A REVIEW ON DRUG ADDICTION AND HABITUATION AND TREATMENT FOR DRUG ADDICTON

A REVIEW ON DRUG ADDICTION AND HABITUATION AND TREATMENT FOR DRUG ADDICTON

Shirish S. Patil * and Sourabh S. Malabade

Shri Appasaheb Birnale College of Pharmacy, Sangli, Maharashtra, India.

ABSTRACT: Drug addiction has become a worldwide problem and the leading cause of death. In recent years, India is seeing a rising trend in drug addiction. The most common drug use in India is alcohol, followed by cannabis and opiates. Drug use, whether licit or illicit, causes serious health problems in individuals. The national survey on drug use in India indicated that the prevalence of drug abuse among males in the general population is significant. Economic burdens disturbed family environments, violence, and psychological problems are other consequences of drug abuse in the family. Adolescent drug abuse is another major area of concern because more than half of the person’s with substance use disorder are introduced to drugs before the age of 15-year Drug treatment is intended to help addicted individuals stop compulsive drug seeking and use. Treatment can occur in a variety of settings, take many different forms, and last for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring. The current paper highlights the causes of drug abuse and describes the treatment and prevention of drug abuse and addiction to properly manage the problem.

Keywords: Drug addiction, HIV, Drug abuse, Psychoactive substances, Dependence, Licit  drugs, Illicit drugs, Alcohol, Cannabis, Opiate, Dopamine

INTRODUCTION:

Drug and Drug Use ¹: A drug is a substance that can be taken into the human body and, once taken, alters some processes within the body. Drugs can be used to diagnose, prevent or treat a disease. Some drugs are used to kill bacteria and help the body recover from infections. Some drugs assist in terminating headaches. Some drugs cross the blood-brain barrier and affect neurotransmitter function.

Overdoses: Overdosing refers to taking enough of a drug such that functioning is grossly impaired, and even survival may be jeopardized. Regarding drug use action, some doses produce the intended effect for a percentage of drug users (i.e., effective dose) and a dose that will kill the drug user (i.e., lethal dose). Different means of administration, time for distribution, time for action, time for elimination, and context factors may affect the effective-to-lethal dose relation.

Overdosing often refers to reaching a near-fatal dose but not always; it may also mean loss of function such that special care is needed. Drug addiction, as described by WHO (1950) is "a stage of periodic and chronic intoxication detrimental to the individual and society, produced by the repeated consumption of a drug (natural or synthetic)."

Its Characteristics Include:

1. An overwhelming desire, a need (compulsion) to continue taking drugs and to obtain it by any means;
2. A tendency to increase the dose;
3. A psychic (psychological), sometimes physical, dependence on the effects of the drugs.

Drug dependence is the process of chemicals that affect the central nervous system in a way experienced as pleasurable but hazardous to health if taken in immoderate amounts. More importantly, from the clinical point of view, their intoxicating effects may acquire a compulsive allure that it is so powerful as to defy rational control. Drug dependence is a psychological and physiological phenomenon where it becomes extremely difficult or impossible for the drug user to stop the habit. Psychological dependence occurs when a drug is so central to the person's thoughts, emotions, and activities that it is extremely difficult to stop or even think about it. An intense craving marks it for the drug and its effects.

Terminologies in Drug Abuse ^{1, 2}:

TABLE 1: TERMINOLOGIES IN DRUG ABUSE

Biology of Drug-Addiction ⁵:

Neurobiology of Reward: Organisms possess adaptive, evolutionarily determined systems that mediate the acquisition of pleasurable rewarding behavior needed for survival, i.e., sex, food, and social affiliation, and avoidance of aversive events. Three brain areas mediate such adaptive behaviour: the nucleus accumbens, which mediates reward-related activities (positive valence); the amygdala, involved in fear-motivated behaviour (negative valence) and the prefrontal cortex, involved in decision-making and prediction of rewarding behaviour by determining salience attribution of environmental stimuli and directing the intensity of the behavioural response. Balanced functioning of motivational and affective states combined with external stimuli that predict reward determine the overall output of a given behavioural response in acquiring natural reward.

