This document discusses drug dependence and abuse. It defines drug abuse as the compulsive and harmful use of substances, and dependence as a compulsive need to use drugs to function normally and experience withdrawal without them. It explores reasons for drug use and the difference between abuse and dependence. Specific drugs discussed include nicotine, alcohol, and opioids. For each drug, modes of use, mechanisms of action in the body, effects, tolerance, dependence and treatment approaches are summarized.

1. drug dependence and
abuse
presented by
Abhishek s Keralli
4th B.Pharm
SSCP TUMAKURU

2.  DRUG ABUSE
 DRUG DEPENDENCE
 TERMINOLOGIES
 WHY DO PEOPLE ABUSE DRUGS?
 DIFFERENCE BETWEEN DRUG ABUSE AND DEPENDENCE
 DRUGS OF ABUSE
 NICOTINE ABUSE
 ALCOHOL ABUSE
 OPIOIDS ABUSE

3.  Compulsive, excessive, and self-damaging use of habit
forming drugs or substances, leading to addiction or
dependence, serious physiological injury (such as damage to
kidneys, liver, heart) and/or psychological harm (such as
dysfunctional behaviour patterns, hallucinations, memory
loss), or death. Also called substance abuse.
 It is defined as usage of drugs for non-therapeutic purpose,
Using a drug for altered mood, consciousness and physical
Development such as misuse of CNS stimulants and
Depressants.
 The term abuse also represents certain drugs Used by people
which are not approved or accepted by society.

4. Substance or Drug
Dependence, commonly
called as Drug Addiction, is
a compulsive need to use
drugs in order to function
normally.
When such substance are
unobtainable, the user
suffers from withdrawal.

5. “When an individual persists in use of alcohol or
other drugs despite problems related to use of
substance, Substance (Drug) Dependence may be
diagnosed. Compulsive and repetitive use may
result in tolerance to the effect of the drug and
withdrawal symptoms when use is reduced or
stopped. This, along with Substance (Drug) Abuse
are considered Substance (Drug) Use Disorders.”

6. DRUG SEEKING BEHAVIOR
Abused drugs and abused substances are known to enhance CNS
effects and an increased demand of drug. The enhanced drug
seeking property of a drug is reinforcing property.
MISUSE-Indiscriminate use of drugs is termed as
misuse.

7. ADDICTION
Chronic use of drug leads to drug addiction. Drug addiction is characterized by
the following:
 The person aims to consume drug at any circumstances.
 Procurement of the drug becomes a must for the person.
 Drug addiction leads to development of drug tolerance.
 Tolerance development increases the effective dose requirement production of
normal therapeutic effect.
 Addicted people must use the drugs regularly to avoid abstinence(self-denial)
syndrome.

8.  Discontinuous of cessation of the drug leads to relapse.
Ex: The drugs like Amphetamines, Lysergic acid Diethylamide,
Cocaine, cannabis and others are liable for addiction. These
drugs produce addiction without physical dependence.

9. HABITUATION
It is a state of mind of a drug abuser characterized by the following
features:
 There is no compulsion to consume the drug.
 Tolerance, withdrawal symptoms are developed to a maximum
extent.
 Habituation is not harmful to society but it is problematic for an
individual.
 It is closely related to addiction.
Ex: Addiction to Tea, Coffee and other beverages, Alcoholism’
consumption of Soft Drinks, Cool Drinks, Energy Drinks, etc., Addiction
to Tobacco in the form of Smoking Cigarettes, Chewing, etc.

10. REBOUND
The recurrence of symptoms of a disease due
to sudden cessation of the drug. Symptoms are vivid and appear to
a greater extent.
RELAPSE
The recurrence of disease which has been
successfully treated earlier. This may occur with similar symptoms
of disease after a gap of certain period due to discontinuation of
treatment.

11. DETOXIFICATION
It is one of the process of drug dependence treatment. It involves
administration of abused drug in reduced doses so that slow
withdrawal is possible.
CRAVING
Increased drug seeking property or wanting of drug or desire to
procure the drug.

12. People take drugs because they want to change
something about their lives.
Here are some of the reasons young people have
given for taking drugs:
 To fit in
 To escape or relax
 To relieve boredom
 To rebel
 To experiment

13.  They think drugs are solution. But eventually, the drugs
become the problem.
 Difficult as it may be to face one’s problems, the
consequences of drug are always worse than the problem
one is trying to solve with them. The real answer is to get
facts and not to take drugs in first place.

14. Substance abuse, also known
as Drug Abuse, is a patterned
use of a substance (drug) in
which d user consumes the
substance in amounts or with
methods neither approved
nor advised by medical
professionals.

