Substance abuse and addiction

Toxicomania and drug addiction - diseases caused by the use of various substances that cause a state of intoxication. Demonstrated a constant need for the intake of these substances, mental disorders, somatic and neurological disorders, a decrease in working capacity, loss of social ties, degradation of the individual. Depending on the substance used for intoxication, there are numerous forms of substance abuse. Due to their high criminality, special drug control is subject to special social control. The list of drugs is approved by the WHO Expert Committee on Drugs. In the USSR, drugs (the term is inaccurate, since it refers to substances not only of sedative action) include drugs of the opium group, a number of synthetic analgesics, hashish (anasha), stimulants, including ephedrine. Other drugs that can be addictive (tranquilizers, hypnotics) are also limited when used for medicinal purposes. Control over many non-narcotic substances used for the purpose of intoxication is difficult because of their widespread prevalence (household chemicals, etc.).

Symptoms, course. For substance abuse is typical of the so-called large drug addiction syndrome (the term is inaccurate, due to the fact that drug addiction was studied first among drug addicts). It includes syndromes of altered reactivity to a particular substance; Mental dependence on a particular substance; Physical dependence; Consequences of chronic intoxication. The syndrome of altered reactivity - an indicator of habituation - indicates a change in the biotransformation of a substance and a distorted response to intoxication of physiological systems. The intake of the substance in the previous doses does not have the desired effect, its effect is shortened, and when overdosage there are no protective reactions. The increase in tolerability is manifested in high single and daily doses (increased intake), in the ability to tolerate daily intoxication, in the disappearance of post-toxication (the next day) disorders. The action of an intoxicating substance varies: the sedative causes activation, the stimulant begins to cause anxiety, the paranoid mood, and a number of other substances - a psychotomimetic effect with an influx of hallucinations.

The syndrome of mental dependence means that the mental state of the patient is already determined by the presence or absence in his body of an intoxicating substance. The absence of it causes irritability, conflict, anxiety, the inability to concentrate on anything, since thoughts are only occupied with where to get the intoxicant. Anyone who prevents the achievement of the goal, causes hatred, those who contribute, sympathy. The syndrome of physical dependence shows that all the systems of the body are involved in the disease - a new, drug-induced homeostasis has been formed. Out of intoxication, the abstinent state develops: relaxation, the fall of muscle, cardiovascular tone, the inability to perform even unskilled physical work. Attraction to intoxication is pronounced and has external signs - mydriasis, pallor, tremor, motor anxiety. The absence of an intoxicating substance causes an acute dysfunctional state, expressed by somato-neurologic excitation (mostly sympathetic), dysphoria. In a state of abstinence, patients are dangerous to themselves and others (suicide, aggression, crime).

In substance abuse, life activity is maintained at a certain level only under the condition of constant intake of intoxicants. With a regular intake of the necessary dose, the condition is safe, but only in comparison with the withdrawal syndrome. With the exception of some forms of drug addiction, even on a background of intoxication sufficient for him, the toxicomaniac is mentally and physically incapable of productive activities, reasonable contacts with others. The syndrome of the consequences of chronic intoxication has the basis of steadily oncoming psychophysical, energy exhaustion. Mental changes develop in the range from asthenic syndrome, neurosis-like conditions to apatoabulic syndrome and gross dementia of an organic nature. Obligatory psychopathy of the individual, which is heavier than the social conflict of the toxicoman. Somatoneurological changes caused by disruption of the drug, not all forms of substance use are quite specific. With different forms of substance abuse, symptoms that complement the syndrome of consequences are different, reflect the particular effects of narcotic drugs, on which the differential diagnosis is based. The most malignant substances are the intoxication which causes the confusion of consciousness (household chemicals, barbituric sleeping pills, hashish, etc.): rapidly forming toxic zncephalopathy and toxic damage to the liver lead to the defeat of other parenchymal organs. Abuse of these substances often leads to death in the early stages of the disease: against a background of unclear consciousness, quantitative control is lost and uncontrollable attraction leads to overdose.

The consecutive development of a large drug addiction syndrome determines the stages of substance abuse: Stage 1 - the syndrome of altered reactivity and the syndrome of mental dependence; II stage-qualitative change of these syndromes and addition of the syndrome of physical dependence; III stage - further qualitative change of all three syndromes. With the course of the disease, the symptoms of activation in intoxication go out as a consequence of psychophysical exhaustion. Tolerance decreases, the clinical and behavioral expression of attraction also loses its intensity. An abstinence syndrome is represented by anergic conditions, dreary depression, immobility, a real threat of collapse. The extinction of the narcotics symptomatic itself means extreme distress: the functional and organic changes in vital systems that have come about by this time lead to death even at a young age. The severity of individual syndromes varies with different forms of substance abuse (predominant symptomatology of mental or physical dependence), as well as a large drug addiction syndrome in general (low intensity for tobacco smoking and high with opium addiction).

With abuse that started at a young age, the syndromes later remain structurally fuzzy. Often the syndrome of consequences distorts the narcotics symptomatology proper (dementia in barbituratism absorbs the symptoms of mental dependence) and even outstrips its full development (cyclodolum substance abuse). The diagnosis is established by a narcologist.

Toxicomans turn to general practitioners to obtain prescriptions for narcotically acting substances. Complain about nervousness, insomnia, sciatica and other disorders that require the appointment of sedatives, hypnotics, analgesics, antispasmodics. Usually they themselves call the medication they need, usually with a sedative component (for example, sedalgin), are persistent, apply repeatedly, to several specialists at the same time. They resort to emergency, emergency care, feigning acute pain syndromes.

