This document discusses various drugs that can cause dependence and addiction. It covers the physiological and psychological effects of dependence, as well as withdrawal symptoms that can occur when stopping use. It categorizes different drugs based on their medical uses and addiction potential, and provides details on the mechanisms of action, dependence, and withdrawal symptoms for several classes of drugs including sedatives, opioids, nicotine, caffeine, amphetamines, cocaine, LSD, marijuana, inhalants, and anabolic steroids. Treatment approaches for managing dependence and withdrawal are also outlined.

1. By Dhuha jamal

2. State result from repeated drug administration
(Weeks to months) That develop tolerance and withdrawal
symptoms upon cessation of drug use. Two type
Physiological dependence :removal of the drug evokes
unpleasant symptoms ,usually the opposite of the drugs effect
Psychological dependence ; the drug taker feels compelled to
use the drug and suffers anxiety when separated from drug
Substance abuse ; The criteria for substance abuse do not
include tolerance , withdrawal but instead include only the
harmful effect of repeated use
Most addictive drugs have action that facilitate of the effects of
dopamine in the CNS

3. Examples
criteria
Flunitrazepam ;heroin ;LSD
No medical use ;high addiction
potential
Amphetamin ;methylphenidate
;cocaine ;strong opioids(morphin
meperidine,fentanyl)
Medical use ;high addiction
potential
Anabolic
steroid;barbiturates;moderate
opiods(codeine,oxycodon )
Medical use ;moderate addiction
potential
Benzodiazepines;cloral hydrate
;weak opioids(propoxyphen)
Medical use ;low abuse potential

4. 1- sedative – hypnotics
The group includes ( barbiturates –benzodiazepines ) are
commonly prescribed drugs for anxiety and produce relaxation
these actions are encourage to repetitive use although the
primary action of these group involve facilitation of GABA; these
drugs also enhance brain dopamiergic pathways this related to
the development of addiction . These drugs cause CNS
depression so in acute overdose ,commonly result in death
through depression of the respiratory and cardiovascular center
flumazenil(I.V) used to reverse CNS depressant effects of
benzodiazepine but there is no antidote for barbiturates .

5. dependance occurs with continued use of sedative hypnotics drugs .
when discontinue of drug after long term therapeutic administration
result withdrawal symptoms,the signs and symptoms of withdrawal
derive from excessive CNS stimulation include (anxiety –tremor –
seizures ) treatment by administration of long acting drug (diazepam)
followed by gradual dose reduction
Withdrawal symptoms with benzodiazepines are less intense than with
barbiturates
Flunitrazepam is a rapid onset benzodiazepin with marked amnestic
propertise no medical used –high addiction potential has been used in
date rape make the victim incapable of resisting rape

6. 2- opioid
opioids have a broad range of effect, their primary use is to
relieve pain and the anxiety that accompanied it . Act by binding
to specific receptors in the CNS to produce effects that mimic
the action of endogenous peptide
. The most commonly abused drugs in this group are heroin,
morphine, codeine, oxycodone. I.V administration of opioids
associated with rapid development of tolerance, dependence
and addiction but oral administration or smoking of opioid
cause milder effects with a slower onset of tolerance and
dependance

8. Treatment of withdrawal by methadone followed by slow dose
reduction . Buprenorphine a partial agonist at μ-Receptor and a longer
acting opioid also used as substitution therapy for opioid addicts .
naloxone (competitive antagonist) may cause precipitate the withdrawal
symptoms of opioid

9. A-Nicotine
Tobacco is usually prepared from leaves of Nicotiana tabacum
contain alkaloids (nicotine, nornicotine)
Nicotine is abused widely all over world in the form of
inhalation
(cigarette, pipe).
Dependance
Nicotine dependance is the most widely prevalent and deadly of all
substance dependencies
The dependence –effects of nicotine appear to be modulated by
dopamine which increased in smoker. signs and symptoms of
nicotin withdrawal can occur within 4 to 8 hours of the last
cigarette ,in fact most chronic smokers experience withdrawal
sypmtoms on waking up each morning
NRT,Bupropion, varenicline has been found to help people stop
smoking.,.

11. Caffeine is the most commonly used in the world. Although consumption of
low to moderate doses of caffeine is generally safe, but some of caffeine
users become dependent on the drug and are unable to reduce consumption
despite knowledge of recurrent health problems associated with continued
use .Caffeine is a central nervous system stimulant drug which
occurs in nature as part of the coffee, tea, cocoa and other
plants .IS used to increase wakefulness, alleviate fatigue, and
improve concentration and focus...Caffeine's mechanism of
action is somewhat different from other drugs, caffeine
blocks adenosine receptors A1 and A2A (stimulation of
adenosine receptors produces feelings of the
need to sleep)
caffeine also increased release of dopamine, noradrenalin, and
glutamate

12. Studies suggest that dopamine release in the nucleus accumbens shell may be
a specific neuropharmacological mechanism underlying the addictive
potential of caffeine. Notably, dopamine release in this brain region is also
caused by other drugs of dependence, including amphetamines and cocaine.
Up-regulation of the adenosine system after chronic caffeine administration
appears to be a neurochemical mechanism underlying caffeine withdrawal
syndrome. This mechanism results in increased functional sensitivity to
adenosine during caffeine abstinence, and it likely plays an important role in
the behavioral and physiological effects produced by caffeine withdrawal.

