Substance Abuse Flashcards
DRUGS OF ABUSE
There are many misunderstandings about the origins and even the definitions of drug abuse and dependence. Although many physicians are concerned about “ creating addicts” only few individuals begin their drug addiction problems by misuse of prescription drugs. Confusion exists because the correct use of prescription drugs for pain, anxiety, and even hypertension commonly produces tolerance and physical dependence. These are normal physiological adaptations to repeated use of drugs from many different categories. Therefore tolerance and physical dependence do not imply abuse or addiction.
tolerance & dependence
While tolerance and physical dependence are biological phenomena that can be defined precisely in the laboratory and diagnosed accurately in the clinic, there is an arbitrary aspect to the definitions of the overall behavioral syndromes. Therefore the American Psychiatric Association diagnostic system uses the term substance dependence instead of addiction for the overall behavioral syndrome.
The APA defines substance dependence as a cluster of symptoms indicating that the individual continues use of the substance despite significant substance-related problems.
ORIGINS of SUBSTANCE DEPENDENCE
Many variables operate simultaneously to influence the likelihood of any given person becoming a drug abuser or drug dependent. These variables can be organized into three categories:
(1) agent (drug)
(2) host (user)
(3) environment
1) agent (drug)
Drugs vary in their ability to produce immediate good feelings in the user. Drugs that reliably produce intensely pleasant feelings (euphoria) are more likely to be taken repeatedly.
Reinforcement refers to the ability of drugs to produce effects that make the user wish to take them again. The more strongly reinforcing a drug is, the greater the likelihood that the drug will be abused. Reinforcing properties of drugs are associated with the ability to increase levels of neurotransmitters.
The abuse liability of a drug is enhanced by rapidity of onset, since effects that occur soon after administration are more likely to initiate the chain of events that lead to loss of control over drug taking.
-mode of administration
-speed of onset and termination of effects
(2) Host (user)
- Heredity-
- innate tolerance
- speed of developing acquired tolerance
- likelihood of experiencing intoxication as pleasure
- psychiatric symptoms
- prior experiences/expectations
- propensity for risk-taking behavior
(3) Environment
- social setting
- community attitudes
- peer influence, role models
- availability of other reinforcers
PHYSICAL DEPENDENCE
Physical dependence is state that develops as a result of the adaptation (tolerance) produced by a resetting of homeostatic mechanisms in response to repeated drug use.
Drugs can affect numerous systems that previously in equilibrium: these systems must find a new balance in the presence of inhibition or stimulation by a specific drug. A person in this adapted or physically dependent state requires continued administration of the drug to maintain normal function. If administration of the drug is stopped abruptly, there is another imbalance and the affected system must go through a process of readjusting to a new equilibrium without the drug.
The appearance of a withdrawal syndrome when the drug is terminated is the only actual evidence of physical dependence.
OPIOIDS
HEROIN, MORPHINE, MEPERIDENE, FENTANYL,OXYCODONE, OPIUM
PHARMACOLOGY:
Routes of Administration: I.V., intranasal, smoked
Some of the CNS mechanisms that reduce the perception of pain also produce a state of well-being or euphoria. Therefore, opioid drugs are taken outside of medical channels for the purpose of obtaining the effects on mood.
Overdose: respiratory depression
opiod withdrawal & detox
Withdrawal
Anxiety & depression, sleep disturbance, nausea & vomiting, sweating, diarrhea, abdominal cramping, tachycardia & hypertension, mydriasis (except meperidine).
Detoxification from opioids
(A) clonidine- clonidine can attenuate the noradrenergic hyperactivity of opiate withdrawal without interfering significantly with activity at the opiate receptors (receptors can return to normal levels of sensitivity). An advantage of clonidine vs. methadone, is no euphoria associated with clonidine. Also given with naltrexone
(B) methadone
``(C) buprenorphine (Subutex) partial mu agonist with naloxone (Suboxone)
STIMULANTS
Amphetamine, Methamphetamine, Methylphenidate, Cocaine
Cocaine Pharmacology
The central nervous system (CNS) actions that result from taking stimulants include: increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death.
effects of stimulants
Stimulants causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death.
Studies have shown that methamphetamine destroys dopaminergic neurons in the striatum—could lead to what disease state____________???
PSYCHEDELIC AGENTS
(1) Hallucinogenic agents-LSD, Psilocybin,
(2) Mixed stimulant & hallucinogenic- MDA, MDMA (Ecstasy), mescaline
(3) Phencyclidine (PCP)
LSD pharm
LSD (lysergic acid diethylamide) is one of the major drugs making up the hallucinogen class. LSD was discovered in 1938 and is one of the most potent mood-changing chemicals. It is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains.
LSD, commonly referred to as “acid,” is sold on the street in tablets, capsules, and, occasionally, liquid form. It is odorless, colorless, and has a slightly bitter taste and is usually taken by mouth. Often LSD is added to absorbent paper, such as blotter paper, and divided into small decorated squares, with each square representing one dose.
Health Hazards
The effects of LSD are unpredictable. They depend on the amount taken; the user’s personality, mood, and expectations; and the surroundings in which the drug is used. Usually, the user feels the first effects of the drug 30 to 90 minutes after taking it. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors.
Sensations and feelings change much more dramatically than the physical signs. The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in a large enough dose, the drug produces delusions and visual hallucinations. The user’s sense of time and self changes. Sensations may seem to “cross over,” giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic.