IMED1004 - Drug Related Issues 1 - Addiction (L20)

DSM-V

- taking the substance in larger amounts and for longer than intended

- wanting to cut down or quit but not being able to do it

- spending a lot of time obtaining the substance

- craving or a strong desire to use the substance

- repeatedly unable to carry out major obligations at work, school, or home due to substance use

- continued use despite persistent or recurring social or interpersonal problems caused or made worse by substance use

- stopping or reducing important social, occupational, or recreational activities due to substance use

- recurrent use of the substance in physically hazardous situations

- consistent use of the substance despite acknowledgement of persistent or recurrent physical or physiological difficulties from using

Tolerance

a need for markedly increased amounts to achieve intoxication/desired effect or markedly diminished effect with continued use of the same amount

Withdrawal

as either characteristic syndrome or the substance is used to avoid withdrawal

THE 5 Cs

- Chronic

- Compulsive use

- control impaired

- craving

- continued use despite harm

Substance dependence is a chronic relapsing brain disesae

- Chronic

- Relapsing

- Brain

- disease

Who becomes dependent

- in a national US survey of persons over 12, found that 13.4% of heroin, 9.2% of crack, 5.8% of marijuana, 3.7% of cocaine and 3.2% of alcohol users were dependent 12 months after initial use

- why do they become dependent:

Genetics and Dependence

- Heritability: a statistic that estimates the degree of variation in a phenotypic trait in a population that is due to genetic variation between individuals in that population

- Heritability ranges from 0 to 1

- Heritability estimates close to 0 = trait is mostly due to environmental factors

- Heritability estimate close to 1 = trait is mostly due to genetic factors

Heritability of substance use disorders

DIAGRAM ON SLIDE 19 (all the stats)

- For example: 60% of the variability in opioid use disorders in a population are due to genetic differences among people

The right environment - risk factors

INITIAL USE:

- gender

- family

- peer and community substance use

- poor academic achievement and low academic aspirations

- mental health disorders

- antisocial behaviour

.

DEPENDENCE:

- child and adult trauma

- emotional, physical and sexual abuse

- homelessness

- socio-economic status

- mental health disorders

The health problems associated with drugs

THE DRUGS:

- overdose

- withdrawal

- endocrine effects

- organ damage e.g kidneys and liver

- neurological disease

- fetal damage

.

THE DRUG LIFESTYLE:

- suicide

- blood borne viruses

- infection

- mental health

- accidents and injury

- homicide

Overdose and Overdose Myths

- only a very small portion of overdose involve excessive quantities of a single drug

- in Australia there is no strong evidence to suggest changes in drug purity or contaminants contribute significantly to overdose

- Although there are high rates of suicide by drug users, drugs are not usually used to commit suicide (<5% overdoses are deemed suicides)

- an interview of 256 heroin overdose survivors found only 9 (3.5%) had intentionally overdoses

DIAGRAM ON SLIDE 22

Overdose Other info

- one of the biggest factors associated with overdose are changes in tolerance

- the other biggest factor is the use of multiple drugs, especially depressants (opioids, alcohol, benzodiazepines)

- Deaths deemed overdoses are often complicated/associated with other problems, for example: aspiration of vomit, heart attack, accidents e.g drowing, pulmonary embolism

Fatal vs Non-Fatal Overdoses

- for every fatal overdose, there is around 25 non-fatal overdoses

- in australia, 2.5x as many people die of a prescription opioids overdoses compared with a heroin overdoses

Withdrawal (no learning outcome)

DIAGRAM ON SLIDE 27

Pregnancy (no learning outcome)

DIAGRAM ON SLIDE 32

Prevention - Targeting risk factors

- strong families - breaking the cycle of drug use

- positive role models

- support for mental illness

- support at school (academic, behavioural)

- participation in activities (sport, clubs etc.)

- social support - housing, healthcare, welfare

Treatment for substance dependence

- treatments include medication for withdrawal and abstinence, residential treatment ('rehab'), counselling, 12 step programs

- approved medications for opioids and alcohol dependence (The right patient, the right medication, the right time, the right dose, and the right route)

- patients often require other services - medical, financial, legal, child, housing, transport, vocational

Medications for opioid dependence

- methadone - mu opioid agonist

- Buprenorphine - mu partial agonist, kappa antaognist

- Naltrexone - mu, kappa and delta antagonist