- Addiction involves psychological and physiological dependence on drugs that affect the central nervous system, causing withdrawal symptoms when discontinued. Commonly abused substances include alcohol, opioids, cannabis, cocaine, and amphetamines. - Drugs used in deaddiction work by interfering with neurotransmitters like dopamine, serotonin, GABA, and endorphins. Medications are used to manage acute withdrawal symptoms from alcohol and opioids, and to prevent relapse for alcohol, opioids, nicotine, and other substances. - Pharmacotherapies for specific substances include disulfiram, acamprosate, and naltrexone for alcohol; methadone and buprenorphine for opioids; nicotine replacement therapy and v

1. DRUGS USED IN DEAADDICTION
Dr. Dilip Kumar Singh
JR
Pharmacology and Therapeutics
KGMU Lucknow

2. ADDICTION
Addiction is a psychological and physiological dependence on drugs of
abuse that effects the central nervous system in such a way that
withdrawal symptoms are experienced when the substance is
discontinued

3. Commonly used substance
• Alcohol
• Opioids
• Cannabis
• Cocaine
• Amphetamines and other sympathomimetics

4. ICD-10 Criteria
• A strong desire/compulsion to take the substance
• Difficulties in controlling substance-taking
• A physiological withdrawal state
• Evidence of tolerance
• Progressive neglect of alternative pleasures
• Persisting with substance use despite clear evidence of OVERTLY
harmful consequences

5. Psychoactive –
Substances that can pass the Blood Brain Barrier and become active
in the brain with effects on mood, cognition, psychomotor
movement, and personality
Drug –
Any chemical entity or mixture that alters biological (body & brain)
function or structure when administered

6. BIOCHEMICAL
• Biologically drugs interfere with/alter neurotransmitters
That allow neurons to communicate with each other
Tell us/body what to do, how to react, what to experience
• The four major neurons addressed in addictions/abuse are:
DOPAMINE-governs- reward; stimulation
e.g Cocaine
SEROTONIN- governs- mood; sleep, appetite, perceptions
e.g.Hallucinogens

8.  GABA
sedative; anti-anxiety
e.g. Benzodiazepines
ENDORPHINS
- governs pain
e.g. Opiates/Opioids

10. Alcohol
• Hydrophilic, with rapid absorption through the gut
• Peak plasma levels reached 30-60 mins post ingestion
• Metabolized by hepatic oxidation

11. Neurobiology of alcohol
• Stimulant at low doses, sedative at higher concentrations
• Anxiolytic effects mediated by potentiation of inhibitory effects GABA
at GABA-A receptors
• Disturbs glutamate transmission by inhibiting NMDA receptors,-
related to withdrawal seizures, DT’s
• Unopposed action of GABA and NMDA, increasing neuronal
excitability

12. Alcohol withdrawal
• Occurs from 6-24 hours after cessation, peak at day 2-3, highest risk
in first 24-48hrs
• C/F
Sweating, tremor, nausea, anorexia, vomiting, anxiety
Insomnia, restlessness, hallucinations, seizures, nightmare,
confusion, hallucinosis

13. Alcoholism Treatment
• combination of psychological in combination with aversion therapy
aided by drugs
• Most drugs used in treating alcoholism are aimed at creating adverse
reaction to drink alcohol

14. Drugs used for alcohol deaddiction
Disulfiram, acamprosate, naltrexone
Chlordiazepoxide ,Diazepam, oxazepam

15. Treatment
Acute withdrawal
Short acting benzodiazepines; chlordiazepoxide, diazepam
Minimise the risk of seizures
40mg chlordiazepoxide, 6 hourly, (Max 300mg in 24hrs)
Reducing doses over 5-10 days
Anticonvulsants- carbamazepine
Multivitamin preparations- Thiamine / vitamin-B
Treat infection, dehydration, suicidal ideation

16. Post-detoxification
Disulfiram (Antabuse)
Inhibitor of aldehyde dehydrogenase
Blocks ethanol metabolism at the acetaldehyde level
Loading dose 600-800mg per day for 3-4 days
Maintenance 200mg daily
Useful in highly motivated groups and where assisted by family or
friends

17. Disulfiram (Antabuse)
• Alcohol is broken down by alcohol dehydrogenase into acetaldehyde
• Further broken down into acetic acid by acetaldehyde
dehydrogenase
• Antabuse works by blocking acetaldehyde dehydrogenase, causing an
excess build up of acetaldehyde

19. Symptoms/Effects of Antabuse
• Due to the excess build up of acetaldehyde in the bloodstream
• Patients feel nausea, vomiting, headaches, chest pain
• Symptoms appears after only five to ten minutes after drinking

20. Naltrexone
• It reduced alcohol craving, number of drinking days and chances
of resumed heavy drinking
• Naltrexone is approved for use as adjuvant in comprehensive
treatment programmes for alcohol dependent subjects

