Addiction/Chemical Dependency
a primary, chronic disease of the brains reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors
Operational definition of addiction
Tolerance + dependence + compulsive drug use
Tolerance
diminished response to same dose that has a pharmacodynamic, drug dispositional, and behavioral factor
Physical Dependence
Characterized by withdraw symptoms (the mirror image of the acute effects of the drug)
Diagnostic Criteria for Chemical Dependency
- Tolerance
- Withdrawal symptoms or drug take to relieve withdrawal
- Drug taken in larger amounts over a longer period than intended
- Persistent desire or unsuccessful effort to cut down on drug use
- A great deal of time in activities to obtain drug, taking the drug or recovering from it
- Craving or strong urge to use the substance
- Recurrent use of the substance resulting in failure to fulfill obligations at work, school or home
- Continued use of substance despite having persistent social or interpersonal problems caused by use
- Social, occupational or recreational activities given up due to drugs
- Recurrent use of substance in situations in which it’s physically hazardous
- Continued use despite knowledge of harmful psychological or physical effects
Psychological Consequences of Addiction
Anxiety, psychosis, depression
Social Consequences of Addiction
Loss of friends, job, family
Physical Consequences of Addiction
Memory lapses, neurological damage, liver damage, increased risk of HIV, death
Hallucinogens from botanical sources
Psilocybin - magic mushrooms peyote cactus - mescaline myristica acid - nutmeg morning glory seeds - lysergic acid amide (related to LSD) Atropa belladona - Deadly nightshade Mandragora officinarum - Mandrake Dratura stramonium - Jimsonweed
Stimulants from botanical sources
Native chewed leaves of the coca shrub - Cocaine
Khat plant - Bath Salts
Determinants of Drug Seeking Behavior
- Positive reinforcing properties
- Aversive properties
- Conditioned stimuli
- Discriminative cue
Hypofrontality
- addiction begins with genes and the reward system
- Addiction ends with disorder of choice - loss of insight and impaired decision making
- deficient frontal cortex which normally guides behavior
- ramped up DA system and deficient cortical glutamate system
Dopamine Pathway
mesocortical pathway; reward pathway in the brain
substitution therapy vs drugs of abuse (pk profiles)
- inhaled, euphoriant, short acting drugs have high abuse potential, such as cocaine and nicotine
- conversely, drugs used to treat addictions are administered orally and have long duration of action such as methadone and nicotine gum
Factors leading to Rx drugs being abused to a greater extent than illegal drugs
- minimal or no curriculum in medical schools pertaining to the treatment of pain
- no curriculum in medical schools about the abuse of pharmaceutical drugs and how to identify “drug seeking” behavior
- Mos tof the drugs are paid for by insurance, workers’ comp, or government insurance
- TV commercials & advertisements
- “greed” and “pill mill” practices
- patients demanding pain medications and the inability of the physicians to say no
- misperception that if it comes from a medicine cabinet it is okay and not illegal
- less risk of overdose
- easier to obtain through “legal” script
- less risk of detection
- lack of serious penalties associated with Rx drugs
- few laws requiring photo ID be shown and recorded whenever a controlled substance prescription is dispensed
Cocaine HCl
most common form; water soluble
Free basing
a method of preparing cocaine base form organic solvents so that it can be smoked
What clinical conditions are under investigation as potential uses for MDMA
- PTSD
- Cancer-related anxiety
Subjective effects of MDMA
- increased ability to interact with others
- decreased defensiveness
- increased awareness of emotions
- decreased aggression
- increased sensitivity to colors
- altered time perception
- “Hug drug”
- decreased impulsivity
Subjective effects of Methamphetamine
Long-term adverse effects: extreme weight loss, “meth mouth”, skin sores
Neurochemical Effects of MDMA
- Lethal hyperthermia
- Neurotoxicity to 5-HT neurons and GABA neurons
- impairment of verbal memory
- long-term sleep and sexual side effects
Psychoactive constituents of “bath salts”
- increased alertness
- euphoria
- increased sex drive
- mild empathogenic effect
Psychological effects of bath salts are said to resemble what other drugs of abuse
cocaine and ecstasy
Plant source of the chemical related, naturally occurring stimulant of bath salts
Khat plant
