Describe the process and mechanism of drug deaddiction.pptx

describes the process and mechanism of drug deaddiction

1. Describe the process and mechanism of drug deaddiction Dr. Pragya Pandey JR-2 Department of Pharmacology & Therapeutics King George’s Medical University Email: [email protected]

2. Drug Dependence It is the altered physiological state produced by repeated use of a drug which causes the requirement of that drug in order to maintain physiological equilibrium It can be physical or psychological

3. Drug Addiction It is compulsive drug use with overwhelming involvement with the use of the drug It is also called psychological dependence It is characterized by the craving to take the drug by the subject Examples of drugs common in drug addiction are amphetamine , cocaine, cannabis

4. Risk factors of drug addiction

5. Reinforcement It refers to the ability of the drug to produce effects that the user likes and thus increases its consumption by the user It enhances drug seeking behavior This is mediated through the mesolimbic system It involves the mechanism of reward system Opioids, cocaine are strong while benzodiazepines are weak reinforcers

6. Drugs of Abuse Depressants Psychostimulants Psychedelics Cannabis Inhalants Opioids Alcohol Benzodiazepines Barbiturates Amphetamine Cocaine Lysergic Acid Diethylamide (LSD) Psilocybin Ecstasy Mescaline Phencyclidine Bhang Ganja Charas Petrol Paint , Thinners Hair Spray Varnishes

7. Cycle of Addiction

8. Essential criteria for substance abuse disorder (ICD-11) Pattern of recurrent continuous use of the substance Harm to health of the individual due to consumption of the substance No evidence to suggest the harm to health of the individual The substance abuse leading to harm to others as well through the individual taking it Evidence of use of the substance for at least 12 months

9. Drug Deaddiction It is the process of delivering the subject free of addiction & maintaining in the addiction free state It is individualized as per the type of drug as well as the history of the addicts National Deaddiction program was launched in 1987 & modified in 1992 National drug dependence treatment center is at Ghaziabad There are about 122 deaddiction centers in country at present

10. Process of Drug Deaddiction Counselling Management of withdrawal symptoms Aversive Therapy Rehabilitation & Psychotherapy

11. Screening of substance abuse disorder Clinical Assessment Psychological Assessment Screening Questionnaire (AUDIT-C, CAGE for alcohol) Investigations (Viral markers, Chest Xray, USG) Drug screening / Toxicology test (Urine samples for drug detection)

12. Counselling & Motivation It is required to prepare the subject for de-addiction program Generally done on OPD basis Multiple sessions are organized Counsellor advises the subject for the most optimum method of de-addiction

13. Detoxification Refers to ridding the addict’s body of the drug It is carried out in institutions after admission of the addict Maintenance of hydration, nutrition and correction of deficiencies is vital at this step

14. Detoxification (contd.) Stopping the Drug Suddenly Gradual decrease of drug Substituting the addictive drug with other drug of same class It will lead to withdrawal symptoms Might be severe or fatal Effect is short lasting Requires supportive measures like i.v. fluids, sedatives No withdrawal symptoms seen Effect lasts longer Easy to manage The replacement drug should be slow and longer acting Examples – oral methadone for i.v. morphine /heroin

15. Pharmacological treatment Opioids : Oral methadone 20-40mg in 3-4 divided doses x 3 days Oral clonidine 0.1mg BD x 1-2 weeks Naltrexone 50mg/day x 7-10 days Alcohol : Oral Disulfiram 500mg/day x 1 week followed by 250mg Amphetamine : Supportive measures (i.v fluids) Cocaine : No specific treatment, supportive measures taken Anti-psychotic drugs can be used for psychotic symptoms

16. Rehabilitation Addiction is a chronic relapsing disorder It is to be managed with rehabilitation in long term Multiple methods including medical, behavioural and social are used Rehabilitation aims at preventing the addict to return to previous habit of drug abuse It can be done on opd basis or institutional both

17. Methods of Rehabilitation Blockage of positive reinforcement: Continuous use of drug enforces a pleasurable effect on addict Stopping the drug eventually leads to loss of interest of the addict Examples include – Naltrexone for opioid addiction Acamprosate for alcoholism They act on the reward system of brain , decreasing the reinforcement

18. Methods of Rehabilitation 2. Aversion therapy: It is a type of negative reinforcement It is indicated in subjects who sincerely desire to leave the habit It causes undesirable effects on taking the drug thus forcing the addict to leave the habit Examples – Disulfiram use in alcoholics

19. Methods of Rehabilitation 3. Psychological therapy Cognitive behavioural therapy Motivational therapy Family groups Peer groups like Alcoholic Anonymous Occupational therapy

20. Approaches to Drug Deaddiction Counselling & Motivation Detoxification Rehabilitation

21. National Deaddiction Helpline 14446 Drug Treatment Clinic KGMU

22. Summary Drug addiction is controlled by the reward pathway of brain Common drugs of abuse include opioids, alcohol, cannabis, cocaine, solvents and thinners Deaddiction aims at reducing craving of the drug, managing withdrawals and preventing relapse Rehabilitation forms an important part of deaddiction

23. References Tripathi KD. Essentials of Medical Pharmacology .9th ed. New Delhi, India: Jaypee Brothers Medical Publishers ; 2024.p.[191-200] Goodman & Gilman’s the pharmacological basis of therapeutics. 14 th ed. New York: Mc Graw Hill Publications ;2023.p.[550-571] Cheron, J., Kerchove d’Exaerde, A.d. Drug addiction: from bench to bedside.  Translational Psychiatry  11 , 424 (2021). https://doi.org/10.1038/s41398-021-01542-0

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