Misuse of Addictive Substances

Misuse of addictive substances often leads to dependence or addiction. The addiction is chronic and relapsing leading to compulsive drug seeking and use regardless of the harmful effect to the addicted person and people around them. The brain changes that take place over time,challenge a person's self control and ability to resist intense impulses urging them to take drugs.[1]

Substances known to cause addiction can be:-


 * STIMULANTS-amphetamine and methamphetamines, caffeine,cocaine
 * SEDATIVES & HYPNOTICS- alcohol,barbiturates,benzodiazepines
 * HALLUCINOGENS:-Psychedelic drugs (e.g. LSD),Dissociatives (e.g. ketamine),Deliriants e.g. diphenhydramine (benadryl)
 * OPIATES- morphine,codeine,heroin,oxycodone,methadone
 * NICOTINE

ALCOHOL:
depresses the CNS.Enhances the effects of major inhibitory neurotransmitter GABA.Causes sedation,slurred speech,ataxia and impaired judgement. These effects are seen in doses of 0.5g/l approximately equivalent to two glasses of wine(in an average 70kg male). Higher concentrations-3-5g/l, 3-5 promile (1promile=1g/l blood) can lead to marked intoxication or coma in a non-tolerant individual and mild intoxication in a chronic alcoholic. In most countries, the maximum quantity per week falls between 140 g–210 g for men and 84g–140g for women, with total abstinence during breastfeeding and pregnancy. Alcohol abuse /misuse can lead to anaemia,increased risk of certain cancers such as oral,laryngeal,oesophageal,liver,breast carcinomas etc.,cardiovascular diseases,liver cirrhosis,alcoholic neuropathy,Wernicke-Korsakoff syndrome (alcoholic encephalopathy),dementia,seizures etc

TREATMENT AND PREVENTION:combination of detoxification and psychosocial therapy. For detoxification, a long-acting sedative-hypnotic drug is substituted for alcohol and then its dose is gradually reduced. This prevents symptoms of alcohol withdrawal. Benzodiazepines are preferred. Drugs that help prevent alcohol abuse: Naltrexone, an opioid receptor antagonist that blocks the effects at μ opioid receptors of exogenous and endogenous opioids Has been shown to reduce craving for alcohol and rate of relapse to alcohol dependence Potentially toxic to the liver.

AMPHETAMINES,METHAMPHETAMINES:
used as a recreational drug.Have a high addictive profile.Ways of administration- oral,smoking,sniffing/snorting,intravenous(injection)[2]. Effects are mostly psychological-euphoria, decreased fatigue, reduced appetite, increased self-esteem, self-confidence, alertness, insomnia, delusions of grandeur,hallucinations. Mode of action:- inhibit activity of Monoamine oxidase which leads to increase in dopamine,serotonin and norepinephrine- neurotoxicity and sympathomimetic toxidrome(general toxicity).

TREATMENT:detoxification followed by treatment programme

OPIODS:
stimulate dopaminergic pathway, cause analgesia, cough depression, nausea and vomiting. Symptoms of withdrawal include-pain,insomnia,diarrhoea,vomiting,involuntary movements, anorexia. Taking a large single dose can lead to severe respiratory depression and death. TREATMENT: detoxification and medication such as methadone-a synthetic opioid that blocks the effects other opioids, eliminates withdrawal symptoms, and relieves drug craving[3].Naloxone,an opiate antagonist can also be used although not as effective as methadone.

HALLUCINOGENS:
lead to subjective changes in perception,thought,consciousness and emotions LSD abuse, main effects caused are sensory and emotional. The user may experience quick changes between a range of emotions such as euphoria and fear,with shifts so quick that they may seem to be experiencing them at the same time. Long term effects- hallucinogen persisting perception disorder(HPPD) also known as 'flashbacks' and persistent or chronic psychosis these class of drugs do not produce the physical dependence that drugs like alcohol or heroine do they cause psychological dependence.Treatment is provided in form of therapy,participation in support groups,anger and medication management.

REFERENCES:Link title [1]- http://www.drugabuse.gov/publications/infofacts/understanding-drug-abuse-addiction [2]- http://www.methaddictiontreatment.com/ [3]- http://www.drug-addiction.com/opioids.htm Katzung B. Basic and Clinical Pharmacology. 10th edition. McGraw-Hill, 2007 http://www.webmd.com/mental-health/alcohol-abuse/alcohol-abuse-and-dependence-treatment-overview http://www.crchealth.com/addiction/hallucinogens-treatment/ http://www.drug-addiction.com/hallucinogens.htm