ADDICTION

Addiction is a term used in everyday language, but what is an Addiction?? Well, informally, addiction may be defined as a degree of involvement in a behavior that can function both to produce pleasure and to provide relief from discomfort, to the point where the cost appear to outweigh the benefits. Heavy involvement in an addictive behavior is often accompanied by the recognition on the part of the ‘addict ‘ of the physical, social or psychological harm he or she incurs, and an expressed desire to reduce or cease the addictive behavior, yet, despite this, change is no easy matter.

Alcoholism and Drug dependence

Definition

The word “drug” is defined as “any substance that, when taken into the living organism, may modify one or more of its function”(W.H.O). “Drug abuse” is defined as self-administration of a drug for non- medical reasons, in quantities and frequencies which may impair an individual’s ability to function effectively, and which may result in social, physical, or emotional harm. “Drug dependence” is described as “a state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterized by behavioral and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence.

The problem

The non-medical use of alcohol and other psychoactive drugs has become a matter of serious concern in many countries. While alcohol abuse is a more or less universal problem, the incidence of drug abusive varies from place to place. An estimated 12-20 million people smoke merijuana in the US. 30- 50 percent of all high school students had made marijuana an accepted part of life. Experience in Sweden indicates that drug dependence has reached a peak in age-group 12-20 years and the problem is less among girls. The problem of drug dependence has reached epidemic proportions in many countries.

Agent factors

Dependence-producing drug

A dependence-producing drug is one that has the capacity to produce dependence, as described above. The specific characteristics of dependence varies with the type of drug involved. ICD-10 recognizes the following psychoactive drugs, or drugs classes, the self administration of which may produce mental and behavioral disorders, including dependence :

  1. Alcohol
  2. Opioids
  3. Cannabinoids
  4. Sedatives or hypnotics
  5. Cocaine
  6. Other stimulants including caffeine
  7. Hallucinogens
  8. Tobacco
  9. Volatile solvents
  10. Other psychoactive substances, and drugs from different classes used in combination.

Although the dependence-producing properties and public health problems caused by tobacco were recognized since long, its acute effects on behavior were minimal. The W.H.O Expert Committee on drug dependence at its meeting in September 1992 felt that tobacco and other forms of nicotine use warranted their inclusion in the report. Furthermore, it recommended that W.H.O should consider expanding the Committee’s term of reference to include substances such as anabolic steroids, which are used because of their performance-enhancing effects. Anabolic steroids are being abused by people who wish to increase muscle mass for cosmetic reasons or for greater strength. In addition to the medical problems, the practice is associated with significant mood swings, aggressiveness, and paranoid delusions. Alcohol and stimulant use is higher in these individuals. Withdrawal symptoms of steroids dependency include fatigue, depressed mood, restlessness, and insomnia.

The drug which are in common use today are

(1) . AMPHETAMINES AND COCAINE : Amphetamines are synthetic drugs, structurally similar to adrenaline. In medical practice, they are used to treat obesity, mild depression, narcolepsy and certain behavior disorders in children. The ordinary therapeutic dose is 10-30 mg a day. There are various brands of amphetamines : the common names are Benzedrine, Dexedrine, Methedrine, etc. These drugs act on the central nervous system. They produce mood elevation, elation, a feeling of well-being and increased alertness and a sense of heightened awareness. Because they give a tremendous boost to self-confidence and energy, while increasing endurance, they are called “superman” drugs. The use of these drugs results in psychic dependence. With large doses, such dependence, is often rapid and strong.

Cocaine is derived from the leaves of the coca plant. It was formerly used in medical practice as a potent local anesthetic. Cocaine is a central nervous stimulant. It produces a sense of excitement, heightened and distorted awareness and hallucinations. Unlike amphetamines, it produces no tolerance. There is ‘no physical dependence ; no withdrawal symptoms’, per se. The chewing of coca leaves a very common practice in Bolivia and Peru in South America.

(2)  BARBITURATES: If amphetamines stimulate, barbiturates sedate. They are a major ingredient in sleeping pills. The drugs-users generally prefer short-acting barbiturates such as pentobarbital and secobarbital to long acting ones. The addiction to barbiturates is one of the worst  forms of suffering. It leads to craving, both physical and psychic dependence.

Barbituric Acid

(3) CANNABIS: Perhaps, the most widely used drug today is cannabis, which is a very ancient drug obtained from the hemp plants- Cannabis sativa, Cannabis indica and Cannabis americana. The resinous exudate from the active ingredients – called hashish or charas. The dried leaves and flowering shoots are called bhang; the resinous mass from the small leaves and brackets of inflorescence is ganja. In USA, the term marijuana is used to refer to any part of the plant which induces somatic and psychic changes in man.

