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
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