DRUG ABUSE and DEPENDENCE

TERMINOLOGY

Drug abuse synonymous with the nonmedical use of

drugs to alter ones mental state
- alter mood and perception of reality,
experience unique sensations, improve mental/physical
capabilities
Dependence (WHO) drug self administered that is
detrimental to the individual or society
Drug abuse detrimental drug use
Dependence alterations in the physiologic conditions
secondary to chronic drug administration

DEPENDENCE:
Psychologic dependence emotional and mental
preoccupation with drug acquisition and use to
receive positive reinforcement
Physical dependence an altered physiologic
condition caused by chronic exposure to a drug
- causes abstinence or withdrawal
syndrome

TOLERANCE prior exposure to a drug decreases the

response to a given dose

Dispositional or Metabolic tolerance consequence of

enhanced elimination of a drug
Functional or Cellular tolerance - develops as a result
of adaptive processes within cells
Behavioral tolerance drug user learns to modify
behavior while under the influence of the drug

CROSS-TOLERANCE once tolerant to one drug

becomes tolerant to other drugs as well

Specific cross-tolerance occurs among drugs within a

given pharmacologic class
- cellular tolerance

Nonspecific cross-tolerance when drugs share a

common and inducible metabolic pathway
- dispositional tolerance

OPIOIDS
- bind stereospecifically to opioid receptors
- possess morphine-like activity
- therapeutic uses: relieve pain, treat diarrhea and suppress
cough
- includes: naturally occurring - morphine and codeine
semisynthetic - heroine (horse, smack, junk, H)
oxymorphone
hydromorphone
synthetic meperidine
methadone
pentazocine (Ts)
propoxyphene

COMPARISON OF COMMONLY ABUSED DRUGS

Tolerance

Psychologic
dependence

Physical
dependence

Opioids
Barbiturates
Antianxiety Agents
Ethyl Alcohol

X
X+
X+
X+

X
X
X
X

X
X
X
X

Amphetamines
Cocaine
Nicotine
LSD

X
X
X
X

X
X
X
X

X~
X~

Phencyclidine
Cannabinoids
Inhalants

X
X
?

X
X
X

X~
X~
X~

Drug Category

Psychotogenic

Characteristics of Abuse:
- euphoria ((peace and contentment) and sedative effects
- central nervous stimulation activation of the chemoreceptor
trigger zone nausea and vomiting
Heroine most widely used opioid
- enters the brain more rapidly
- thrilling sensation in the lower abdominal area (sexual
orgasm
- sedation (sleep and vivid dreams)
- depress respiration
- marked miosis
- no mental or physical deterioration
- (+) psychological and physical dependence
- psychological tolerance dictates continued use and recidivism
- tolerance lessens sedation, euphoria and respiratory depression

- miosis and constipation persist

- upon withdrawal tolerance rapidly diminishes
- high degree of cross-tolerance

- abstinence syndrome: (shorter acting) 8 hours

peak : 36 72 hours
8 -12 hours lacrimation, yawning and diaphoresis
13 hours restless sleep
20 hours gooseflesh, dilated pupils, agitation and tremors
2nd and 3rd day weakness, insomnia, chills, intestinal
cramps, nausea, vomiting, diarrhea, violent yawning, muscle
aches in the legs, severe low back pain, increased BP and CR,
diaphoresis and gooseflesh

- administration of an opioid agonist at any point will

dramatically eliminate the symptoms and restore apparent
normalcy (cross-dependence)
- mild symptoms may persist for months
- craving may continue for years
- longer acting like methadone milder and more prolonged
syndrome

Opioid abstinence syndromes in babies born to opioid

dependent mothers: (1st day of life) high-pitched crying,
tremors, hyperreflexia, sucking of the fist, sneezing, yawning,
vomiting and hyperthermia
-slow detoxification by administering sufficient opioid usually
paregoric tapered

Treatment of opioid dependence:

