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Substance Abuse And Dependence

An exploration of substance abuse, its causes, effects, and treatment options.

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    Substance Abuse and Dependence Important 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 desired effect. b. A larger dose than the previous one must be used to produce the same effect.

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    Dependence:  This is an adaptive psychological, physiological and biochemical state caused by the repeated exposure to a drug.  Continued use of the drug becomes necessary for the well - being of the organism.  Sometimes the word "dependence" is used as a synonym of addiction.

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    Withdrawal * Withdrawal syndrome: psychological or physiological symptoms may occur. * A closely related substance is taken to relieve or avoid withdrawal symptoms.

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    Compulsive substance taking behavior: * The substance is taken in larger amounts or over a longer period than intended. * Unsuccessful efforts to cut down or control substance use. * A great deal of time is spent in obtaining, using and recovery from substance effects. * Social, occupational or recreational activities are given up or reduced. * Continuing despite physical or psychological problems.

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

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

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    Gateway Substances  These are addictive substances their frequent use has been directly related to subsequent abuse and dependence of other more dangerous substances, such as Heroin and Cocaine.  They include: 1. Tobacco 2. Cannabinoids (Hashish, Marijuana, Bango )  They are the best predictor of other drug use during adolescence.

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

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

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    Types of Drugs of Abuse and Dependence 6. 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 is common. Substances may be mixed with others.

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

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    ( 1 ) Nicotine  Nicotine also increases nor epinephrine, epinephrine, and serotonin and these increases may modulate some of the reinforcing effects from cigarettes.  In large toxic doses, it exerts an inhibitory effect on peripheral cholinergic receptors.

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