lecture 1- drug abuse and drug dependence

Question 1

Overview of the drug addiction problem

Answer 1

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.

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

Question 2

What is drug addiction

Answer 2

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)

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

DSM 5 substance abuse disorder- If you have more than 2 out of 12 symptoms you may have disorder

Question 3

Factors Contributing to Vulnerability to Develop Addiction

Answer 3

genetic-some SNPs have been associated w increased risk of drug addiction
you can have a specific receptor that makes you prone to developing addiction but if you’re not exposed in that environment, nothing will happen

environmental

drug induced effects

Question 4

mental health comborbidity with drug addiction

Answer 4

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

Question 5

stages of addiction cycle

Answer 5

acute reinforcement/social drug taking
compulsive use
dependence
withdrawal
protracted withdrawal
recovery
(often goes from withdrawal back to compulsive use
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

Question 6

opioid addiction example issues

Answer 6

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 [5-8]. 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) [9, 10]. 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.

Question 7

what is tolerance

Answer 7

when a person’s reaction to a drug decreases such that larger doses are needed to achieve the same effect

Question 8

what is drug dependence

Answer 8

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

Question 9

Impulse control disorders vs compulsive disorders

Answer 9

ICD: tension/arousal- impulsive acts- gratification- regret/guilt- tension arousal

compulsive disorders: anxiety/stress- repetitive behaviour- relief- obsession- anxiety

Question 10

criteria for substance dependence

Answer 10

preoccupation/anticipation

Binge intoxication

negative withdrawal effect