Substance Abuse And Dependence

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Substance Abuse and DependenceImportant DefinitionsToleranceDependenceAddictionCompulsive substance taking behaviorWithdrawalCravingSubstance AbuseGateway Substances

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Tolerance1. Previous exposure to a drug or to a similar one2. Quantitative response characterized by either:a. A usual dose no longer evokes its desiredeffect.b. A larger dose than the previous one must be used toproduce the same effect.

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Dependence:This is an adaptive psychological, physiologicaland biochemical state caused by the repeatedexposure to a drug.Continued use of the drug becomes necessary forthe well-being of the organism.Sometimes the word "dependence" is used as asynonym of addiction.

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Withdrawal* Withdrawal syndrome:psychological or physiologicalsymptoms may occur.* A closely related substance is takento relieve or avoid withdrawalsymptoms.

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Compulsive substance takingbehavior:* The substance is taken in larger amounts or over alonger period than intended.* Unsuccessful efforts to cut down or controlsubstance use.* A great deal of time is spent in obtaining, usingand recovery from substance effects.* Social, occupational or recreational activities aregiven up or reduced.* Continuingdespitephysicalorpsychologicalproblems.

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Craving:it is a strong subjective drive to use the substance. It islikely to be experienced by most (if not all) individualswith substance dependence.

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Substance Abuse:It is repetitive use of substances resulting in recurrentand significant adverse consequences, e.g.* Failure to fulfill major role obligations at work,school or home.* Recurrent substance use in situations in which it isphysically hazardous (e.g. driving an automobile).* Recurrent substance related legal problems.

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Gateway SubstancesThese are addictive substances their frequent use hasbeen directly related to subsequent abuse anddependence of other more dangerous substances, suchas Heroin and Cocaine.They include:1. Tobacco2.Cannabinoids(Hashish, Marijuana,Bango)They are the best predictor of other drug useduring adolescence.

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Addiction:The diagnosis of addiction implies the use of adrug with the following clinical criteria:* The use of the drug is not upon medicalindication* Tolerance* Withdrawal

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Types of Drugs of Abuse andDependenceMost of substances known to be amenable for abuseand dependence (Addiction) can be grouped intothe following classes:1. Alcohol.2. Sedatives, hypnotics oranxiolytics.3.Cannabinoids[e.g.Bango-Hashish-Marijuana].4.Opioids[e.g. Heroin, Opium, Morphine, Codeineand Codeine-containing cough sedatives].5. Cocaine.

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Types of Drugs of Abuse andDependence6. Amphetamines and other stimulants.7. Tobacco.8. Caffeine.9. Hallucinogens [e.g. LSD,Anticholinergics, Mescaline...]10. Phencyclidine [e.g.Ketamine]11. Volatile solvents.N.B. Poly-substance abuse and dependence iscommon.Substances may be mixed with others.

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(1) NicotineNicotine, in mild to moderate doses, is acentral nervous system stimulant.It enhances central cholinergic receptors(activated by acetylcholine).The dependence-producing effects ofnicotine appear to be modulated bydopamine (nicotinic-cholinergicreceptors lie on dopamine neurons,nicotine increases dopamine).

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(1) NicotineNicotine also increases nor epinephrine,epinephrine, and serotonin and theseincreases may modulate some of thereinforcing effects from cigarettes.In large toxic doses, it exerts an inhibitoryeffect on peripheral cholinergic receptors.

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