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Drug Dependence

Drug dependence is a complex disorder characterized by substantial changes in patient's behavior and daily life. Both physical and psychological dependence have been recognized as separate entities. Numerous symptoms may develop and the diagnosis mandates a thorough patient history that will determine which substance was used, a thorough physical examination, and toxicology.


Presentation

The clinical presentation can somewhat vary depending on the drug used, but the persistent need for drug use despite potentially harmful consequences, inability to regulate the frequency of its consumption and prioritizing its consumption over all other activities are hallmarks of drug dependence [1]. Two main types of dependence are recognized [2] [3]:

It is important to note that both physical and psychological dependence may be encountered in patients, making additional criteria highly useful in defining the diagnosis. Symptoms such as craving, tolerance (necessity to use larger amounts over time), repeated attempts to quit or control drug use, as well as giving up daily life activities due to dependence can be reported. When three or more symptoms are reported within a 12-month period, the diagnosis can be confirmed based on clinical criteria [2] [4].

Weight Loss
  • Half of them consumed MPH daily by intravenous route and reported amphetamine-like effects (cardiovascular events, weight loss, psychiatric adverse events).[ncbi.nlm.nih.gov]
  • Physical Loss or increase in appetite, change in eating habits, unexplained weight loss or gain Slowed or staggered walking, bumping into things Smell of alcohol on breath Slow or slurred speech Irregular sleep patterns, having difficulty sleeping, awake[sfad.org.uk]
  • These problems can lead to difficulties in feeding, which can mean weight loss or failure to thrive. Difficulties with state regulation.[sheknows.com]
  • loss, leptin, and genetic predisposition.[doi.org]
Weight Gain
  • Princeton University Press, Princeton Google Scholar Elliott SS, Keim NL, Stern JS et al (2002) Fructose, weight gain, and the insulin resistance syndrome.[doi.org]
  • Rats were weighed weekly to ensure consistent weight gain across the experiment.[dx.plos.org]
  • Weight gain following smoking cessation. Journal of Consulting and Clinical Psychology. 1993; 61 (5):768–77. [ PubMed : 8245274 ] Perkins KA. Smoking cessation in women. Special considerations.[ncbi.nlm.nih.gov]
  • Rodent models using access to high fat, high sugar, or “cafeteria style” diet result in increased caloric intake and elevated weight gain, principal components of human obesity ( Rothwell and Stock, 1979, 1984 ; Lin et al, 2000 ).[ncbi.nlm.nih.gov]
Prostitute
  • Abuse began among people who worked at night: jazz musicians, artists, bohemians and prostitutes, but it quickly spread broad strata of the population.[web.archive.org]
  • It made addicts conform to the image of nonscience; as they robbed or cheated or prostituted themselves to support the illicit price, they did indeed become debauched, corrupt, and depraved.[druglibrary.org]
Cushingoid
  • Both patients exhibited tolerance and withdrawal symptoms, and both developed serious systemic effects from the corticosteroids, including cataracts, diabetes mellitus, and cushingoid signs.[ncbi.nlm.nih.gov]
Asymptomatic
  • Similarly, the prevalence of past-year remission status three years after baseline at wave 2 was: abstinence (69.1%), asymptomatic drug use (15.5%), partial remission (8.4%), and still drug dependent (7.0%).[ncbi.nlm.nih.gov]
Yawning
  • In addition, the March of Dimes also lists the symptoms: Fussiness, excessive crying or having a high-pitched cry Fever, sweating or blotchy skin Trouble sleeping and lots of yawning Stuffy nose or sneezing Treatment for babies Babies with NAS can be[sheknows.com]
Pneumonia
  • RESULTS: In Year 5 after index date, CFMs of adults with AODD were more likely to be diagnosed with depression and AODD than CFMs of adults with asthma or diabetes and were less likely to be diagnosed with asthma, otitis media, and pneumonia than CFMs[ncbi.nlm.nih.gov]
Nausea
  • As alcohol also irritates the stomach, heavy drinking can cause sickness and nausea, and sometimes diarrhoea. Alcohol also has a dehydrating effect, which is the main reason why excessive drinking can lead to a hangover.[ufs.ac.za]
  • These symptoms include: anxiety depression muscle weakness nightmares body aches sweating nausea vomiting When drug abuse escalates to dependence, treatment becomes complicated.[healthline.com]
  • Alcoholism is a disease with four main features: craving - a strong need to drink loss of control - not being able to stop drinking once you've started physical dependence - withdrawal symptoms, such as nausea, sweating, or shakiness when you don't drink[icd9data.com]
  • However, THC-based drugs to treat pain and nausea are already FDA approved and prescribed, and scientists continue to investigate the medicinal properties of other chemicals found in the cannabis plant—such as cannabidiol, a non-psychoactive cannabinoid[web.archive.org]
  • Abdominal pain , nausea , vomiting , and diarrhea are possible. Vomiting blood, or blood in bowel movements, can be life threatening. Withdrawal syndromes are variable depending on the agent but can be life threatening.[emedicinehealth.com]
Abdominal Pain
  • Abdominal pain , nausea , vomiting , and diarrhea are possible. Vomiting blood, or blood in bowel movements, can be life threatening. Withdrawal syndromes are variable depending on the agent but can be life threatening.[emedicinehealth.com]
Low Back Pain
  • Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores.[ncbi.nlm.nih.gov]
Shoulder Pain
  • Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores.[ncbi.nlm.nih.gov]
Knee Pain
  • Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores.[ncbi.nlm.nih.gov]
Hip Pain
  • Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores.[ncbi.nlm.nih.gov]
Anhedonia
  • Pers Soc Psychol Bull 31:121–135. doi: 10.1177/0146167204271309 PubMed CrossRef Google Scholar Wise RA (1982) Neuroleptics and operant behavior: The anhedonia hypothesis.[doi.org]