The following signs serve as a basis for suspecting substance abuse. The state of intoxication, in the evaluation of which one should pay attention to the uplift of mood, unclear consciousness and vegetative symptoms. Behavior is always inadequate to the situation of the patient's contact with the doctor: lack of due seriousness, excessive initiative in the conversation, discussion of topics not related to the subject matter, lack of sense of distance, etc. Consciousness is changed by the type of obscuration (sometimes mild) or narrowing; The latter is characteristic of opium intoxication. Vegetative symptoms also depend on the type of narcotic active substance, its dose and the stage of intoxication; May be manifested by predominant sympathetic or parasympathetic irrigation. Particular attention should be paid to the size of the pupils, lateral nystagmus, fixation of the eye, clarity of the iris, blood filling of the superficial tissues, muscle tone, tremor, coordination, blood pressure level and heart rate.

A characteristic feature of intoxication is its rapid dynamics: observation for 20-30 minutes confirms this. In a number of cases, a particular smell emanates from the intoxicated: "chemical" with the abuse of volatile, narcotically acting agents, potassium permanganate by oral ingestion of processed ephedrine; Hashish and opium (when smoking) are also easily captured by the sense of smell. Appearance of the toxicant gradually acquires the characteristic features: premature aging, marked trophic disorders (sluggish, wrinkled skin, dullness and brittle nails and hair, lack of many teeth). Depletion outstrips and therefore does not correspond to existing somatoneurological disorders.

It is necessary to pay attention to traces of intravenous injections, especially numerous in abusing ephedrine; Experienced patients avoid insertion into the cubital veins using less well-known vessels (on the hands, feet, etc.). Intravenous injection very quickly causes vein sclerosis, not always accompanied by phlebitis. The veins are dense to the touch, the skin over them is pigmented. Some patients are forced to wear long sleeves. For opioans, cannabis, for those using stimulants, pallor is characteristic with subicbacteria of the skin and mucous membranes, emaciation, for abusing sleeping pills, sedatives, household chemicals - pallor with a grayish shade, pastoznost, pustular rashes. With the abuse of synthetic analgesics, the skin acquires a "coffee with milk" shade, interstitial nephritis is characteristic. When abuse of hypnotics, especially barbiturates, a strip of brown plaque is formed on the back of the tongue, it is difficult to remove, with the abuse of ephedrine - raspberry tongue, brilliant, excessive mobility, twitching of individual muscle beams attracts attention.

Drastically different reactions, movements, speech, ingenuity (bradykinesia, bradyphasia, bradypsychia) are markedly abused by hypnotics and sedatives. At the appointment of a neurologist, cases of flaccid paralysis with dysarthria, and striopaplidar symptomatology are possible with manganese toxic encephalopathy due to the preparation of ephedrine concentrate with potassium permanganate. Abuse of narcotics active substances are characterized by mood swings with bouts of spiteful irritation, pickiness, and also desocialization (loss of places of study, work, change of social circle, alienation, life outside the family).

Acute conditions during the course of the illness make the drug addicts patients in many specialized health services. The withdrawal syndrome compels to simulate the need for various types of urgent care; At a dissimulation it is possible hospitalization in infectious hospitals with the diagnosis "influenza", "intestinal infection", etc. In case of an overdose, patients are sent to toxicological centers; Unlike accidentally poisoned healthy individuals, the severity of the condition does not correspond to the concentration of the narcotic active substance in the blood, the exit from the coma is very rapid, without subsequent asthenia (altered reactivity, high tolerance). In acute psychosis (syndromes of psychomotor agitation, psychomotor retardation, delirious, hallucinatory-paranoid), its toxic-human nature can be suspected on the basis of the exogenous nature, the dynamics of the syndrome, its short duration (2-10 days). Diagnostic difficulty arises in the case of acute psychosis in a cyclodol-abusing adolescent, as cyclophilic intoxication is similar to that of schizophrenia.

Treatment is carried out only in a specialized closed-type hospital or in psychiatric hospitals allocated to drug addicts. All acute conditions, especially with the symptoms of motor excitement, require the maintenance of cardiovascular activity, acute psychosis - the appointment of sedative therapy. The introduction of seduxen, tizercin, elenium, haloperidol, aminazine, lytic mixtures with aminazinom intravenously, with the impossibility (due to the obstruction of the available veins) - intramuscularly. Venesection is contraindicated because of the psychotic state, oral administration is ineffective. In case of poisoning (sopor, coma), but with a known history and diagnosis of substance abuse, the purpose of detoxification (dialysis, hemosorption) should be preceded by the observation and appointment of cardiovascular agents, since independent withdrawal from the coma is possible. Upon exiting the acute state, the behavior of the toxicomaniac is psychopathologically, uncontrollably, affectively-excessively, disorganizes the work of the medical institution and requires an early transfer of the patient to a specialized hospital or an extract with notification to the narcological dispensary and the police station at the place of residence.

Prevention is a general societal task, solved by many services of the society; Includes educational, restrictive measures and punishment for the distribution (preparation, sale, involvement of minors) of narcotic substances.

Medical prevention includes health education, monitoring of the prescription of drugs and narcotic drugs (strict adherence to evidence, short-term, dose control, alternation of drugs to avoid addiction), timely detection of cases of abuse (primary prevention), monitoring remission after treatment, prevention of relapse Secondary prevention).