Boisses

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Addiction

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Defined by Who

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Defintion of Substance Abuse as defined by the DSM -

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Maladaptive use of a substance leading to clinically significant impairment or distress as manifested by at least one of the following within a 12 month period. Recurrent substance use

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1.

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results in a failure to fulfill major role obligations at work, school, or home

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2.

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in situations in which it is physically hazardous

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3.

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related legal problems

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4.

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continued use despite having problems caused or exacerbated by the effects of the substance

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Substance Dependence as defined by the DSM

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A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 3 or more of the following in the same 12 month period:

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1.

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tolerance

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2.

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withdrawl

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3.

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substance is taken in larger amounts or over a longer period than intended

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4.

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there is apersistend desire or unsuccessful efforts to cut down or control substance use

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5.

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a great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects

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6.

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important social/occupational activities are given up or reduced because of use

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7.

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the use is continued despite knowledge of having a persistet or recurrent problem that is likely caused by the substance

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Physical Dependence

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The reestablishment of homesstatic state following chronic drug exposure such that the continued use of the drug is required to maintain normal function – develops covertly and withdrawl syndrome emerges first when drug is stopped abruptly

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Withdrawl syndrome

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Signs an symptoms of withdrawl are usually the opposite of the direct effects of the drug

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Spontaneous withdrawl

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Withdrawl due to abrupt removal

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A dependent subject will show _______ when given small doses of receptor antagonist

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Dramatic response/withdrawl effects

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Tolerance

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A reduction in drug response over time that requires an increase in the dose of the drug to be effective

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The mechanism of tolerance where an increase in rate of drug by the metabolism gives rise to tolerance

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Metabolic or Dispositional

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The mechanism of tolerance where a diminished capacity of drug receptors is responsible for the decreased response

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Functional or CNS

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Are Tolerance and physical dependence alone sufficient criteria for abuse and dependence?

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NO

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Sensitization or Reverse Tolerance refers to

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An increase in response to the same dose over time or a decrease in the dose require to elicit the same response over time (may be implicating in sudden cardiac death in cocaine abusers)

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Abused drugs which directly inhibit the Dopamine transporter

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Cocaine and amphetamine

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Abused drugs which also reliably elevate extracellular levels of DA by diverse indirect mechanisms are

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Alcohol, opioids, nicotine

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What three factors are responsible for the origins of drug abuse and dependence?

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Drug, individual, environment

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The half life of cocaine is

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30 -90 minutes (its metabolites 4-6 hours) (detectable in urine for 1-3 days)

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The half life of THC

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1 week (detectable in urine for up to 2 months)

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Half life of Alcohol

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No half life, limited metabolism because goes from first order to zero order 30 mL/hr

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Cross Tolerance

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Resistance to the effects of a substance as a result of continued exposure to a different substance having a similar pharmacologic action.

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Drugs used for Alcohol Relapse Prevention?

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Alcohol Detox: chlordiazepoxide or oxazepam (BDZ)

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Drugs used for Heroin Relapse Prevention?

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Detox: methadone or clonidine

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Drugs used for Cigarette Relapse prevention?

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Detox: Nicotine gum/patch or vareniciline

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Alcohol, Barbiturates, BZDs, GHB, Ketamine are all _____________________

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CNS Depressants

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Most common medical problem associated with alcohol

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Liver disease (fatty liver, alcoholic heptatitis, cirrhosis, liver failure)

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Gi problems associated with chronic alcohol toxicity

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Malabsorption of vitamins, gastritis, pancreatitis

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Benzodiazpeines have a syngeristic interaction with ________

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Alcohol (can lead to death)