  • Parallel changes in dopamine D2-receptor binding in limbic forebrain associated with chronic mild stress-induced anhedonia and its reversal by imipramine. Psychopharmacology. 1994; 115 441-446 66 Martin M, Hurley R A, Taber K H.[doi.org]
  • Novelty reward as a measure of anhedonia. Neurosci Biobehav Rev. 2005; 29 :707–714. [ PubMed ] [ Google Scholar ] Bjornebekk A, Mathe AA, Brene S.[ncbi.nlm.nih.gov]
  • Dopamine and reward: the anhedonia hypothesis 30 years on. Neurotox Res 2008 ;14: 169 - 183 14. Schultz W. Getting formal with dopamine and reward. Neuron 2002 ;36: 241 - 263 15. Kauer JA, Malenka RC. Synaptic plasticity and addiction.[doi.org]
Denial
  • Denial among users was 69.2% and denial among negative self report was 45%. A poor level of agreement (K) was found between results of self-report and urinalysis for all the treatment seekers.[ncbi.nlm.nih.gov]
  • Though "denial" used to be considered a symptom of addiction, recent research has shown that people who are addicted have far less denial if they are treated with empathy and respect, rather than told what to do or "confronted."[web.archive.org]
  • It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.[icd9data.com]
  • Though denial is a common symptom of addiction, people who are addicted have far less denial if they are treated with empathy and respect, rather than told what to do or being confronted.[medlineplus.gov]
  • You may be met with excuses, denial or anger. Be prepared to respond with specific examples of behavior that has you worried. Don’t expect the person to stop without help: you have heard it before - promises to cut down, stop - but, it doesn’t work.[psychiatry.org]
Suicidal Ideation
  • Lynskey MT, Glowinski AL, Todorov AA, Bucholz KK, Madden PA, Statham DJ, Martin NG, Heath AC: Major depressive disorder, suicidal ideation, and suicide attempt in twins discordant for cannabis dependence and early-onset cannabis use.[doi.org]
Sexual Dysfunction
  • dysfunction F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder F19.19 …… with unspecified psychoactive substance-induced[icd10data.com]
Irritability
  • Central nervous system hyperactivity, mydriasis, tremors, gastrointestinal irritation, and diarrhea are typical for opioid withdrawal, including heroin, while tachycardia, hyperreflexia, confusion, and seizures are reported after cessation of benzodiazepine[symptoma.com]
  • As alcohol also irritates the stomach, heavy drinking can cause sickness and nausea, and sometimes diarrhoea. Alcohol also has a dehydrating effect, which is the main reason why excessive drinking can lead to a hangover.[ufs.ac.za]
  • […] friends, friends who are known alcohol or drug users Changes in habits at home, loss of interest in family and family activities Can’t pay attention, forgetting things Not motivated to do anything, has no energy or self-esteem Moody, has sudden outbursts, irritated[sfad.org.uk]
  • Long-term marijuana users trying to quit report withdrawal symptoms including irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to abstain.[web.archive.org]
  • They can have problems going smoothly from sleep to awake states, and often become irritable and cry. Difficulties with reactivity to stimuli.[sheknows.com]
Apathy
  • The link between dopamine function and apathy in cannabis users: an [18F]-DOPA PET imaging study. Psychopharmacology (Berl.) 231, 2251–2259 (2014) 103. von Sydow, K., Lieb, R., Pfister, H., Hofler, M. & Wittchen, H. U.[doi.org]
  • Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cereb Cortex. 2006; 16 :916–928. doi: 10.1093/cercor/bhj043. [ PubMed ] [ CrossRef ] [ Google Scholar ] 122. Goldman-Rakic PS.[ncbi.nlm.nih.gov]
  • Drugs such as cocaine and methamphetamine are associated with severe emotional withdrawal symptoms such as depression and apathy, and people may be at risk for accidents due to issues with judgment during the withdrawal period. 5 Alcoholism Treatment[projectknow.com]
  • The link between dopamine function and apathy in cannabis users: an [18 F]-DOPA PET imaging study. Psychopharmacology 2014; 231 : 2251–2259. 61. Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS et al.[doi.org]
  • The link between dopamine function and apathy in cannabis users: an [18F]-DOPA PET imaging study. Psychopharmacology. 2014; 231 (11):2251–2259. [ PubMed ] [ Google Scholar ] 61. Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS, et al.[ncbi.nlm.nih.gov]
Headache
  • J Headache Pain. 2012 Nov;13(8):653-60. doi: 10.1007/s10194-012-0492-z. Epub 2012 Oct 18.[ncbi.nlm.nih.gov]
  • Associated with their medical condition is a dependence on narcotics and/or psychotropic medications for such complaints as pain, headache, insomnia, and anxiety.[ncbi.nlm.nih.gov]
  • Many people in our society are dependent on caffeine and experience withdrawal symptoms such as headache, fatigue, and difficulty concentrating if they miss their morning cup of coffee 8 .[drugabuse.com]
  • […] irritability, anger or aggression, nervousness or anxiety, sleep difficulty, decreased appetite or weight loss, restlessness, depressed mood, and physical symptoms causing significant discomfort such as shakiness or tremors, sweating, fever, chills, and headaches[doi.org]
Agitation
  • Alternatively, the person may be agitated, angry, anxious, and unable to sleep . Hallucinations are possible. Abnormal vital signs (temperature, pulse rate, respiratory rate, blood pressure ) are possible and can be life threatening.[emedicinehealth.com]
  • If you feel relaxed and happy when you are high, then you experience intense anxiety and agitation when you are in withdrawal. You may feel sick when you try to stop using, and you need to keep using to feel normal.[wikihow.com]
  • Withdrawal from Meth is associated with disturbed sleep, anxiety, depressed mood, reduced energy and agitation ( McGregor et al., 2005 ).[ncbi.nlm.nih.gov]
Personality Change
  • Early research raised fears that even occasional puffing on a joint might lead to personality changes, birth defects, brain shrinkage, sterility in men, lowered resistance to disease and heart damage.[druglibrary.org]

