بسم الله الرحمن الرحيم drug dependence introduction the non - medical use of...

الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم

Drug dependenceDrug dependence

IntroductionIntroduction

• The non - medical use of drugs is a The non - medical use of drugs is a worldwide problem that has reached worldwide problem that has reached almost epidemic proportions.almost epidemic proportions.

• A drug is any substance that, when A drug is any substance that, when introduced into the living organism, introduced into the living organism, may modify one or more of its may modify one or more of its function. function.

Introduction cont.Introduction cont.

• However, the non-medical use of However, the non-medical use of certain groups of drugs, particularly certain groups of drugs, particularly those to which dependence will those to which dependence will develop, is a major problem of develop, is a major problem of concern.concern.

• The health of the drug dependant will The health of the drug dependant will be adversely affected and his be adversely affected and his behavior may become antisocial and behavior may become antisocial and bring him into conflict with the law. bring him into conflict with the law.

Introduction cont.Introduction cont.• Drug dependence is one aspect of Drug dependence is one aspect of

the wider problems of non-medical the wider problems of non-medical use of drugs and is a problem with use of drugs and is a problem with serious implications for the user and serious implications for the user and the society in which he lives.the society in which he lives.

• Drug dependence is best defined as a Drug dependence is best defined as a physical and psychic state resulting physical and psychic state resulting from the repeated (chronic) from the repeated (chronic) interaction between a living organism interaction between a living organism and a drug, characterized by: and a drug, characterized by:

Definition:Definition:

1- Irresistible desire to take the drug.1- Irresistible desire to take the drug.

2- Tolerance: 2- Tolerance:

3- Physical and physiological 3- Physical and physiological dependence dependence

4- Withdrawal symptoms .4- Withdrawal symptoms .

5- Harmful effects to the individual and 5- Harmful effects to the individual and society .society .

Drug habituation:Drug habituation:

• A condition in which the individual A condition in which the individual feels a desire for the drug, without feels a desire for the drug, without suffering any ill-effects when such suffering any ill-effects when such drug is not taken. Thus in case of drug is not taken. Thus in case of habituation the desire is only habituation the desire is only emotional (psychic), there is no emotional (psychic), there is no withdrawal symptoms, no tolerance withdrawal symptoms, no tolerance and no physical dependence on the and no physical dependence on the drug.drug.

Diagnosis of Diagnosis of dependencedependence1- History from the addict, his relatives or 1- History from the addict, his relatives or

friends.friends.

2- Drowsiness, inability to concentrate 2- Drowsiness, inability to concentrate and sometimes itching over the and sometimes itching over the injection sites.injection sites.

3- Scars of injection along the veins of 3- Scars of injection along the veins of forearm, abscesses, ulcers and forearm, abscesses, ulcers and thrombophlebitis.thrombophlebitis.

4- Appearance of withdrawal symptoms if 4- Appearance of withdrawal symptoms if the drug was not taken in the last 24 Hs.the drug was not taken in the last 24 Hs.

Diagnosis:Diagnosis:

5- Constriction of the pupils in case of 5- Constriction of the pupils in case of opiates or dilatation after opiates or dilatation after amphetamine and cannabis.amphetamine and cannabis.

6- Nalline test for opiates: Injection of 6- Nalline test for opiates: Injection of 3 mg Nalline leads to rapid dilatation 3 mg Nalline leads to rapid dilatation of pupils.of pupils.

7- Urine and blood analysis for the 7- Urine and blood analysis for the detection of the drug.detection of the drug.

CROSS- DEPENDENCE:CROSS- DEPENDENCE:•The ability of one drug to The ability of one drug to

suppress the manifestations of suppress the manifestations of physical dependence produced by physical dependence produced by another and to maintain the another and to maintain the physically dependent state. It physically dependent state. It may be partial or complete and may be partial or complete and the degree is more closely related the degree is more closely related to pharmacological effects than to to pharmacological effects than to chemical similarities.chemical similarities.

Drugs causing dependenceDrugs causing dependence

* Drug to which dependence may * Drug to which dependence may develop all act on the central nervous develop all act on the central nervous system, some are more depressant, system, some are more depressant, others more stimulant. The drugs others more stimulant. The drugs include:include:

• Opiates and their synthetic analogues Opiates and their synthetic analogues

• Coca leaves and cocaine.Coca leaves and cocaine.

• Ethyl alcohol.Ethyl alcohol.

