DRUG ADDICTION AND ALCOHOLISM Yard. Doç. Dr. N. Berfu Akbaş Yeditepe Üniversitesi Psikiyatri Anabilim Dalı

DEPENDENCE: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, manifested by TOLERANCE, WITHDRAWAL, PERSISTANT DESIRE, a great time and activity spent, social activities given up, use is continued despite knowledge of harms. ABUSE: recurrent substance use in a failure to fulfill major role obligations, use in situations physically hazardous, recurrent legal problems, continued use despite social and interpersonal problems INTOXICATION: the development of a reversible substance-specific syndrome due to recent exposure ( clinicaly significant maladaptive behavioral or psychological changes on central nervous system ) WITHDRAWAL: the development of a reversible substance-specific syndrome due to the cessation of substance

ALCOHOL RELATED DISORDERS %0.05 in blood: thought, judgment, restraint loosened % 0.1 : voluntary motor actions clumsy % 0.3 : confusion and stupor 0.5 promil: 0.5gr alcohol in 1lt blood: %0.063 alcohol Intoxication: inappropriate behaviour, mood lability, impaired judgement, slurred speech, incoordination, nystagmus, impaired attention amd memory, coma Withdrawal: autonomic hyperactivity, hand tremor, insomnia, nausea-vomitting, hallusinations, illusions, psychomotor agitation, anxiety, grand mal seizures Delirium Tremens: Alcohol ıntoxication delirium, mortal %20. ın 1 week after alcohol cessation. Hallusinations, delusions, tachycardia, diaphoresis, fever, hypertension, hyperexcitability or lethargy

Wernicke-Korsakoff Sydrome: alcohol-induced persisting amnestic disorder. Thiamine deficiency. Wernicke’s Encephalopaty: alcoholic encephalopaty, ataxia, confusion, nystagmus, gaze palsy, anisocoria. Reversible if treated, if not→ Korsakoff’s Sydrome: chronic amnestic sydrome. Marciafava-Bignami Syndr: demyelination of corpus callosum, optic tracts, cerebellar peduncles. Medical complications of alcohol use: Liver damage, peptic ulcer, pancreatitis Peripheral neuropathies, myopathy, hepatocerebral degeneration, cerebellar degeneration, HT, stroke cardiomyopathy, anemia, electrolyte imbalances Ca of mouth, pharynx, liver, breast

Idiosyncratic alcohol intoxication: small amounts, agression Pathological jealosy Alcoholic hallusinosis: auditory

AMPHETAMINE-RELATED DISORDERS Ice, crystal, speed, XTC, adam, eve...psychostimulants. Metamphetamine, ephedrine, pseudoephedrine A single dose ( 5mg): ıncrease the sense of well-being, elation, euphoria, friendliness, improve attention, increase performance, anorexia Severe hypertension, myocardial infarction, cerebrovascular infarction, ischemic colitis, seizures, coma.

CAFFEINE RELATED DISORDERS A cup of coffee: 100-150mg. Caffeine ( methylxanthine) Low doses: + reinforcer, doses > 300mg: increased anxiety and mild dysphoria. Global cerebral vasoconstriction Intoxication:restlessness,nervousness, excitement, muscle twitching, cardiac arrhytmia Withdrawal: fatique, drowsiness, anxiety and depression, nausea and vomitting

CANNABIS-RELATED DISORDERS Hashish ( flower), marijuana ( leaves) Red eye, tachycardia, increased appetite, hypotension, long term use; cerebral atrophy, seizures, chromosomal damage, decreased testesterone, amotivational syndrome

COCAINE-RELATED DISORDERS Produces euphoria→personality changes, impulsive behaviour, weight loss, insomnia,nasal congestion, cerebrovascular, cardiological disorders ( arritymia, MI, CMP )seizures, death crash syndrome ( post intoxication depression) formication ( cocaine bugs)

Hallucinogen Related Disorders: mushrooms( psilocybin), mescaline ( cactus),LSD “hallucinogen persisting perception disorder”- “flashbacks” Inhalant Related Dısorders: solvents, glues, thinners, paints Maladaptive behavioral and psychological changes Nicotine related disorders:improved attention,learning, reaction time, skeletal muscle relaxation→long term use decrease CBF Toxication.: nausea, vomit, abdominal cramps, confusion, HT, tremors

Opioid Related Disorders: morphine, heroin, fentanyl, codeine. Euphoric high ( rush )→ sedation, respiratory depression, pinpoint pupils, smooth muscle contraction, anaphylactic shock, arrithmia, constipation,HT... Sedative-hypnotic Related Disorders:benzodiazepines, barbiturates Anabolic Steroid abuse: testesterone analogs İnitially induce euphoria and hyperactivity→ anger, irritability, hostility, anxiety, depression, manic states