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DRUG ABUSE — ADDICTION — INTOXICATION

By Dr. T. VISHNU MURTHY
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Drug addiction is behaviour that results from the complex interaction of an individual, his social and cultural environment, and availability of particular drugs. There is no sharp line that distinguishes appropriate use from misuse of any drug. Drug abuse may therefore be defined as the use of any substance in a manner that deviates from medical, social, or legal patterns within a given society. This section will consider the abuse of drugs that are primarily used to induce alterations in mood precipitation, and behaviour. These may be grouped into six major clauses: 1) Opiates 2) Central Nervous System depressants, including alcohol, hypnotics, and tranquillisers;3) central nervous system stimulants, including the Amphetamine group and cocaine; 4) cannabis; 5) psychedelic; and 6 miscellaneous inhalants.

Abuse of some drugs may be intermittent and lead to little physical, psychologic, deterioration.In other cases, the user may become dependent on the drug in order to function at what he perceives to be a satisfactory level. This psychologic dependence, or habituation, varies in intensity and may culminate in compulsive drug abuse, in which the supply and particular drugs become primary concerns of living. In addition, certain have capacity to produce physical dependence. This is an altered physiologic state induced by the repeated administration of a drug that requires the continued administration of the drug to prevent the appearance of a syndrome characteristic for each drug the withdrawal or abstinence syndrome. The term “addiction” has been used in the literature to refer to either behavioural or pharmacological events. As used here in, it refers to a pattern of compulsive drug use that includes both physical dependence and an overwhelming involvement with the supply and use of a drug. Neither a diabetic who is on Insulin nor is well-adjusted patient in methadone maintenance treatment is an addict in this sense the term, although both physically dependent on their medication.

SOCIOLOGIC FACTORS

Social and cultural factors determine which drug abuse patterns are acceptable for a given group; and in some cases, groups derive their identity from particular drug-using behaviour. The use of alcohol is condoned and even encouraged in many segments of society. Cannabis and psychedelic use are an integral part of membership in some while middle-class groups. Heroin use until recently, was an involving, exciting pursuit in inner-city ghetto areas. Given the limited opportunities to experience pleasure, satisfaction, or pride in certain underprivileged groups, moreover, the aggressive, goal oriented life of a heroin addict may appear attractive to a young boy or girl. Social factors also determine the availability of particular drugs. Patterns of abuse change rapidly in response to a variety of social and cultural factors.

Psychobiologic Factors: personality characteristics, in part, the psychoactive effects that drugs elicit in individual users and influence the choice of drugs and patterns of abuse. Amphetamines may produce tranquility in some people. Alcohol and barbiturates impair behaviour control in others and may permit more aggressive personality types to act out in a hostile and violent manner.

Controversy exists whether drug abuse implies a personality disturbance that attitudes drug use and that can be classified in distinct groups according to the drug and pattern of abuse. Most authorities agree that the experimental or intermittent abuse of drugs is not necessarily an indication of psychopathology. Compulsive drug use is frequently associated with serious psychopathology. Some workers describe addictive or alcoholic personality types, characterised by a mixture of neurotic traits and character disorders. Narcotic addicts have been described as passive individuals who experience intolerable anxiety related to physical pain, sexuality, hunger, and aggression. Opiates relieve this anxiety and permit the addict to withdraw from these inner tensions.

Evidence is accumulating to suggest that personality characteristics in drug abusing populations vary considerably and that psychologic factors play a markedly variable role in the etiology of drug abuse. It is well known that some seriously disturbed people have experimented with alcohol, opiates, and other drugs and have not become compulsive users. Learning influences the nature of the drug experience and patterns of abuse. Conditioned factors have been implicated in the drug-carving and abstinence symptoms that occur when an abstinent ex-addict returns to a site of former drug use.

Various disease states are treated with psychoactive drugs for prolonged periods. The drug use of a small percentage of patients may come to exceed medically recommended dosage or indications and eventuate in addiction in some cases. Psychologic and sociologic factors should be considered in the etiology of these behaviour pattering addition to the physical and pharmacologic determinants. Genetic and physical factors may also influence the response to drugs in some individuals.

PHARMACOLOGIC FACTORS

The nature of the psychic and physical effects of particular drugs in a determinant of their initial abuse potential. Considerations of physical dependence and tolerance influence the pattern of abuse. Tolerance refers to the decreased effect obtained from repeated administration of a given dose of a drug or to the need for increased amounts to obtain the effects that occurred from the first dose. Tolerance may be either drug disposition ( metabolic ) in type, in which there is more rapid inactivation or excretion of a drug, or pharmacodynamic ( cellular ) in which cells in the nervous system adapt to drug concentrations. Both may occur with the same drug. The physical dependence that develops concurrently with tolerance to opiates, barbiturates, and alcohol is poorly understood and may be related to pharmacodynamic tolerance mechanisms. Cross-dependence refers to the ability of one drug to suppress abstinence symptoms produced by withdrawal of another. Cross-dependence may be complete or partial, as with alcohol and the barbiturates.

PREVENTION

Drug abuse prevention programs have focused on educational efforts in which the risks of drug abuse are publicized and on increased leagal stringency. Both approaches have serious deficiencies. Perhaps more important than either of these would be the provision of reasonable, attractive vocational, recreational, and educational alternatives to drug abuse in those most at risk, namely, the young and society disadvantaged. Finally physicians must be extremely prudent in their prescribing practices with respect to potentially abusable drugs.

TREATMENT

Treatment procedures should vary according to the individual and his social set, the pattern and extent of abuse, and the pharmacology of the abused drugs, as well as the goals of treatment. In Ayurvedic treatment we have best herbal plants for the healing in drug abuse and we can assure to make a normal person.