Download - Addiction
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Addiction/dependence
A state of periodic or chronic intoxication, produced by
repeated consumption of a drug/substance
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Characteristics Preoccupation/anticipation-
constant craving & effort to obtain the substance Binge/intoxication-
consuming the substance with its deleterious effects Tolerance-
requiring increasing amount of substance for similar effect
Withdrawal- reducing/stopping consumption associated with psychological & physical manifestations like insomnia, irritability, anger, depression, loss of appetite
Affects health, occupation, family, society
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Target
Nearly all addictive drugs target the brain’s reward circuit, the mesolimbic system
Main neurotransmitter- dopamine Drugs- CNS depressants- alcohol, opioids,
benzodiazepines CNS stimulants- nicotine, amphetamine, cocaine
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Nicotine Tobacco use, smoked or chewed,
releases nicotine- half-life ~2 hours Nicotine activates receptors
in CNS releasing dopamine & in SNS/adrenal medulla releasing epinephrine
Benefits of nicotine/smoking- Less revascularization required after PCI Reduces risk of ulcerative colitis, Kaposi sarcoma,
breast cancer in women with BRCA gene, pre-eclampsia
Delays onset of Parkinson’s disease Improve schizophrenia & ADHD
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Health effects of tobacco Single greatest cause of preventable death Nicotine causes dependence Carcinogens- benzopyrene, acrolein,
nitrosamines Diseases caused- COPD CAD, CVA, HT Cancers- oral, larynx, lung,
esophagus, stomach, pancreas, kidney, bladder
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Alcohol Screening- CAGE questionnaire- ≥2
felt need to Cut down, felt Annoyed on being asked, felt Guilty, need for an Eye-opener?
Long-term effects- cirrhosis, pancreatitis, dementia, epilepsy, polyneuropathy, nutritional deficiencies, sexual & ovulatory dysfunction
Anxiety & depression are common Social effects- increased crime- theft, child abuse,
rape, domestic violence, accidents, loss of job/occupation Withdrawal- anxiety, delirium tremens, seizures,
hallucinations
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Cannabis- marijuana/bhaang
Commonest illicit drug usedRepeated use leads to
dependence
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Opioids
Morphine/afeem, heroin, codeine, oxy/hydrocodone, buprenorphine etc.
High addiction potential Withdrawal symptoms- x 2 days-6 weeks Insomnia, anxiety, panic attacks, depression Leg & abdominal cramps Vomiting, diarrhea Rhinitis, lacrimation
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Benzodiazepines Commonest cause of therapeutic drug
dependence Frequent if taken for >4 weeks & with
use of potent short-acting benzodiazepines
Withdrawal symptoms- Anxiety, depression, insomnia Tremors, twitches Muscular pain. Headache Hypersensitivity to touch & pain Suicidal tendency
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Cocaine Snorted, smoked or injected;
with increasing addiction potential Causes CNS stimulation leading to
euphoria, insomnia, erratic behaviour Withdrawl leads to ‘comedown’/crash-
dysphoria, exhaustion, craving CNS depressants- alcohol/opioids-
commonly used together to dull crash
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Amphetamine CNS stimulant Commonly ingested Causes euphoria & insomnia Tolerance develops rapidly leading to
increasing use of drug Withdrawl causes dysphoria, exhaustion Alcohol, opioids, benzodiazepines
commonly used together to blunt withdrawl effects
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Management- principles Addiction is a mental disease Needs treatment that is- Readily available Tailored Comprehensive Options- Detoxification Medications Counseling-individual/group & behavioural therapy Regular follow-up- to ensure abstinence &
compliance
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Drugs used
Tobacco/nicotine- nicotine replacement- patch, gum,spray,lozenges bupropion, varenicline
Alcohol- naltrexone, acamprosate, disulfiram, calcium carbimide, topiramate
Opioid- methadone, buprenorphine, naltrexone