What Happens to the Brain when Drugs are taken: Drugs tap into the brain’s communication system and disrupt the normal functioning of the brain cells sending, receiving, and processing information. There are two ways a drug can disrupt normal cell functioning:

1. By imitating the brain neurotransmitters
2. By over-stimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have structural similarities to some neurotransmitters naturally produced by the brain and fool the brain receptors and activate the nerve cells to send abnormal messages. Some drugs, such as cocaine and methamphetamines, stimulate the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. It produces greatly amplified messages and disrupts normal communication patterns. Almost all addictive drugs target the brain’s reward system by flooding the circuit with dopamine. These drugs activate the mesolimbic dopamine system, reinforcing pharmacological and natural rewards. The mesolimbic system consists of dopaminergic neurons in the ventral tegmental area (VTA) and their axonal projections to terminal fields in the nucleus accumbens (NA) and the prefrontal cortex (PFC). Addictive drugs act on this system to increase synaptic levels of dopamine (DA). These drugs have specific receptors in the brain, and an increase in dopamine levels in the mesolimbic system produces their final effect.

Causes of Drug Addiction ³:

1. Environmental Causes
2. Genetic causes
3. Development causes
4. Traumatic causes
5. Mental Health Causes

(A) Environmental Causes: A person's environment plays a large role in the development of drug addiction. Some people turn to drug use to cope with problems in their real lives. Being around drugs and being exposed to addicts can also lead to drug addiction. If a family member or close friend uses or is addicted to drugs, it seems more acceptable for other members to engage in similar behavior. It becomes a tolerated activity.

(B) Genetic Causes: Not everyone who tries a drug will become addicted. Researchers have determined that some people have a genetic predisposition to becoming addicted to drugs. For example, the dopamine D2 receptor A1 gene is more common in alcoholics and cocaine abusers than in the general public. Researchers believe this gene is linked to compulsive or feeling-seeking behavior. However, some people in the general public have this gene without developing an addiction; addiction likely involves more than just a gene and requires other factors to play a role. Researchers have also found other genes associated with an increased or decreased susceptibility to drug (or alcohol) addiction. CYP2A6 is more common in non-smokers and causes nausea and dizziness after smoking; people who have two copies of the ALDH*2 gene variation are less likely to become alcoholics.

(C) Developmental Causes: Events during development can increase one's risk of becoming addicted. Confused parental environments, childhood experiences, and early drug use can all have an influence. Adolescents are in a very vulnerable position because of their development or lack of it. The earlier drug use begins, the more likely it is to progress to abuse. Drug use changes the way the brain functions and makes it more likely that a person will become addicted; drug use makes it difficult to make clear decisions, control your behavior, and feel OK without the drug. Adolescents also lack the appropriate decision-making skills and are more prone to risk-taking behavior like drug use.

(D) Traumatic Causes: Drug use and abuse may also result from traumatic experiences. Sexual assault, a history of abuse, natural disasters, or post-traumatic stress disorder can all trigger drug or alcohol addiction.

(E) Mental Health Causes: Drug addiction can also be caused by using drugs to mask other mental problems. For example, depressed people frequently use drugs to escape their sad feelings. Schizophrenics find that some street drugs can control their hallucinations. In some cases, the drug use itself may lead to mental problems.

Drugs of Abuse ^{3, 4}:

Alcohol: People drink to socialize, celebrate, and relax. Alcohol often has a strong effect on people; throughout history, people have struggled to understand and manage alcohol’s power. Why does alcohol cause people to act and feel differently? How much is too much? Why do some people become addicted while others do not? The National Institute on Alcohol Abuse and Alcoholism is researching the answers to these and many other questions about alcohol. Here’s what is known:

• Alcohol’s effects vary from person to person, depending on a variety of factors, including:
• How much you drink
• How often you drink
• Your age
• Your health status
• Your family history
• While drinking alcohol is not necessarily a problem, drinking too much can cause a range of consequences, and increase your risk for various problems.

For more information on alcohol’s effects on the body, please see the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA’s) related web page describing alcohol’s effects on the body. NIAAA also has some information about mixing alcohol with certain medicines.

Ayahuasca: A hallucinogenic tea made in the Amazon from a DMT-containing plant (Psychotria viridis) along with another vine (Banisteriopsis caapi) that contains an MAO inhibitor preventing the natural breakdown of DMT in the digestive system, thereby enhancing serotonergic activity. It was used historically in Amazonian religious and healing rituals.

TABLE 2: DRUG OF ABUSE: AYAHUASCA

Central Nervous System Depressants: Medications that slow brain activity, which makes them useful for treating anxiety and sleep problems.

TABLE 3: DRUG OF ABUSE: CENTRAL NERVOUS SYSTEM DEPRESSANTS

Cocaine: A powerfully addictive stimulant drug made from the coca plant leaves native to South America.

TABLE 4: DRUG OF ABUSE: COCAINE

GHB: A depressant approved for narcolepsy, a disorder that causes daytime "sleep attacks."