15. Substance/Drug abuse is not limited to mood-
altering or psycho-active drugs. If an activity is
performed using the objects against the rules and
policies of the matter (as steroids for performance
enhancement in sports) it is also called substance
abuse.

16. The mood-altering and psychoactive
substance are not the only types of
drugs abused. Using illicit drugs –
narcotics, stimulants, depressants
(sedatives), hallucinogens, cannabis
(Marijuana/Ganja) etc.
Substance abuse or Drug abuse often
includes problems with impulse
control and impulsive behavior.

17. The DSM-IV-TR identifies two different severities of Substance
Use Disorders. These are Substance Abuse and Substance
Dependence.
DRUG ABUSE
Substance Abuse is the less severe diagnosis. It includes the following
symptoms:
 The repeated and continued use of a substance despite negative
consequences (within a 12-month period).
 “Negative consequences” includes four primary types.

18. 1. One negative consequence is continued use despite problems
with work, school or family/social obligations. This might
include repeated work absences, poor school performance,
neglect of children, or failure to meet household
responsibilities.
2. Another negative consequence occurs when a person
becomes involved in legal difficulties related to their
substance use (e.g. DUI, assault, theft).

19. 3.A third type of negative consequence is repeatedly using
substances in physically dangerous situations. For instance,
using alcohol or other drugs while operating machinery or
driving a car.
4.Abuse may also be indicated when someone continues
substance use despite having interpersonal problems
because of the substance use. This could include arguments
with family members spouse/partner about the substance
use; or loosing important friendship because of continued
use.

20. Substance dependence as compared to Substance Abuse, is the more severe
diagnosis. Substance Dependence requires at least three of the following seven
symptoms(within a 12-month period)
1. Tolerance
2. Withdrawal symptoms
3. Using for longer periods
of time than intended, or using
larger amounts than intended;
4. Wanting to reduce use, yet being
unsuccessful doing so;

21. 5. Spending excessive time
getting/using/recovering from the drug use;
6. Isolated Behavior : Giving up social or
occupational activities due to use;
7. Continuing to use despite knowing about
physical/psychological problems related to use.

22. DRUG RELATED FACTORS
Drugs posses different abilities to produce reinforcement in
individual. Drug variables play major role in the development of drug
abuse and drug addiction.
Examples: Availability of the drug, Cost of the drug, potency, Route of
administration, speed of action etc. are the important drug related
factors.

23.  Every individual has a different mechanism of action for drug
absorption, metabolism and other pharmacokinetic &
pharmacodynamics properties.
 Genetic factors of an individual closely control the various
activities. Almost 60% of people are genetically addicted to
drugs. Alcohol abuse may be due to genetic factor.
Apart from genetic factors, other factors related to the host
that control drug abuse and addiction include development of
tolerance euphoria, intoxication, psychiatric symptoms,
metabolism etc.

24.  These factors are closely related to the society and surroundings in
which the person lives.
 People living in underdeveloped areas where job opportunities and
educational exposures less are more susceptible to drug abuse and
addiction. Drug abusers, dealers influence the local people to consume
the drugs.
 The consumption of abused drugs lead to reinforcement and increased
craving of the drug.
Examples: Substances like Cannabis, Cocaine, Heroine, Marijuana,
Nicotine, Alcohols are abused intentionally.

25. NICOTINE ALCOHOL OPIOIDS

26. Nicotine is obtained from
Nicotiana tobaccum to a
maximum extent and is potent,
toxic substance that exists in
tobacco and is responsible for
drug dependence.
 Addiction to nicotine has been
increasing over past few years.
 it is globally consumed in
various forms; smoked as cigars,
cigarettes, beedi, hooka; inhaled
as snuff; chewed as jarda, khaini,
gutka etc.

27. CIGARETTES & CIGARS
BEEDI GUTKA

28.  Nicotine acts on the acetylcholine receptors which
are present in cortex and hippocampus religions of
the brain at the presynaptic and postsynaptic areas.
 Nicotine is involved in stimulation and
desensitization of acetylcholine.
 Stimulation of acetylcholine causes excitation of
neurons, which leads to rapid neuronal transmissions.
 Chronic administration of nicotine desensitizes
acetylcholine receptors.

30. 1. ON CENTRAL NERVOUS SYSTEM
Nicotine stimulates CNS by stimulating receptors and the
resultant effect includes alertness, attention, decreased
depression, anorexia and improved memory. Stimulation of
supraoptic nucleus causes release of anti-diuretic hormone.
Apart from regions of brain, nicotine also stimulates
respiratory centers and vomiting centers. It inhibits spinal
reflexes which causes relaxation of skeletal muscle
stimulating cells of spinal cord. Excess intake of nicotine
causes adverse effects like seizures, coma and even death
due to respiratory failure.