13. Withdrawal
Caffeine withdrawal refers to a time-limited syndrome that develops after
cessation of chronic caffeine administration. Common symptoms include
headache, fatigue, difficulty concentrating, and dysphoric mood
The symptoms of caffeine withdrwawl usually start about 12 to 24 hours after
not having caffeine
steps to lower dependence on caffeine:
1-Increase water intake.
2-Replace one caffeine drink a day with a caffeine-free option. For
example, herbal tea or hot water with lemon.
3-incorporate exercise into your daily routine. It’s a natural stimulant for
your body and central nervous system.

14. C-Amphetamine
amphetamine causes emotional and cognitive effects such as
euphoria and increased wakefulness. Amphetamines increas
the concentration of dopamine in the synaptic gap so cause
dependance and wihdrawal symptoms can be avoid by tapering
the dose

15. An alkaloid ester extracted from the leaves of plants
including coca. It is a local anesthetic and
vasoconstrictor. It also has powerful CNS effect ,feelings
of well-being and euphoria .Act by inhibiting the
reuptake of serotonin,NE and dopamine ,This results in
greater concentrations of these neurotransmitters in the
brain
Cocaine is the second most frequently used Illegal drug,
after cannabis
withdrawal of cocaine cause dysphoria and depression
felt after initial high due to lack of normal amount of
serotonin and dopamin in the brain.

16. Cocaine has a relatively short half-life, withdrawal symptoms can
begin as soon as 90 minutes after the last dose. The symptoms of
acute cocaine withdrawal resolve after 7-10 days.
Treatment
A-There are no FDA-approved medication that specifically treat
cocaine withdrawal. However, there is some promising research on the
use of buprenorphine and naltrexone to treat cocaine withdrawal
B-benzodiazepine or Propanolol for treatment anxiety and
psychological problem
C-Anti depressant drugs may also be indicated

17. A-lysergic acid diethylamide(LSD),hallucinogenic effects may
also occur with scopolamine and other antimuscarinic
agents.None of these drugs has action on dopaminergic
pathways in the CNS ,interestingly,They do not cause
dependence.
People using these drug can safely stop taking it without
experiencing any physical symptoms of withdrawal. For this
reason, physical withdrawal treatment is not often required.

18. B- marijuana
Tetrahydrocannabinol(THC) is a component of marijuana act both
centrally and peripherally on endogenous cannabinoid receptor
Activation of cannabinoid receptors affects serotonin
release.therapeutic effects of marijuana include decrease
intraocular pressure , antiemetic effect and appetite stimulant ,
CNS effect include feeling of high with euphoria
Marijuana withdrawal symptoms may not be as severe as
withdrawal symptoms OF other substance cocaine and heroin

20. These symptoms can range from mild to severe, and they vary from person to
person. These symptoms may not be severe or dangerous, but they can be
unpleasant.Treatment
A-Slowly reducing marijuana use may help to a marijuana-free life.
B- Stay hydrated. Drink lots of water and avoid sugary, caffeinated beverages
like soda.
C- Eat healthy foods. Fuel your body with a generous supply of fresh fruit,
vegetables, and lean protein..
D- Exercise every day. Squeeze in at least 30 minutes of exercise each day.
This provides a natural mood boost, and it can help remove toxins as you
sweat.
E- Find support. Surround yourself with friends, family members, and others
who can help you through any withdrawal symptoms you may experience.

21. Certain gases or volatile liquid are abused becouse they provide a feeling of
euphoria . three group
A- Anesthetic ; this group include nitrous oxide , chloroform
B- Industrial solvents; include gasoline,aerosol propellant,rubber cements
and shoe polish. These substance are most frequently abuse by children in
early adolescence
C- organic nitrites; include amyl nitrite and isobutyl nitrite

22. Anabolic steroids are controlled substance based on their potential for
abuse . Effects sought by abusers are increase in muscle mass and
strength rather than euphoria . However,excessive use can have
adverse behavioral(increased in libido and aggression)also increase
risk of myocardial infract , acne and masculinization in females .a
withdrawal syndrome has been described with fatigue and decreased
appetite
Steroid use cannot be stopped abruptly , tapering the drug gives the
adrenal glands time to return to their normal patterns of secretion