Substance abuse

Narcotic and psychotropic substances (hereinafter referred to as OPL ) is the designation for a number of substances, also referred to as addictive substances (NL) or drugs. When used, they cause qualitative or quantitative changes in thinking, behavior , experience, etc. The use of OPL can lead to addiction , withdrawal syndrome ( withdrawal symptoms ) and numerous somatic diseases (either due to the effect of the active substance directly or inappropriate application). NL abuse can limit a person in other areas as well (deterioration of work performance and relationships, committing crimes under the influence of OPL, etc.)

Division of narcotic and psychotropic substances
OPLs are often divided into different groups. However, this division is problematic and often inaccurate.

By origin:
 * Synthetic ( meth, LSD)
 * Natural - typically of plant origin ( cocaine, marijuana ), but also of animal origin (excreta of some toads containing bufotenin), or of mushroom origin (shrimp, red toadstool).

The label "semi-synthetic" (typically the production of heroin from morphine or cocaine from coca) is not appropriate, as the basic precursor of every synthetic drug is always a natural substance.

According to the risks associated with use:
 * Soft (usually tobacco, alcohol, caffeine, sometimes cannabis)
 * Hard ( meth, heroin , cocaine )

According to the effect:  These are substances that stimulate the activity of the CNS (otherwise known as stimulants, psychostimulants, analeptics ), substances that dampen the activity of the CNS (also sedatives, hypnotics, tranquilizers ) and hallucinogens.


 * Stimulants (e.g. amphetamine and its derivatives or analogues, cocaine, methylphenidate, caffeine ) increase alertness, delay fatigue, and a subjective feeling of increased performance occurs. The reaction time is shortened, but often at the expense of priority. The somatic component usually represents tachycardia, restlessness, anxiety, paranoia or hallucinations (toxic psychosis) in case of overdose. Nicotine is also usually included here, or tobacco.


 * Sedatives (alcohol, opiates, benzodiazepines, barbiturates ) - often referred to as narcotics or hypnotics. These include medicines (primarily benzodiazepine anxiolytics - alprazolam, bromazepam, clonazepam). In general, they are characterized by a rapid onset of dependence (both psychological and physical), and withdrawal states can be life-threatening ( delirium tremens with alcohol, status epilepticus with benzodiazepines).

Even this division is not unambiguous - tobacco is usually placed on the border between stimulants and sedatives, while cannabis is between sedatives and
 * Hallucinogens ( LSD, lysohlavky, DMT, clary sage) - cause significant qualitative changes in perception. Hallucinogens are a very dangerous risk of developing toxic psychosis ( bad trip in slang ). In such cases, paranoid delusions, massive anxiety, etc. may develop, to which the intoxicated person may react inappropriately due to lack of foresight by escaping from the situation (jumping out of a window, running over a busy road). On the other hand, the risk of addiction (especially for the mentioned representatives) is almost minimal - there is a sharp increase in tolerance. Most conventionally used hallucinogens are also only minimally toxic. Hallucinogens usually also include marijuana.

Diagnostic criteria
Currently, a standardized questionnaire of six or seven closed questions. If the answer to three of them is positive, the patient can talk about harmful use or addiction. We use the ICD classification for diagnosis:

For the fourth character of the code (e.g. F10.0 - acute alcohol intoxication), the rules stated in this article apply.

General properties of addictive substances
In order for a substance to be classified as a drug, it must meet at least one of the following properties. However, almost all of them meet several criteria.

'''A drug is a substance that generally has the ability to remove unpleasant psychological states, or to induce pleasant ones. More generally speaking, to induce feelings of euphoria, an influx of energy, alleviation of anxiety and fear, a psychospiritual experience ( hallucinations ), while the drug here does not mean ordinary food.'''

Typical properties of drugs
 * qualitative changes in perception, typically hallucinations (e.g. LSD )
 * change in the way of experiencing or behavior ( depersonalization, derealization ) or behavior (aggression, indifference)
 * changing thought contents, possibly speeding up or slowing down the flow of thoughts
 * causing CNS depression ( ethanol, benzodiazepines )
 * causing CNS excitation - stimulants in general ( cocaine, methamphetamine , caffeine , nicotine )
 * causing withdrawal symptoms when stopping use (almost all drugs except psychedelics)
 * the emergence of craving, i.e. a strong desire to use the drug again

related articles
Psychoanaleptics Hallucinogens Stimulants Sedatives Withdrawal syndrome Detoxification Intoxication Mental disorders and behavioral disorders caused by the use of psychoactive substances

Resources
Papežová a kol., Naléhavé stavy v psychiatrii (1.st ed., pp. 430-447). Praha: Maxdorf.

RABOCH, Jiří a Petr ZVOLSKÝ, c2001. Psychiatrie. Praha: Galén. ISBN 80-726-2140-8.

KALINA, Kamil, 2015. Klinická adiktologie 1 - Klinická farmakologie návykových látek. Praha.