31. 2. ON CARDIOVASCULAR SYSTEM
Nicotine stimulates autonomic ganglia and adrenal
medulla which results in vasoconstriction of peripheral
regions and the ultimate effect is tachycardia, increased
cardiac output and arterial pressure.
3. ON GASTROINTESTINAL TRACT
Salivary secretions are increased by stimulatory
effects of nicotine. Other effects on GIT include nausea,
vomiting. Excess stimulation of GIT delays healing of
peptic ulcers, increased motor activity and diarrhea are
noticed.

32.  Nicotine is absorbed rapidly when it is inhaled in the form of smoke.
Cigarettes possess 0.8g of tobacco and 9-17g nicotine.
 Cigar or pipe smoke gets absorbed rapidly from mouth to pharynx.
Absorption of nicotine from cigar occurs at slower rate and lasts for
longer duration.
 Consumption of one cigarette increases about 15-30mg/ml of
nicotine concentration in the plasma within 10 minutes. The obtained
concentration reduces to half after another 10 minutes and slowly
declines within 1 to 2 hours as it gets distributed to tissue and blood.
 Nicotine is metabolized by liver. Oxidation of nicotine takes place and
the oxidized metabolic product is cotinine, plasma half-life of
metabolic product is for longer duration.

33. 1. RESPIRATORY DISORDERS
Chronic smokers have high risk of cancer attack.
Occurrence of cancer in lungs, upper respiratory
tract, oesophagus, bronchi, larynx have been
noticed. Cancer is associated with symptoms like
dyspnoea, wheezing cough, chest pain, respiratory
tract infections, etc. Risk of cancer is greater in
smokers when compared to non smokers.

34. 2. ON CARDIOVASCULAR SYSTEM
Thrombosis induced by smoking results in coronary heart
diseases. Hypertension and ischemia also occur due to excess
release of catecholamine, anti-diuretic hormone and fatty
substances in plasma.
3. REPRODUCTIVE DISORDERS
Smoking may lead to several complications in pregnant
women such as premature delivery, spontaneous abortion and
placenta praevia. It may also show deleterious effects in the
newborns such as decreased birth weight, physical and mental
abnormalities. It may also lead to tachycardia in infants
dependent on mother’s milk.

35.  Nicotine activates the Reward-Reinforcement pathway by increasing the
dopamine levels. Prolonged use of nicotine leads to desensitization of
nicotinic acetylcholine receptors.
 Nicotine stimulates autonomic ganglia in order to stimulate postganglionic
nerves. But higher dose of nicotine blocks the ganglionic transmission by
producing depolarization.
 Tolerance is rapidly developed due to desensitization of acetylcholine
receptors because of chronic administration of nicotine. The desensitization
of acetylcholine receptors is responsible for blockage of ganglionic
stimulations.
 The withdrawal symptom of nicotine is craving of cigarettes. This symptom
lasts for a month. Over symptoms include anxiety, sleeplessness, restlessness,
etc.

36.  Nicotine dependence and withdrawal symptoms can be treated by
using nicotine substitutes and other suitable antagonists for
nicotinic receptors.
 Nicotine Replacement Therapy is found useful in treating nicotine
dependence where a substitute to nicotine is administered to the
dependents which contain relatively small amounts of nicotine.
 Drugs for treatment of nicotine and tobacco are:
- Bupropion
- Rimonabant
- Varenicline
- Clonidine

37.  Alcohol beverages are widely
distributed and available globally.
 Alcohol is one of the most
abused drugs. People prefer
alcohol for pleasure and euphoria.
 The reinforcement of alcohol is
high as a result several people are
currently suffering from
alcoholism.
 Alcohol primarily acts as a CNS
depressant and gradually initiates
sedations.

38. BEER WINE LAGER

39. WHISKY VODKA RUM

40.  Chronic alcohol consumption produces various adaptive
neuronal changes in order to counter attack the acute cellular
effects produced by alcohol.
 The density of GABA receptors decreases up regulation of NMDA
(N-methyl-D-aspartase) receptors and proliferation of Ca2+
channels takes place.
 Alcohol enhances the neurotransmitters of reward pathway. It
elevates dopamine, 5-HT, acetylcholine, norepinephrine and
other opioid receptors with a similar mechanism as that opioids
i.e. enhances the drug dependence activity since it produces
pleasant feelings.

41. 1.CNS MANIFESTATION
Initial effects include impairment of cognitive functions like ability to
learn, attention, contraction, slurred speech, euphoria, highly excited
nature, self confidence, sedation, ataraxia. Excess of alcohol results in
melancholy, aggressive nature, mood disorders, impaired sensory
parameters, etc.
2. CARDIOVASCULAR MANIFESTATION
These include peripheral vasodilatation, sweating, excessive sweating
increased heart rate flushing.

