An overview of common addictions and their management

1. Addiction/dependence
A state of periodic or chronic
intoxication, produced by repeated
consumption of a drug/substance

2. Characteristics
 Preoccupation/anticipation-
constant craving & effort to obtain the substance
 Binge/intoxication-
consuming the substance with its deleterious effects
 Tolerance-
requiring increasing amount of substance for similar effect
 Withdrawal-
reducing/stopping consumption associated with
psychological & physical manifestations like
insomnia, irritability, anger, depression, loss of
appetite
 Affects health, occupation, family, society

3. Target
 Nearly all addictive drugs target the
brain’s reward circuit, the mesolimbic
system
 Main neurotransmitter- dopamine
 Drugs-
 CNS depressants- alcohol, opioids, benzodiazepines
 CNS stimulants- nicotine, amphetamine, cocaine

4. Nicotine
 Tobacco use, smoked or chewed,
releases nicotine- half-life ~2 hours
 Nicotine activates receptors
in CNS releasing dopamine &
in SNS/adrenal medulla
releasing epinephrine
 Benefits of nicotine/smoking-
 Less revascularization required after PCI
 Reduces risk of ulcerative colitis, Kaposi sarcoma,
breast cancer in women with BRCA
gene, pre-eclampsia
 Delays onset of Parkinson’s disease
 Improve schizophrenia & ADHD

5. Health effects of tobacco
 Single greatest cause of preventable death
 Nicotine causes dependence
 Carcinogens- benzopyrene, acrolein,
nitrosamines
 Diseases caused-
 COPD
 CAD, CVA, HT
 Cancers- oral, larynx, lung,
esophagus, stomach, pancreas, kidney, bladder

6. Alcohol
 Screening- CAGE questionnaire- ≥2
felt need to Cut down, felt Annoyed on being asked,
felt Guilty, need for an Eye-opener?
 Long-term effects- cirrhosis, pancreatitis, dementia,
epilepsy, polyneuropathy, nutritional deficiencies,
sexual & ovulatory dysfunction
 Anxiety & depression are common
 Social effects- increased crime- theft, child abuse, rape,
domestic violence, accidents, loss of job/occupation
 Withdrawal- anxiety, delirium tremens, seizures,
hallucinations

7. Cannabis- marijuana/bhaang
Commonest illicit drug used
Repeated use leads to
dependence

8. Opioids
 Morphine/afeem, heroin, codeine,
oxy/hydrocodone, buprenorphine etc.
 High addiction potential
 Withdrawal symptoms- x 2 days-6 weeks
 Insomnia, anxiety, panic attacks, depression
 Leg & abdominal cramps
 Vomiting, diarrhea
 Rhinitis, lacrimation

9. Benzodiazepines
 Commonest cause of therapeutic drug
dependence
 Frequent if taken for >4 weeks & with use of
potent short-acting benzodiazepines
 Withdrawal symptoms-
 Anxiety, depression, insomnia
 Tremors, twitches
 Muscular pain. Headache
 Hypersensitivity to touch & pain
 Suicidal tendency

10. Cocaine
 Snorted, smoked or injected;
with increasing addiction potential
 Causes CNS stimulation leading to
euphoria, insomnia, erratic behaviour
 Withdrawl leads to ‘comedown’/crash-
dysphoria, exhaustion, craving
 CNS depressants- alcohol/opioids-
commonly used together to dull crash

11. Amphetamine
 CNS stimulant
 Commonly ingested
 Causes euphoria & insomnia
 Tolerance develops rapidly leading to
increasing use of drug
 Withdrawl causes dysphoria, exhaustion
 Alcohol, opioids, benzodiazepines commonly
used together to blunt withdrawl effects

12. Management- principles
 Addiction is a mental disease
 Needs treatment that is-
 Readily available
 Tailored
 Comprehensive
 Options-
 Detoxification
 Medications
 Counseling-individual/group & behavioural therapy
 Regular follow-up- to ensure abstinence & compliance

13. Drugs used
 Tobacco/nicotine-
nicotine replacement- patch,
gum,spray,lozenges bupropion, varenicline
 Alcohol-
naltrexone, acamprosate, disulfiram,
calcium carbimide, topiramate
 Opioid-
methadone, buprenorphine, naltrexone