Workup

The diagnostic workup must start with a carefully obtained patient history, as only a few questions during the interview may reveal the cause of symptoms and the substance that caused dependence. Physicians must bear in mind that peak dependence rates are during adolescence - Alcohol and marijuana dependence most likely occurs around 17-18 years of age, whereas cocaine abuse peaks around 23-25 years. of age [5]. What is worrisome is that more than 10% of cocaine, marijuana and alcohol users become dependent within the first 10 years of use [5]. These findings further emphasize the importance of a meticulous patient history regarding prior substance use and additional questions that will identify whether diagnostic criteria for dependence can be met [2]. More importantly, information from parents, close relatives or friends may be particularly helpful when there is a suspicion of drug dependence, as the patient may not always disclose such information. If the diagnosis is not confirmed, toxicology testing can be performed for marijuana, cocaine, opioids, amphetamines, phencyclidine, benzodiazepines, barbiturates, and alcohol [2]. Urine is tested most commonly, while blood, saliva, sweat or hair samples can be used as well [2].

Treatment

  • METHOD: A systematic search of four relevant databases was undertaken to identify peer-reviewed, quantitative drug treatment outcome studies that reported alcohol use pre-, post-treatment and follow-up.[ncbi.nlm.nih.gov]
  • The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community-based treatment[ncbi.nlm.nih.gov]
  • Post-treatment logins to the program and access of clinical content were measured, as was post-treatment alcohol use. RESULTS: Use of the program was frequent in the first 30 days following treatment but steadily decreased over time.[ncbi.nlm.nih.gov]
  • Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.[ncbi.nlm.nih.gov]
  • We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis of Drug Dependence & Abuse The importance of abstaining from drug use is clear given the devastating, sometimes fatal prognosis of drug abuse and dependence. Drug abuse can affect every major organ system, even after a single use.[emedicinehealth.com]
  • Outlook (Prognosis) Drug abuse and dependence may lead to a fatal drug overdose. Some people start taking the drugs again after they have stopped. Relapses can lead to continued dependence.[web.archive.org]
  • Long-term outlook Once these babies have worked through their withdrawal period, what is their long-term prognosis? The effects of drugs and alcohol on the developing infant can go way beyond just the physical symptoms.[sheknows.com]
  • In some cases, it can even worsen the long-term prognosis for recovery. To facilitate life-long recovery, addiction treatment providers must have an in-depth understanding of each disease and the complex interactions between them all.[timberlineknolls.com]

