Drug Dependence

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Chapter: Essential pharmacology : Adverse Drug Effects

Drugs capable of altering mood and feelings are liable to repetitive use to derive euphoria, withdrawal from reality, social adjustment, etc. Drug dependence is a state in which use of drugs for personal satisfaction is accorded a higher priority than other basic needs, often in the face of known risks to health.


DRUG DEPENDENCE

 

Drugs capable of altering mood and feelings are liable to repetitive use to derive euphoria, withdrawal from reality, social adjustment, etc. Drug dependence is a state in which use of drugs for personal satisfaction is accorded a higher priority than other basic needs, often in the face of known risks to health.

 

There is a lot of confusion in terminology and definitions; the following may serve to describe different aspects of the problem.

 

Psychological dependence It is said to have developed when the individual believes that optimal state of wellbeing is achieved only through the actions of the drug. It may start as liking for the drug effects and may progress to compulsive drug use in some individuals. The intensity of psychological dependence may vary from desire to craving. Obviously, certain degree of psychological dependence accompanies all patterns of self medication.

 

Reinforcement is the ability of the drug to produce effects that make the user wish to take it again or to induce drug seeing behaviour. Certain drugs (opioids, cocaine) are strong reinforcers, while others (benzodiazepines) are weak reinforcers. Faster the drug acts, more reinforcing it is.

 

Physical dependence It is an altered physiological state produced by repeated administration of a drug which necessitates the continued presence of the drug to maintain physiological equilibrium. Discontinuation of the drug results in a characteristic withdrawal (abstinence) syndrome. Since the essence of the process is adaptation of the nervous system to function normally in the presence of the drug, it has been called ‘neuroadaptation’.

 

Drugs producing physical dependence are— opioids, barbiturates and other depressants including alcohol and benzodiazepines. Stimulant drugs, e.g. amphetamines, cocaine produce little or no physical dependence.

 

Drug abuse Refers to use of a drug by self medication in a manner and amount that deviates from the approved medical and social patterns in a given culture at a given time. The term conveys social disapproval of the manner and purpose of drug use. For regulatory agencies, drug abuse refers to any use of an ilicit drug.

 

Drug addiction It is a pattern of compulsive drug use characterized by overwhelming involvement with the use of a drug. Procuring the drug and using it takes precedence over other activities. Even after withdrawal most addicts tend to relapse. Physical dependence, though a strong impetus for continued drug use, is not an essential feature of addiction. Amphetamines, cocaine, cannabis, LSD are drugs which produce addiction but little/no physical dependence. On the other hand, drugs like nalorphine produce physical dependence without imparting addiction in the sense that there is little drug seeking behaviour.

 

Drug habituation It denotes less intensive involvement with the drug, so that its withdrawal produces only mild discomfort. Consumption of tea, coffee, tobacco, social drinking are regarded habituating, physical dependence is absent.

 

Basically, habituation and addiction imply different degrees of psychological dependence and it may be difficult to draw a clearcut line of distinction between the two. Therefore, it is better to avoid using these terms in describing drug dependence and related conditions.

 

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