Drug Addiction
Drug Abuse And Dependence
Introduction:
It is impossible to find a single definition for drug dependence, as different drugs have different effects, which includes the risk of dependence. There are some aspects that are found in the definition of drug dependence, namely tolerance to the drug, followed by physical dependence. Tolerance means that there is a progressive need to increase the dose, when in the past the same effect of the drug was noticed with smaller doses.
Physical dependence manifests itself in withdrawal symptoms. Another feature is psychological dependence. It means that the use translates into feelings of satisfaction and a desire to repeat the experience. There is a feeling of discontent and intense craving if the drug is withheld. Addiction is characterized by a lifestyle where drug use has become compulsive and the involvement with it overwhelming. Even though the addicted patient is aware of dangers and risks, he or she will continue. Due to the destructive pattern of use it is necessary to stop drug use, whether the addict agrees and understands or not.
Drug Abuse
Drug abuse is multifaceted and it may involve experimenting with recreational drug use, which is usually illegal and brings the patient into conflict with the law. There is also the abuse of prescription drugs. They may have been useful first to prevent problems or symptoms, but through continued use the patient may become dependent and continues the use to avoid the discomfort of withdrawal. Abuse of illegal as well as prescription drugs occurs in all socioeconomic classes. The most destructive use of psychoactive drugs is still seen in connection with poverty. Here the person involved may hope to find a way out of deprivation by selling drugs and profiting from it, but instead gets more addicted and poor.
Recreational Drugs and their use have been on the rise in the Western culture. Most of them are psycho stimulant or hallucinogenic in nature and they are used to get "high" or experience a state of altered consciousness rather than to relieve psychologic distress. Crude opium (hash), marijuana, hallucinogenic mushrooms (shrooms) and alcohol are part of a group that is close to plant origin. But being close to "natural" does not imply that these substances are harmless and without risk.
Alcoholism
Drug addiction is usually associated with the use of street drugs, the abuse of prescription painkillers or illegal drug use. It is easy enough to overlook the fact, that alcohol is the most commonly used drug. Due to the fact that it is legal and freely available and alcohol use is socially acceptable, it is not a surprise that alcoholism is the most common disorder. Alcoholism is a chronic illness.
Statistics:
About 75 % of the adult population of America drinks alcoholic beverages.
About 10 % of the population of North America suffers of alcoholism or have experienced some problems with alcohol misuse at one time or another.
Males are more often affected than females. (The male: female ratio is about 4:1) and the age of onset is earlier in males than in females.)
Course of alcoholism:
People who develop alcoholism usually start as regular alcohol users, but then increase their consumption and become heavy regular users. There is usually one point, which the person will remember when "there was a switch". The habit is no longer a habit, but it has become an overpowering urge to drink. The onset is so insidious that the progression from habit to addiction is not even noticed. Societal factors play a role. Children of alcoholics have a higher risk to become alcoholics. Certain personality traits like shyness, hostility, a history of a broken home and a disturbed relationship with parents play a role.
Symptoms:
Severe dependence or addiction is the hallmark of alcoholism. Denial of the condition is common. Frequent intoxication is obvious. Unreliability at work (accidents and absenteeism) and conflicts with the law (drunk driving) will have a serious impact on daily living and relationships. High doses of alcohol, which chemically is known as ethanol, will cause serious damage. Ethanol is a cell poison that damages various organs. It kills brain cells, depresses the central nervous system and manifests its damages in the form of liver cirrhosis, gastritis, pancreatitis and damages to the heart (arrhythmias). Inadequate nutrition and inadequate glycogen storage are often present, as well as nutritional deficiencies (thiamine deficiency). These deficiencies coupled with the toxic action of alcohol are also responsible for peripheral nerve degeneration and brain damage.
Complications:
Persons may die after heavy drinking, as a lethal dose is only minimally higher than an intoxicating dose. The most common cause of death is either respiratory depression due to an alcohol overdose or aspiration after vomiting.
Essentially ethanol (alcohol) has the effect of a slow chemical burn on the central nervous system and nerves in general.
Degenerative diseases of the brain like Korsakoff's syndrome and Wernicke's encephelopathy can develop as a result of alcohol abuse. In CT scans the superior vermis and the anterior cerebellar lobes show atrophy. Another condition, Marchiafava-Bignami disease, is a demyelination of the corpus callosum, the part of the brain that connects both brain halves. This degenerative brain condition is associated with agitation and progressive dementia. Some patients recover over several months, provided they are detoxified, but others will deteriorate despite all medical efforts. Seizures add to the complications, followed by coma and death.
