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Dr. Ariful Bari ChowdhuryDepartment of Public Health

North South University

Drug Addiction

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Drug addiction means compulsive, out of control drug use despite negative consequences.

Addictive drugs induce pleasurable states or relief from distress thus motivating repetition.

Basic Terminologies

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Basic Terminologies

Types of addiction:1) Physical addiction: It develops when a person’s

body becomes dependent on a particular substance.If a physically addicted person stops using a substance then he may develop withdrawal symptoms like muscle cramp, watering from eyes and nose, anxiety, confusion, sleeplessness and fits.

2) Psychological addiction: happens when the cravings for a drug are psychological or emotional. People who are psychologically addicted feel overcome by the desire to have a drug. They may lie or steal to get it.

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Signs of AddictionSigns of physical addiction: Changes in sleeping habit Changes in eating habit Weight loss or gain Feeling shaky or sick when trying to stop

Signs of psychological addiction: Problem with work at home, school or office Loss of interest in activities that used to be important Changes in friendship Anxiety, anger or depression Stealing or selling belongings to be able to afford

drugs Spending a lot of time figuring out how to get drugs

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Anatomy & Physiology of Addiction

• Addictive drugs act on brain’s reward neurons.• Main component of brain’s reward neurons is

dopamine.• Dopamine is a neurotransmitter which is

released from neurons of the brain to perform different activities.

• Functions of dopamine:

1. Control of behavior, memory, learning

2. Control of voluntary movement

3. Inhibition of prolactin production

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Circuits Involved In Drug Addiction

All of these must be consideredin developing strategies to effectively treat addiction

All of these must be consideredin developing strategies to effectively treat addiction

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Anatomy & Physiology of Addiction

• Dopamine is released from the brain in response to naturally rewarding experiences like food, sex, drug etc.

• Majority of the addictive drugs like nicotine, cocaine, amphetamine directly or indirectly cause an increase of dopamine level in the body.

• Dopamine provides feelings of enjoyment and thereby motivates a person to desire for the rewarding experience like food, sex, drug which cause an increase in dopamine level and thereby gives more pleasurable feelings.

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Brain…Brain…

Gets Rewired

by Drug Use

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Risk Factors• Family issues• Emotional trauma• Curiosity or imitation• Bad influence of friends• Poor self-image• Low religiosity• Poor school performance or any problem at school• Parental rejection• Family dysfunction• Over or under-controlling by parents• Family history• Divorce or romantic breakup• Abuse

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Different Types of Drugs

Cannabinoids: Hashish, Marijuana• How Consumed: Swallowed, smoked• Effects: Euphoria, slowed thinking,

confusion, impaired balance and coordination

• Consequences of long term use: Cough, frequent respiratory infections, impaired memory, increased heart rate, anxiety, panic attacks

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Depressants

• Depressants: Barbiturates, benzodiazepines • How Consumed: Swallowed, injected• Effects: Reduced anxiety, feeling of well-

being, slow pulse and breathing, low blood pressure, poor concentration

• Consequences of long term use: Fatigue, confusion, impaired memory & judgment, respiratory depression and death

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Anesthetics

• Anesthetics: Ketamine• How Consumed: Injected, swallowed,

smoked• Effects: Increased heart rate and blood

pressure, impaired motor function, panic, aggression

• Consequences of long term use: Memory loss, numbness, nausea/vomiting, depression

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Hallucinogens

• Hallucinogens: LSD• How Consumed: Swallowed, smoked• Effects: Increased body temperature, heart

rate, blood pressure, loss of appetite, sleeplessness, numbness, weakness, tremors, nausea

• Consequences of long term use : Persisting perception disorder

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Opiods

• Opiods: Codeine, heroin, morphine, opium • How Consumed: Injected, swallowed,

smoked• Effects: Pain relief, euphoria, drowsiness • Consequences of long term use: Nausea,

constipation, confusion, sedation, respiratory depression and arrest, unconsciousness, coma, death

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Stimulants

• Stimulants: Amphetamine, cocaine, methamphetamine, nicotine

• How Consumed: Injected, smoked, swallowed

• Effects: Increased heart rate, blood pressure, metabolism, feelings of exhilaration, energy, increased mental alertness

• Consequences of long term use : Rapid or irregular heart beat, reduced appetite, weight loss, heart failure, nervousness, insomnia

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Other• Steroid • Injected, swallowed, applied to skin• Hypertension, blood clotting and cholesterol changes,

liver cysts and cancer, kidney cancer, hostility and aggression, acne, premature stoppage of growth, prostate cancer, reduced sperm production, shrunken testicles, breast enlargement, menstrual irregularities, development of beard and other masculine characteristics

• Dextromethorphan • Swallowed• Distorted visual perceptions, memory loss, numbness,

nausea/vomiting

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AlcoholAlcohol

• How Consumed: Swallowed • Effects: It is an addictive agent that

depresses the central nervous system. • Consequences of long term use: Alcohol is

cumulatively poisonous and damages many organs of the body when used excessively (including the brain, liver, and heart). Chronic, heavy use of alcohol may lead to irreversible physical and neurological damage.

