Professional Documents
Culture Documents
Drug Abuse
Prof.Dr.dr.M T Kamaluddin,M.Sc.,SpFK
Bagian Farmakologi
Fakultas Kedokteran Unsri
2012
SUBSTANCE ABUSE
DRUG
Neurobiology
Behavior
Manjadda wajadda
Addiction
dr.Choiriah 6
Rethinking the Social Environment: Integrating
Social and Genetic Epidemiology
Future Initiative?
Manjadda wajadda dr.Choiriah 7
• A person’s social environment
includes their human relationships,
living and working conditions, income
level, educational background and
the communities they are a part of.
All of these are shown to have a
powerful effect on health.
Manjadda wajadda dr.Choiriah 8
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Epidemiological Triad
Host
Drug Abuse
Social Agent/Vector
Environment
time/history
Berkman and Kawachi social epidemiology as the study of the distribution of health
outcomes and their social determinants. This definition builds on the classic
epidemiologic triangle [SWITCH TO SLIDE] of host, agent, and environment to focus
explicitly on the role of social determinants in disease transmission and progression.
Nancy Krieger
Manjadda describes these determinants
wajadda are the “features and pathways by 10
dr.Choiriah which
societal conditions affect health.
Biological explanations for
the use and abuse of drugs.
Genetic theory
– predisposition to drug use can be
found in the gene structure
“Addiction to pleasure”
it is biologically normal to continue a
pleasure stimulation when drugs are
proven to be a pleasurable experience
Manjadda wajadda dr.Choiriah 11
Biological explanations for
the use and abuse of drugs.
Q. All the major biological explanations
related to drug abuse assume that
these substances exert their
psychoactive effects by altering brain
chemistry. Drugs of abuse interfere
with chemical messengers of the
brain called .
A. neurotransmitters
Manjadda wajadda dr.Choiriah 12
Biological explanations for
the use and abuse of drugs.
Q. It is generally believed that
most drugs with abuse potential
enhance the pleasure centers by
causing the release of what
specific brain neurotransmitter?
A. dopamine
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Drugs can be “Imposters” of
Brain Messages
Motivation
Dopamine
Addiction
Manjadda wajadda dr.Choiriah Reward & well-being21
Dopamine is a brain chemical
involved in many different
functions including movement,
motivation, reward — and
addiction. Nearly all drugs of abuse
directly or indirectly increase
dopamine in the pleasure and
motivation pathways and in so
doing, alter the normal
communication between neurons.
Manjadda wajadda dr.Choiriah 22
The Neuron: How the Brain’s
Messaging System Works
Dendrites
DA Concentration (% Baseline)
200 200
NAc shell
% of Basal DA Output
150 150
100 100
Empty
50
Box Feeding
Female Present
0
0 60 120 180 Sample 1 2 3 4 5 6 7 8
Time (min) Number
% of Basal Release
900 DA
% of Basal Release
300 DOPAC
800 DA HVA
700 DOPAC
600 HVA 200
500
400
300 100
200
100
0 0
0 1 2 3 4 5 hr 0 1 2 3 4 5 hr
% of Basal Release
Accumbens 0.5 mg/kg
% of Basal Release
Caudate 200
1.0 mg/kg
150 2.5 mg/kg
150 10 mg/kg
100
100
0
0 1 2 3 hr 0
0 1 2 3 4 5 hr
Manjadda wajadda
Time After Drug dr.Choiriah 33
Time After Drug
Di Chiara and Imperato, PNAS, 1988
Nearly all drugs of abuse increase dopamine
neurotransmission. This slide shows the increase
in brain dopamine (DA) levels (measured in
animals) following exposure to various drugs of
abuse. All of the drugs depicted in this slide have
different mechanisms of action, however they all
increase activity in the brain reward pathway by
increasing dopamine neurotransmission. It is
because drugs activate these brain
regionsusually more effectively and for longer
periods of time than natural rewardsthat they
have an inherent risk of being abused.
introversion extroversion
Drug Abuse
& Addiction
• Characterized by:
– Compulsive Behavior
– Continued abuse of drugs despite negative
consequences
– Persistent changes in dr.Choiriah
Manjadda wajadda
the brain’s structure and 48
function
Decades of research have revealed addiction
to be a disease that alters the brain. We now
know that while the initial decision to use drugs is
voluntary, drug addiction is a disease of the brain
that compels a person to become singularly
obsessed with obtaining and abusing drugs
despite their many adverse health and life
consequences.
