Drug dependence withdrawal syndrome. Elimination of drug addiction

Drug dependence occurs with prolonged use or repeated courses of the same medications, after the withdrawal of which a deterioration in health is observed. There is a relapse of the disease, the person plunges into a depressive state. Taking the drug again or increasing its dosage will help change poor health.

A person suffering from addiction cannot control himself and takes medications without a doctor’s prescription or urgent need.

A person’s addiction to medications occurs due to unreasonably long-term use of them, or a decrease in sensitivity to the medication, requiring an additional dose. This dependence is formed due to genetic, social, and psychological factors. Thinking and perception of the world as a whole changes, pain and fear recede, and an irresistible desire appears to receive a portion of an emotionally positive state.

Withdrawal of the drug leads to physical and mental disorders. The syndrome provokes a person to resort to the same remedy for an increasingly longer time, gradually increasing the dose.

When visiting a doctor, there is a fear of stopping the medication; an adult may experience uncontrollable hysterics if it is necessary to abandon it.

Which drugs are more likely to cause addiction?

Drug dependence is divided into two types - addiction to drugs that eliminate the symptoms of the underlying disease and drugs that affect metabolism and nervous regulation. Not all medications are addictive.

The first type of substances includes painkillers, antidepressants, tranquilizers and others used for insomnia, panic attacks, autonomic disorders, and cough relief. All of these diseases require long-term treatment, and symptom management is an integral part of therapy.

However, many patients stop taking medications when the first signs of the disease are eliminated, and the underlying disease returns. The patient again, as a rule, without consulting a doctor, uses drugs known to him. As a result, the underlying disease is not cured, and drug dependence develops.

The prognosis in this case is favorable, but requires strict implementation of all specialist recommendations.

The second type of addiction is addiction to drugs that act on the central nervous system, psychotropic drugs, narcotic analgesics, large doses of tranquilizers, and, less commonly, glucocorticosteroids.

Stopping taking these substances can lead to damage to the peripheral nervous system and brain.

Treatment in this case is not always favorable and depends on the degree of damage to the nerve cells.

Types of drug addiction

Addiction to medications is divided into physical, psychological dependence, and withdrawal syndrome. Each stage has its own symptoms.

Physical

At this stage, a person, in order to avoid mental, neurological, vegetative-somatic disorders that occur when the drug is discontinued, continues to take medications without doctor’s recommendations. What leads to abstinence - deviations at the physical and psychological levels.

Mental

Taking pills becomes an obsession; a person is drawn to certain drugs that he uses for a long time. Occurs when there is a break in use or the introduction of substances that reduce the effect of the medication. The dose of the drug is increased.

Withdrawal syndrome

If the drug is abruptly discontinued, a hypertensive crisis, arrhythmia, angina pectoris, thromboembolism and other negative reactions of the body occur.

Symptoms

Many people daily use various medications necessary to normalize their mental or physical health. Manifestations of addiction are:

slight or severe pain;
vegetative crises;
increased nervous excitement;
slowness of action;
blood pressure disorders;
lack of strength, lethargy, sleep disturbance;
changes in blood tests.

The listed symptoms appear when the regimen and amount of the drug used are violated. You should consult a doctor immediately.

Diagnostics

It is quite simple for relatives or the attending physician to determine that a person has developed a drug addiction. It is enough to observe the person, and if in doubt, force him to take a blood test. Addiction can be diagnosed based on the following signs:

an irresistible need to use certain drugs;
increasing the dose of the drug used;
anxiety, irritability before stopping treatment;
trembling hands, increased sweating;
intolerance to loud sounds, bright light;
personality change.

In this situation, it is necessary to determine the degree of dependence and the patient’s desire to fight addiction, because the treatment regimen and result depend on this.

How is drug addiction treated?

Therapy carried out to eliminate drug addiction is based on the degree of dependence and the type of drug. The main factor here is the will and readiness of the person to recover. To strictly adhere to the recommendations of a specialist, inpatient treatment is necessary, including a full complex - psychotherapy, cleansing the body, prescribing medications, physical therapy, and occupational therapy.

During treatment, the daily dose of the dependent drug is regularly reduced until it is completely abandoned or replaced with a less complex one. Then the underlying disease and internal organs affected by drug addiction are treated. First of all, these are the liver, kidneys, and nervous system. Psychotherapy is aimed at getting rid of depression and the desire to start taking medications again, which led to addiction.

Drug addiction is very difficult to treat. The sooner drug addiction is diagnosed, the more likely a complete cure is, and the damage done to the body will be minimal.

The basis of rehabilitation is the participation of relatives, attending group or individual therapy classes. The person cured should be under the supervision of a psychotherapist. It is necessary to strictly follow all the doctor’s recommendations upon discharge and continue to engage in exercise therapy.

