DRUG
DEPENDENCE
DEFINITION
“Drug Dependence is a state psychic, and
sometimes also physical, that results from
the interaction between a living organism
and a drug, characterized by behavioural and
other responses that always include a
compulsion to take the drug on a periodic or
continuous basis, in order to experience its
pleasurable effects or to avoid the
discomfort of its absence” - WHO
1
Stages of
Drug
Dependence
EXPERIMENTAL CIRCUMSTANTIAL
DRUG USE
RECREATIONAL
2
Characteristics
of Drug
Dependence
OVERPOWERING DESIRE TO TAKE THE DRUG
CHARACTERISTICS
OF DRUG DEPENDENCE
TENDENCY TO INCREASE THE DOSE TENDENCY TO WITHDRAWAL SYNDROME
3
Types of Drug
Dependence
Psychological
Dependence
TYPES OF DEPENDENCE
Psychological
and Physical
Dependence
Psychological
Dependence
A feeling of satisfaction and a
psychic drive that requires the
presence of the drug to gain
pleasure /avoid discomfort
It describes the emotional and
mental processes that are
associated with the development of,
and recovery from, a substance use
disorder
Psychological
and Physical
Dependence An adaptive state achieved by the
body characterised by intense
physical disturbances that result
when the drug is withdrawn
4
Origins of
Drug
Dependence
Drug Variables
Origins of Substance
Abuse
Host Variables Environmental
Variables
❖ Availability
❖ Cost
❖ Speed of onset
Drug
❖ Mode of administration
Variables
❖
❖ (Chewing,Inhalation,
gastro-intestinal,injection )
❖ Euphoriant actions
❖ Positive reinforcement
❖ Negative reinforcement
Environmental
Variables
❖ Reinforcement is the ability of an agent to
produce effects that induce the user to take
the drug repeatedly
❖ Heredity
❖ Innate tolerance
Host
❖ Drug disposition, receptor
Variables
interaction
❖ Psychiatric Illness
❖ Prior experiences
❖ Prior expectations
Environmental
❖ Propensity for drug
Variables taking
behaviour
❖ Social setting
❖ Community attitude
Environment ❖ Peer influence , role models
Variables
❖ Availability of other
reinforcers
❖ Educational/Employment
opportunities
Environmental
Variables
5
Agents that
Produce
Dependence
❖ Cocaine
Drugs that ❖ Cannabinoids (Marijuana)
produce only ❖ Psychedelic agents
Psychic
Dependence ❖ L.S.D.
❖ Ecstacy
❖ Ketamine
❖ Caffeine
❖ Phencyclidine
Drugs Amphetamine & congeners
that produce
❖ Amphetamine
definite Psychic
Dependence but ❖ Methamphetamine
questionable
❖ Methylphenidate
physical
Dependence Opiate antagonists
❖ Nalorphine
❖ Levallorphan
❖ Cyclazocine
Alcohol -Barbiturate Type
❖ Ethyl alcohol
Drugs ❖ Barbiturates
that produce
severe Psychic ❖ Chloral hydrate
Dependence as ❖ Benzodiazepines
well as physical
Dependence Opioids
❖ Morphine
❖ Pethidine
❖ Codeine
❖ Heroin
Nicotine
General
Principles of
6 Management
of Substance
Abuse
❖ Hospitalisation
❖ Gradual/Sudden withdrawal of drug
❖ Sudden if toxic dose
❖ Substitution therapy
(Methadone for Morphine, heroin)
❖ Specific drug therapy
(Aversion therapy ,Disulfiram for Ethyl Alcohol)
❖ Correction of nutritional deficiencies
❖ Community therapy and rehabilitation
❖ Prolonged follow-up to avoid relapse
Management of
8 Opioid
Dependence
❖ Outcomes of de-addiction unsatisfactory because
❖ High relapse rate
❖ Severity of relapse
❖ Gradual Morphine withdrawal
❖ Substitution therapy with Methadone
(Opioid agonist, longer half-life, lower addiction liability 1 mg of
Methadone for 4 mg of Morphine)
❖ Once patient is stabilised on Methadone, reduce dose gradually by
10 - 20 % daily and can be stopped from 6 - 10th day
❖ Control of Opiate withdrawal with Clonidine, Propranolol
to counter adrenergic overactivity
Management of
9 Alcohol
Dependence
❖ Detoxification - Providing safe withdrawal
❖ Rehabilitation - Psychotherapy, Institutional therapy
❖ Severity of relapse
Drugs used in rehabilitation prevent relapse , support complete
rehabilitation
❖ Aversion drugs - Disulfiram (Antabuse) 500mg OD 1-2 weeks
under supervision
Maintenance dose: 125-250 mg OD
- Citrated Calcium Cetrimide
❖ Opioid antagonist - Naltrexone, Nalmefene
❖ Dopaminergic antagonist - Tiapride
❖ NMDA receptor antagonist - Acamprosate
(Reduces voluntary alcohol consumption ,craving)
❖ Supporting drugs - Carbamazepine, Topiramate , Selective
Serotonin Reuptake Inhibitors
❖ Correction of nutritional deficiencies
❖ Social, occupational rehabilitation
Management of
10 Nicotine
Dependence
NICOTINE SUBSTITUTION THERAPY
❖ Increase success rate for quitting smoking
❖ Basis for use - Reinforcing effects
❖ Inhalation >> Oral >> Transdermal use
❖ Preparations used
Transdermal patch
Chewing gum/lozenges
Nasal spray
Oral inhaler
❖ In contrast to smoking , slower rise in and variable , lower plasma
concentrations facilitates abstinence,cessation
NICOTINE RECEPTOR PARTIAL AGONISTS
❖ Varenicline - orally efficacious 1mg after meals b.d.
❖ half life 14-24 hours
❖ helps some patients quit
DOPAMINE /NORADRENALINE REUPTAKE INHIBITORS
❖ Bupropion - Antidepressant , decreases craving , can be used
along with nicotine patches
THANK YOU