Most commonly the plant is cut, dried, chopped and incorporated into cigarettes. It is also taken with drinks or incorporated in foods like sweets and cakes. A marijuana cigarette will produce intoxication within minutes and last from 1 to 4 hours. The oral consumption results in a delayed onset of action and a prolonged effect lasting many hours.

The most common reaction is the development of a dreamy state of altered consciousness. Relaxation, euphoria, and an increased tendency to laugh, greater awareness of colors and sounds, interference with perception of both time and space, and paranoia are among the psychological effects reported by marijuana users. Human death appears to be a rare phenomenon. There is psychic dependence.

Cannabis sativa

(4) . HEROIN : Heroin, morphine, codeine, methadone, pethidine are narcotic analgesics. Addiction to heroin is perhaps the worst type of addiction because it produces craving. With narcotics generally psychic dependence is strong and tends to develop early. Tolerance to narcotics also occurs rapidly, making it necessary to take increasing doses of the drug to achieve the same effect.

(5) . LSD : Lysergic acid diethylamide (LSD) was synthesized in 1938 by Hoffmann in the Sandoz Laboratories in Switzerland. Its psychic properties were noticed much later in1943, when he accidentally sniffed a few micrograms of it.

LSD is a potent psychotogenic agent. Although amounts as low as 20-25 micrograms may produce subjective disturbances, oral doses in the range of 100-250 micrograms are usually required to effect intense depersonalization. The lethal dose in man is not known.

LSD alters the normal structuring of perception. The individual perceives the world in a different manner. There is intensification of color perception and auditory acuity; body image distortions, visual illusions, fantasies pseudohallucinations are common. Colors are heard and music becomes palpable. Subjective time is deranged so that seconds seem to be minutes and minutes pass as slowly as hours.

Physical dependency does not develop with LSD; hence there is no addiction liability. No characteristic abstinence syndrome is manifest upon abrupt discontinuation of chronic use of the drug.

Lysergic Acid Diethylamide (Chemical Formula)

(6) . ALCOHOL : By pharmacological definition, alcohol is a drug and may be classified as a sedative, tranquilizer, hypnotic or anesthetic, depending upon the quantity consumed. Of all the drugs, alcohol is the only drug whose self-induced intoxication is socially acceptable.

Alcohol is rapidly absorbed from the stomach and small intestine. Within 2-3 minutes of consumption, it can be detected in the blood – the maximum concentration is usually reached about one hour after consumption. The presence of food in the stomach inhibits the absorption of the stomach inhibits the absorption of alcohol because of diluton.

Over the past 30-40 years, increasing percentages of young people have started to drink alcoholic beverages, their alcohol consumption has increased in quantity and frequency, and the age at which the drinking starts has declined. This situation is disturbing because the young people concerned may run a greater risk of alcoholic problems in later life and also, in the short term, because of increased rates of drunkenness and involvement in road accidents.

Worldwide, an estimated 2.3 million people die from alcohol-related causes. This is 3.7 percent of all deaths; 6.1 percent among men and 1.1 percent among women. Also, 64.9 million daily are lost due to alcohol related causes. W.H.O has estimated that there are about 2 billion people worldwide who consume alcoholic beverages and 76.3 million with disorders arising out of harmful use of alcohol. Unintentional injuries and suicides account for large number of deaths due to alcohol.

In India, survey showed that around that around 20-30 percent of adult males and around 5 percent of adult females use alcohol. While alcohol is used traditionally by men, its use by women is now on the increase. The proportion of dependent users is large. Issues of concern include domestic violence, alcohol’s contribution to poverty, illicit and home-brewed alcohol, and reduction in average age of initiation. In a study in Bangalore, nearly 28 percent of traffic injuries were found directly attributable to alcohol. Alcohol use is considered a risk factor for high risk sexual behavior leading to sexually transmitted disease including HIV/AIDS.

Alcohol has a marked effect on the central nervous system. It is not a “stimulant” as long believed, but a primary and continuous depressant. Alcohol produces psychic dependence of varying degrees from mild to strong. Physical dependence develops slowly.

