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Drug Abuse. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine, The University of Jordan April, 2014. Drug Dependance. A condition in which the user has a compelling desire to continue taking the drug either to experience its effects or to avoid the discomfort of its absence. - PowerPoint PPT Presentation
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Drug Abuse
Munir Gharaibeh, MD, PhD, MHPE
Faculty of Medicine, The University of Jordan
April, 2014
Drug Dependance
• A condition in which the user has a compelling desire to continue taking the drug either to experience its effects or to avoid the discomfort of its absence.
Apr 21, 2023 2Munir Gharaibeh MD, PhD,
MHPE
Apr 21, 2023 3Munir Gharaibeh MD, PhD,
MHPE
Apr 21, 2023Munir Gharaibeh MD, PhD,
MHPE 4
Psychologic Dependence
Psychic dependence.Psychic craving. Compulsive abuse.
A condition characterized by an emotional or mental drive to continue taking the drug, the effects of which the user believes are necessary to maintain his sense of optimal well being.
Apr 21, 2023 5Munir Gharaibeh MD, PhD,
MHPE
Psychologic Dependence
• * Occurs when a drug affects the reward system of the brain.
• ** When the drug is withheld, adaptations in the brain reward system manifest as dysphoria and drug craving.
• *** Can occur even with drugs that do not produce tolerance and physical dependence.
• Cross DependenceApr 21, 2023 6
Munir Gharaibeh MD, PhD, MHPE
Physical Dependence
Physiological DependenceAdaptive Dependence• Is an altered or adaptive physiologic state
produced in an individual by the repeated administration of a drug.
• Revealed only when the drug is abruptly withdrawn or when its actions are diminished by the administration of a specific antagonist.
• ** Results from many of the same mechanisms that produce tolerance.
• Cross Dependence
Apr 21, 2023 7Munir Gharaibeh MD, PhD,
MHPE
Tolerance
Decreased effect of a drug that develops with continued use. The dose- response curve shifts to the right as larger doses are needed to produce the same response.
• Tachyphylaxis.• Cross Tolerance.
Apr 21, 2023 8Munir Gharaibeh MD, PhD,
MHPE
Types of Tolerance
• A. Innate Tolerance:Interindividual variations in sensitivity to the drug that are present before its first administration( i.e. genetic variability in drug's receptors or pharmacokinetics).
Apr 21, 2023 9Munir Gharaibeh MD, PhD,
MHPE
Types of Tolerance
• B. Acquired Tolerance:• a. Pharmacokinetic• b. Pharmacodynamic:• **Changes in receptor number or a change in the
signal transduction pathway.• Short Term:• Inactivation (e.g. phosphorylation).• Internalization• Degradation• Long Term: • Gene regulation of protein (e.g.
adenelyl cyclase by morphine, glutamate receptor and synapses).
Apr 21, 2023 10Munir Gharaibeh MD, PhD,
MHPE
Types of Tolerance
• C. Learned Tolerance:• The drug produces
compensatory changes that are unrelated to its actions (i.e. Behavioral Tolerance and Conditioned Tolerance).
Apr 21, 2023 11Munir Gharaibeh MD, PhD,
MHPE
• Tolerance and physical dependence are normal physiologic adaptations to the continued use of a drug.
Apr 21, 2023 12Munir Gharaibeh MD, PhD,
MHPE
Addiction
Changes in neuronal pathways that cause the individual's priorities to be centered on harmful or compulsive drug –seeking and drug –using behaviors at the expense of normal medical and social interactions.
Apr 21, 2023 13Munir Gharaibeh MD, PhD,
MHPE
Addiction
A maladaptive pattern of substance use leading to clinically significant impairment or distress associated with any of a number of symptoms.
• Usually for nonprescription drugs, e.g. Nicotine and alcohol.
Apr 21, 2023 14Munir Gharaibeh MD, PhD,
MHPE
Apr 21, 2023Munir Gharaibeh MD, PhD,
MHPE 15
DSM-IV Dependence Criteria
Tolerance Withdrawal Use in larger amounts or for longer than intended Desire to cut down or control use Great deal of time spent in obtaining substance
or getting over effects Social, occupational, or recreation activities
given up or reduced Use despite knowledge of physical or
psychological problem
Drug Misuse
Commonly refers to the improper use of prescribed compounds or the use of such compounds for nontherapeutic purposes. e.g. Morphine and benzodiazepines.
Apr 21, 2023 17Munir Gharaibeh MD, PhD,
MHPE
Mechanisms of Physical Dependence
Typically results from mechanisms similar to those that produce pharmacodynamic tolerance.
Apr 21, 2023 18Munir Gharaibeh MD, PhD,
MHPE
Mechanisms of Psychological Dependence
Reward Sites in the Brain:• Ventral Tegmental Area (VTA)
directly projects dopaminergic neurons to Nucleus Accumbens (NA) through the Medial Forebrain Bundle.
• Repeated administration of a drug will cause adaptations of these reward pathways, which would be unmasked upon cessation of the drug.
Apr 21, 2023 19Munir Gharaibeh MD, PhD,
MHPE
Mechanisms of Addiction• Was thought to be mainly due to physical
and psychological dependence.• Cravings can persist long after symptoms of
withdrawal have abated.• Relapses are possible after years of sobriety.
i.e. it is an interplay between reward circuitry and memory circuitry in the brain.
• Cocaine and amphetamines are highly addictive but produce few symptoms of physical dependence.
• Addicts strive for the euphoregenic experience of the high.
• Addiction is due to a long-lasting change in the underlying brain reward system and/or memory systems related to the reward system.Apr 21, 2023 20
Munir Gharaibeh MD, PhD, MHPE
Variables Affecting Development of Addiction
The Drug:• Ability to produce
psychological dependence.• Pharmacokinetic properties:
Short ActingRapid ActingHigh Peak
Apr 21, 2023 21Munir Gharaibeh MD, PhD,
MHPE
Variables Affecting Development of Addiction
The Individual:• Genetic Influences: at least in
alcoholics.• Personality Differences: Risk-
Taker vs Risk- Aversive
Apr 21, 2023 22Munir Gharaibeh MD, PhD,
MHPE
Variables Affecting Development of Addiction
The Environment:• Societal Attitude• Cost• Availability
Apr 21, 2023 23Munir Gharaibeh MD, PhD,
MHPE
Apr 21, 2023 24Munir Gharaibeh MD, PhD,
MHPE