TABLE 5: DRUG OF ABUSE: GHB

Heroin: An opioid drug made from morphine, a natural substance extracted from the seed pod of various opium poppy plants.

TABLE 6: DRUG OF ABUSE: HEROIN

Inhalants: Solvents, aerosols, and gases found in household products such as spray paints, markers, glues, and cleaning fluids; also nitrites (e.g., amyl nitrite), which are prescription medications for chest pain.

TABLE 7: DRUG OF ABUSE: INHALANTS

Ketamine: A dissociative drug used as an anesthetic in veterinary practice. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. For more information, see the Hallucinogens and Dissociative Drugs Research Report

TABLE 8: DRUG OF ABUSE: KETAMINE

LSD (Lysergic Acid): A hallucinogen manufactured from lysergic acid found in ergot, a fungus that grows on rye and other grains. LSD is an abbreviation of the scientific name lysergic acid diethylamide.

TABLE 9: DRUG OF ABUSE: LSD (LYSERGIC ACID)

Marijuana (Cannabis): Marijuana is made from the hemp plant, Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol or THC.

TABLE 10: DRUG OF ABUSE: MARIJUANA (CANNABIS)

MDMA (Ecstasy/Molly): A synthetic, psychoactive drug similar to the stimulant amphetamine and the hallucinogen mescaline. MDMA is an abbreviation of the scientific name 3, 4-methylenedioxy-metham-phetamine.

TABLE 11: DRUG OF ABUSE: MDMA (ECSTASY/MOLLY)

Methamphetamine: An extremely addictive stimulant amphetamine drug.

TABLE 11: DRUG OF ABUSE: METHAMPHETAMINE

Over-the-Counter Medicines:

Dextromethorphan (DXM): Psychoactive when taken in higher-than-recommended amounts.

TABLE 13: DRUG OF ABUSE: DEXTROMETHORPHAN (DXM)

Over the Counter Medicines:

Loperamide: An anti-diarrheal that can cause euphoria when taken in higher-than-recommended doses.

TABLE 14: DRUG OF ABUSE: LOPERAMIDE

PCP (Phenylcyclidine): A dissociative drug developed as an intravenous anesthetic that has been discontinued due to serious adverse effects. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. PCP is an abbreviation of the scientific name phencyclidine.

TABLE 15: DRUG OF ABUSE: PCP (PHENYLCYCLIDINE)

 Prescription Opioids: Pain relievers with an origin similar to that of heroin. Opioids can cause euphoria and are often used nonmedically, leading to overdose deaths.

TABLE 16: DRUG OF ABUSE: PCP (PHENYLCYCLIDINE)

Prescription Stimulants: Medications that increase alertness, attention, energy, blood pressure, heart rate, and breathing rate.

TABLE 17: DRUG OF ABUSE: PRESCRIPTION STIMULANTS

Rohypnol® (Flunitrazepam): A benzodiazepine chemically similar to prescription sedatives such as Valium® and Xanax®. Teens and young adults tend to misuse this drug at bars, nightclubs, concerts, and parties. It has been used to commit sexual assaults due to its ability to sedate and incapacitate unsuspecting victims.

TABLE 18: DRUG OF ABUSE: ROHYPNOL

Steroids (Anabolic): Man-made substances used to treat conditions caused by low levels of steroid hormones in the body misused to enhance athletic and sexual performance and physical appearance.

TABLE 19: DRUG OF ABUSE: STEROIDS (ANABOLIC)

Tobacco: Plant grown for its leaves, which are dried and fermented before use.

TABLE 20: DRUG OF ABUSE: TOBACCO

Disadvantages of Drug Addiction:

Treatment for Drug Addiction ⁴: There are many options that have been successful in treating drug addiction, including:

1. Therapies
2. Medication
3. Medical devices and applications used to treat withdrawal symptoms.

(A) Therapies: Therapies used in addiction treatment are based on an individual’s health and substance abuse patterns. Options for therapy include an array of individual or group therapy sessions, which addiction counselors typically organize.

Behavioral Therapies Help Patients:

• Modify their attitudes and behaviors related to drug use
• Increase healthy life skills
• Persist with other forms of treatment, such as medication
• Patients can receive treatment in many different settings with various approaches.

