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drug_dependency

drug dependency

Drug Dependence & Addiction:

Drug abuse:
  • use, usually by self-admin., of any drug in a manner that deviates from the approved medical or social patterns within a given culture;
Non-medical drug use:
  • encompasses recreational & compulsive use excl. society factor;
Drug dependence:
  • a behavioural syndrome where the use of a drug is given a much higher priority than other behaviours that once had a higher value → degrees of dependence.
  • may not be a concern if drug low toxicity & inexpensive (eg. caffeine) → no medical or social problem;
  • often but not necessarily associated with:
    • tolerance:
      • rpt doses → decr. potency → need to incr. dose for effect;
    • physical dependence:
      • altered physiol. state (neuroadaptation) produced by rpt admin. which requires continued admin. to prevent withdrawal or abstinence syndrome for that drug.
  • defining criteria (Am.Psych.Ass.1987) :
    • 1. taking drug more often or incr. dose than intended;
    • 2. unsuccessful efforts to stop or decr. drug use;
    • 3. large amt time spent acquiring/using/recovering from drug;
    • 4. frequent intoxication or withdrawal symptoms
    • 5. abandonment of social or occupation activities due to drug use;
    • 6. continued use despite adverse psych. or physical effects;
    • 7. marked tolerance;
    • 8. frequent use of drug to relieve withdrawal symptoms;
Addiction:
  • severe degree of drug dependence that is an extreme on a continuum of involvement in drug use;
Drugs as Reinforcers:
  • The intrinsic tendency of a drug to induce re-self-administration of that drug;
  • In decreasing order: opioids/cocaine; nicotine; caffeine; ethanol; phenoth. (nil);
  • mechanism of primary reinforcement:
    • ? involve dopaminergic neurons in ventral tegmental area → limbic/pallidum/frontal;
Cross-dependence:
  • the ability of one drug to suppress the manifestations of physical dependance produced by another, & to maintain the physically dependent state.
  • May be partial, complete, symmetric or assymetric;
  • eg. most sedative-hypnotics (ethanol & benzodiazepines)
    • ? all share some capacity to influence Cl channels regulated by GABA;
The Severe Substance Dependence Treatment Act 2010
  • provides for up to 14 days of detention and treatment (currently St Vincent's Hospital) of people with severe substance dependence
  • must be a matter of urgency to save life or prevent serious damage to health
  • similar to Mental Health Act as there must be no less restrictive means available to treat the patient
  • patient must lack capacity to make own decisions at time of detention
  • seek expert Drug & Alcohol advice
  • Magistrate's Court makes the treatment and detention orders
  • Addiction Medicine Specialists, Psychiatrists & Custodial Medical Officers are currently allowed to make recommendations for detention
drug_dependency.txt · Last modified: 2015/12/31 02:31 by gary1