Abuse and addiction have been defined and redefined by several organizations over the past 35 years. The reason for these revisions and disagreements is that abuse and addiction are behavioural syndromes that exist along a continuum from minimal use to abuse to addictive use. While tolerance and physical dependence are biological phenomena that can be defined precisely in the laboratory and diagnosed accurately in the clinic, there is an arbitrary aspect to the definitions of the overall behavioural syndromes of abuse and addiction.

The appearance of a withdrawal syndrome when administration of the drug is terminated is the only actual evidence of physical dependence. Withdrawal signs and symptoms occur when drug administration in a physically dependent person is terminated abruptly. Withdrawal symptoms have at least two origins: (1) removal of the drug of dependence and (2) CNS hyper arousal owing to readaptation to the absence of the drug of dependence. Pharmacokinetic variables are of considerable importance in the amplitude and duration of the withdrawal syndrome. Withdrawal symptoms are characteristic for a given category of drugs and tend to be opposite to the original effects produced by the drug before tolerance developed.

Thus, abrupt termination of a drug (such as an opioid agonist) that produces meiotic (constricted) pupils and slow heart rate will produce a withdrawal syndrome including dilated pupils and tachycardia. Tolerance, physical dependence, and withdrawal are all biological phenomena. They are the natural consequences of drug use and can be produced in experimental animals and in any human being who takes certain medications repeatedly. These symptoms in themselves do not imply that the individual is involved in abuse or addiction.

Patients who take medicine for appropriate medical indications and in correct dosages still may show tolerance, physical dependence, and withdrawal symptoms if the drug is stopped abruptly rather than gradually. For example, a hypertensive patient receiving a b adrenergic receptor blocker such as metoprolol may have a good therapeutic response, but if the drug is stopped abruptly, the patient may experience a withdrawal syndrome consisting of rebound increased blood pressure temporarily higher than that prior to beginning the medication.

Medical addict is a term used to describe a patient in treatment for a medical disorder who has become “addicted” to the available prescribed drugs; the patient begins taking them in excessive doses, out of control. An example would be a patient with chronic pain, anxiety, or insomnia who begins using the prescribed medication more often than directed by the physician. If the physician restricts the prescriptions, the patient may begin seeing several doctors without the knowledge of the primary physician. Such patients also may visit emergency rooms for the purpose of obtaining additional medication.

This scenario is very uncommon, considering the large number of patients who receive medications capable of producing tolerance and physical dependence. Fear of producing such medical addict results in needless suffering among patients with pain because physicians needlessly limit appropriate medications. Tolerance and physical dependence are inevitable consequences of chronic treatment with opioids and certain other drugs, but tolerance and physical dependence by themselves do not imply “addiction.”

The treatment of physically dependent individuals will be discussed with reference to the specific drug of abuse and dependence problems characteristic to each category: CNS depressants, including alcohol and other sedatives; nicotine and tobacco; opioids; psychostimulants, such as amphetamine and cocaine; cannabinoids; psychedelic drugs; and inhalants (volatile solvents, nitrous oxide, and ethyl ether). Abuse of combinations of drugs across these categories is common.

Alcohol is so widely available that it is combined with practically all other categories. Some combinations reportedly are taken because of their interactive effects. An example is the combination of heroin and cocaine (“speedball”), which will be described with the opioid category. Alcohol and cocaine is another very common combination. When confronted with a patient exhibiting signs of overdose or withdrawal, the physician must be aware of these possible combinations because each drug may require specific treatment.

The need is of the fact that every government should introduce programs to educate its people. Drug addicts eventually become a parasite for society. They do not only become great trouble for their family but for a society as well. Many skilful individuals ruin their life by taking these drugs regularly. This is sad indeed!

By: Ammarah Khan


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