What is a drug?
A medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body
What is addiction?
Chronic, primary, neurobiological condition influenced by genetic, phychosocial and environmental factors
What are the risk factors involved in addiction?
- genetics
- environment
- stress
- conditioning effects
What are the steps involved in addiction?
- acute reinforcement/social drug taking
- escalating/compulsive use/binge drinking
- dependence
- withdrawal
- protracted withdrawal
- (relapse)
- recovery?
What are additional considerations when dealing with addiction?
- trauma history
- comormidity
- homelessness
- interactions with criminal justice system
What is initiation of drug abuse more associated with?
Social and environmental factors
What is the progression of substance disorder (addiction) more associated with?
Neurobiological factors
Describe opioids pattern
- intense initial intoxication
- development of profound tolerance
- escalation in intake
- profound dysphoria, physical discomfort, and somatic withdrawal signs during abstinence
Describe the pattern of alcohol
- initial intoxication less than opioids
- pattern characterised by binges
- emotional and somatic withdrawal syndrome
- intense craving for the drug often driven by negative or positive emotional states
What are brain reward systems?
- important role in transition from occasional drug user to addiction
- neurobiological theory
- reward pathway
What is the reward pathway?
- includes a number of areas of the brain including the ventral tegmental area (VTA), the nucleus accumbens and the prefrontal cortex
- when activated by a rewarding stimulus eg food, information travels from the VTA to the nucleus accumbens and then up the the prefrontal cortex
- dopamine mediated transmission allows us to feel pleasure
What leads to euphoria?
Increased levels of dopamine
What leads to a decrease in contentment level?
Decreased levels of serotonin
What are the three factors in the psychiatric view on addiction?
- preoccupation/anticipation
- binge/intoxication
- withdrawal/negative effect
What is the psychodynamic theory?
Two critical elements:
- disordered emotions and disordered self-care
Two contributory elements:
- disordered self esteem and disordered relationships
Describe the effects of prolonged exposure to drugs
- addiction through reward pathway
- chronic exposure leads to reduced sensitivity of the brain to reward systems
- as addiction evolves there appears to be greater role of habituation and compulsion of conditioning and environmental stimulii
What are the factors involved in drug dependence?
- psychological dependence
- physical dependence
- withdrawal syndrome
- tolerance
What are the three classifications of drugs?
- behavioural
- pharmacodynamic
- legal
What are the risks of illicit drug use?
- increased risk of infections eg TB/sexually transmitted/IVDU
- health and social issues related to alcohol and smoking
How are drugs taken (with examples)?
- oral eg alcohol
- transmucosal eg cocaine
- inhaled/smoked eg cannabis
- intramuscular eg ketamine
- intravenous eg heroin
What are complications with injections?
- cellulitis
- abscess
- thrombophlebitis
Discuss STIs and drug use
- high rates of STIs among DUs
- independent risk factors for HIV
- trade sex for drugs
- unprotected
Discuss blood borne viruses and drug use
HIV/Hep B/Hep C (most common)
- contaminated injection equipment
- health care needle stick injuries
- tattoos and piercings
- sharing razors and toothbrushes
- mother to child transmission in pregnancy
- unprotected sex
What is a fix room?
- site provided to allow for supervised drug use
- reduces public injecting
- reduces needle sharing
- improved uptake of addiction treatment
