Abuse/Dependece/Addiction

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Definitions of Abuse/Dependence/Addiction

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Abuse/Dependece/Addiction

  1. 1. DRUG ABUSE DRUG DEPENDENCE DRUG ADDICTION Tahar AbdAlaziz MD, PhD
  2. 2. Terminology Problems The terms drug dependence & drug addiction are often used interchangeably, but this leads to confusion regarding the diagnostic effects of these terms. The definitions of 1957 & 1964 regarding addiction, dependence and abuse persist to the present day in medical literature. In 1957 WHO defined addiction and habituation as components of drug abuse. In 1964 WHO found these definitions to be inadequate, and suggested using the term "drug dependence”.
  3. 3. In 2000, the Diagnostic Statistical Manual of Mental Disorders (DSM-IV-TR) introduced specific criteria for defining abuse and dependence. (DSM-IV-TR) uses the term substance dependence instead of addiction, and defined it as A maladaptive pattern of substance abuse, leading to clinically significant impairment or distress, as manifested by three (or more) specified criteria, occurring at any time in the same 12-month period.
  4. 4. Criteria of Dependence & Abuse according to DSM-IV-TR Dependence (3 or more in a 12-month period) 1) Tolerance (marked increase in amount; marked decrease in effect) 2) Characteristic withdrawal symptoms; substance taken to relieve withdrawal 3) Substance taken in larger amount and for longer period than intended 4) Persistent desire or repeated unsuccessful attempt to quit 5) Much time/activity to obtain, use, recover 6) Important social, occupational, or recreational activities given up or reduced 7) Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous) Abuse (1 or more in a 12-month period) Symptoms must never have met criteria for substance dependence for this class of substance. 1) Recurrent use resulting in failure to fulfill major role obligation at work, home or school 2) Recurrent use in physically hazardous situations 3) Recurrent substance related legal problems 4) Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance
  5. 5. New Changes 2013
  6. 6. • DSM-5 consolidates substance abuse and dependence into one disorder: substance use disorder • Criteria are nearly identical to DSM-IV with exception of: -Recurrent substance-related legal problems criterion has been deleted from DSM-5. -And new criterion: craving, or a strong desire or urge to use a substance added. • The threshold is set at 2 or more criteria vs. 1 or more for abuse and 3 or more for dependence in the DSM-IV.
  7. 7. Severity of the problem (NEW) In DSM-5 severity for substance use disorders is based on the number of criteria endorsed: – MILD= 2-3 criteria – MODERATE= 4-5 criteria – SEVERE= 6 or more criteria •
  8. 8. In 2001, • American Academy of Pain Medicine • America Pain Society • American Society of Addiction Medicine jointly issued "Definitions Related to the Use of Opioids for the treatment of pain”.
  9. 9. Drug abuse The substance is used in a manner that does not conform to social norms; the motivation to use the substance may or may not be particularly strong compared with other motivators.
  10. 10. Drug addiction • A behavioral syndrome characterized by behaviors that include one or more of the following: – Impaired control of drug use – compulsive drug use – continued use despite harm – craving
  11. 11. Drug dependence A state where the individual is dependent upon the drug for normal physiological functioning. Abstinence from the drug produces withdrawal reactions which constitute the only evidence for dependence.
  12. 12. Comparison Some substances may produce physical dependence without producing an addiction • The therapeutic uses of certain steroids and some antihistamines produce characteristic withdrawal syndromes when abruptly discontinued without motivation to continue the use of these substances for most patients. Some substances may produce psychological dependence without producing an addiction • substances can produce a notable psychological dependence without producing an exceptionally strong motivation to avoid abstinence such as caffeine or nicotine.
  13. 13. Risk Factors Drug abuse can lead to drug dependence or addiction. People who use drugs for pain relief may become dependent. The exact cause of drug abuse and dependence is not known. However, a person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress all can be factors.
  14. 14. Risk factors Peer pressure can lead to drug use or abuse, but at least half of those who become addicted have depression, attention deficit disorder, PTSD, or another mental health problem. Children who grow up in an environment of illicit drug use may first see their parents using drugs. This may put them at a higher risk for developing an addiction later in life for both environmental and genetic reasons.
  15. 15. Risk factors People who are more likely to abuse or become dependent on drugs include those who: • Have depression, bipolar disorder, anxiety disorders, and schizophrenia • Have easy access to drugs • Have low self-esteem, or problems with relationships • Live a stressful lifestyle, economic or emotional • Live in a culture where there is a high social acceptance of drug use
  16. 16. Theories of Addiction 1) MEDICAL MODEL 2) PSYCHODYNAMIC MODEL 3) SOCIAL MODEL 4) MORAL MODEL 5) BIO‐PSYCHO‐SOCIAL MODEL
  17. 17. Medical TheoryThis theory describes addiction as a disease. It attributes addiction to changes in dopaminergic (mesolimbic) pathway Addiction as a “brain disease” due to Neurotransmitter imbalance •Disease Model: •Agent: drug •Vector: dealers •Host: addict
  18. 18. 1 10 100 Child Teen Young Adult Adult 1.5% 67% 5.5% <12 12-17 18-25 >25 Addiction is a Developmental Disease: It Starts Early 26%
  19. 19. Copyright ©2004 by the National Academy of Sciences Gogtay, Giedd, et al. (2004) Proc. Natl. Acad. Sci. USA 101, 8174-8179 MRI Scans of Healthy Children and Teens Over Time
  20. 20. MRI Scans of Healthy Children and Teens Over Time brain development through early adulthood, with blue indicating the mature state Prefrontal cortex (white circles), which governs judgment and decision- making functions, is the last part of the brain to develop. •This may help explain: • why teens are prone to risk-taking •vulnerable to drug abuse •why exposure to drugs at this critical time may affect propensity for future addiction.