YELLOW
shows places in
brain where
cocaine binds
(e.g., striatum)
Low
Healthy Brain Diseased Brain/ Healthy Diseased Heart
Cocaine Abuser Heart
1.6%
1.6% CANNABIS
% in each age group who
1.4%
1.4% ALCOHOL
1.2%
1.2%
1.0%
1.0%
0.8%
0.8%
0.6%
0.6%
0.4%
0.4%
0.2%
0.2%
0.0%
0.0%
55 10
10 15
15 21
21 25
25 30
30 35
35 40
40 45
45 50
50 55
55 60
60 65
65
Age
psychological dependence
physiological dependence
mental disorder
aberrant behavior
• narcotic drug
• psychotropic drug
• Withdrawal reaction
• Bradycardia Aspiration
• Tolerance
– Happens with all sedative-hypnotics
– Appears very quickly even during short-
term use.
– Discontinuation will bring receptor
response back to normal after drug has
been metabolized
– Withdrawal symptoms may take up to a
week to see in some patients
Manjadda wajadda dr.Choiriah 91
Chloral hydrate
• “Micky Finn” when mixed with alcohol
• Rapidly absorbed, acts quickly
• Drowsiness, sleep
• Alcohol, chloral hydrate compete for
metabolism by same enzyme
• Prolonged action for both when mixed
• Not commonly abused
Manjadda wajadda dr.Choiriah 92
Barbiturates
• Introduced in 1903
• Replaced older sedative-hypnotics
• Quickly became major health problem
• In 1950’s-60’s barbiturates were
implicated in overdoses; were responsible
for majority of drug-related suicides
• Examples
– Indole hallucinogens – Amphetamine-like
• LSD (acid) hallucinogens
• Morning-glory • Peyote
seeds • Mescaline
• Psilocybin • DOM
• DMT • MDA
• MDMA (ecstasy)
Insulate to withdrawal
Substitution therapy
Barbiturates:Phenobarbital
Alcohol:clormethiazole;clorazepate
Opioid:methadone;
The earlier a person begins to use drugs the more likely they are to progress to
more serious abuse
Some people will never develop diabetes because they never go over a certain
weight –much like some people will never become drug dependent because they
never try drugs. If they did they would in both cases
People usually sniff it through the nose (snort), smoke or inject it.
It can also be swallowed, in the form of tablets or capsules
Speed is often mixed or ‘cut’ with other things that look the same to make the
drug go further
Some mixed-in
Manjadda wajadda substances can have dr.Choiriah
unpleasant or harmful effects 169
ICE
•Making ice, the smokable form of methamphetamine, from standard quality
methamphetamine HCl is essentially a purification process. Methamphetamine HCl is
added slowly to water that has been heated 80-100°C until a supersaturated solution is
obtained. When the slurry is cooled, pure HCl salt of methamphetamine (ice)
precipitates. Methamphetamine HCl, unlike cocaine HCl, is volatile and can be
smoked. Other solvents, such as isopropanol, have been used in place of water to
speed the process. Uncontrolled variations of this process can result in unreliable
removal or addition of impurities. The physical characteristics of the final product
depend on the quality and type of reagents used and on contaminants that may have
been introduced. The lack of significant further processing of methamphetamine HCl
has resulted in increased availability and popularity of smoking the drug.
•One reason for the popularity of smoked methamphetamine is the immediate
clinical euphoria that results from the rapid absorption in the lungs and deposition
in the brain.
•Smoking methamphetamine HCl powder, crystals, or ice occurs first by placing
the substance into a piece of aluminum foil that has been molded into the shape of
a bowl, a glass pipe, or a modified light bulb and heating it over the flame of a
cigarette lighter or torch. Then, the volatile methamphetamine fumes are inhaled
through a straw or pipe.
