ADDICTION

JATISH SHAHADDICTION COUNSELLOR

SHAH BAUG, NO: 1, GROUND FLOOR, GARDEN LEVEL,BYRAMJI GAMADIA ROAD, OFF: DR. G. DESHMUKH MARG,

BEHIND PRABHU KUNJ (BUILDING), MUMBAI 400 026.

CONTACT NUMBER: +91 98195 33496

E.MAIL I.D.: shah_jatish@hotmail.com

The National Council on Alcohol and Drug Dependence (U.S.A) defines alcoholism this way:

"Alcoholism is a primary, chronic disease with genetic, psychological, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortion in thinking, most notably denial."

W.H.O. defines that Drug addiction is a stage of periodic and chronic intoxication detrimental to the individual and to society, produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: 1. An overpowering desire, a need (compulsion) to continue taking drugs and to obtain it by any means. 2. A tendency to increase the dose. 3. A psychic (psychological) and sometimes a physical dependence on the effects of the drugs. From the above definition it is evident that physiological and psychological need of the drug is inherent in drug addiction. The need is so overwhelming that the craving for the addiction forces the individual to acquire it by any means.

DSM-IV-R gives the following seven criteria for addiction

1. Tolerance.2. Withdrawal.3. Increased consumption.4. Persistent desire to control substance use5. Great deal of time is spent in consuming the substance6. Important occasions are ignored.7. Continued consumption despite knowing the negative consequences. At least three of the above criteria should have occurredtogether in the same period of 12 months.

I.C.D – 10 has similar diagnostic criteria.

Addiction is a Primary Disease and is recognized as such by the W.H.O.

Alcoholics / Narcotics Anonymous state that Alcoholism / Addiction is a tri-faceted disease comprising of a

- Physical Craving - Mental Obsession - Spiritual Bankruptcy

The demand that the physical being makes when deprived of the addictive substance.This is best seen during “Withdrawals” symptomswhich occur when the chemically dependent victim is deprived of the substance or behavior.

- Tremors, Abdominal Cramps, Loose motions,Joint Pains, Cold Sweating, Inability to sleep fitfully, Loss of Appetite, Restlessness, Disorientation. In extreme cases – Delirium Tremens, Rum Fits and Hallucinations.

When not actually using, the chemically dependent person is thinking about using the addictive substance/behavior of his choice.

He thinks about, plans, dreams and looksforward to using the substance/behavior of his choice.

All his plans will revolve around the substance/behavior that he is addicted to.

This is the inability to relate to – SELF – Self hating, low self-worth. GOD – a transactional relationship. OTHERS – Isolation and Loneliness.

The inability to express ones self openly, honestly and fearlessly.

Poor communication skills.

The disease of addiction, as per AA / NA is:

Progressive – If not treated it can only get worse with time.

Incurable – There is no cure. However, it can be arrested.

Predictable – If not arrested, insanity or/& death is definite.

NEUROBIOLOGICAL FACTORS.A.Brain reward mechanism – repeated use of substances triggers off reward area of the brain.

B.Neuro-regulator system – reinforcement of substance use is mediated by raised dopamine release.

C.Craving – has been linked to change in neurotransmitters.

D.Membrane studies – substance induced changes in membrane lipid are studied for dependence and tolerance.

Psycho-dynamic factors.A. Oral fixation and overly punitive super ego.B. Sense of power and raised self-esteem.C. Reduce tension, anxiety and psychic pain.

Socio-cultural factors.A. Social settings – e.g: college dorms, military barracks. B. Cultural differences – e.g: Asians tend to drink less.

Behaviour & learning theories Re-inforcement of feeling of well-being and euphoria, reduction of fear, anxiety, tension through substance use.

