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Drug Abuse And Dependence

Drug dependence (addiction) is compulsive use of a substance despite negative consequences which can be severe; drug abuse is simply excessive use of a drug or use of a drug for purposes for which it was not medically intended.

Chronic drug abuse, especially I.V. use, can lead to life-threatening complications, such as cardiac and respiratory arrest, intracranial hemorrhage, acquired immunodeficiency syndrome, tetanus, subacute infective endocarditis, hepatitis, vasculitis, septicemia, thrombophlebitis, pulmonary emboli, gangrene, malnutrition and GI disturbances, respiratory infections, musculoskeletal dysfunction, trauma, depression, increased risk of suicide, and psychosis. Materials used to "cut" street drugs also can cause toxic or allergic reactions.

Drug abuse can occur at any age. Experimentation with drugs commonly begins in adolescence or even earlier. Drug abuse often leads to addiction, which may involve physical or psychological dependence or both. The most dangerous form of abuse occurs when users mix several drugs simultaneously - including alcohol.

Causes

Drug abuse commonly results from a combination of low self-esteem, peer pressure, inadequate coping skills, and curiosity. There is also evidence of familial patterns of addiction.

Most people who are predisposed to drug abuse have few mental or emotional resources against stress, an over dependence on others, and a low tolerance for frustration. Taking the drug gives them pleasure by relieving tension, abolishing loneliness, allowing them to achieve a temporarily peaceful or euphoric state, or simply relieving boredom.

Drug dependence may follow experimentation with drugs in response to peer pressure. It also may follow the use of drugs to relieve physical pain, but this is uncommon.

Signs and symptoms

The signs and symptoms displayed by a person depend on what substances the person has abused. A person who has not abused drugs extensively may experience unpleasant symptoms and may seek help from family members and friends. Chronic drug abusers generally know what to expect from their drug use and rarely seek help for themselves.

• Most agents cause a change in level of consciousness-usually a decrease in responsiveness. A person using drugs may be hard to awaken or may act bizarrely.
• Abnormal vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be life threatening. Vital sign readings can be increased, decreased, or absent completely.
• Cannibis users may exhibit red eyes with dilated pupils, increased appetite, dry mouth , and rapid pulse; they may also be sluggish and slow to react.
• Nausea and vomiting
• Opioid drug users exhibit slurred speech, drowsiness, impaired memory, and constricted (small) pupils. They may appear slowed in their physical movements.
• Skin can be cool and sweaty, or hot and dry.

Diagnosis

Various tests can confirm drug use, determine the amount and type of drug taken, and reveal complications. For example, a serum or urine drug screen can detect recently ingested substances.

Characteristic findings in other tests include elevated serum globulin levels, hypoglycemia, leukocytosis, liver function abnormalities, positive rapid plasma reagin test results because of elevated protein fractions, elevated mean corpuscular hemoglobin levels, elevated uric acid levels, and reduced blood urea nitrogen levels.

Treatment

Treatment for the person with drug abuse or dependence begins with the recognition of the problem. Though previously "denial" was considered a symptom of addiction, recent research has shown that this symptom can be dramatically reduced if addicts are treated with empathy and respect, rather than told what to do or "confronted."

The patient may first need treatment for drug intoxication, followed by long­term therapy to combat drug dependence.

Drug intoxication

The patient with acute drug intoxication should receive symptomatic treatment based on the drug ingested. Measures include fluid replacement therapy and nutritional and vitamin supplements, if indicated, and detoxification with the same drug or a pharmacologically similar drug. (Exceptions include cocaine, hallucinogens, and marijuana, which aren't used for detoxification.)

Medications include sedatives to induce sleep; anticholinergics and anti-diarrheal agents to relieve GI distress; anti-anxiety drugs for severe agitation, especially in cocaine abusers; and symptomatic treatment of complications.

Depending on the dosage and time elapsed before admission, additional treatments may include gastric lavage, induced emesis, activated charcoal, forced diuresis and, possibly, hemoperfusion or hemodialysis.

Drug dependence

Treatment of drug dependence commonly involves a triad of care: detoxification, short- and long-term rehabilitation, and aftercare. The latter means a lifetime of abstinence, usually aided by participation in Narcotics Anonymous or a similar self help group.

Detoxification is the gradual withdrawal of an abused substance in a controlled environment. Sometimes a drug with a similar action is substituted during the withdrawal process to reduce the unpleasant symptoms and risks associated with withdrawal. The process can be managed on an inpatient or outpatient basis.

Depending on which drug the patient has abused, detoxification may be managed on an inpatient or outpatient basis. For example, withdrawal from CNS depressants can produce hazardous adverse reactions, such as generalized tonic-clonic seizures, status epilepticus, and hypotension.

Opioid withdrawal causes severe physical discomfort and can even be life-threatening. To minimize these effects, chronic opioid abusers commonly are detoxified with methadone.

People who are acutely intoxicated may need hospitalization for detoxification. Some cities have detoxification centers for sobering from drug and alcohol intoxication.

Prevention

Drug education programs may be helpful though none has proved effective in the long term.