From emedincine.com
Manjadda wajadda dr.Choiriah 170
Methamphetamine
• Well-being to Euphoria
• Increased Energy
• Enhanced Mental Activity
• Increased Sex Drive
• Decreased Need for Sleep
• Decreased Appetite
• Increased Sensory Awareness and Alertness
• Feeling of Omnipotence
• Intensify Emotions
• Alter Self-esteem
• Increased aggressiveness
Manjadda wajadda dr.Choiriah 174
Reasons for First Use of Methamphetamine March 1998- Nov 1998
RUSH
(5-30 Min.) BINGE (3-15 Days )
TWEAKING
(4-25 Hours)
NORMAL NORMAL
(2-14 Days)
WITHDRAWAL
(30-90 DAYS)
• Man-made • Plant-derived
• Daily use • Recreational use
• Longer binges • Intermittent binges
• Smoking produces • Smoking produces
a high that last 8-24
hours a high that lasts 20-
30 minutes
• 50% of the drug is
removed from the • 50% of the drug is
body in 12 hours removed from the
body in 1 hour
Manjadda wajadda dr.Choiriah 177
Meth vs. Cocaine Effects on the Brain
Cocaine
Methamphetamine
Dopamine Index
Cheeseburger 1.5
Sex 2.0
Nicotine 2.0
Cocaine 4.0
Methamphetamine 11.0
Source: UCLA Integrated Substance Abuse Programs. Michael Mode/The Oregonian
Manjadda wajadda dr.Choiriah 179
Effects of Methamphetamine Use on the Brain
• Paranoia
• Visual and auditory hallucinations
• Mood disturbances
• Delusions (ex. The sensation of insects
creeping on the skin)
• Homicidal thoughts
• Suicidal thoughts
• Out of control rages
• Can persist for years after use discontinued
Manjadda wajadda dr.Choiriah 186
Other Effects of Chronic Meth Use
• Tooth decay
• Hepatitis B and C
• STD’s : sexually transmitted disease
• HIV : associated with needle use and unprotected sex
• Sexual Impotence
• Cognitive impairment (reduced ability to process
information)
• Unplanned pregnancy, victims of domestic violence
• Physical:
Polyphagia (excessive hunger)
Hypersomnolence (sleepiness)
• Psychological:
Depression
Anxiety/agitation “Free floating” anxiety
Delusional state lasting up to a week
Fatigue/malaise
Paranoia
Hallucinations
Aggression
Intense craving for the drug
Manjadda wajadda dr.Choiriah 191
Abstinence Syndrome
After awaking from the crash, symptoms continue:
Psychological/Behavioral Symptoms
• Affordable
• Available
• Appetite suppressor
• Energy enhancer
• Weight loss
• Mood elevator
• Libido enhancer
• The growing illicit drug of choice among young
women
• 47% of those presenting for meth treatment females,
other substances 20-25% females
Manjadda wajadda dr.Choiriah 194
The impact on children may be connected to the
fact that women are more likely to use meth than
other illegal drugs.
For one thing, the drug is associated with weight
loss.
You can take exception to the person’s behavior but you must
accept the person in order to make progress.
Relapse rates for drug-addicted patients are compared with those suffering from
diabetes, hypertension, and asthma. Relapse is common and similar across these
illnesses (as is adherence to medication). Thus, drug addiction should be treated
like any other
Manjadda chronic illness, with relapse
wajadda serving as a trigger for renewed
dr.Choiriah 203
intervention.
People Can and Do Recover from Meth Addiction
Outcomes data provided by SSAs confirm that people can and do recover from meth
addiction. Examples include:
• Colorado’s Alcohol and Drug Abuse Division reported in FY 2003 that 80% of
meth users were abstinent at discharge.
• Iowa’s Division of Behavioral Health and Professional Licensure found, in a 2003
study, that 71.2% of meth users were abstinent 6 months after treatment.
• Tennessee’s Bureau of Alcohol and Drug Abuse reported in a 2002-2003 study that
over 65% meth clients were abstinent 6 months after discharge.
• The Texas Department of State Health Services examined outcomes data for
publicly funded services from 2001-2004 and found that approximately 88% of meth
clients were abstinent 60 days after discharge.
• Utah’s Division of Substance Abuse and Mental Health reported that in State Fiscal
Year 2004, 60.8% of meth clients were abstinent at discharge.
Relapse
Stage
Motivational
Enhancement Assessment
Strategies & Treatment Relapse
Matching Prevention
& Relapse
Management
Manjadda wajadda dr.Choiriah 216
Treating a Biobehavioral Disorder Must Go
Beyond Just Fixing the Chemistry
We Need to Treat the
Whole Person!
Pharmacological Behavioral Therapies
Treatments
(Medications)