1. Withdrawal gradually reducing the dosage of drug over a period of
several days
Methadone substitutes for most other opioids
- well absorbed orally
- longer duration of action (decreasing doses need
only be given once in a 24 hour period)
- abstinence syndromes less severe
- Methadone Maintenance Programs: patient not
detoxified but given a high daily dose
Rationales: 1) Additional opioid no reinforcing
qualities
2) Patients will not engage in
drug-seeking behavior

Clonidine reduces severity of opioid withdrawal by

depressing preganglionic sympathetic nerve activity
- safe, nonopioid therapy that reduces withdrawal
symptoms
- hypotension
2. Rehabilitation
- Administering a pure opioid agonist will prevent reinforcing
effects.

Naltrexone long acting agonist

- must not be started before detoxification is complete

Medical Problems:
- street heroin 2-5% opioid + adulterants \
OVERDOSE
- withdrawal
/
Signs and symptoms of overdose:
1. respiratory depression
2. central nervous system depression
3.miosis
Death secondary to respiratory arrest or noncardiogenic pulmonary
edema.
Naloxone (Narcan) reverses apnea nd coma
- can precipitate a full abstinence syndrome

Other medical problems:

Unsterile needles AIDS

Viral hepatitis
Bacterial and fungal infections
Chronic liver disease
Thrombophlebitis
Cellulitis
Local abscesses
Designer drugs
MPTP meperidine analog
- degeneration of the nigrostriatal dopamine neurons
and a syndrome similar to Parkinsons disease

CENTRAL NERVOUS SYSTEM DEPRESSANTS

I. Barbiturates
- short acting preferred
- secobarbital (reds, red devils, red birds)
pentobarbital (yellow jackets)
amobarbitals (blues, blue heavens)
- tranquility, relaxation and disinhibition
- (+) mental or physical deterioration
- sedation (w/o analgesia), decreased mental activity, slowed speech
and emotional lability
- high doses: ataxia, diplopia, nystagmus, vertigo, stupor, sleep
respiratory depression coma death
- high risk of overdose because actions of central depressants are
additive
- may ingest more drug than intended because of decreased mental
acuity and impaired memory

- treatment: maintaining respiration and supporting the

cardiovascular system
- no specific antagonist to reverse apnea and coma
- (+) Tolerance : dispositional induce hepatic microsomal
enzymes
functional mechanism unknown
- (+) Cross-tolerance
- (-) tolerance to the lethal actions increased dosage
increased risk of overdose
- (+)psychologic and physical dependence
- abstinence syndrome is life threatening
weakness, restlessness, tremulousness, and insomnia
abdominal cramps, nausea, vomiting, hyperthermia,
orthostatic hypotension, confusion, disorientation
convulsions (inc. status epilepticus) occurring on the 2nd - 3rd
day (short acting)/ 3rd 8th day (long acting)

Treatment of barbiturate dependence:

- hospitalization
- stabilized with a suitable barbiturate (pentobarbital)
dose tapered over the next 7 14 days to minimize
withdrawal
syndrome and convulsions
- abstinence syndrome in babies born to drug dependent
mother similar
to that of opioids but more dangerous
treatment: stabilized on a central nervous system
depressant (benzodiazepine) detoxified

II. Nonbarbiturate Sedatives and Antianxiety Agents

- meprobamate
methaqualone (quaalude, ludes)
glutethimide
chloral hydrate
benzodiazepines
- euphoria, feelings of tranquility and intoxication
- overdose similar to the barbiturates
Benzodiazepines: less powerful
respiratory depression and coma unlikely
but if they occur, flumazenil can reverse them
Methaqualone: large doses convulsions, pulmonary edema
and respiratory arrest
- (+) tolerance and cross-tolerance to the sedative and reinforcing
properties but little tolerance to the lethal effects
- (+) strong psychologic and physical dependence
- abrupt withdrawal life threatening abstinence syndrome but
dose related, dependent on type of drug used and duration of use

