drug dependency

Drug Dependence & Addiction:

use, usually by self-admin., of any drug in a manner that deviates from the approved medical or social patterns within a given culture;

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;

severe degree of drug dependence that is an extreme on a continuum of involvement in drug use;

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;

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;

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