Treatment:
Alcoholic patients may seek treatment for their drinking or they may be coming into hospital with problems like liver disease or delirium tremens. At this point it becomes possible to address the problem and offer help, which may be accepted or vehemently denied. Treatment of alcoholism belongs into the hands of professionals. After heavy alcohol abuse the addicted patient will not be able to quit on his own. Alcohol withdrawal is associated with withdrawal symptoms such as tremor, weakness, sweating, overactive reflexes and symptoms of the gastro-intestinal tract, such as vomiting and abdominal pains. Symptoms will occur beginning 12 to 48 hours after cessation of alcohol use. Some patients have tonic-clonic seizures (alcohol epilepsy, also dubbed "rum fits").
It is essential to help the patient in a clinical setting to cope with any withdrawal symptoms, some of which can be severe and dangerous.
Abrupt abstinence after heavy use often produces hallucinations, which are terrifying to the patient. Usually these hallucinations that resemble a schizophrenic disorder are transient, and recovery occurs within 1 to 3 weeks.
Delirium tremens is a more severe condition. The onset is usually 48 to 72 hours after alcohol withdrawal. Confusion, disorientation, restlessness, frightening dreams and hallucinations are common. The patient's temperature and pulse rate are elevated, and a high fever is a warning sign. Delirium tremens can be fatal, but usually it is self-limited and should resolve within 24 hours.
Detoxification:
As a first step alcohol is withdrawn.
Medication may be needed if withdrawal symptoms are severe.
The mainstays of therapy are benzodiazepines. Dosage depends on vital signs and the mental status of the patient. They are mostly used for sedation in the agitated phase of the patient who undergoes withdrawal. Phenobarbital is useful for conditions like severe delirium tremens. Hallucinations respond to treatment with chlorpromazine or other antipsychotic medicine.
Many patients can be detoxified without drugs, if proper attention is given to reassurance and psychological support. Specialized clinics for the treatment of alcohol addiction work with psychologists and therapists in an approach and environment that is supportive and non-threatening. The patient's behavior has to undergo a change to achieve and maintain sobriety. The patient has to be warned that trying to drink "in a controlled manner" will only lead to excuses to drink more and get out of control again. Various types of psychotherapy have been used in detox programs. Group therapy is considered superior to the one-on-one approach.
Antabuse:
This medication, also known under the name of disulfiram interferes with the metabolism of acetaldehyde (a product in the oxidation of alcohol). The accumulation of acetaldehyde causes great discomfort. If the patient drinks any alcoholic drink within 12 hours of taking disulfiram, he will experience throbbing headaches, a fast heartbeat and sweating. Nausea and vomiting will follow in 30 to 60 minutes. The patient may feel dizzy and faint, and the reaction will last 1 to 3 hours. The discomfort is so intense that few patients risk ingesting alcohol while they are on disulfiram. Antabuse works in the sense of a chemical behavior modification. Patients who have been free of alcohol for 4 to 5 days can use the medication. They as well as their families have to be warned that the effects of the drug may persist for 3 to 7 days after the last dose. It also means that the patient cannot use alcohol-containing medicines, tinctures and cough syrups. Disulfiram is only useful for compliant patients. Follow-up by a physician is necessary to ensure and encourage continuation as part of an abstinence program. The drug is unsuitable in patients with cardiac decompensation and contraindicated in pregnancy.
Alcoholics Anonymous (AA)
The work of AA groups has been of invaluable help to group members within the group as well as to alcoholics to whom they reach out.
These groups provide the patient with non-drinking friends who are always available. It gives the patient access to an area where it is possible to socialize away from the pub. The patient has to find a group in which he is comfortable. Some groups in large metropolitan areas have AA groups where the members share other interests like groups of physicians and dentists.
In the group the patient will hear of persons who are on the path of healing from alcohol addiction. He will hear others confess in front of the group every rationalization he has ever thought privately for his own drinking. He will find himself in the role of helping others again, which will give him self-respect. He will also find confidence, which he previously found only with the help of alcohol.
The group also offers help to family members who live with alcoholics. It is believed that the voluntary approach of AA may be the most effective one. Nonvoluntary enrollees who are ordered to attend by court order or probation officer order may recognize the support of the group as their chance to turn their lives around. If the person is not motivated or receptive, the benefit of AA would likely be less significant.
Alcohol addiction has to be seen as a condition that needs lifelong vigilance, and AA members take the commitment to sobriety serious.
Herbal Drugs
The abuse of drugs that can be found in the form of plants and weeds has been a human drug problem for centuries. No statistics are available about overdoses, brain damage or death from the past. However, it is well known that Indians in the Southwest have used hallucinogenics for a variety of rituals.
British troops who were sent to Jamestown in 1676 were short of rations and cooked the foliage of a plant. The result of them eating Jimsonweed was described by Robert Beverly in his History And Present State Of Virginia (1705). Whoever had eaten of the plant acted like "a natural fool". The condition lasted for 11 days after which they "returned to themselves again, not remembering anything that had passed." Had the British troops not cooked the leaves, few could have survived, as the potent hallucinogens produced by the thorn apple plant are extremely toxic. Other species are known as Indian Apple or Sacred Datura (Datura meteloides).