III. Ethyl Alcohol

- most serious drug abuse problem in the Western society
- contributing factor in 35 50% of cases of marital violence
10% of occupational injuries
18,000 or more (40%) traffic deaths
- intoxicating and euphoric feelings and relief from anxiety
- small amounts: decrease mental acuity and impair motor
coordination
- higher doses: paradoxic stimulation with feelings of buoyancy
and exaggerated marked impairment of motor skills, slurred
speech, unsteady gait, stupor unconsciousness
- (+) genetic predisposition to dependence
- (+) dispositional and functional tolerance
- (+) cross-tolerance
- (+) psychologic and physical dependence
- abstinence syndrome is life threatening

-Withdrawal symptoms: few hours tremors, weakness,

anxiety, intestinal cramps
and
hypereflexia
12 24 hours visual hallucinations
48 hours acute neurologic syndrome
Acute neurologic syndrome confusion, disorientation and
delusional thinking
if w/ gross tremors delirium tremens
- recovery by the 5th 7th day
Treatment of dependence:
- requires fluids, nutrients and vitamins (esp Vitamin B)
- stabilized on other central nervous system depressants like
benzodiazepines then dose is reduced gradually
- rehabilitation: Alcoholics Anonymous
Disulfram (Antabuse) accumulation of
acetaldehyde

Medical Problems:
- cirrhosis of the liver (+/- portal hypertension)
peripheral neuropathy
alcoholic gastritis
Korsakoffs psychosis
Wernickes encephalopathy
- interferes with the immune function
- prenatal exposure to alcohol developmental defects in
the brain (motor dysfunction, hypotonia, cognitive
deficiencies and microcephaly)
- fetal alcohol syndrome 2% of babies

CENTRAL NERVOUS SYSTEM STIMULANTS

I. Amphetamines (bennies, dex)
- appetite suppressants
- treat narcolepsy
- treat ADHD
- euphoria, elevate mood, enhance sense of well being and
reduce fatigue, enhance mental or physical
performance
- taken orally, sniffed or injected IV (rush), recently, pure
form smoked high incidence of overdose
- higher doses reduce mental acuity, and impair
performance of simple tasks
- anxious, restless, irritable and irrational
- overdose: dizziness, tremor, heperreflexia, confusion,
agitation,
hostility, delirium and paranoid ideation

- Amphetamine psychosis: visual and auditory hallucinations

and paranoid delusions disappears a few days after drug is
discontinued
- stimulation fatigue and depression (crash) prolonged sleep,
anxiety and agitation run or speed run exaggerated
crash
- mydriasis, hypertension, hyperreflexia and hyperthermia
- hypertensive crisis with intracranial hemorrhage, cardiac
arrhythmias, myocardial infarction and cardiovascular
collapse
- lowers seizure threshold convulsions
II. Methamphetamine (meth, speed, crystal, ice, crank)

III. Cocaine
- local anesthetic and vasoconstrictor
- naturally occurring in the leaves of the coca plant,
Erythroxylon coca
- 1986, 15% of The US population had tried cocaine
- sniffed, injected IV or smoked
- affordable to the impoverished and the young
- toxicity: extreme agitation, restlessness, confusion, chest
pain, anxiety, palpitations and headache paranoid
thinking, hallucinations, CVA, convulsions, MI and
cardiac arrhythmias depression and possibly
medullary paralysis and respiratory failure
- extremely dangerous
- ischemic necrosis and perforation of the nasal septum

- (+) tolerance to euphoric effects

- (-) tolerance to cardiovascular effects or to the
subsequent psychosis
- (+) psychologic tolerance
- (?) physical tolerance
- abstinence syndrome
- serious depression and anxiety with suicidal ideation

Treatment of dependence:

- control of various symptoms produced by the drug

cardiac complications beta adrenergic receptor agonist
or Ca channel blocker
convulsions/hyperactivity diazepam
psychiatric complications antipsychotic/antidepressant
drugs
- acidification of urine -? Value