It is necessary to avoid increased nervousness, anxiety, and depression. Then the desire to resort to medications will not arise.

How to prevent addiction from developing?

In order to prevent addiction to medications, you should not self-medicate. Pharmacists in pharmacies are also incompetent in making a diagnosis, much less prescribing therapy.

Drugs for the treatment of diseases and determination of their dosage is the prerogative of a doctor of the appropriate profile. Those. A psychiatrist, not a therapist, should treat depression and give a prescription for psychotropic substances.

Drug dependence is a pathological condition, often mental, but sometimes even physical, which was formed as a result of the influence of pharmacological drugs on the human body, characterized by various reactions, mainly of a behavioral type, including the desire to constantly or periodically take a certain substance in order to prevent discomfort caused by breaks. while taking this medication.

Dependence can be on one drug or on several at the same time. Its development is based tolerance, - a decrease in sensitivity to the influence of a medicinal substance, requiring an increase in its dose to achieve the same effect that previously occurred from lower doses.

Symptoms characteristic of drug addiction

It can manifest itself in several syndromes that characterize the phases of its development:

Mental dependence syndrome;
Physical dependence syndrome;
Withdrawal syndrome.

Mental dependence

This is a human condition that is characterized by an unhealthy need to take various kinds of psychotropic drugs in order to prevent the appearance of discomfort and mental disorders that develop if they stop using them. and other drugs, which is in such a phase does not manifest itself in the form

Physical dependence

In this phase of its development, the pathology is characterized by the possibility of developing abstinence in the event of a break in taking the medication or the administration of antagonist substances. An addiction that has gone so deep is characterized by tolerance; it is characteristic of taking opiates.

Withdrawal syndrome

This condition develops when the addictive medication is abruptly stopped. For example, if clonidine is suddenly discontinued, a hypertensive crisis may occur, quinidine withdrawal may provoke the development of severe arrhythmia, antianginal medications may cause angina pectoris, and anticoagulants may cause thromboembolism.

Drug dependence – drug addiction or addiction

Experts from the expert committee of the World Health Organization decided to combine both of these concepts, and now this dependence is both mental and physical considered both an addiction and an addiction. However, all forms of this pathological phenomenon also have common symptoms. Important components of the development of the disease are the special characteristics of a person’s personality, his socio-economic status, as well as the extent to which drugs that cause drug dependence are available. This condition is not primarily a pharmacological problem, since people suffering from it may substitute one drug of choice for another. WHO recommended differentiating this pathology based on the drug taken. The following stand out: kinds:

Morphine;
Barbiturate;
Cocaine;
Nicotinic;
Alcoholic;
Mixed.

Treatment

How to get rid of this deviation? Treatment depends on the type of drug that caused the pathology. For example, in the case of the development of barbituromania, extended hypnotic sessions (from one to one and a half hours) are recommended. Also for such patients it may be useful to carry out autogenic training. They have a tranquilizing effect, normalize sleep, and are able to “replace” the hypnotic effect of barbiturates. Treatment of any type of addiction involves increasing attention to the patient’s personality, the role of addictive substances in his life, and solving his personal problems. It is important to use psychotherapeutic, and especially group treatment methods. After all, a constant feeling of discomfort in the mental state, as well as the presence of symptoms directly related to the withdrawal state, make contact with the patient difficult. This is especially due to the silencing of the very fact of pathological attachment by the patient, due to his fear of being deprived of access to the drug. In a group, patients, seeing people around them who have exactly the same problems and are trying to get rid of them, can open up and share with the doctor all the information that he had previously hidden. However, other patients, on the contrary, may need individual psychiatric sessions before undergoing group sessions.

Video: Drug addiction

There are two types of drug addiction: physical and mental.

Mental dependence- a condition in which a medicinal substance causes a feeling of satisfaction and mental uplift and requires periodic administration of medicinal substances to normalize the mental state. With mental drug dependence, stopping the use of the substance that caused it is accompanied by emotional and psychological discomfort. Mental dependence on drugs arises as a result of a person’s opinion formed at a reflex level that after taking an antidepressant, mental discomfort is eliminated, and it is replaced by a state of calm, positivity and tranquility. There are psychotropic substances (cocaine, Indian hemp preparations, lysergic acid diethylamide) that cause predominantly mental dependence.

The basis for the formation of mental L.Z. is, obviously, the ability of psychotropic substances to change a person’s mental state, since many of them (narcotic analgesics, psychostimulants, sedatives and hypnotics, tranquilizers, alcohol) affect mood, perception, thinking, cause euphoria, reduce anxiety, fear, tension. In this regard, a certain circle of people, due to predisposing psychological, biochemical, genetic, social and situational factors, may develop a certain need for repeated use of any psychotropic drug to achieve a comfortable state, euphoria or reduce fear, anxiety, anxiety. An extreme form of such an artificial need is the formation of a pathological craving for psychoactive compounds with the subsequent development of drug addiction or substance abuse.