  21. 21. that starts in adolescence and childhood National Epidemiologic Survey on Alcohol and Related Conditions, 2003.National Epidemiologic Survey on Alcohol and Related Conditions, 2003. AgeAge Age at tobacco, alcohol and cannabis dependence per DSM IV 0.0%0.0% 0.2%0.2% 0.4%0.4% 0.6%0.6% 0.8%0.8% 1.0%1.0% 1.2%1.2% 1.4%1.4% 1.6%1.6% 1.8%1.8% 55 1010 1515 2121 2525 3030 3535 4040 4545 5050 5555 6060 6565 %ineachagegroupwhodevelop first-timedependencefirst CANNABIS ALCOHOL TOBACCO Addiction Is A Developmental Disease
  22. 22. Circuits Involved In Drug Abuse and Addiction PFC – prefrontal cortex; ACG – anterior cingulate gyrus; OFC – orbitofrontal cortex; SCC – subcallosal cortex; NAc – nucleus accumbens; VP – ventral pallidum; Hipp – hippocampus; Amyg – amygdala The developing strategies to treat addiction must put in consideration these areas for better results
  23. 23. Pshychodynamic Model Psychodynamics is the theory and systematic study of the psychological forces that underlie human behavior. It is especially interested in the dynamic relations between conscious motivation & unconscious motivation.
  24. 24. • In Freudian thought, psychodynamics is the study of transformations and exchanges of “psychic energy” in the personality • The psychodynamic model explains behaviors through the interactions of Freud’s innate emotional forces, the id, ego, and super-ego.
  25. 25. Social Theory • This theory hypothesizes that substance addiction is a learned behavior and it develops as a result of social problems such as poverty, violence, family dysfunction. • These forces are believed to act as social stressors and substance addiction is considered to be an adaptation to the resultant misery and unhappiness.
  26. 26. Moral Theory • The moral theory denotes substance addiction as a vice ‫الرذيلة‬ or a sin ‫الخطيئة‬ . • The theory implies that some individuals, through their own free will, make a conscious choice to become substance addicts. • According to this theory drug abusers choose to use drugs and they are anti‐social and should be punished
  27. 27. Bio-psycho-social Theory • Substance addiction is the net result of a complex interaction between a combination of all of the factors: – Biological – Psychological – Social – Spiritual • Each person’s drug use is a result of some aspects of some or all the other models. • Treatment and recovery require addressing the body, mind, social environment, and spiritual needs of an individual (including nutrition, employment, family issues, psychological issues, etc.).
  28. 28. The highest Risk Periods for Children • The high risk periods for drug abuse among children occur during major transitions in children’s lives. • Transitions include: – Significant changes in physical development (for example, puberty) – Social situations (such as moving or parents divorcing) – When they leave the security of the family and enter school – When they advance from elementary school to middle or high school, they often experience new academic and social situations, such as learning to get along with a wider group of peers and having greater expectations for academic performance. •
  29. 29. Incidence of Addiction Worldwide, 149-271 (million) people used an illicit drug at least once in 2009; which equals 1 in 20 people aged 15 to 64 who have used an illegal drug. In North America, nearly 11% of population aged 15 to 64 used cannabis in 2009. Worldwide, 14-56 (million) people aged 15 to 64 used amphetamine-type stimulants, such as speed and crystal meth. Cocaine had 14 million to 21 million users worldwide. Opioid use, including heroin, had an estimated 12 million to 21 million users globally. The highest rates of use were in the Near and Middle East, where up to 1.4% of the population aged 15 to 64 had tried the drug at least once in 2009. Worldwide, 11 million to 21 million people inject drugs. The Lancet
  30. 30. Classification of Addictive Drugs 1) Narcotic Analgesics: drugs with opium like effects. 2) Stimulants: drugs which excite the central nervous system. 3) Depressants: drugs which depress the functions of the central nervous system. 4) Hallucinogens: drugs which affect perception, emotions and mental processes. 5) Cannabis 6) Volatile Solvents: volatile hydrocarbons, Petroleum derivatives 7) Other drugs of abuse: medically used drugs that do not fall into any of the above categories, such as • Muscle relaxants • Painkillers • Anti-histamines • Anti-depressants / anti-psychotics
  31. 31. Commonly Used Psychoactive Substances SOURCE: National Institute on Drug Abuse. SUBSTANCE EFFECTS Alcohol (liquor, beer, wine) euphoria, stimulation, relaxation, lower inhibitions, drowsiness Cannabinoids (marijuana, hashish) euphoria, relaxations, slowed reaction time, distorted perception Opioids (heroin, opium, many pain meds) euphoria, drowsiness, sedation Stimulants (cocaine, methamphetamine) exhilaration, energy Club Drugs (MDMA/Ecstasy, GHB) hallucinations, tactile sensitivity, lowered inhibition Dissociative Drugs (Ketamine, PCP, DXM) feel separated from body, delirium, impaired motor function Hallucinogens (LSD, Mescaline) hallucinations, altered perception 32
  32. 32. Examples of Addictive Drugs Alcohol • alcohol abuse causes over 100,000 deaths in the USA and Canada each year. It is the drug most commonly abused by children ages 12 to 17. Alcohol-related motor vehicle accidents are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in deviated sexual behaviors . Heroin • It is a diacetylmorphine that functions as a morphine prodrug. It can be used for medical purposes as analgesic to treat severe pain with the name diamorphine. The name "heroin" is only used when being discussed in its illegal form.