III. Methylphenidate

- used to treat ADHD and narcolepsy

- less potent than amphetamines
- fewer side effects
- higher doses: effects similar to amphetamines

IV. Nicotine

- alkaloids found in the tobacco plant, Nicotiana tabacum

- mild stimulant
- well being, increased alertness, sense of relaxation
- strong psychologic dependence
- stimulation of respiration, tremors, relaxation of skeletal
muscles
- high doses: convulsions
- dizziness, nausea, vomiting (activation of the
chemoreceptor trigger zone and
vagal reflexes)
- increased BP and CR
- (+) tolerance
- (+) psychologic dependence
- (-) physical dependence

- withdrawal; irritability, anxiety, restlessness, headache,

insomnia and decreased
cognitive abilities but not a defined abstinence syndrome
- Nicotine gum (Nicorette) and Clonidine may be of help
Medical problems:
- labored breathing, wheezing, shortness of breath, and
frequent URTIs
-reversible on cessation
- smokers w/ greater risk of chronic bronchitis, emphysema
and lung CA
-increases risk for CV diseases like coronary artery disease and
CVA
- chronic smoking during pregnancy low infant birth weight
and increased likelihood for perinatal mortality

V. Caffeine
- coffee bean (Coffea arabica), tea plant (Thea sinensis) and
seeds of
the chocolate tree (Theobroma cacao)
- most widely used central nervous system stimulant
- increases alertness and elevates mood
- no casual relationship with health problems
- (+) psychologic dependence
- little if at all physical dependence
- withdrawal: headache, irritability, nervousness and
lethargy

HALLUCINOGENS

I. Lysergide
- synthesized from alkaloids of ergots (Claviceps purpurea) found in
fungus that attacks rye and other grains
- psychotogenic and physiologic effects that lasts for 8 12 h
- unique and altered sensory experience, feelings of altered reality
and perceptions of understanding hidden truths
- trip: initial feelings of depersonalization and loss of body
image, altered sensorium, altered perceptions of colors, shapes
and distances and frank hallucinations, synesthesias
- ecstasy profound despair
- slight increase in BP and CR, mydriasis, hyperreflexia, muscular
incoordination, salivation and lacrimation
- dissociative reactions, acute panic reaction or psychotic episodes
- paranoid and suicidal, may worsen underlying psychosis

- symptoms of the trip recurs weeks or months flashback

- permanent damage to thought or behavior
- amotivational syndrome
- (+) tolerance and cross-tolerance
- (+) psychologic dependence
- (-) physical dependence
- uneventful resolution of intoxication
- acute panic attacks benzodiazepines
- antipsychotic drugs for confusion and agitation
- quiet and reassuring environment

II. Mescaline
- tops of the peyote cactus (Lophophora williamsii)
- physiologic and psychotogenic effects similar to LSD
- thousand times less potent than LSD
- slow onset of action associated with nausea, profuse sweating and
tremors
- vivid and colorful hallucinations
- last for 8 12 hours
- (+) tolerance and psychologic dependence
- (-) physical dependence

III. Psilocybin

- Psilocybe and other mushrooms

- similar effects w/ LSD
- shorter duration of action (2 3 hours)
- less potent
- (+) tolerance and psychologic dependence

IV. Phencyclidine
- 1st developed as a veterinary anesthetic
- misrepresented as LSD and marijuana
- central nervous system depressant, stimulant and
hallucinogenic properties
- low doses: euphoria, disinhibition, intoxication and
increased emotional lability
- larger doses: dissociative state, analgesia, delirium, stupor,
and hallucinations
- hostile and bizarre behavior with unprovoked aggression
- tachycardia, hypertension, flushing, sweating, and miosis
- hyperreflexia, nystagmus, ataxia and rigidity
convulsions, status epilepticus, hypertensive crisis, cardiac or
respiratory arrest and coma
- (+) tolerance and psychologic dependence
- treatment of overdose: treat symptoms

