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Substance Abuse and Dependence

Definitions

Abuse

definitions vary; generally, abuse is defined as substance use which may result in dependence, drug tolerance, and withdrawal symptoms (addiction).

Usually applies to illicit substances (i.e., drugs, or other controlled substances) but can also refer to unsanctioned use of otherwise legal products such as paint, glue, or gasoline

Abuse is not coextensive with actual addiction, but abuse often precipitates addiction

Dependence

a physical, psychological, or behavioral state where the substance is necessary in order to function normally

Occurs as a result of habituation; the “high” is reduced as the body acclimates to the drug. In some cases, the body stops producing certain chemicals to counterbalance the drug. When that occurs, weaning off the drug will produce withdrawal symptoms until the body re-adjusts

Example: while cocaine, heroin, and alcohol create physical dependence, behavioral dependence is much more common among marijuana users. In those cases, “withdrawal” is experienced as a sense of anxiety or uncertainty about what to do with yourself during times when you would have otherwise smoked, and increased anxiety due to the need for other coping mechanisms besides marijuana.

Tolerance

A physical state where increasing dosages are required to achieve the same effect as the initial dose

“Chasing the Dragon” – as the body becomes more tolerant to the drug, the drug loses its potency, creating a need to increase the dose

Overdoses occur for two reasons: either because of an unexpectedly pure or potent dose, OR because of intentionally increasing the dosage to counteract the tolerance effect

Withdrawal and the Rebound Effect

Withdrawal symptoms are prima fascie evidence of dependence

usually they take the form of the opposite of the drug’s effect (rebound)

example: alcohol withdrawal results in tremors, agitation, sweating, anxiety, and CNS activation

example: caffeine withdrawal results in crankiness, lack of concentration, drowsiness, and migraines

Negative Reinforcement

addiction becomes negatively reinforced when the illicit substance relieves the uncomfortable symptoms of withdrawal

Common Psychoactive Substances

Depressants – reduce CNS activity by acting as a GABA agonist, producing relaxation, sedation, euphoria, amnesia, and in toxic doses, coma and respiratory arrest

HIGH potential for dependence and tolerance due to anxiety and physical discomfort of withdrawal symptoms

Alcohol

alcohol withdrawal can cause “delirium tremens,” an extremely dangerous symptom which has a relatively high fatality rate

Benzodiazepenes

anti-anxiety medications (Xanax, Ativan) and the date-rape drug (rohypnol/flunitrazopam)

Barbituates

Tranquilizers; generally not used for anxiety due to possibility of overdose

Inhalants

paint, gasoline, glue, rubber cement, etc.

greater possibility of brain damage due to direct aspiration of chemicals into the olfactory neurons

Anti-Histamines

produce sedative effects by blocking the action of histamines, rather than GABA receptors

includes diphenhydramine (benadryl), which is sometimes prescribed off-label for anxiety and insomnia (DO NOT DO THIS, YOU COULD DIE)

Opiates

produce euphoria and pain relief (analgesia) by acting on opiate receptors in the nucleus accumbens and sensory nerves

HIGH probability of dependence and addiction due to (a) positive reinforcement of euphoria and (b) negative reinforcement of pain relief

withdrawal symptoms include severe, intractable pain which is usually not harmful but which lasts for the duration of the withdrawal period due to temporary reduction in endorphin production. This reduction MAY be permanent

substances include opium and its derivatives (morphine, heroin, oxycodone, hydrocodone)

Overdose causes CNS arrest, coma, and death

Stimulants

produce feelings of alertness, energy, resistance to fatigue, and positive mood

by far the most commonly abused substances

legal stimulants have mild withdrawal symptoms and low use cost, reducing incentive to stop using

Action varies by substance

Caffeine

blocks adenosine receptors, which normally signal fatigue

increases dilation of blood vessels in the body

decreases dilation of cranial blood vessels, reducing headaches

found in OTC migraine preparations, usually with acetaminophen, and in prescription migraine medication such as Fioricet (with acetaminophen and bulbital, a barbituate). Withdrawal CREATES migraines

Methylphenidate (Ritalin) and Amphetamine/Dextroamphetamine (Adderall/Dexadrine)

used to treat attention deficit disorder

if abused, creates dependency and contributes to behavioral problems

dopamine and norepinephrine agonists

Ephedrine and Psuedoephedrine

stimulate cranial nerves to reduce inflammatory responses (used as decongestants), and used in the creation of methamphetamine

Nicotine

acetylcholine agonist

highly addictive

Cocaine

Dopamine and Norepinephrine RI and increases DO and NE production

Amphetamines (and derivatives)

includes methamphetamine, crystal meth, MDMA (Ecstasy)

Withdrawal symptoms include sluggishness, depression

Can cause “stimulant induced psychosis” due to increase in dopamine

Psychedelics

increase dopamine and serotonin, thereby increasing euphoria and sensory awareness

Generally not physically addictive due to varying experiences (i.e., the possibility of a “bad trip”)

LSD

increases dopamine and serotonin, producing perceptual hallucinations

can also cause paranoia and terror (the bad trip)

THC

low-dose hallucinogen which produces vague feelings of wellbeing as well as heightened perceptual experiences

Psylocibin (Mushrooms)

Mescaline

Bufotenin

with DMT, the hallucinogenic compound found in cane toad secretions (Bufo means “toad”)

Ayahuasca

brewed from plants containing dimethyltryptamine (DMT) combined with a plant which yields an MAOI (which potentates the effect)

Dissociatives

produce out-of-body experiences, blackouts, anaesthesia (insensitivity to pain)

Ketamine

better tolerated as an anaesthetic than PCP

Phencyclidine (PCP)

initially used as an anaesthetic, but not tolerated well

produces dissociative states and insensitivity to pain, causing individuals to be extremely violent and unpredictable since they are not stopped by normal pain stimuli

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