effectiveness
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Terminology
Addiction:
physical, psychological dependence,
tolerance
uncontrollable obsession to
obtain and use drug
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Classes of Drugs of Abuse
-Opioids
-CNS Depressants
-CNS Stimulants-Nicotine
-Cannabinoids
-Psychedelics
-Arylcyclohexylamines
-Inhalants
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Factors in Drug Abuse
Drug:
effects, availability, price
User:
heredity, psychiatric disorders,
risk-taking behaviorEnvironment:
social setting, peers
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Treatment of Drug Addiction
High Relapse Rate- CRAVING
Success---> Long term treatment
Supportive and/or Psych therapyAA and NA
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Tolerance
Dispositional- pharmacokinetic
Pharmacodynamic- functional
Behavioral- learned
Cross- similar class- substitute
Degree- dose, frequency, duration
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Physical Dependence
Not a single mechanism
Linked to Tolerance and Adaptation
Three Conditions:
-Sufficient Dose
-Sufficient Frequency-Sufficent Duration
Withdrawal in Absence of Drug
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Intensity of Withdrawal
Degree of Cellular Adaptation
Half-life of the drug
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Cross- Dependence
Clinical use of drugs from the
same class as the drug of
addiction- to reduce withdrawal:
methadone for heroinbenzodiazepines for ethanol
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Opiate Addiction
Significant # of health care
professionals
stress
easy access to pharmaceuticalgrade opiates
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Opiate Effects
intensely pleasurable feelings
IV Heroin
Rapid Tolerance- 100x doseincrease
Short t1/2
grade of heroin
Opiate Addiction
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Opiate Withdrawal- Signs
craving mydriasis
restlessness sweating
pain sensitivity goosefleshnausea vomiting
cramps diarrhea
muscle aches blood pressure
dysphoria yawning
insomnia fever
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Opiate Addiction Intervention
Methadone Substitution
titrated downward over
time
Clonidine for autonomicsymptoms
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Opiate Addiction Intervention
Methadone: long half-life
High
Normal
Sick
Heroin
Methadone
0 6 12 18 24
Hours
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Opiate Addiction Intervention
Acetylmethadol
Buprenorphine- partial agonist
Naltrexone- antagonist
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CNS Depressant Addiction
Cognition and Psychomotor
Performance
Overdosage--> Respiratory Arrest
Tolerance to Psychic and Motor
Effects, but not to respiratory
depression
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CNS Depressant Withdrawal
Must be treated
Risk of fatal status epilepticus
Ethanol and Barbiturates- more
dangerous than Benzodiazepines
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Concluding Remarks
Polysubstance Abuse
Underreporting of alcohol andnicotine use
Shame in admission of illicit
drug abuse
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Study Guide
1) Understand tolerance and
physical dependence.
2) Contrast opioid and CNS
depressant withdrawal symptoms.
3) Contrast medical managementof withdrawal from opioid and
CNS depressants.