The document discusses drugs used in de-addiction and treatment approaches. It begins by defining key terms like addiction, drug dependence, tolerance, and withdrawal syndrome. It then classifies common drugs of abuse such as narcotics, CNS depressants, stimulants, hallucinogens, cannabis, and others. For treatment, it describes pharmacological approaches like short-term drug substitution, aversive therapies, antagonists, and rehabilitation. Specific treatments are provided for addictions to opioids, alcohol, barbiturates, CNS stimulants, hallucinogens, cannabis, tobacco, and volatile inhalants.

1. DRUGS USED IN
DE-ADDICTION
DR. NIBY, PHARM-D
ASSISTANT PROFESSOR
LITTLE FLOWER COLLEGE OF PHARMACY
BANGALORE.

2. TERMINOLOGIES
• ADDICTION- It relates to a strong psychological or physiological dependence on
a substance, such as alcohol, hashish, ganza, opium, and drugs.
• DRUG DEPENDENCE- It describes two important conditions:
a) a state arising from repeated, periodic or continuous use of a drugs.
b) a state when drug taking becomes compulsive and takes precedence over
other needs.
• DRUG ABUSE- It includes certain volatile substances e.g. lacquer paint solvents,
petrol, nail polish remover etc. that may critically affect CNS are also inhaled by
drug seekers. This type of drug abuse was earlier classified as ‘ SUBSTANCE
ABUSE ’.

3. • SUBSTANCE DEPENDENCE- The substance abuse are usually of two types-
 PSYCHOLOGICAL DEPENDENCE- which is characterised by following
symptoms:
a) Drug seeking behaviour(craving) moderate and for personal satisfaction;
e.g: cigarette smoking
b) Withdrawal effects are less frequent and mild
c) Tolerance is usually absent
 PHYSICAL DEPENDENCE- which is characterised by following symptoms:
a) Intense craving for the drug, e.g. alcohol, use of opioids.
b) Withdrawal effects are severe.
c) Tolerance is present.

4. • TOLERANCE- It refers to the decrease in pharmacological effect on repeated
(successive) administration of the drug.
• WITHDRAWAL SYNDROME [or ABSTINENCE SYNDROME]- It categorically
describes the physical and physiological adverse effects after stopping use of a
drug.
[ NOTE: Recently, the American Psychiatric Association has recommended
use of a single term “substance dependence” in place of many confusing
terms such as: habituation, addiction and drug dependence.]

5. CLASSIFICATION OF DRUGS OF ABUSE:
The following drugs are regarded to be the common drugs of abuse, namely:
1. NARCOTICS-
E.g: Heroin, Morphine, Codeine.
2. CNS(Central nervous system) DEPRESSANTS-
E.g: Alcohol, Barbiturates, Non- Barbiturate Sedatives and Antianxiety Drugs.
3. CNS(Central nervous system) STIMULANTS-
E.g: Cocaine, Amphetamines, Anorectics
4. HALLUCINOGENS-
E.g: Lysergic acid diethyl amide(LSD), Psilocybins, Mescaline
5. CANNABIS PREPARATIONS
6. MISCELLANEOUS:
E.g: Nicotine, Paint Thinner, Acetone, Nail Polish Remover And Petrol.

6. PHARMACOLOGICAL APPROACHES TO TREAT
DRUG DEPENDENCE
The main pharmacological approaches to treat drug dependence and withdrawal
are of five critical variants, namely :
I. Short term or long term substitution of abused drug by a similar drug.
II. Aversive therapies to induce unpleasent responses.
III. Use of an antagonist to block the effects of abused drug.
IV. Use of such drugs which modify craving for the abused dug
V. Rehabilitation and psychological interventions.

7. • Opioid addiction is one of the oldest addictions of mankind.
• The group of drugs essentially include: Heroin, Morphine, Codeine And Other
Synthetic And Semisynthetic Derivatives.
• Heroin (diacetyl morphine) and its crude form known as ‘brown sugar’ have
widest illicit use.
• Opioids produce both psychological and physical dependence..
• The withdrawal symptoms are manifested by lacrimation, sweating, anxiety,
restlessness, rhinorrhoea and tremors.
1. NARCOTICS ADDICTION

8. 1. METHADONE:
• Slowly withdraw the abused drug and substitute it by the long acting
agonist(methadone).
• It is effective orally, it is more potent and as opioid receptor remains occupied
for long duration which prevents withdrawal symptoms.
• The dose is adjusted according to the degree of dependence – 1mg
methadone once daily for 4 mg of morphine.
• It may be withdrawn in tapering doses over a period extending to a couple of
weeks.
•TREATMENT FOR NARCOTIC DEPENDENCE

9. 2. NALTREXONE:
• A long –acting orally active opioid antagonist
• Dose- 100-150 mg thrice times in a week to the patients who are detoxified by
giving methadone therapy.
3.CLONIDINE:
• A centrally acting alpha- agonist can reduce some of withdrawal symptoms like :
hypertension, anxiety, vomiting, nausea and diarrhea.
• It is given for 7-10 days and withdrawn over 3-4 days.

10. A) ALCOHOL ABUSE-
• It is a major drug problem in the various societies.
• Depending upon blood concentration, acohol may cause :
-euphoria (50mg/dl)
- impaired motor coordination, concentration and memory(100-150 mg/dl)
- profound cardio respiratory depression and coma (300-400 mg/dl)
• Withdrawal of alcohol after several week of consumption results in tremors,
anxiety, confusion, GIT disturbances, insomnia and delusion.
• Withdrawal of alcohol after a long period of consumption can lead to delirium,
hallucination and convulsions.
2. CNS DEPRESSANTS ADDICTION

11. 1. SEDATIVES:
• Use of sedatives or anti convulsants – e.g. Diazepam and barbiturates.
2. PSYCHIATRIC COUNSELLING: For chronic alcoholism
3. AVERSION THERAPY:
• DISULFIRAM – It blocks an enzyme that is involved in metabolizing alcohol
intake., which produces very unpleasant side effects(flushing, sweating,
increased thirst, swelling, rapid weight gain, neck pain, throbbing headache,
blurred vision )when combined with alcohol in the body.
• Initial dose: 500 mg orally once a day (first 1 to 2 weeks)
Maintenance dose: 250 mg orally once a day (range: 125 mg to 500 mg once a
day)
Maximum dose: 500 mg once a day.
•TREATMENT FOR ACUTE ALCOHOL
WITHDRAWAL

12. • Barbiturates are generally used for induction of anaesthesia and in epilepsy.
• The short acting barbiturates like: amobarbital, secobarbital and pentobarbital
are mostly abused as they produce euphoria [extreme state of perceived well
being].
• Symptoms of barbiturate intoxication depend on blood levels and also include:
blurred speech, confusion, weak pulse, cyanosis, and respiratory failure.
• Withdrawal symptoms include anxiety, confusion, weakness, anorexia, tremors,
hallucination and convulsions.
B. BARBITURATES DEPENDENCE:

13. 1. The incidence of symptomatic chronic barbiturate dependence may be treated
by substituting phenobarbital with the abused drug.
2. Taper the dose extended gradually over a period of weeks.
•TREATMENT OF CHRONIC BARBITURATE
DEPENDENCE

14. • Cocaine and amphetamine are commonly abused CNS stimulants.
• Methamphetamine by IV injections produce euphoria and intense pleasurable
feelings.
• Withdrawal results in fatigue , muscle pain, anxiety, visual disturbances, and
hallucination.
TREATMENT:
• Supportive therapy with tranquilizers and antidepressants .
• psychiatric and social counseling is usually employed.
3.CNS STIMULANTS ADDICTION

15. • They are termed as psychomimetics
• Example: LSD, Psilocybin, Mescaline.
• These drugs produce hallucinations, euphoria, delusions, mydriasis, increased
blood pressure and body temperature.
TREATMENT:
• Immediate advice for adequate rest, reassurance, psychiatric counselling are
invariably successful.
• Benzodiazepines (diazepam)can also be used effectively.
4.HALLUCINOGENS

16. • Synonym- Marijuana.
• It is obtained from the leaves and flowering tops of hemp plants(Cannabis sativa;
C.indica). Its products are Hashish,Charas, Bhang,Ganja and marijuana.
• Cannabis withdrawal happens when you have used cannabis for a long period of
time, and you suddenly take less or stop taking it.
• Withdrawal symptoms may start on the first day and may last up to 2 weeks,
which involves decreased appetite and weight loss, night sweats and trouble
sleeping, craving for cannabis, irritability, feeling agitated, anxious, or restless,
depressed or negative mood.
TREATMENT:
Motivational enhancement therapy (MET)
5. CANNABIS

17. • NICOTINE is the active ingredient in tobacco.
• It causes mild CNS stimulation followed by decreased –skeletal-muscle tone and
loss of appetite.
• Long term effect of smoking are:
-lung cancer
-increased risk of heart attack
-Decreased life-span.
6. TOBACCO

18. 1. NICOTINE TRANSDERMAL PATCH
-This medication slowly releases nicotine and provides a consistent low level of
nicotine throughout the day. It is available over-the-counter in strengths of 7, 14
and 21 mg.
-The main side effects from the patch are local skin irritation and vivid dreams
that require removing the patch before bedtime.
2. AMFEBUTAMONE OR BUPROPION
- a sustained release (SR) medication that's also used as an anti-depressant.
- It alters dopamine levels in the brain, which helps to relieve nicotine
withdrawal symptoms.
-The most common side effects include headache, insomnia and dry mouth.
3. CLONIDINE- May reduce withdrawal effects.
•TREATMENT OF NICOTINE DEPENDENCE

19. • It occurs when someone deliberately breathes in the gas or vapours of a
substance to purposefully get ‘high’. It is sometimes called ‘bagging’, ‘huffing’ or
‘sniffing’.
• Volatile inhalants are inhaled to produce CNS excitation and hallucinations.
TREATMENT-
• Provide oxygen, respiratory assistance and other supportive measures to treat
acute intoxication symptoms.
7.VOLATILE INHALANTS:

20. 1. Ashutosh Kar,S C Mehta; Basic pharmacology for nurses and allied health
professionals.
2. KD Tripathi; Essentials of medical pharmacology.
BIBLIOGRAPHY:

21. THANK YOU