  33. 33. Tramadol Tramadol hydrochloride (Tramal) is a centrally acting synthetic analgesic used to treat moderate to moderately severe pain. Tramadol is converted to O-desmethyltramadol (potent μ-opioid agonist). The opioid agonistic effect of tramadol and its major metabolite(s) is almost exclusively mediated by μ-opioid receptors.
  34. 34. Vicodin • Hydrocodone or dihydrocodeinone is a semi-synthetic opioid • It is an orally active narcotic analgesic & antitussive. • It acts at μ-opioid receprors. • It is metabolized to hydromorphone • About 53% of patients in rehabs across USA were chemically dependent on Vicodin.
  35. 35. Ecstasy • MDMA (3,4-methylenedioxy-N- methylamphetamine)
  36. 36. • an empathogenic (entactogenic) drug of the phenethylamine & amphetamine class. • MDMA has become widely known as "ecstasy" (shortened to "E", "X", or "XTC), usually referring to its street pill form. • MDMA can induce euphoria, a sense of intimacy. • MDMA is criminalized. • For 2008 the UN estimated between 10–25 million people globally used MDMA at least once in the past year. Ecstasy
  37. 37. Desomorphine (Krokodil) • Desomorphine is a synthetically derived morphine isomer. • Animal trials of desomorphine showed that, by comparison with morphine: – Stronger and more rapid analgesic effect – Longer effect duration – Quicker addiction
  38. 38. GHB (Gama Hydroxybutyric Acid) • Asynthetic depressant available as a prescription for sleep disorders • In some countries was banned (in the U.S.) by the FDA in 1990 because of the dangers associated with its use. • GHB and its analogs are considered "date rape" drugs because they can be mixed with liquids (even water) and a victim wouldn't notice by smelling or looking at it. • GHB, by itself, has a soapy or salty taste--but when mixed in a drink it may be difficult to detect.
  39. 39. Dextromethorphan (DXM) • DXM is a cough-suppressing ingredient in a variety of over-the-counter cold and cough medications. • Dextromethorphan, a semisynthetic narcotic, is an ingredient found in more than 70 different products. • DXM acts centrally to elevate the threshold for coughing. • At high doses dextromethorphan produces dissociative effects similar to those of PCP and ketamine.
  40. 40. Benzodiazepines • About 35 members of this group are presently marketed in different countries. • Shorter-acting benzodiazepines used to manage insomnia include estazolam (ProSom) • Benzodiazepines with a longer duration of action are utilized to treat insomnia in patients with daytime anxiety. These benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam (Valium) • Rohypnol (flunitrazepam), most commonly known as a date-rape drug. • One of the significant effects of the drug is anterograde amnesia, a factor that strongly contributed to be one of the drugs used in rape. • Anterograde amnesia is a condition in which events that occurred while under the influence of the drug are forgotten.
  41. 41. Ketamine (“Special K”) Anesthetic developed to replace PCP, manufactured by Pfizer Used in human and veterinary medicine Injected or dried and snorted “Vitamin K” “K” “Bump”
  42. 42. FENTANYL • Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical. • The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. • Fentanyls are most commonly used by IV administration, but like heroin, they may also be smoked or snorted.
  43. 43. ABUSE OF ANABOLIC STEROIDS • Anabolic Steroid abuse has become an international concern. • These drugs are used illicitly by weight lifters, body builders, long distant runners, cyclists, and others who claim that the drugs give them a competitive advantage and/or improve their physical appearance. • The American Controlled Substance Act (CSA) defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogen, progestins, and corticosteroids), that promotes muscle growth.
  44. 44. Menace of Drug Abuse Nitrosun
  45. 45. Peer Pressure
  46. 46. SCARRY BODY OF AN ADDICT

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