Drug abuse and dependence Flashcards
what are the consequences of drug addiction?
- Loss of control.
- Large behavioural changes.
- Drug takes over a person’s life – will do anything to get hold of it.
How has addiction impacted the EU?
- Drug addiction is a serious chronic relapsing brain disorder.
- Economically, drug dependence is the fourth most costly mental disorder in Europe.
- Alcohol and opioid addiction costs the EU 66 billion Euros a year and if you include smoking this will amount to 200 billion a year which is much higher than dementia, anxiety, depression, psychotic disorders and sleep disorders and as high as the European cost for cardiovascular disorders.
- Even more insipidus is the effect of drug abuse has on social relationships. It is not surprising that a big chunk of money spent of drug addiction is spent on costs associated with antisocial or criminal behaviour and family services.
- Stigmatisation has been the prevailing response of society which results in social isolation of drug addicts. Although social isolation is not only considered a marker but also a risk factor for mental illness, yet it has been severely understudied in the field of drug addiction.
describe the epidemiology of alcohol and opiates
Alcohol…
• 4-5% prevalance with a life-time prevalence of 14%.
• Cost (working days lost, health care, crime) 3% of GDP.
• Increasing consumption of 15-25 year olds in last ten years – liver damage used to be an elderly disease.
Opiates…
• Less than 1% in most parts of UK.
• Directly kills more than any other drug.
• Major health risks associated with drug use.
• Acquisitive crime >£500million/year.
describe the epidemiology of cannabis and nicotine
Cannabis…
• 40-50% prevalence with a 3% usage at age 12.
• Association with schizophrenia (Odds ratio 10): age/genetic risk. Risk of developing schizophrenia is much higher if cannabis use starts at a younger age as the brain is still developing.
• Increasing consumption due to increased purity (3-20% THC).
• Potential cause of neurotoxicity despite it not being as addictive as other drugs.
Nicotine… • 650 million people worldwide. • 16% of population in UK. • Cessation services cost £20million per year. • 1 in 10 deaths are smoking related.
what are UK’s top 10 dangerous drugs?
- heroin
- cocaine
- barbituates
- methadone
- alcohol
- ketamine
- benzodiazepines
- amphetamine
- tobaccos
- buprenorphine
danger rating is based on number of deaths caused. by each drug in relation to the number of users. In terms of deaths and users, heroin is the most dangerous drug but in terms of availability and affordability, alcohol is the most dangerous.
what is drug addiction?
Drug addiction is a chronic relapsing disorder characterised by…
- Compulsion to seek and take the drug.
- Loss of control in limiting intake (even when they know the consequences of taking it).
- Emergence of a negative emotional state (dysphoria, anxiety, irritability) – withdrawal symptoms.
what is the clinical definition of drug addiction?
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following occurring with a 12-month period…
- drug taken in larger amounts than intended.
- unsuccessful efforts to reduce or control use
- excessive time spent using, obtaining or recovering from use.
- failure to fulfil major role obligations e.g. looking after children, going to work.
- withdrawal reactions
- tolerance effects
- craving
- and others
what are the factors that contribute to vulnerability to develop addiction?
- Use of the drug of abuse – 100%.
- Environmental (can induce epigenetic changes which alter gene expression) – very high.
- Drug- induced effects (changes in the brain) – very high.
- Genetic – we now know this can be up to 60%! e.g. SNP’s and alcohol addiction – alcohol dehydrogenase SNP.
All of these factors interact with each other.
describe mental health comorbidity with drug addiction
- Prevalence of mental disorders in drug/alcohol services: 60-80%.
- Emotional disorders key predictor of alcohol use.
- Social anxiety disorders are severe in 60% of drug abusers seeking help.
- Comorbidity is usually accompanied by more severe symptoms, longer illness duration, higher service utilization and higher relapse rates.
- Comorbidity of these two disorders are notoriously underdiagnosed by physicians. Patients are often shifted to be treated for individual disorders and not both – there is no protocol for treatment of comorbidity.
name the stages in the addiction cycle
- Acute Reinforcement/Social Drug-Taking – most people do not go on to the next step.
- Escalating/Compulsive use due to tolerance.
- Dependence
- Withdrawal from abstinence.
- Protracted Withdrawal
- Relapse
- Biggest hurdle: Maintenance of drug-free state as 70% relapse. Current pharmacotherapy ineffective at maintaining this.
- Physical withdrawal symptoms decrease over time whereas emotional withdrawal symptoms persist for months.
- 40% co morbidity between opioid addiction and anxiety, depression.
- Impairment of social behaviour in heroin abstinent individuals.
describe heroin addiction
- Heroin addiction is a chronic relapsing disorder which is characterised by loss of control over drug administration, compulsive drug taking and the emergence of negative physical and emotional withdrawal symptoms (irritability, anxiety, depression, social withdrawal) when the drug is ceased or cleared from the body.
- The major problem for heroin addicts who are recovering from their addiction is the maintenance of a drug-free state. It is generally accepted that the main process driving relapse back to drug administration is the desire of the addicts to alleviate the adverse effect of the withdrawal symptoms by administering the drug of abuse (negative reinforcement). Although physical symptoms of opioid withdrawal have been extensively studied in human and animal models, there has been less attention focussed on the emotional symptoms of withdrawal, which are entirely clinically relevant as they may serve as a motivational trigger to re-administer the drug and to relapse. Despite the many physical symptoms of withdrawal typically decreasing after a short period of time, symptoms associated with emotional distress and dysphoria such as anxiety, irritability, stress, depression, restlessness, anhedonia may linger for months or even up to a year (protracted withdrawal) in recovering heroin addicts.
- The high prevalence (30%-50%) of major depression and anxiety in post dependent heroin addicts has been well documented and the negative impact of impaired social behaviour in recovering addicts has been recognised, especially in light of the significant benefits that psychosocial support has in maintaining addicts off the drug. Their drug seeking behaviour has completely taken over at the expense of the social behaviour. As a result, we propose that a good strategy to prevent relapse would be to find a way to alleviate the emotional withdrawal symptoms and especially reinforce social behaviour and relationships. Indeed, SSRIS have been used for the treatment of opioid abstinence associated depression with very limited efficacy.
define tolerance
when a person’s reaction to a drug decreases such that larger doses are needed to achieve the same effect.
what is drug dependence?
An adaptive state that develops from repeated drug administration and which results in the emergence of physical and emotional withdrawal symptoms upon cessation of drug use.
Physical, characterised by abstinence syndrome (LC): sweating, gooseflesh (Cold turkey), irritability, aggression.
Psychological, craving to avoid withdrawal effects.
what drive relapse of a drug
Both positive (effects of drug) and negative (withdrawal symptoms) reinforcement drives relapse of drug use and continued drug addiction