According to current concepts, alcoholism is considered a disease and alcohol a “disease agent” which causes acute and chronic intoxication, cirrhosis of the liver, toxic psychosis, gastritis, pancreatitis, cardiomyopathy and peripheral neuropathy. Also, evidence is mounting that it is related to cancer of the mouth, pharynx, larynx and esophagus. Further, alcohol is an important and other accidents, and injuries and deaths due to violence. The health problems for which alcohol is responsible are only part of the total social damage which includes family disorganization, crime and loss of productivity.

(7) TOBACCO : Tobacco is in legal use everywhere in the world, yet it causes far more deaths than all other psychoactive substances combined. About 3 million premature deaths a year (6 percent of the world total) are already attributed to tobacco smoking. Tobacco is responsible for about 30 percent of all cancer deaths in developed countries. More people die from tobacco related diseases other than cancer such as stroke, myocardial infarction, aortic aneurysm and peptic ulcer. Young people who take up smoking have been shown to experience an early onset of cough, phlegm production, and shortness of breath on exertion. There is evidence that the earlier a person begins to smoke, the is the risk of life – threatening diseases such as chronic bronchitis, emphysema, cardiovascular disease, and lung cancer. Experimentation with smoking as a symbol of “adult” behavior is common in adolescence. It is suggested that three factors are associated with young people smoking : peer pressure, following the example of siblings and parents, and employment outside the home. If a child’s older sibling and parents smoke, the child is four times as likely to smoke as one with no smoking model in the family.

Women who smoke run even more risks than men. For example, the adverse effects of oral contraceptives use are markedly increased in women smokers. Osteoporosis is accelerated with tobacco use. Some evidence indicates that fertility is impaired with smoking. Tobacco use is also associated with a higher rate of spontaneous miscarriages. In pregnancy, smoking contributes to perinatal complications such as bleeding, which is dangerous for both mother and fetus, especially in poor countries where health facilitates are inadequate. Intrauterine growth retardation and low-birth-weight babies are known our-comes of smoking during pregnancy. The babies of mothers who smoke may weigh, on an average, 200 grams less at birth than those of non-smokers. The harm from maternal smoking can extend beyond pregnancy, affecting the child’s growth and development. This is often compounded by the child’s exposure to second-hand smoke from parents and other adults.

Passive smoking

Second-hand tobacco smoke is the combination of smoke emitted from the burning end of a cigarette or other tobacco products and smoke exhaled by the smoker.

Smoking harms non-smokers too. The first conclusive evidence of the danger of passive smoking came from a study carried out by Takeshi Hirayama, in 1981, on lung cancer in non-smoking Japanese wives married to men who who smoked. Surprising at the time, those women showed a significantly increased risk of dying from lung cancer, despite never having smoked a cigarette. Hirayama believed that passive smoking (i.e. breathing in the smoke from their husbands) caused these women’s excess cancer risk. About 40 further studies have confirmed this link.

Today, research indicates that passive smoking can also give rise to other potentially fatal diseases such as heart disease as heart disease and stroke, and new scientific evidence on the adverse effects of second-hand smoke continues to accumulate.

(8) VOLATILE SOLVENTS : In a number of countries, the sniffing of the substances such as glue, petrol, diethyl ether, chloroform, nitrous oxide, paint thinner, cleaning increasing concern, as it can result in death, even on the first occasion. These substances are central nervous system depressants and produce effects comparable to those produced by alcohol. There may be initial euphoria and exhilaration, followed by confusion, disorientation and ataxia. Some of the substances like petrol and toluene may also produce marked euphoria, grandiosity, recklessness, delusions and hallucinations and a substantial loss of self-control. With increasing doses, there may be convulsions, coma and death. In chronic abusers damage to the brain, peripheral nervous system, kidney, liver, heart or bone marrow may occur. Lead encephalopathy can be associated with sniffing lead gasoline.

(9) CAFFEINE : Caffeine is one of the most commonly used drug worldwide. About 10 billion pounds of coffee are consumed yearly throughout the world. Tea, cocoa, and cola drinks also contribute to an intake of caffeine that is often very high in a large number of people. The approximate content of caffeine in a cup (180 ml) of beverage is as follows : brewed coffee 80-140 mg; instant coffee 60-100 mg; decaffeinated coffee 1-6 mg; black leaf tea 30-80mg; tea bags 25-75 mg; instant tea 30-60 mg; cocoa 10-50 mg; and 12 oz cola drinks 30-65mg. Symptoms of caffeinism (usually associated with ingestion of over 500mg/day) include anxiety, agitation. restlessness, insomnia and somatic symptoms referable to the heart and gastrointestinal tract. Withdrawal from can produce headache, irritability, lethargy, and occasional nausea.

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