Genetic factors. Genetic predisposition in an individual is supported by various monozygotic and twin studies

+ Family history of alcoholism, addiction or antisocial behavior

Family modeling of substance use behaviors

Poor parenting skills, family dysfunction

Permissive attitude toward teen use ↑ household conflict, family chaos Child abuse or neglect (physical,

sexual)

• ↓ interest in school and achievement, early academic failure

• ↓ self-esteem• ↓ religious activity• Rebelliousness and social alienation• Early antisocial behavior, delinquency• Psychopathology, especially depression or

mood disorders.• Sexual dysfunction or sexual deviance.• Early ↑ risky behaviors: ATOD*, sex

* Alcohol, Tobacco, Other Drugs

Perceived peer ATOD use, best friend’s ATOD use

Ethnic or cultural influences Community/neighborhood

deterioration/ disorganization Easy access, early access Advertising and media portrayal

NARCOTICS DEPRESSANTS STIMULANTS HALLUCINOGENS CANNABIS OTHERS

These are drugs that anaesthetize or neutralize pain. They contain opium or substances that are similar to Opium.

Opium (Afeem). Morphine. Codeine (Corex, Phensidyl) Heroin (Diacetylmorphine, Smack, Brown Sugar, Gard) (Second most abused) Meperidine (Demerol, Pethidine) Methadone Others (Lomotil /Lomofen)

These are drugs that slow down the CNS. Alcohol (The KING of all addictions) Barbiturates (Amytal, Barbital, Seconal, Phenobarbital) Benzodiazepines (Librium, Valium, Alam, Alprax, Lopez, Calmpose, Ativan, Trika,

Restyl, Etc) Methaqualone (Mandrax, Mandy) Other depressants (Placidyl) (Alcohol and tranquilizers/sedatives are substitutive addictive substances)

These are drugs that stimulate the CNS.

Cocaine (Crack). Amphetamines (Dexerine, Biphetamine) Phenmetrazine Methylphenidate (Ritalin) Dextroamphetamine

These are drugs that alter perception of reality. Time and space get warped. Hallucinogens induce a state of CNS excitation and central autonomic hyperactivity, manifested as changes in perception and mood (usually euphoric, sometimes depressive).

LSD (Acid, Blotting paper, Cork). Amphetamine Variants ( MDMA, Ecstasy) Phencyclidine Phosphate (PCP) Others (Magic Mushrooms / Psilocybin)

These drugs create a long term change in personality and can lead to cannabis insanity. Delta Tetrahydrocannabinol (THC) is the active ingredient in Cannabis.

Marijuana (Grass, Weed, Ganja, Bhang). Hashish (Hash, Charas). Hashish Oil (Hash Oil).

Nicotine

Inhalents

Date Rape Drugs (which may fall under one of the above categories, but are mentioned seperately because they are newer and their function in society has changed)

POPPY POD

OPIUM

HEROIN

OPIUM AND DERIVATIVES

OPIUM USER

Opioid receptors. Endogenous opioids.

Analgesic. Effects on various body systems.

THE WITHDRAWAL SYNDROME IS SELF-LIMITED AND, ALTHOUGH SEVERELY DISCOMFORTING, IS NOT LIFE THREATENING.

The withdrawal syndrome from an opioid generally includes Symptoms and signs of CNS hyperactivity. Severity of the syndrome increases with the size of the

opioid dose and the duration of dependence. Symptoms appear as early as 4 to 6 h after withdrawal

and, for heroin, peak within 36 to 72 hrs. Anxiety and a craving for the drug. Increased resting respiratory rate (>16 breaths/min) Yawning, perspiration, lacrimation, and rhinorrhea. Other symptoms include mydriasis, piloerection

(gooseflesh), tremors, muscle twitching, hot and cold flushes, aching muscles and anorexia.

IV fluids. Clonidine.

Dextropropoxyphene. Buprenorphine.

Benzodiazepines. Symtomatic management.

Pulmonary Hepatic

Musculoskeletal Immunologic

Neurologic Others

Opioid analgesics (sometimes termed narcotic analgesics) are either derived from the opium poppy or manufactured synthetically. They include heroin, morphine, methadone, meperidine and codeine. They are used medically primarily for the relief of pain, although they are also employed to suppress a cough, and occasionally in the treatment of severe diarrhea. Their dependence liability is generally high.

