Drug abuse and drug dependence Flashcards
LO.1 - understand an overview of the problem :
Economic and ethical issues with drug abuse
Drug addiction is serious brain chronic relapsing brain disorder. In economic terms, which is how people nowdays evaluate its impact, drug dependence is the fourth most costly mental disorder in Europe. Here you see a table showing the estimated number of subjects affected by brain disorders as well as its economic cost (direct and indirect). You can see that alcohol and opioid addiction only 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.
However, even more insipidous 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. Nonetheless, 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.
However, getting some scientific insight in understanding the biology behind the social consequences of drug abuse will enable to tackle questions such as “why are drugs disruptive to social relationships?” Why does persistent threat of imprisonment over addicts might not be the way forward? “Should drug addicts be treated as criminals? Should therapeutic interventions focus more on strengthening social ties with family and community? “Should the government spend more money on psychosocial support vs normal substitution based pharmacotherapy which efficacy is questionable?
alcohol related deaths- 3rd largest cause of drug related deaths, number 1 is nicotine
LO.1 - understand an overview of the problem :
Scale of the problem for cannabis and nicotine
E.g. Cannabis
40-50% prevalance with a 3% usage at age 12
Association with schizophrenia (Odds ratio 10): age/genetic risk
Increasing consumption due to increased purity (3-20% THC)
E.g. Nicotine
>1 billion people worldwide
14.4% of population in UK
Cost of smoking to UK GOV £14billion/year (cost to NHS £2.6Billion a year)
1 in 10 deaths are smoking related
LO.2: What is the definition of addiction
A chronic relapsing disorder characterised by:
Compulsion to seek and take the drug
Loss of control in limiting intake
Emergence of a negative emotional state (dysphoria, anxiety, irritability)
Substance use disorder:
A maladaptive pattern of substance use leading to clinically significant impairment
or distress, as manifested by two (or more) of the following occurring with
a 12 month period
Mental health disorder comorbidity with drug addiction
Facts
Prevalence in drug/alcohol services: 60-80%
Emotional disorders key predictor of alcohol use
Social anxiety disorders is severe in 60% of drug
abusers seeking help
It is accompanied by more severe symptoms, longer
illness duration, higher service utilization and higher relapse rates
Describe the addiction cycle
Social drug taking/acute reinforcement Compulsive use Dependence Withdrawal Protracted withdrawal Recovery
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
Addiction cycle with reference to heroin
I am going to focus my talk on 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 animals models, there has been less attention focussed on the emotional symptoms of withdrawal, which are, nonetheless, entirely clinically relevant as they may serve as a motivational trigger to re-administer the drug and to relapse [4].
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 [5, 6].
The high prevalence (30%-50%) of major depression and anxiety in postdependent heroin addicts has been well documented [7, 8] and the negative impact of impaired social behaviour in recovering addicts has been recognised [9], especially in light of the significant benefits that psychosocial support have 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.
tolerance and dependence
when a person’s reaction to a drug decreases such that larger doses are needed to achieve the same effect.
Drug dependence is 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
Psychiatric perspective on addiction
Impulse control disorders:
tension- impulsive acts- gratification- regret/guilt- back to tension
Compulsive disorders:
anxiety/stress- repetitive behaviours- relief of anxiety- obsessions- back to anxiety/stress
What is the criteria for substance dependence
withdrawal/negative effect
Preoccupation/anticipation
binge/intoxication
