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Criteria of Dependence & Abuse according to DSM-IV-TR Dependence (3 or more in a 12-month period) Abuse (1 or more in a 12-month period) Symptoms must never have met criteria for substance dependence for this class of substance. Recurrent use resulting in failure to fulfill major role obligation at work, home or school Recurrent use in physically hazardous situations Recurrent substance related legal problems Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance • Tolerance (marked increase in amount; marked decrease in effect) • Characteristic withdrawal symptoms; substance taken to relieve withdrawal • Substance taken in larger amount and for longer period than intended • Persistent desire or repeated unsuccessful attempt to quit • Much time/activity to obtain, use, recover • Important social, occupational, or recreational activities given up or reduced • Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous)
DSM-5 consolidates substance abuse and dependence into one disorder: substance use disorder 2. Criteria are nearly identical to DSM-IV with exception of: - Recurrent substance-related legal problems criterion has been deleted from DSM-5. - And new criterion: craving, or a strong desire or urge to use a substance added. 3. The threshold is set at 2 or more criteria vs. 1 or more for abuse and 3 or more for dependence in the DSM-IV.
Severity of the problem (NEW) In DSM-5 severity for substance use disorders is based on the number of criteria endorsed: • MILD 2-3 criteria • MODERATE 4-5 criteria • SEVERE 6 or more criteria
In 2001, • American Academy of Pain Medicine • America Pain Society • American Society of Addiction Medicine jointly issued "Definitions Related to the Use of Opioids for the treatment of pain”.
Drug abuse The substance is used in a manner that does not conform to social norms; the motivation to use the substance may or may not be particularly strong compared with other motivators. استخدام الدواء بطريقة لا تتماشى مع المعايير الاجتماعية وليس بالضرورة وجود حافز
Drug addiction • A behavioral syndrome characterized by behaviors that include one or more of the following: • Impaired control of drug use • compulsive drug use • continued use despite harm • craving
Drug dependence A state where the individual is dependent upon the drug for normal physiological functioning. Abstinence from the drug produces withdrawal reactions which constitute the only evidence for dependence.
Comparison Some substances may produce physical dependence without producing an addiction Some substances may produce psychological dependence without producing an addiction substances can produce a notable psychological dependence without producing an exceptionally strong motivation to avoid abstinence such as caffeine or nicotine. • The therapeutic uses of certain steroids and some antihistamines produce characteristic withdrawal syndromes when abruptly discontinued without motivation to continue the use of these substances for most patients.
Theories of Addiction • MEDICAL MODEL • PSYCHODYNAMIC MODEL • SOCIAL MODEL • MORAL MODEL • BIO‐PSYCHO‐SOCIAL MODEL
Medical Theory This theory describes addiction as a disease. It attributes addiction to changes in dopaminergic (mesolimbic) pathway Addiction as a “brain disease” due to Neurotransmitter imbalance Disease Model: Agent: drug Vector: dealers Host: addict
Addiction is a Developmental Disease: It Starts Early 67% 26% 5.5% First Marijuana Use, (Percent of Initiates) 1.5% 12-17 <12 18-25 >25
MRI Scans of Healthy Children and Teens Over Time Gogtay, Giedd, et al. (2004) Proc. Natl. Acad. Sci. USA 101, 8174-8179 Copyright ©2004 by the National Academy of Sciences
MRI Scans of Healthy Children and Teens Over Timebrain development through early adulthood, with blue indicating the mature state Prefrontal cortex (white circles), which governs judgment and decision-making functions, is the last part of the brain to develop. This may help explain: why teens are prone to risk-taking vulnerable to drug abuse why exposure to drugs at this critical time may affect propensity for future addiction.
Addiction Is A Developmental Disease that starts in adolescence and childhood 1.8% 1.8% TOBACCO CANNABIS 1.6% 1.6% ALCOHOL 1.4% 1.4% 1.2% 1.2% 1.0% 1.0% % in each age group who develop first-time dependence 0.8% 0.8% 0.6% 0.6% first 0.4% 0.4% 0.2% 0.2% 0.0% 0.0% 5 10 15 21 25 30 35 40 45 50 55 60 65 5 10 15 21 25 30 35 40 45 50 55 60 65 Age Age Age at tobacco , alcohol and cannabis dependence per DSM IV National Epidemiologic Survey on Alcohol and Related Conditions , 2003. National Epidemiologic Survey on Alcohol and Related Conditions , 2003.
Circuits Involved In Drug Abuse and Addiction PFC – prefrontal cortex; ACG – anterior cingulategyrus; OFC – orbitofrontal cortex; SCC – subcallosal cortex; NAc – nucleus accumbens; VP – ventral pallidum; Hipp – hippocampus; Amyg – amygdala The developing strategies to treat addiction must put in consideration these areas for better results
In Freudian thought, psychodynamics is the study of transformations and exchanges of “psychic energy” in the personality • The psychodynamic model explains behaviors through the interactions of Freud’s innate emotional forces, the id, ego, and super-ego.