CANNABINOIDS
- weed, pot, hash, maryjane, smoke, reefer, dope
- found in marijuana from the hemp plant (Cannabis sativa)
- highest concentration found in the flowering tops (hashish)
- sedative, euphoric and hallucinogenic effects
- THC
- used medically to decrease nausea and vomiting occurring with
chemotherapy
- increased well-being, altered perception of space and time
- sleepy rather than aroused
- short term memory, motor skills and performance of goal-oriented
and complex tasks are diminished
- higher doses: hallucinations, delusions, and depersonalization,
paranoid ideation
- anxiety, fear and panic reactions
- dry mouth, tachycardia, increased/decreased blood pressure and
reddening of the conjunctiva
- impair spermatogenesis, inhibit testosterone, suppress LH and FSH
production

- reduces intraocular pressure

- bronchodilator
- rapid psychogenic effect lasting for 2 3 hours
- enhancement of paranoid thought disorder and
exacerbation of psychosis in schizophrenic patients
- develop asthma and bronchitis
- (+) tolerance to altered mood and sensorium, CV
effects, diminished psychomotor performance and
decrease in intraocular pressure
- (+) strong psychologic tolerance
- little physical dependence
- withdrawal: irritability, restlessness, nervousness,
insomnia, weight loss, chills, tremors and increased
REM sleep

INHALANTS
- Anesthetics agents, volatile nitrates, hydrocarbon solvents and
fluocarbon aerosol propellants
- Nitrous oxide: most abused general anesthetic
intoxicating effects and pleasant sensations
death hypoxia
- Volatile nitrates: amyl nitrite and isobutil nitrite (poppers,
snappers)
relax smooth muscles
transient euphoria, lightheadedness and
perceptual distortions
thought to enhance sexual performance
headache, dizziness and flushing
large doses: profound hypotension, nausea,
vomiting, glaucoma, decreased respiration and
unconsciousness
- (+) tolerance to vasodilating effect

Volatile solvents and fluocarbon aerosol propellants: gasoline,

lacquer thinners, various glues and cements, cleaning fluids, nail
polish remover, lighter fluid and aerosol propellants
- Toluene, acetone, benzene, n-hexane, isobutane
- Most abused by children and teenagers because of availability
- Intoxicated, ataxic, w/ sensory and perceptual distortions and
delusions
- Higher doses: loss of consciousness, cardiac arrhythmias, nausea,
vomiting, diarrhea, headache and irritation of the eyes
- Long term effects peripheral nerve damage, hepatotoxicity,
nephrotoxicity, cerebellar atrophy, damage to the respiratory
tract, lead poisoning and bone marrow depression
- Death due to : cardiac arrhythmias, cardiac failure and
suffocation
- (+) tolerance and psychologic dependence

HOW TO MAKE DRUGS ADDICTS OF YOUR KIDS:

1.
2.
3.
4.
5.
6.

7.
8.
9.

Spoil them.
When they do wrong, you may nag them but never spank them.
Foster their dependence on you, so drug or alcohol can replace you
when they are older
Protect them from your spouse and from all those mean teachers who
threaten to spank them. Sue them if you wish.
Make all their decisions for them.
Criticize their other parent openly, they, particularly as the other
parents same sex offspring can lose their own self respect and
confidence.
Always bail them out of trouble so they will like you.Never let them
suffer the consequence of their actions
Always step in and solve their problems for them.
Take lots of prescription drugs yourself.

ANSWERS FOR THE CHRISTIAN FAMILY

1.
2.
3.
4.
5.
6.
7.

Lead your child to Christ.

Model a healthy life.
Spend your time with your teen.
Utilize peer groups.
Get help for the whole family.
Attend church regularly.
Dare your child to be a Daniel.

1 John 2:14 I write to you young men, because you are strong, and the word
of God lives in you, and you have overcome the evil one.