It suffices to state that "natural" does not mean harmless. Persons who abuse a hallucinogenic substance like datura will be in grave danger of accident or injury due to the wild hallucinations they experience. Death due to overdose is also a possibility.
Of other plants that are abused because of their hallucinogenic effects, mushrooms are a
source.
Magic Mushrooms (psilocybe) are the commonly abused plant, which in their effect are likened to LSD. Complications are manifold. Some drug seekers pick mushrooms, what they assume to be "funny mushrooms". Often a poisonous variety is ingested resulting in an emergency situation due to mushroom poisoning. People experimenting with the Fly Agaric (Amanita muscaria) risk death.
Symptoms:
The use of psilocybe can cause severe disturbances like extreme anxiety and paranoia. Users who had a "bad trip" remember feelings of aggression and violent outbursts. Episodes of confusion have been reported, where the intoxicated user lost his way and was found miles away from home.
Frequently psilocybe has been mixed with other substances such as PCP (phencyclidine or Angel Dust) resulting in even more devastating effects. Damages to the nervous system due to PCP are irreversible and crippling. The chemical burn of the drug permanently destroys nerve cells. Patients present with chronic symptoms likened to schizophrenia. An early onset of Parkinson's disease can also be observed eventually leading to premature disability and dementia.
Treatment:
Hospital admission in a psychiatric unit and sedation may be needed for the confused, hallucinating patient who is a danger to others and himself.
Any drug addiction treatment presents a challenge. If the admission has been involuntary, the patient will in all likelihood revert back to his drug seeking behavior. Successful addiction treatment is based on the patient's motivation to seek help. The process of recovery can be expected to take months. Specialized multidisciplinary drug treatment centers where the patient is removed from the drug scene can have a positive and life changing impact. Long-term follow up and support are a necessity.
Opium
Opium is one of the oldest illicit drugs that were originally extracted from poppy plants. It was historically responsible for the opium wars. Since then many semi synthetic narcotics such as heroine, morphine and many others that are used for pain relief have been developed. Narcotics can produce the same "high" as opium and this is why drug addicted people seek them out.
Heroin, Hashish and Marijuana
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This link (http://www.opioids.com/heroin/
heroinhistory.html) shows how heroin was synthesized in the Bayer Laboratory in Germany by the chemist, Heinrich Dreser. It was supposed to function as a pain reliever that would be more powerful and less addictive than morphine, which had caused a lot of problems of drug addiction. The marketing people at that time said it would be safe to use as a powerful cough suppressant for patients with pneumonia and tuberculosis, which ran rampant in Europe at the time. After a few years of use it became clear that heroin was much more potent and addictive than morphine and Bayer decided to voluntarily close their heroin production plant. Incidentally the production and sale of ASA that was started at the same time by Bayer more than 100 years ago carries on to this day.
Hashish is another example where a plant (marijuana plant) that contains a mix of hallucinogenic and pain controlling chemicals is used and in an attempt of concentrating the chemicals that stimulate the brain the drug is made more potent. There is no "quality control" and what is sold as Hashish on the street may only contain 6% of THC's (http://www.gdcada.org/statistics/hashish.htm) as this site explains.
Marijuana is derived from the hemp plant, Cannabis sativa. The most potent hallucinogenic compound appears to be delta-9-tetrahydrocannabinol (THC). However, there are about 400 other chemicals in that plant many of which are as addicting. There is a lobby movement that seeks to legalize the use of marihuana for chronic illnesses and pain conditions, but the problems of addiction are identical to the story described under heroin above. There is no safe dose of any of these drugs as the hallucinogenic effect produced in the brain is from the subjective experience of the chemical burn and damage of brain cells that takes place. There are differences of neurotoxicity with alcohol being the least potent one when used diluted, but increasing in toxic effect depending on the chemical configuration and the potency of the agents.
Street Drugs
Angel Dust (PCP), LSD, cocaine, ecstasy and others are all just different variations of the same theme, namely that different chemicals are being used by people addicted to drugs to get a "high". The consequences of the effects of these chemicals are being ignored. Crystal Meth (http://www.cbc.ca/news/background/drugs/crystalmeth.html) is a concentrated amphetamine that targets the dopamine receptors in the brain. It gives the user a more profound "rush" and activates the person into movements and actions. Unfortunately the time interval between the start of Crystal Meth and irreversible damage to the brain is likely the shortest among all of these drugs. A person who recently got into Crystal Meth and wishes to stop should get in contact with http://www.crystalmeth.org/ before it is too late.
Summary:
In summary, any prescription drug has an effect and a side effect. In medical school the physician is trained to balance the beneficial effect on the body with the harm that may be done. Lifestyle habits including street drugs, alcohol, cigarette smoking etc. are often thought of by the public to be "safe". The truth is that these chemicals are likely even worse than some of the most toxic chemotherapeutic cancer drugs that are used in medicine.
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