Pharm 100 - Lesson B.2
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The term "drug addiction" has often been used to describe an intense pattern of drug use that is detrimental to the individual and society.
The term "drug habituation" has been used to refer to a less intense form of drug use that produces detrimental effects on the individual only.
dependence vs addiction
Currently the term dependence is used to denote “physical dependence” and addiction is used to denote “psychological dependence”.
- Drug dependence is a state of periodic or chronic intoxication produced by repeated consumption of a drug (natural or synthetic). Its characteristics include:
- An overpowering desire or need (compulsion) to continue taking the drug and to obtain it by anymeans.
- A tendency to increase the dose.
- A psychic (psychological) “addiction” and sometimes a physical dependence “dependence” on the effects of the drug.
three important aspects of drug dependence:
- (a) drug tolerance,
- (b) physical dependence,
- (c) psychic (psychological) dependence.
Drug tolerance is defined as a state in which repeated administration of a given dose or a drug has progressively less pharmacological effect or a state in which the dose of a drug must be increased to obtain the same magnitude of pharmacological effect as was produced by the original drug dose
Physical dependence (dependence) is defined as an abnormal physiological state produced by repeated administration of a drug that leads to the appearance of a characteristic and specific group of symptoms (withdrawal syndrome) when drug administration is discontinued or decreased. The intensity of physical dependence is gauged by the severity of the withdrawal syndrome.
Psychological dependence (addiction) is a state in which stopping or abruptly reducing the dose of a given drug produces non-physical symptoms. Psychological dependence is characterized by emotional and mental preoccupation with the drug's effects and by a persistent craving for the drug. Craving is believed to be a major factor governing the continued self-administration of psychoactive drugs. It was only believed that the sleep disturbances and irritability that occur when heavy users stop their drug use were of psychological origin, but these symptoms are now widely believed to be subtle withdrawal effects associated with physical dependence
What is compulsive use?
The individual takes the substance in larger doses and for a longer period of time than intended, e.g. a patient who takes morphine for pain may continue taking the drug longer than intended. The individual may express a desire to stop taking the drug, but are often unsuccessful. The person spends a predominant amount of their time obtaining and using the drug. Daily activitiesrevolve around the drug. The user will withdraw from family or society to use the drug. Preference will be to spend time with drug-using friends.
What is harmful use?
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol). The diagnosis requires that actual damage should have been caused to the mental or physical health of the user.
Drug Abuse: Medical Perspective
- A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of substances. There may be a repeated failure to fulfil major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and repeated social and personal problems.
- The symptoms have never met the criteria for substance dependence for the class of substance
Drug Abuse: Social Perspective
- The use of prohibited drugs.
- The use of any therapeutic drugs for other than its intended use.
- The intentional ingestion of any therapeutic drug in amounts greater than that prescribed, or taking the drug by routes other than those medically approved.
- Taking drugs in combination in order to obtain a greater pleasurable effect.
- The excessive use of licit (legal) social drugs (alcohol, caffeine, tobacco).
The concept of abuse potential involves three main contributors: the intrinsic dependence liability of the drug, the availability of the drug, and its inherent harmfulness to cause physical and psychological effects.
The availability of a drug in society is a major factor in determining abuse potential. The more widespread a drug, the more likely it is to be abused. Alcohol, which has only moderate intrinsic dependence liability, is the most highly abused psychoactive substance in our society, largely because itis readily available. Heroin, on the other hand, has very high intrinsic dependence liability, but has posed a lower overall risk in North America as availability is controlled by law and cost
- Nature of the drug: Most, if not all, drugs are natural reinforcers, much the same as food, water and sex. The pleasurable effects produced by a drug increases the probability that the drug will be taken again. Heroin and cocaine produce intensely pleasurable effects and have a high intrinsic dependenceliability.
- Route of administration: Drugs that can be administered by routes that give rapid absorption and hence rapid effects have a greater potential for abuse than drugs which produce the effect more slowly. For example, drugs that are taken by sniffing, inhalation or intravenously are usually more abuse-prone than those taken orally.
- Amount used: The greater the dose and the frequency of use, the greater the potential for development of dependence. For example, occasional use of alcohol in moderation (social drinking) will rarely lead to dependence, but frequent, high-dose use will lead to dependence.
The inherent harmfulness of a drug refers to the potential of the drug to cause harm. If a drug is perceived to be a serious risk to life and health, it will not be used even if widely available. Methylalcohol (wood alcohol) is widely available, and when consumed, it produces inebriating effects similar to those produced by ethyl alcohol (beverage alcohol). However, methyl alcohol, in small doses, can cause blindness and death and hence is not abused even though it is widely available.
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