Drug Addiction Overview

Drug Addiction (Updated)

• This presentation covers drug addiction, delivered by Professor Dr Hussain Habil, Head of School and Addiction Medicine Consultant and Psychiatrist.

Learning Outcomes

• Students should be able to describe various types of stimulant drugs.
• Students should be able to state criteria for drug dependence.

Definition of Drugs & Drug Abuse

• Drugs are chemical substances used for treatment, cure, prevention, or diagnosis of disease, or to enhance physical/mental well-being.
• Drug abuse is using any drug in a way that deviates from accepted social or medical norms, or using it in a maladaptive way resulting in biological, psychological, or social impairments.

Criteria for Drug Dependence (Based on ICD-10)

• Dependence is diagnosed if three or more of the following have been experienced in the last year:
  • Strong desire or compulsion to use the substance.
  • Difficulty controlling substance use (onset, termination, or levels of use).
  • Physiological withdrawal symptoms (characteristic withdrawal syndrome or reducing substance use to avoid withdrawal symptoms).
  • Tolerance, needing increased doses for the same effect.
  • Neglecting other interests or pleasures because of substance use, or spending excessive time obtaining/using/recovering from substance use.
  • Continued substance use despite knowing it is causing harm.

Based on DSM-5 Classification

• DSM-5 does not have a separate category for dependence, instead using the number of symptoms (2-3, 4-5, or 6 or more) to categorize severity.
• Symptoms concern use in larger amounts, or longer periods than intended; problems with cutting down; craving; use taking over more of the person's life; use despite harm to health; and tolerance/withdrawal.

Commonly Used Drugs in Malaysia

• Methamphetamine (syabu)
• Alcohol
• Cannabis
• Heroin

Classification for Drug Dependence

• Drugs are classified into categories based on their effect on the central nervous system (CNS). These groups include CNS depressants, opioids, stimulants, and hallucinogens.

Alcohol

• Alcohol is a CNS depressant and a common substance abuse issue globally. It comes in various forms like beer, wine, and liquor.

Alcohol Intoxication

• DSM-5 diagnostic criteria for alcohol intoxication/simple drunkenness are based on recent ethanol ingestion, maladaptive behavior, and at least one symptom. Symptoms include slured speech, dizziness, incoordination, unsteady gait, nystagmus, and impaired attention/memory. Levels of intoxication correlate with different degrees of impairment.

Alcohol Withdrawal

• Withdrawal symptoms vary in severity and timing, based on the length of use. Symptoms can range from minor issues like tachycardia and tremors to major issues like seizures or delirium tremens.

Alcohol-Induced Disorders

• Alcohol can cause various disorders, including psychotic disorders, mood disorders, anxiety disorders, persisting dementia, and persisting amnestic disorders.

Opioids

• Opioids (like heroin) have powerful pain-relieving and mood-altering effects.
• Epidemiology shows heroin is widely abused, often by those with lower socioeconomic backgrounds to fund drug acquisition.
• Examples include Morphine, Codeine, Heroin and synthetic analgesics like pethidine/methadone.
• Routes of administration include intravenous use, subcutaneous, and inhaled routes.
• Clinical effects include respiratory depression, constipation, reduced appetite, and lowered libido.
• Withdrawal involves intense cravings, restlessness, insomnia, muscle/joint pain, and potentially severe symptoms like diarrhea and rapid heart rate.

Cannabis

• Cannabis is derived from the Cannabis sativa plant, often used in various ways (smoked cigarettes, tea).
• Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive component.
• Epidemiology shows cannabis is a widely used recreational drug, especially among younger age groups.
• Clinical features after use include euphoria, reddening of eyes, dry mouth, tachycardia, irritation of the respiratory tract, and coughing.
• Adverse effects can include chronic respiratory diseases, lung cancer, cerebral atrophy, seizure susceptibility, chromosomal damage, birth defects, impaired immune function, hormonal changes, and menstrual cycle irregularities.

Cannabis Use Disorder

• Regular cannabis use over several weeks to months can lead to dependence, with a risk around 1 in 10 for users.
• Earlier initiation of use, increased frequency, and longer use are associated with increased risk of dependence.

Cannabis Intoxication

• Symptoms show within minutes of use, peaking in 30 minutes, and lasting 2-4 hours.
• Effects include euphoria, heightened senses (colors seem brighter), slowing of time perception, and impaired motor skills.

Cannabis Withdrawal

• Withdrawal in heavy users can manifest within one to two weeks of cessation.
• Symptoms include irritability, cannabis cravings, weight loss, depressed mood, restlessness, headaches, chills, disturbed/vivid dreams, gastrointestinal upset, sweating, and tremors.

Stimulant Drugs

• Drugs in this category include amphetamines and cocaine.

Amphetamines

• Amphetamines have effects similar to increasing dopamine and norepinephrine, and are used pharmacologically to treat ADHD and narcolepsy.
• They are often illegally used as "speed" or "whizz".
• Routes of administration include oral, intravenous, and inhalation.

Amphetamine Withdrawal

• Withdrawal symptoms include low mood, depression, anxiety, tremors, lethargy, fatigue, nightmares, drug cravings, and even suicidal thoughts.

Cocaine

• Cocaine, derived from the coca plant, stimulates the central nervous system, producing effects similar to amphetamines.
• Effects include excitement, increased energy, euphoria, grandiose thinking, impaired judgment, sexual disinhibition, visual/auditory hallucinations, and formication.
• High doses can lead to paranoid psychosis and violent behavior.

Hallucinogens

• Hallucinogens like LSD, PCP, psilocybin, and mescaline produce alterations in perception and consciousness, including hallucinations.

• Synthetic hallucinogens are often easily made and distributed, with notable examples of LSD and PCP.

• Hallucinogens frequently involve oral ingestion, although some are smoked or injected.

• Psychedelic/psychotomimetic effects include a reduction in reality contact and heightened sensory awareness as well as hallucinations.

• Hallucinogen use is most prevalent in young adults (15-35) and often White men, with lower morbidity/mortality compared to some other drugs.