Social Theory • This theory hypothesizes that addiction is a learned behavior and it develops as a result of social problems such as poverty, violence, family dysfunction.
Moral Theory • The moral theory denotes substance addiction as a vice الرذيلة or a sin الخطيئة • Some individuals, through their own free will, make a conscious choice to become substance addicts. • According to this theory drug abusers choose to use drugs and they are anti‐social and should be punished
Bio-psycho-social Theory • Substance addiction is the net result of a complex interaction between a combination of all of the factors: • Biological • Psychological • Social • Spiritual • Each person’s drug use is a result of some aspects of some or all the other models. • Treatment and recovery require addressing the body, mind, social environment, and spiritual needs of an individual (including nutrition, employment, family issues, psychological issues, etc.).
Commonly Used Psychoactive Substances SOURCE: National Institute on Drug Abuse.
Examples of Addictive Drugs Alcohol • alcohol abuse causes over 100,000 deaths in the USA and Canada each year. It is the drug most commonly abused by children ages 12 to 17. Alcohol-related motor vehicle accidents are the leading cause of death in teenagers. People who drink alcohol are more likely to engage in deviated sexual behaviors . Heroin • It is a diacetylmorphine that functions as a morphine prodrug. It can be used for medical purposes as analgesic to treat severe pain with the name diamorphine. The name "heroin" is only used when being discussed in its illegal form.
Vicodin • Hydrocodone or dihydrocodeinone is a semi-synthetic opioid • It is an orally active narcotic analgesic & antitussive. • It acts at μ-opioid receprors. • It is metabolized to hydromorphone • About 53% of patients in rehabs across USA were chemically dependent on Vicodin.
Ecstasy • MDMA (3,4-methylenedioxy-N-methylamphetamine)
Ecstasy • an empathogenic (entactogenic) drug of the phenethylamine & amphetamine class. • MDMA has become widely known as "ecstasy" (shortened to "E", "X", or "XTC), usually referring to its street pill form. • MDMA can induce euphoria, a sense of intimacy. • MDMA is criminalized. • For 2008 the UN estimated between 10–25 million people globally used MDMA at least once in the past year.
Desomorphine (Krokodil) • Desomorphine is a synthetically derived morphine isomer. • Animal trials of desomorphine showed that, by comparison with morphine: • Stronger and more rapid analgesic effect • Longer effect duration • Quicker addiction
GHB (Gama Hydroxybutyric Acid) • A synthetic depressant available as a prescription for sleep disorders • In some countries was banned (in the U.S.) by the FDA in 1990 because of the dangers associated with its use. • GHB and its analogs are considered "date rape" drugs because they can be mixed with liquids (even water) and a victim wouldn't notice by smelling or looking at it. • GHB, by itself, has a soapy or salty taste--but when mixed in a drink it may be difficult to detect.
Dextromethorphan (DXM) • DXM is a cough-suppressing ingredient in a variety of over-the-counter cold and cough medications. • Dextromethorphan, a semisynthetic narcotic, is an ingredient found in more than 70 different products. • DXM acts centrally to elevate the threshold for coughing. • At high doses dextromethorphan produces dissociative effects similar to those of PCP and ketamine.
Benzodiazepines • About 35 members of this group are presently marketed in different countries. • Shorter-acting benzodiazepines used to manage insomnia include estazolam (ProSom) • Benzodiazepines with a longer duration of action are utilized to treat insomnia in patients with daytime anxiety. These benzodiazepines include alprazolam (Xanax®), chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam (Valium) • Rohypnol (flunitrazepam), most commonly known as a date-rape drug. • One of the significant effects of the drug is anterograde amnesia, a factor that strongly contributed to be one of the drugs used in rape. • Anterograde amnesia is a condition in which events that occurred while under the influence of the drug are forgotten.
Ketamine (“Special K”) • Anesthetic developed to replace PCP, manufactured by Pfizer • Used in human and veterinary medicine • Injected or dried and snorted • “Vitamin K” • “K” • “Bump”
FENTANYL • Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical. • The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. • Fentanyls are most commonly used by IV administration, but like heroin, they may also be smoked or snorted.
ABUSE OF ANABOLIC STEROIDS • Anabolic Steroid abuse has become an international concern. • These drugs are used illicitly by weight lifters, body builders, long distant runners, cyclists, and others who claim that the drugs give them a competitive advantage and/or improve their physical appearance. • The American Controlled Substance Act (CSA) defines anabolic steroids as any drug or hormonal substance chemically and pharmacologically related to testosterone (other than estrogen, progestins, and corticosteroids), that promotes muscle growth.
Menace of Drug Abuse Nitrosun