42. 3. GASTROINTESTINAL MANIFESTATION
Alcohol enhances gastric acid secretions and
results in impairment of normal functioning of GIT.
4. RENAL MANIFESTATION
Diuresis due to inhibition of anti-diuretic
hormone. Hyperuricemia (excess uric acid in blood)
due to abnormal excretion of uric acid.

43. Chronic alcohol consumption leads to various neurological
disorders such as-
a. Wernicke’s Encephalopathy
b. Polneuropathy
c. Karsakoff’s Neuropathy
d. Retrobuar Neuropathy
e. Marchiafava Bignami Syndrome
f. Hepatic Encephalopathy

44.  Tolerance and Dependence are also major problems.
 They are a result of prolonged consumption of alcohol
which desensitizes and decreases GABA receptors,
increases NMDA subtype glutamate receptors.
 These changes play a vital role in development of
tolerance.
 Cells and tissues function abnormally due to tolerance
development.
 Elimination of alcohol at a faster rate is also one of the
reasons for tolerance development.

45.  Administration of glucose, thiamine and other electrolytes reduces
metabolic alterations like hypoglycemia and ketosis, preventing
respiratory depression hence treating alcohol toxicity.
 Administration of sedatives and hypnotics like chlordiazepoxide
and diazepam reduces withdrawal symptoms to a certain extent,
preventing seizures, delirium and arrhythmias, β-Blockers like
clonidine, propranolol are helpful in inhibiting neurotransitter
release and controlling sympathetic activity.
 Aversion therapy is a primary approach in treating alcoholism.
Disulfiram (Antabuse, Antabus) is a drug of choice used in the
therapy, however it has its own set of adverse effects.

46.  Aversion therapy is a primary approach in treating
alcoholism. Disulfiram (Antabuse, Antabus) is a
drug of choice used in the therapy, however it has its
own set of adverse effects.
 Naltrexone (Revia, Depade, Vivitrol), an opioid
receptor antagonist is helpful in reducing the craving
for alcohol in addicts.
 Acamprosate (Campral) is another preferred drug
for alcohol dependents. It has multiple effects on
various receptors and neurotransmitters.

47.  An opioid is any psychoactive
chemical that resembles
morphine in its pharmacological
effects. Opioids work by binding
to opioid receptors, which are
found principally in the central
and peripheral nervous system
and the gastrointestinal tract.
 Commonly abused opioids are
morphine, heroin, codeine,
oxycodeine, meperidine.

48. MORPHINE HEROIN CODEINE

49.  Opioids act on G-protein coupled receptors μ, ĸ, δ which are known to
inhibit adenyl cyclase, cAMP, protein kinase A, voltage gated Ca2+
channels.
 The inhibitory actions of opioids leads to depression upon mild
exposure.
 Prolonged exposure of opioids exert an opposite effect on the G-protein
coupled receptors resulting an increase in the compensatory response
element binding.
 The rise inn CREB exerts excitatory actions due to enhanced Na+
channel functions and cAMP up regulation.
 All these cellular effects not only decrease the inhibitory actions of
opioids but also lead to development of tolerance, dependence and
withdrawal symptoms.

50.  Physical and psychological dependence develop in
opioid drug abusers.
 Physical dependence develops to a greater extent
that compared to psychological dependence.
 Sudden withdrawal of opioids may lead to death of
individuals.

51.  The symptoms of physical dependence include dysphoria,
GI upset, mydriasis, cough, hyperventilation, ocular
discharge, diarrhea, yawning, hyperthemia, piloerection,
aggressiveness and emesis.
 Psychological dependence is characterized by craving. The
enhanced dopamine levels enhance the craving effect.
 Sudden withdrawal effects are termed as noradrenergic
storm due to increased release of norepinephrine.

52.  Desensitization of opioid receptors, increased CREB
(compensatory response element binding), reduced
receptor-effector coupling mechanism are the various
changes produced due to chronic administration of
opioids.
 All these changes lead to the development of tolerance.
 Tolerance is developed to euphoria, respiratory
depression, sedation and emetic actions.
 Tolerance to euphoria develops at faster rate.
 Cross tolerance to opioid agonists is also developed.

53.  Replacement therapy is found useful in treating opioid
dependence. Long acting drugs are administered in place of
short acting drugs.
 Methadone (Symoron, Dolophine, Amidone, Methadose,
Physeptone, Heptadon), levo-α-acetyl methanol,
buprenorphine are known to be potent opioid replacement
agonists.
 Opioid agonists like Naltrexone (Revia, Depade, Vivitrol) is
effective against euphoria and withdrawal symptoms of
opioids.
 Lofexidine, α-2-adrenergic receptor agonist is also effective
against withdrawal effects of opioids.