Drug Addiction: The problem of non-medical use of drugs is largely a social one with a profound impact upon the families of the addicts and society. Drugs like, opium, caffeine, nicotine, cocaine, caffeine are usual to relax get pleasure and satisfaction which cause serious in our contemporary culture. It is the responsibility of everyone who cares for civilization and welfare of the mankind. Few terminologies are related to drug abuse and drug dependence.
1. Drug Abuse: It is defined as the use of a drug apart from medical need or in unnecessary quantities’ (The harmful effects of drug abuse include; drug dependence, antisocial behavior, and traffic accidents). The majority of drug abuse are the agents that act on the central nervous system to produce profound effects on mood, feeling, and behavior. The broad definition of drug abuse also includes the habitual use by laymen of drugs like; laxatives, headache remedies, antacids, and vitamins.
2. Drug Addiction: Drug Addiction is a condition of chronic intoxication that is caused by excessive drug use. Its attributes include:
(i) An intense urge or need (compulsion) to proceed to acquire the medication by whatever means.
(ii) A dose-increasing tendency.
3. Drug misuse: Drug misuse may be defined as the use of drugs for purposes or conditions for which they are unsuitable or even acceptable but in an inappropriate dosage.
4. Drug dependence: Drug dependency is a condition in which the patient has a compelling need to continue taking the drug, either to feel its effect or to escape the pain of its absence, psychological and often physical. The medication has two distinct components, i.e.
(a) Psychological dependence: This means “A feeling of satisfaction and a psychic drive that require continuous administration of the drug to produce pleasure or to avoid discomfort” is called psychic dependence.
(b) Physical drug dependence: It is a condition in which withdrawal symptoms are manifested by physical disturbances. Physical dependence cannot occur without tolerance. It is an altered or adaptive physiological state of the body.
5. Drug Tolerance: Drug tolerance is a state of reduced sensitivity to the pharmacological effect of a medicinal product arising from previous exposure to that medicinal product or a similar medicinal product.
Reasons for Drug Addiction
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The drug addict continues taking the drug for the following reasons:
- For its medicinal use.
- To satisfy curiosity about drug effects.
- To have a new dangerous experience.
- To relax from stress and strength.
- To accept from reality and have a dreamy state.
Some important drugs of abuse and their treatment are discussed below:
Narcotic Analgesics (Opiates)
For example Morphine, opium, heroin, codeine. The addicts commonly use heroin, morphine, pethidine, methadone, etc. Heroin is a drug of preference; chronic opiate abuse results in physical dependence which increases with an increase in dose and development of a tolerant state manifested by decreased sensitivity to opiate agonists and increased sensitivity to antagonists. Psychological dependence develops rapidly and is severe.
The abuse of narcotics results in a syndrome that includes; drowsiness and relaxed feeling restlessness excitement pinpoint pupil, malnutrition, vitamin deficiency, constipation, hepatitis infection especially pulmonary edema, cardiorespiratory collapses, and coma.
Withdrawal symptoms are as below.
- After eight hours: Sweating, anxiety, tearing.
- After twenty hours: Chills, sweating, panic
- After 24-48 hours- Nausea, vomiting, diarrhea, fever, and hypertension.
- Up to one week- Muscle cramps.
- Up to several month-Insomnia.
1. Morphine should not be prescribed readily for chronic pain except in cases of compelling situations. For example Cancer pain.
Gradual withdrawal of morphine with substitution of author narcotic analgesic to decrease the severity of withdrawal syndrome. The symptoms can be suppressed by the substitution of another narcotic for opium. For example Methadone. Dose: 20 mg in dividend dosage for first 3 days and 10 mg for 3 days.
2. 1-d acetyl methanol (LAAM) is a longer-acting drug used for narcotic addiction. This drug is superior to methadone as it is not to be administrated daily.
3. Naltrexone is another long-acting antagonist used for the treatment of narcotic addiction.
Alcohol: It includes Acute and Chronic Alcoholism.
Alcoholism is a mental condition and a state of permanent illness due to ongoing and prolonged alcohol use. Physical impairment and impaired mental, occupational, and interpersonal adaptation are caused by this.
Alcohol addiction may include both tolerance and physical dependence. As tolerance develops, a person consumes a progressively increasing amount of alcohol to achieve the same state of psychological reinforcement previously induced by smaller closes of alcohol. The dependences develop slowly.
(a) Medical Complications:
Medical complications of alcohol abuse include; malabsorption, gastritis, cirrhosis, alcoholic hepatitis, fatty liver, chronic diarrhea, beriberi, cutaneous ulcers, delirium tremens, convulsive disorders, alcoholic myopathy, pellagra, and hyper or hypoglycemia.
(b) Withdrawal Symptoms:
The habitual consumption of large quantities of alcoholic drinks induces a state of physical dependence. Sudden withdrawal of alcohol results in withdrawal syndrome. Shortly after alcoholic drinking, there is tremor, nausea vomiting, and profuse perspiration.
After cessation of alcohol ingestion, withdrawal symptoms vary from hangover to delirium tremens. After around 6-8 hours of stopping the alcohol, withdrawal symptoms start with sweating, insomnia, headache, muscle twitching, cramps, diarrhea, vomiting, and agitation in more severe cares. These symptoms reduce after 40 to 50 hours of cessation.
After 2 to 3 days hallucinations, disorientation, seizures occur followed by delirium tremens.
The treatment is suppositive to maintain respiration, blood pressure, and body temperature until the ethanol is removed from the body by metabolism or hemodialysis. If intracranial pressure is increased hypertonic mannitol solution is administered intravenously. Phenothiazine is used to control psychotic behavior. Artificial respiration and electrolytes are given for balance.
It results in the development of tolerance and then physical dependence. The withdrawal of alcohol results in tremors, if its anxiety, insomnia, confusion, gastrointestinal disturbances like chronic gastritis, peptic ulcer cirrhosis, pancreatitis, hepatitis bone marrow suppression, and gout.
It consists of counseling and attention to society and behavior factors supportive social literature. It also requires pharmacotherapy with anti-anxiety agents and aversion therapy using Disulfiram.
Diazepam is given IV. supplemented with haloperidol 2-4 mg every 4-6 hours. Dose of diazepam- 40 mg for 4 days.
30 mg for 3 days
20 mg for 2 days
10 mg for 1 day
The chronic abuse of barbiturates results in drowsiness, ataxia, reduce quality and quantity of work increase appetite, impaired instability, and poor judgment. Pentobarbitone, which must be given to prevent withdrawal syndrome.
Medical complications of chronic abuse of barbiturates include; impairment of psychomotor functions, altered sleep pattern, impaired psychomotor skills, folate deficiency, and rickets in children, and osteomalacia in adults.
Withdrawal symptoms start after around 36 hours. It includes:
- Weight loss
- EEG abnormalities, etc. Recovery occurs after several weeks.
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