Outpatient Behavioral Treatment: It includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule. Most of the programs involve individual or group drug counseling, or both. These programs typically offer forms of behavioral therapy such as:

Cognitive-behavioral therapy helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs. Multidimensional family therapy developed for adolescents with drug abuse problems as well as their families addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning through motivational interviewing, which makes the most of people's readiness to change their behavior and enter motivational treatment incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs

Inpatient or Residential Treatment: It can also be very effective, especially for those with more severe problems (including co-occurring disorders). Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention. Residential treatment facilities may use various therapeutic approaches, generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment. Examples of residential treatment settings include:

Therapeutic communities are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. The entire community, including treatment staff and those in recovery, act as key agents of change, influencing the patient’s attitudes, understanding, and behaviors associated with drug use. Shorter-term residential treatment typically focuses on detoxification and providing initial intensive counseling and preparation for treatment in a community-based setting. Recovery housing provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.

(B) Medication ^{2, 3, 5}: Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. People who use more than one drug, which is very common, need treatment for all of the substances they use. in May 2018, the FDA approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms

Opioids: Methadone (Dolophine®, Methadose®), buprenorphine (Suboxone®, Subutex®, Probuphine®, Sublocade™) and naltrexone (Vivitrol®) are used to treat opioid addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone blocks the effects of opioids at their receptor sites in the brain and should be used only in patients who have already been detoxified. All medications help patients reduce drug-seeking and related criminal behavior and help them become more open to behavioral treatments.

A NIDA study found that once treatment is initiated, both a buprenorphine/ naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid addiction. Because full detoxification is necessary for treatment with naloxone, initiating treatment among active users was difficult, but once detoxification was complete, both medications had similar effectiveness.

Tobacco: Nicotine replacement therapies have several forms, including patches, spray, gum, and lozenges. These products are available over the counter. The U.S. Food and Drug Administration (FDA) has approved two prescription medications for nicotine addiction: bupropion (Zyban®) and varenicline (Chantix®). They work differently in the brain, but both help prevent relapse in people trying to quit. The medications are more effective when combined with behavioral treatments, such as group and individual therapy as well as telephone quitlines.

Alcohol: Three medications have been FDA-approved for treating alcohol addiction; a fourth, topiramate, has shown promise in clinical trials (large-scale studies with people). The three approved medications are as follows:

Naltrexone blocks opioid receptors involved in the rewarding effects of drinking and the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some patients. Genetic differences may affect how well the drug works in certain patients. Acamprosate (Campral®) may reduce long-lasting withdrawal symptoms, such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). It may be more effective in patients with severe addiction.

Disulfiram (Antabuse®) interferes with the breakdown of alcohol. Acetaldehyde builds up in the body, leading to unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the patient drinks alcohol. Compliance (taking the drug as prescribed) can be a problem, but it may help patients who are highly motivated to quit drinking

(C) Devices: Devices can help suppress withdrawal symptoms during detoxification. Detoxification is not in itself "treatment" but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications (SAMHSA, 2014).

In November 2017, the Food and Drug Administration (FDA) granted a new indication to an electronic stimulation device, NSS-2 Bridge, for use in helping reduce opioid withdrawal symptoms. This device is placed behind the ear and sends electrical pulses to stimulate certain brain nerves.

CONCLUSION: Drug use and addiction cause a lot of diseases and disabilities in the world. Recent advances in neuroscience may help improve policies to reduce the harm that the use of tobacco, alcohol and other psychoactive drugs impose on society.

Effective action should take into account the following:

• Since, the effects of drugs on health vary greatly depending on the type of drug and on the way it is used, the public health response to drug use should be proportional to the health-related harm it causes.
• The use of psychoactive substances is expected because of their pleasurable effects and social influences. The greater the frequency and amount of drug used, the higher the risk of becoming dependent.
• Effective public health policies and programmes that address drug dependence and other forms of harmful drug use could significantly reduce the overall health burden of drug use.
• The risk of becoming dependent on drugs is determined by biological, genetic, psychological, social, cultural, and environmental factors. Currently, it is impossible to predict who will become drug dependent.
• Drug dependence is a medical disorder, not a lack of willpower or strength of character.
• Drug dependence and mental illnesses often affect the same individuals. Therefore, it would be useful to integrate research, assessments, and treatments for both disorders.
• The cost-effective treatment and management of drug dependence can save lives, improve health, and reduce costs to society. Beyond stopping drug use, effective treatment requires changes in the behaviour of users and often the use of substitute drugs.
• Treatment must be accessible to all in need and the health care sector should provide the most cost-effective treatments.

ACKNOWLEDGEMENT: Nil

CONFLICTS OF INTEREST: Nil

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   How to cite this article:

   Patil SS and Malabade SS: A review on drug addiction and habituation and treatment for drug addicton. Int J Pharm Sci & Res 2023; 14(1): 157-71. doi: 10.13040/IJPSR.0975-8232.14(1).157-71.

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