Favoured drugs include the analgesics meperidine, oxycodone and codeine, and the cough suppressants hydromorphone and hydrocodone (in Corex and Phensidyl cough syrups).

Cough suppressants ( Corex, Phensidyl, Codiene Linctus, Etc) are very widely used by the youngster of today and, tragically, physicians to prescribe these as they “appear” harmless and offer quick relief.

Codeine can be injected, or taken orally depending on the form in which it is – Liquid or Tablet.It is used for pain relief and euphoria but it can lead to drowsiness / nausea, constipation, confusion, sedation, respiratory depression and arrest, tolerance, addiction, unconsciousness, coma and even death.

Oxycodone HCL and Hydrocodone bitartrate are also used for the feeling of well being that they generate.

Generally found in the form of cough syrups, they have the same effect as codeine

90% population consumes alcohol at some point of time in their lives.

30% - temporary alcohol related problems. 10% - alcohol dependence. 25-30% - alcohol abuse. 45% - co-morbid depression. 14% - ASPD traits.

Type I and Type II. Jellinek’s classification – alpha, beta, gamma,

delta & epsilon. Early onset & Late onset.

Alcohol is a highly lipid soluble and is largely absorbed in the small intestine.

Pharmacokinetics:

Ethanol Acetaldehyde Acetic Acid Alcohol Acetaldehyde dehydrogenase dehydrogenase

Exits through Urine/Sweat.

The clinical presentation depends upon the Blood Alcohol Concentration (BAC).

BAC (mg/dl) Clinical presentation 30 Attention difficulties,

Euphoria. 50 Co-ordination problems. 100 Ataxia, Impaired judgment. 200 Confusion, Consciousness. > 400 Anaesthesia, Coma?, Death?.

Apart from these symptoms, the patient may

present with a fall and have head injury.

Occasionally, presented are:

Delirium. Pathological intoxication.

In withdrawal, an alcoholic may present:

Delirium tremens – abnormal perception, agitation, terror, autonomic instability,

confusion, auditory & visual hallucinations.

Other symptoms that may be presented are:

Restlessness. Tremulousness.

Withdrawal seizures. Lack of sleep.

Tactile sensations.

Central Nervous System. Peripheral Nervous System.

Gastro-intestinal Tract. Cerebrovascular and Cardiovascular

system. Haematological effects.

Cancer. Metabolism.

Persisting dementia. Psychotic disorders.

Persisting mood disorders. Persisting amnestic disorders. Persisting anxiety disorders.

Other behavioural and sexual disorders.

Pathological intoxication. Alcohol withdrawals

Delirium tremens

Routine lab investigations Specific investigations

GGTP / Liver function tests. Serum Ammonia.

MCV. Uric acid.

Triglycerides. USG

Carbohydrate deficient transferrin (CDT).

BARBITURATES

The barbiturates have been used since the early 1900s for epilepsy. Although their dangers were universally recognized - severe respiratory depression, high-dependence liability and life-threatening withdrawal reactions, safer alternatives did not exist until recently.

The short-acting barbiturates such as

Secobarbital are still used illicitly, since they take effect quickly and produce the most euphoria. They are often administered to enhance the effects of other sedative-hypnotics or to terminate the unpleasant effects of a long stimulant binge.

HYPNOTICS

The many prescription drugs that slow the activity of the central nervous system are called sedative-hypnotics. They include the barbiturates, general anesthetics, anti-anxiety tranquillizers (eg, benzodiazepines) and a number of non-barbiturate sedatives. These substances are prescribed to relieve anxiety, to induce sleep, to prevent or treat epileptic seizures, or to produce surgical anesthesia. All can create dependence in some individuals.

The benzodiazepines (13 different kinds are being sold in India)

Diazepam Chlordiazepoxide

Oxazepam Flurazepam Midazolam Triazolam Alprazolam Lorazepam Nitrazepam Clonazepam

Estizolam Flunitrazepam

Physicians agree that these drugs are safe for short-term uses (i.e, less than 4 weeks), but there is a high abuse potential and dependence.

The effects of Benzodiazepines are sedation, Drowsiness /dizziness

Methaqualone known as Mandrex or Mandy. This has been withdrawn from the market. However, it is available as a street drug and contains a lot of impurities. The effect seen on consuming Mandrex are euphoria/depression, poor reflexes, slurred speech, coma.

Fentanyl is used for pain relief, however it is abused for the feeling of euphoria that it creates.It can cause drowsiness/nausea, constipation, confusion, sedation, respiratory depression and arrest, tolerance, addiction, unconsciousness, coma, death.

Psychological dependence leading to profound psychological addiction, produced by high doses of cocaine, which can cause euphoric excitement.

Tolerance occurs, but physical dependence has not been confirmed; no stereotypical withdrawal syndrome occurs when the drug is discontinued. However, the tendency to continue taking the drug is strong.

short acting drug – repeated use leading to: Toxic effects, such as tachycardia, hypertension,

mydriasis, muscle twitching, sleeplessness, and extreme nervousness.

Hallucinations, paranoid delusions, and aggressive behavior can develop. Pupils are maximally dilated

Sympathomimetic effect increases heart and respiration rates and BP.

Overdose may produce tremors, convulsions, and delirium. Death may occur due to arrhythmias and cardiovascular failure.

“Snorting” Coke

Psychological dependence produced by

amphetamine causes elevated mood; increased wakefulness, alertness, concentration and physical performance and a feeling of well-being.

Known on the streets as chalk, crank,

crystal, fire, glass, go fast, ice, meth, speed, it can cause aggression, violence, psychotic behavior/memory loss, cardiac and neurological damage, impaired memory and learning, tolerance, addiction.

Crystal Meth is the latest entrant in this field.

Known on the streets as Adam, Clarity, Ecstasy, Eve, Lover's speed, Peace, STP, X, XTC, it can cause mild hallucinogenic effects, increasedtactile sensitivity, empathic feelings/impaired memory and learning, hyperthermia, cardiac toxicity, renal failure, liver toxicity, etc, etc.

A new and very dangerous drug. This, too has found its way into India and instances of abuses are beninning to be seen

The chemical n-methyl-1-phenyl-propan-2-amine is called methamphetamine, methylamphetamine, or desoxyephedrine. The shortened name is simply 'meth'. When it is in its crystalline form, the drug is called crystal meth, ice, Tina, or glass.

What Are the Effects of Methamphetamine Use?This is a list of effects associated with pure methamphetamine use. Because of how it's made, crystal meth is never pure, so the dangers associated with taking the street drug extend beyond these effects.

Common Immediate Effects Euphoria Increased energy and alertness Diarrhea and nausea Excessive sweating Loss of appetite, insomnia, tremors, jaw-clenching Agitation, irritability, talkativeness, panic, compulsive

fascination with repetitive tasks, violence, confusion Increased libido Increased blood pressure, body temperature, heart rate,

blood sugar levels, bronchodilation Constriction of the walls of the arterties In pregnant and nursing women, methampetamine

crosses the placenta and is secreted in breast milk

Effects Associated with Chronic Use Tolerance (needing more of the drug to get the

same effect) Drug craving Temporary weight loss Withdrawal symptoms including depression and

anhedonia "Meth Mouth" where teeth rapidly decay and fall

out Drug-related psychosis (may last for months or

years after drug use is discontinued)

Yaba is a combination of methamphetamine (a powerful and addictive stimulant) and caffeine. Yaba, which means crazy medicine in Thai, is produced in Southeast and East Asia. The drug is popular in Asian communities in the United States and increasingly is available at raves and techno parties.

It has made its entry into India through Bangladesh and Burma

Rapid heart rate, increased blood pressure, and damage to the small blood vessels in the brain that can lead to stroke. Chronic use of the drug can result in inflammation of the heart lining. Overdoses can cause hyperthermia (elevated body temperature), convulsions, and death. Individuals who use Yaba also may have episodes of violent behavior, paranoia, anxiety, confusion and insomnia.

Although most users administer Yaba orally, those who inject the drug expose themselves to additional risks, including contracting HIV (human immunodeficiency virus), hepatitis B and C, and other blood-borne viruses.

CANNABIS

Smoked cannabis produces a dreamy state of consciousness in which ideas seem disconnected, unanticipated, and free-flowing. Time, color, and spatial perceptions may be altered.

In general, a feeling of well-being and relaxation (a "high") results.

Tachycardia, conjunctival injection, and dry mouth occur regularly.

Panic reactions have occurred, particularly in naive users, but have become unusual as the culture has become more familiar with the drug.

Communicative and motor abilities are decreased, depth perception and tracking are impaired, and the sense of timing is altered--all hazardous in certain situations (eg, driving, operating heavy equipment).

Schizophrenic symptoms may be exacerbated by marijuana, even in patients being treated with antipsychotic drugs (eg, chlorpromazine).

Appetite often increases. Cannabis induced psychosis is common

and cannabis induced lunacy can follow in the case of daily users.

The “high” felt by a marijuana smoker is a very unique conglomeration of feelings, and there are only two known sources for the substances which activate the neuroreceptor for THC. The first source is our own brains, which produce a neurochemical very similar to THC called anandamide. The second source for this substance is the cannabis plant from which comes marijuana.

Unfortunately, there are negative side effects that occur from using marijuana. Some of these include frequent respiratory infections, impaired memory, increased heart rate, impaired learning, panic attacks and physical dependence on the substance. Additionally, if used during the first month of breast feeding, infants can suffer from impaired motor development. Marijuana may produce blissful effects in the minds of those who use it, but its side effects are far from blissful.

Research has shown that THC changes the way in which sensory information is transmitted to the brain and the way that the hippocampus acts upon the information. The hippocampus is a component of the limbic system that is critical for learning, memory and the integration of emotions, motivations and sensory experiences. THC has been shown to suppress the neurons involved in information processing by the hippocampus, and it has also been shown that learned behaviors (which depend on the hippocampus to “stick” in the brain) also deteriorate.

A person who smokes marijuana on a regular basis may suffer from many of the same respiratory problems that tobacco smokers have. These people may cough daily and have excess phlegm, may have symptoms of chronic bronchitis and much more frequent chest colds.

Continual smoking of marijuana can lead to abnormal functioning of the lungs due to tissue damage caused by marijuana smoke. Additionally, the amount of tar inhaled by marijuana smokers is three to five times more than tobacco smokers, which can lead to further lung damage.

Smoking marijuana while taking other drugs (both legal and illegal) can lead to a sharp increase in heart rate and blood pressure, which can stress the cardiovascular system and risks overload and potential heart failure.

The Effects on MenIn addition to providing pleasurable effects, marijuana can also affect parts of the brain responsible for sex and growth hormones. In men, marijuana can decrease testosterone, cause enlarged breasts and lead to a decrease in sperm count and infertility.

The Effects on WomenAs in males, marijuana also effects women’s hormones, which can cause problems such as irregular menstrual cycles, depression, an increased testosterone level and the possibility for having children with moderate to severe physical and mental deficiencies ranging from learning disabilities to babies born with weak central nervous systems.

I.V. Fluids for supportive treatment

Treatment of any medical complications.

Treatment for co-morbidity, such as Psychosis, Anxiety, Mood disorder, etc

Counselling and psycho-education

TOBACCO Nicotine is the substance in cigarettes along with

other harmful chemicals (approximately 4400)that smokers become dependent on. Thus, nicotine dependence is essentially dependence on tobacco products – cigarettes, bidis, gutka, cigars, etc. About 70% of smokers have acknowledged that they desire to quit smoking but are unable to do so. Of people who quit, 90% do so on their own, but only about 3 to 4% successfully quit in any given year.