Etiology

  • BACKGROUND: We investigated the etiological nature of comorbid alcohol, tobacco, and cannabis DSM-IV dependence symptoms in late adolescence and young adulthood while accounting for gender differences in the magnitude of genetic and environmental influences[ncbi.nlm.nih.gov]
  • Factors explaining variance in beliefs among addiction-treatment providers regarding the etiology of addiction were investigated ( n 295).[doi.org]
  • Central catecholamines may be hypothesized as an etiological factor in the development of alexithymia. References Fava, G. A., Freyberger, H. J., Bech, P., Christodoulou, G., Senski, T., Theorell, T., & Wise, T.[doi.org]
  • Implications for the etiology and therapy of depression. Arch Gen Psychiatry. 1981 Oct; 38 (10):1160–1180. [ PubMed ] [ Google Scholar ] Gawin F, Riordan C, Kleber H.[ncbi.nlm.nih.gov]
  • Conclusions Findings from AD GWAS and post‐GWAS analyses have greatly increased our understanding of the genetic etiology of AD.[doi.org]

Epidemiology

  • Author information 1 Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES EA2415, University of Montpellier, Montpellier, France. 2 Laboratory of Clinical Pharmacy, Faculty of Pharmacy, University of Montpellier, Montpellier[ncbi.nlm.nih.gov]
  • Author information 1 Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, and Pacific Northwest Evidence-based Practice Center, Portland, Oregon.[ncbi.nlm.nih.gov]
  • METHODS: Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only.[ncbi.nlm.nih.gov]
  • Virtually all published estimates for this facet of drug dependence epidemiology are from life histories elicited years after first use.[ncbi.nlm.nih.gov]
  • Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the prevalence and predictors of past-year remission status.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • A greater understanding of the associated changes in brain pathophysiology supports the notion that pharmacological treatments are part of the necessary treatment options. Craving is a core symptom of addictive disorder.[ncbi.nlm.nih.gov]
  • Kreek MJ: Molecular and cellular neurobiology and pathophysiology of opiate addiction, in Neuropsychopharmacology: The Fifth Generation of Progress. Edited by Davis KL, Charney D, Coyle JT, Nemeroff C.[doi.org]
  • David P Finn, Maria-Paz Viveros and Eva M Marco, The endocannabinoid system and emotional processing: pathophysiology and therapeutic potential, Journal of Psychopharmacology, 26, 1, (3), (2012). Shizhong Han, Bao-Zhu Yang, Henry R.[doi.org]
  • First of all, there is no gene coding specifically for the pathophysiology of addiction.[ncbi.nlm.nih.gov]
  • It has been further applied in psychiatry research for understanding the pathophysiology of schizophrenia and depression.[ncbi.nlm.nih.gov]

Prevention

  • Logistic regression was used to determine whether the CFMs of AODD adults were more likely to be diagnosed with medical conditions, or get preventive care, than the CFMs of adults with asthma or diabetes.[ncbi.nlm.nih.gov]
  • Author information 1 National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.[ncbi.nlm.nih.gov]
  • Furthermore, the report discusses the use of terms, the use of pharmacovigilance data for the assessment of abuse and dependence potential, balancing medical availability and prevention of abuse of medicines manufactured from controlled substances, and[ncbi.nlm.nih.gov]
  • […] maltreatment subtypes, and its association with exposure to additional environmental adversity, understanding the processes that potentiate child neglect and link neglect to subsequent child externalizing psychopathology may shed light on key targets for preventive[ncbi.nlm.nih.gov]
  • The identification of addiction endophenotypes may be useful in facilitating the rational development of therapeutic and preventive strategies.[ncbi.nlm.nih.gov]

References

Article

  1. Gould TJ. Addiction and Cognition. Addict Sci Clin Pract. 2010;5(2):4-14.
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. Am J Psychiatry. 2013;170(8):834-851.
  5. Wagner FA, Anthony JC. From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology. 2002;26(4):479-488.

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Last updated: 2019-07-11 21:51