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Physical Impact

• Damage of Different body parts• Brain and liver damage – Alcohol• Lung and heart disease – Marijuana• Stroke and heart disease – Cocaine• Heart disease and liver damage – Amphetamine

• Problems with Pregnancy• Transmission of STD and various other diseases occur

due to sharing of contaminated syringes • Overdose of cocaine, heroine, alcohol can kill someone

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Psychological Impact• Influence of Amphetamines

• Makes people alert, energetic

& confident.• Influence of Steroids

• Leads to confusion, depression & paranoia.• Influence of Cocaine

• Similar to amphetamines but short lived.• Regular users often become nervous, excited, euphoric,

nauseous.• Influence of Alcohol

• Might lead to sweating, anxiety, trembling.• Influence of Analgesics

• Makes people drowsy, contended.• Influence of Marijuana

• Low dose leads to depression• High dose makes user distressed

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Social Impact

• On Family & Community

• Distance grows with family members

• Socially accepted norms are not followed

• Drug abuse effects Central Nervous System which changes mood and reduces the capability of tolerating other people

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Impacts on Education

• Overall performance decreases

• Marijuana kills brain cells and disrupt learning ability

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Impacts on Employment

• Work efficiency decreases

• Abusers have 55% more chances of industrial accidents and 85% more chances of injuries

• Drug abuser employee becomes liability

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Impacts on Criminal Activities

• Rise in both violent & acquisitive crime

• Abusers often resort to various crimes for money

• Strong link found between violent crimes & drugs

• Influence of alcohol is found in 50% of murderers and 70% of assaulters.

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Treatment Strategies For Clients With Substance Abuse Problems

• Cognitive-Behavioral Therapies: Helps clients develop the skills to deal with their addictions (e.g. self-control, coping mechanisms, relapse prevention.)

• Individual Psychodynamic/Interpersonal Therapies: Formulation of the counseling relationship and skill development.

• Group Therapies: Gives support and encouragement and generates problem-solving strategies.

• Family Therapy: Some feel family therapy is necessary as the addiction affects the family and the family affects the addiction.

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Stages of Change During Treatment

• Precontemplation: Clients are resistant and deny they have a problem.

• Contemplation: Clients are aware they have a problem and are actively wondering what they should do about it.

• Preparation: Client have taken some action, were unsuccessful, but plan to try again.

• Action: Clients are taking action and are making changes.

• Maintenance: Efforts are on relapse prevention.

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Relapse Prevention

• It is estimated that 90% of all clients have a relapse within four years of treatment.

• Factors that influence: Changes in lifestyle or stress reduction .

• Preventative factors: Coping mechanisms and self-efficacy development.

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The Counseling Process

• Develop trust

• Assess the problem

• Establish goals

• Implement a plan

• Train for relapse avoidance or minimization

• Termination

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The Counseling Process

• Structuring the Sessions: Most counselors provide strict guidelines (e.g. come straight; do homework etc.)

• Assessment: Examples of questions that need to be answered are:• How significant is the problem?• How long has the client been a user?• Has the client tried to stop?• Does the client have a another disorder?• How has the client been functioning socially?

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The Counseling Process

• Goal Setting: It is usually either abstinence or controlled use. It might also include behavioral change or lifestyle change.

• Plan Implementation: Implementation of plans to meet goals.

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The Counseling Process

• Relapse Prevention: Relapses are most likely to occur within six months. Help the client become aware of what his or her triggers for relapse are and develop a plan to deal with these.

• Termination: Termination occurs when both counselor and client feel the client can cope without the substance.

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Protective Factors for Adolescents to prevent Drug

Addiction• Nurturing home with good communication• Teacher commitment• Positive self-esteem• Self-control• Assertiveness• Social competence• Academic achievement• Religiosity• Intelligence• Avoiding bad peers

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Topics to studied in the next class

• Global burden of drug addiction• Bangladesh burden of drug addiction• Smoking among adolescents, adverse

health outcomes and prevention

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