Nicotine is highly addictive. Nicotine provides an almost immediate “kick”

Addiction to nicotine results in withdrawal symptoms when a person tries to stop smoking - increased anger, hostility, and aggression, and loss of social cooperation. Persons suffering from withdrawal also take longer to regain emotional equilibrium following stress

Inhalation of 4000+ noxious chemicals. 43 of these are proven to be

carcinogens. Nicotine, Pyridine, Methyl Alcohol,

Ammonia, Formaldehyde, Carbon Monoxide, Benzopyrene, Phenols, Acetone, Arsenic, Formic Acid, Oxalic Acid, Citric Acid, Acetic Acid, Hydrogen Cyanide are some of the toxins that are available in tobacco.

One cigarette contains approximately 100 Mcg of Nicotine. 500 Mcg directly injected would cause instant death.

Nicotine is physically addictive and a harmful intoxicant.

Inhaled nicotine takes just 7 seconds to affect the brain and the C.N.S.

Tar – directly linked to cancer Carbon Monoxide has been used to commit

suicide in enclosed place. Hydrogen Cyanide was used to gas criminals

to death in U.S.A. once upon a time....And yet we happily consume these

chemicals thinking that the cigarette is relaxing for us, is good for us, makes us think better, etc.

Lung cancer Coronary heart disease Chronic lung diseases – bronchitis/emphysema Gastric and duodenal ulcers Cirrhosis of the liver Various cancers – pancreas, stomach, kidneys, prostrate, bladder, liver, gall bladder Cancers of the oral cavity – lips, mouth, tongue, throat And many, many more.

CANCER CURES SMOKING

Pharmacological treatment combined with behavioral treatment, including psychological support and skills training to overcome high-risk situations, results in some of the highest long-term abstinence rates

Nicotine chewing gum Transdermal patch Bupropion Varnecline Tartrate (Champix) Anti-depressants Mood stabilizers

Among teenagers, inhalants are used more frequently than cocaine or LSD but less frequently than marijuana or alcohol. Inhalant use is particularly a problem among children aged 12 and younger. Inhalants are found in many common household products.

ADHESIVES•Airplane Glue•Rubber Cement

•Polyvinyl Chloride Cement

AEROSOLS•Spray Paint•Hair Spray

CLEANING AGENTS•Dry Cleaning Fluid•Stain Remover

•Degreaser

SOLVENTS AND GASES•Typing Correction

Fluid Thinner•Nail Polish Remover

•Paint Thinner•Acetone

•Cigarette Lighter Fluid•Petrol Fumes

•Fuels

All inhalants cause stimulation, loss ofinhibition, headache, nausea or vomiting, slurred speech, loss of motor coordination, wheezing, unconsciousness, cramps, weight loss, muscle weakness, depression,memory impairment, damage to cardiovascular and nervous systems. Inhalants can lead to sudden death due to arrhythmia and asphyxia.

KETAMINE induces a lack of awareness

to pain and to one's general surroundings, leading to a scattered feeling or to a feeling of detachment. Ketamine is usually injected intravenously and may be snorted as well.

Also known as Vitamin K, Special K, KO, Horse (because it has veterinary use).

It is also a common “date rape” drug.

GAMMA HYDROXIBUTYRATE (GHB) is taken by mouth. It is similar to Ketamine in its effects.

GHB produces feelings of relaxation and tranquillity. It may also cause fatigue and feelings of being uninhibited.

Also known as “Easy Lay”, “Liquid Ecstasy”.

This is another “date rape” drug”

MAY GOD HELP ADDICTS

WHERE EVERTHEY BE.

FOR IF THEYDO NOT GET

HELP, THE END IS INEVITABLE -

- INSANITY AND / OR DEATH

THANK YOU!

…… JATISH SHAH.