• Barbiturates and other sedatives Barbiturates and other sedatives

Drugs causing dependenceDrugs causing dependence• Amphetamine and related Amphetamine and related

compounds.compounds.• Tranquillizers.Tranquillizers.• Volatile solvents e.g. acetone, Volatile solvents e.g. acetone,

toluene and carbon toluene and carbon tetrachloride.tetrachloride.

• Anabolic-Androgenic SteroidsAnabolic-Androgenic Steroids

• Designer drugs .Designer drugs .• Nicotine. Nicotine.

1- Opium dependence1- Opium dependence

• The condition may follow the repeated The condition may follow the repeated medicinal use of the drug. Addicts take the medicinal use of the drug. Addicts take the drug either by mouth, by smoking or by drug either by mouth, by smoking or by injection.injection.

• The patient becomes careless, The patient becomes careless, unreliable and dishonest, but no much unreliable and dishonest, but no much harm results from him.harm results from him.

• Loss of weight, anorexia and chronic Loss of weight, anorexia and chronic constipation.constipation.

• PPP.PPP.

Withdrawal symptoms Withdrawal symptoms (Abstinence):(Abstinence):• They usually start after 12-24 hours They usually start after 12-24 hours

from the last dose, and then the from the last dose, and then the symptoms disappear gradually within symptoms disappear gradually within 7-10 days. They disappear on the 7-10 days. They disappear on the spot if morphine is given. spot if morphine is given.

• Increased secretionsIncreased secretions

• Increased respiratory and pulse rate.Increased respiratory and pulse rate.

• General muscular twitches and General muscular twitches and abdominal cramps.abdominal cramps.

• Neonates from drug-dependent Neonates from drug-dependent mothers may show withdrawal mothers may show withdrawal symptoms up to 56 hours from birth symptoms up to 56 hours from birth and will require therapy.and will require therapy.

Treatment :Treatment :

• The addict should be treated as a patient The addict should be treated as a patient not as a criminal .not as a criminal .

• Needing careful and continuous medical Needing careful and continuous medical attention for several months in special attention for several months in special hospitals or sanatoria.hospitals or sanatoria.

• The success of treatment of addiction in The success of treatment of addiction in general depends on the patient's intention general depends on the patient's intention and his co-operation and his co-operation

Treatment :Treatment :

• Gradual withdrawal :Gradual withdrawal :

• Abrupt withdrawal :Abrupt withdrawal :

• Symptomatic treatment :Symptomatic treatment :

• Psychiatric therapy:Psychiatric therapy:

• Social measurementsSocial measurements

2- COCAINE DEPENDENCE2- COCAINE DEPENDENCE

• Clinical pictureClinical picture

1-Anorexia, vomiting and loss of weight.1-Anorexia, vomiting and loss of weight.

2- Tremors, convulsions and toxic 2- Tremors, convulsions and toxic psychosis.psychosis.

3- Nasal septal perforation if taken as 3- Nasal septal perforation if taken as snuff.snuff.

4- Tactile hallucinations4- Tactile hallucinations

Methods of usesMethods of uses

Cerebral hemorrhage due to cocaine Cerebral hemorrhage due to cocaine dependencedependence

3- ALCOHOL 3- ALCOHOL DEPENDENCEDEPENDENCE

1- General appearance 1- General appearance

2- Conjunctivitis and bronchitis2- Conjunctivitis and bronchitis

3- Chronic gastritis with hypochlorhydria 3- Chronic gastritis with hypochlorhydria

4- Liver cirrhosis 4- Liver cirrhosis

5- Fine tremors and sensory neuritis.5- Fine tremors and sensory neuritis.

6- 6- Alcoholic paranoid states & Korsakoff's Alcoholic paranoid states & Korsakoff's psychosis.psychosis.

7- 7- The addict becomes selfish and jealous The addict becomes selfish and jealous

Treatment:Treatment:• Diazepam or chlorpromazine if there is Diazepam or chlorpromazine if there is

convulsion.convulsion.

• Mannitol for cerebral edema Mannitol for cerebral edema

• Lumbar puncture for delirium tremensLumbar puncture for delirium tremens • Ant abuse (disulfuram):Ant abuse (disulfuram):

• Vitamin B and liver supports.Vitamin B and liver supports.