21. Naltrexone….
• Approved for use in the treatment of alcoholism in April of 2006
• The mechanism of action is not quite fully understood
• Naltrexone is aimed at reducing the psychological need or craving for
alcohol
• Naltrexone can be administered in a 50mg tablet
• A Naltrexone intramuscularly, is also available
• Naltrexone has been shown to be effective for up to 30 days

22. Acamprosate
• Alcohol inhibits the activity N-Methy-D-aspartate receptors (or
NMDARs), causing the brain to create more NMDARs
• Absence of alcohol, or no inhibition of the receptor, causes these
receptors to be overly active and cause symptoms such as delirium
tremens (DT)
• Acamprosate has also been shown in some studies to act as a neuro-
protective and protect neurons from damage caused by alcohol
withdrawal

23. Acamprosate…..
• It is a weak NMDA-receptor antagonist with modest GABAA receptor
agonistic activity
• Used for maintenance therapy of alcohol abstinence
• It has been found to reduce relapse of the drinking behavior
• It should be started soon after withdrawing alcohol
ADR
Loose motion is a common side effect
Others are nausea, abdominal pain and itching

24. Post Detoxification…..
Psychological interventions
Relapse prevention, social skills, relaxation techniques, Family
therapy
Residential rehabilitation

25. OPIOIDS
• Strong narcotic analgesics
• Derived from the capsule of the poppy plant
• Crude opium contains morphine, codeine, other alkaloids
• Diamorphine (heroin) made by acetylation
• Eaten, sniffed, smoked, injected

26. OPIOIDS….
Short term effects –
Euphoria, analgesia, sedation
Long term effects / Repeated use-
Rapid tolerance & physical dependence
Over dose – Lethal respiratory depression

27. Opiates &The dopamine pathway
• Natural rewards and addictive drugs stimulate the release of
dopamine causing euphoria & reinforcement of the behaviour
• Habituation ( rapid adaptive changes ) occur with natural rewards but
not with addictive drugs & each dose stimulates the release of
dopamine

28. Opiate withdrawal
• When opiate levels fall the unopposed neurones lead to adrenergic
over activity
• Activation of к receptors in the ventral tegmental area decreases
dopamine leading to dysphoria and anhedonia

29. • Grade 0 – drug craving, anxiety, drug seeking
• Grade 1 – yawning, sweating, runny nose, restless sleep
• Grade 2 – dilated pupils, hot and cold flushes, goose flesh,
aches and pains
• Grade 3 – insomnia, restlessness and agitation, abdominal cramps,
N+V, diarrhoea, increased pulse , BP and RR

30. Methadone
• Synthetic opiate
• Administered orally
• Half-life 24-36 hrs (10-90) ; once daily dosage
• µ receptor agonist
• Because of slow and persistent nature of action, sedative and
subjective effects are less intense
• Maintenance / Detoxification

31. Benefits of methadone
• Safe substitution drug
• Effective in engaging and retaining people in treatment
• Reduces risk, reduced levels of injection
• A factor in improving physical/Mental health and quality of life of
patients and their families
• Reduces criminal activity and demands on the criminal justice system

32. Naltrexone
• Narcotic antagonist
• Half-life 96 hours
• Dose 50mg daily
• Used after detoxification
• Breaks the cycle of craving

33. NICOTINE DEADDICTION
• Nicotine Replacement Therapy
• Non nicotine replacement

35. First-line pharmacotherapy
Nicotine Replacement Therapy
• Patch
• Gum
• Lozenge
• Inhaler
• Nasal spray

36. NRT: Nicotine gum
• 2 mg (<25 cigs) vs 4 mg (>24 cigs)
• 1-2 per hour for first 6 weeks-taper
• Chew (release peppery taste) and park, continue for 30 minutes
• Absorbed in a basic environment, avoid acidic beverages 15 minutes
pre and during dose (coffee, soda, juice)
• Use enough pieces each day (max 24)
• Side effects: dyspepsia, mouth soreness

37. NRT: Nicotine patch
• 24 hr (21, 14, 7mg) Nicoderm/generic
• 16 hr (15, 10, 5 mg) Nicotrol
• Available OTC
• A new patch is applied each morning
• Rotating placement site can reduce irritation
• 6 weeks for 1st dose-taper over 4-6 weeks
• Side effects: Insomnia, local rash

38. Nicotine Lozenge (OTC)
• 2 mg smoke cig >30 minutes on waking
• 4 mg smoke <30 minutes
• Allow to dissolve 30 min
• Cannot drink or eat 15 minutes before using
• First 6 weeks take one 1-2 hr (9-20 /day) than taper up to 6 weeks

39. Non nicotine replacement
Buproprion
• A sustained-release formulation is marketed as an aid to smoking
cessation
• Bupropion may be acting by augmenting the dopaminergic reward
function
• Better results are obtained when it is combined with nicotine patch
• The nicotine withdrawal symptoms were less severe in bupropion
recipients
• it can cause insomnia, agitation, dry mouth and nausea

40. Varenicline
• Varenicline is used to treat nicotine addiction
• It both reduces cravings for and decreases the pleasurable effects of
tobacco products

42. THANK YOU