Alcoholic Liver cirrhosisAlcoholic Liver cirrhosis

4-BARBITURATE DEPENDENCE4-BARBITURATE DEPENDENCE

• Short acting barbiturates are used by Short acting barbiturates are used by the addicts due to rapid effect the addicts due to rapid effect

• Barbiturates dependence is very Barbiturates dependence is very serious as heroin dependence serious as heroin dependence

Clinical picture:Clinical picture:

1- Physical signs:1- Physical signs:

• Anorexia,Anorexia,

• constipation.constipation.

• Anemia.Anemia.

• Cyanosis.Cyanosis.

• Renal manifestation.Renal manifestation.

2- Neurological signs :2- Neurological signs :

• Tremors Tremors

• Thick slurred speech.Thick slurred speech.

• Ataxia Ataxia

• Nystagmus.Nystagmus.

• DysdiadochokinesisDysdiadochokinesis..

3- Mental disorders :3- Mental disorders :

• Poor memoryPoor memory

• Mental confusion.Mental confusion.

• Negligence of personal appearanceNegligence of personal appearance..

** Abrupt withdrawal is dangerous.Abrupt withdrawal is dangerous.

* Gradual withdrawal is the ideal * Gradual withdrawal is the ideal method. complete in 2-3 week method. complete in 2-3 week

5- AMPHETAMINES 5- AMPHETAMINES DEPENDENCEDEPENDENCE

• marked stimulant effect on the CNS marked stimulant effect on the CNS including a sense of alertness and well -including a sense of alertness and well -being. being.

Clinical picture:Clinical picture:•Anxiety•Tremors .•Visual and auditory hallucinations. •Shock or collapse•antisocial activities.

Withdrawal symptoms:Withdrawal symptoms:

• SomnolenceSomnolence

• Tremors.Tremors.

• Sever fatigue.Sever fatigue.

• Risk of suicideRisk of suicide. .

• Abrupt withdrawal.Abrupt withdrawal.

• Sedation with phenobarbitone or Sedation with phenobarbitone or chlorpromazine.chlorpromazine.

6- TRANQUILIZERS 6- TRANQUILIZERS DEPENDENCEDEPENDENCE• Prolonged use of minor tranquilizer may Prolonged use of minor tranquilizer may

lead to addiction e.g. valium . lead to addiction e.g. valium .

** Clinical Picture** Clinical Picture• Depression,Depression,• Masked Face, andMasked Face, and• Dry Mouth Dry Mouth • Dilated pupilsDilated pupils• HypothermiaHypothermia

7- VOLATILE SOLVENT INHALATION• Solvent abuse, Solvent abuse, • Solvent sniffingSolvent sniffing• Glue sniffingGlue sniffing ** The inhalation of volatile organic solvents ** The inhalation of volatile organic solvents

Acetone, carbon tetrachloride, chloroform, Acetone, carbon tetrachloride, chloroform, ether, Toluene, n-Hexane) for pleasurable ether, Toluene, n-Hexane) for pleasurable effects is most commonly in poor.effects is most commonly in poor.

Why there is a rapid Why there is a rapid effects ?effects ?• These compounds are highly lipid These compounds are highly lipid

soluble and therefore have marked soluble and therefore have marked effects on nervous tissue .effects on nervous tissue .

• Snuffers are unlikely to come to medical Snuffers are unlikely to come to medical

attention but they develop some serious attention but they develop some serious acute complication such as deep coma.acute complication such as deep coma.

THEY MAY PRESENT LATER THEY MAY PRESENT LATER WITH:WITH:

• JaundiceJaundice

• Renal failureRenal failure

• Acute encephalopathyAcute encephalopathy

• Cerebellar degeneration.Cerebellar degeneration.

• Mixed polyneuropathy.Mixed polyneuropathy.

TreatmentTreatment

• Stopping solvent inhalation.Stopping solvent inhalation.

• Sedation in a state of panic.Sedation in a state of panic.

• Patient in coma require supportive Patient in coma require supportive

• Renal and hepatic damage may be Renal and hepatic damage may be reversible but neurological no improvereversible but neurological no improve

• Abstinence from further solvent abuse Abstinence from further solvent abuse is vitally important.is vitally important.

Other abused substancesOther abused substances

8-ANABOLIC-ANDROGENIC STEROIDS8-ANABOLIC-ANDROGENIC STEROIDS

9- DESIGNER DRUGS 9- DESIGNER DRUGS

10- NICOTINE10- NICOTINE