Physical dependence– an adaptive condition manifested by severe somatic disorders when the administration of the drug that causes this condition is stopped. In physical drug dependence, withdrawal of the substance or drug that caused it leads to the development of withdrawal syndrome, manifested along with various mental vegetative-somatic and neurological disorders. The development of withdrawal syndrome can also be caused by the administration of antagonists of a substance that causes physical dependence. In the development of physical L.z. In addition to conditioned reflex mechanisms, an important role is probably played by adaptive reactions associated with changes in the organs in the number and sensitivity (affinity) of receptors with which psychotropic substances interact, for example, opiate receptors under the action of morphine-like substances, benzodiazepine receptors under the action of benzodiazepine tranquilizers, etc. . In addition, under the influence of psychotropic drugs in the body, the production of endogenous substances (ligands) that interact with the same type of receptors with which psychotropic drugs interact can change. It is known, for example, that when systematically taking morphine in the body, pronounced changes occur in the content of endogenous opioid peptides, and when taking phenamine and other psychostimulants, the metabolism of catecholamines increases and the content of cyclic nucleotides in the c changes. n. With. Stopping the administration of psychoactive substances that cause the above-mentioned adaptive changes in neurotransmitter systems leads to the development of withdrawal syndrome, the clinical picture of which is characterized by manifestations that are opposite to the effects of the drug that caused it. psychoactive substance. Thus, with morphinism, withdrawal syndrome is characterized by pain, increased salivation, and diarrhea. Cancellation of barbiturates in case of developed pulmonary disease. leads to convulsive reactions, withdrawal of tranquilizers leads to anxiety, etc.

66. Non-steroidal anti-inflammatory drugs. Classification. Mechanisms of analgesic and antipyretic action. Pharmacological characteristics of analgesic-antipyretic drugs. Clinical application. Possible complications.

Classification of NSAIDs

Today there are many drugs in the NSAID group, and their classification should help the doctor in choosing the most appropriate drug. This classification contains only international nonproprietary names.

Chemical structure

Based on their chemical structure, non-steroidal anti-inflammatory drugs are classified.

salicylates:

pyrazolidines:

oxicams:

alkanones:

sulfonamide derivatives:

By impact on COX-1 and COX-2

Celecoxib;

Rofecoxib;

Valdecoxib;

Parecoxib;

Lumiracoxib;

Etoricoxib.

New generation drugs

Movalis

Nimesulide

Xefocam

Rofecoxib

Indomethacin;

Diclofenac;

Piroxicam;

Ketoprofen;

Nimesulide.

NSAIDs in tablets

Ibuprofen;

Indomethacin tablets;
Analgin;
Rofecoxib (Denebol).

Analgesics-antipyretics

Analgin. It has pronounced antipyretic and analgesic (pain-relieving) properties. But to reduce fever, it is taken in cases where the temperature exceeds 39 degrees C, and other means do not help. In many countries it is prohibited due to side effects affecting the blood (agranulocytosis). Preparations containing analgin - analgin ultra, baralgin, analgin-quinine, sedalgin.

Paracetamol. Acts directly on the centers of thermoregulation and pain. Taking paracetamol is accompanied by the lowest risk of any side effects, but if the dosage is exceeded or taken for a long time, a negative effect on the liver may occur. In combination with caffeine, the antipyretic effect is enhanced. It is included in the preparations calpol, ibuclin, panadol, cefekon, and almost all combined cold powders and tablets.

Propyphenazone. The safest among representatives of this group. There were no cases of agranulocytosis with its use. A component of the drugs pentalgin, saridon, and many other cold remedies.

67. Nonsteroidal anti-inflammatory drugs. Classification. Mechanisms of development of main and side effects. Pharmacological characteristics of drugs with a predominant anti-inflammatory effect. Application. Possible complications and their prevention.

Nonsteroidal anti-inflammatory drugs (NSAIDs, NSAIDs) – This is a group of medicines whose action is aimed at symptomatic treatment (pain relief, inflammation relief and temperature reduction) for acute and chronic diseases. Their action is based on reducing the production of special enzymes called cyclooxygenase, which trigger a reaction mechanism to pathological processes in the body, such as pain, fever, inflammation.

The common properties of all drugs in this group are their three main effects - anti-inflammatory, analgesic, antipyretic.

This explains another name for this group - non-narcotic analgesics, as well as the enormous breadth of their use. These three effects are expressed differently in each drug, so they cannot be completely interchangeable.

Unfortunately, all NSAID drugs have similar side effects. The most famous of them are the provocation of gastric ulcers, toxicity to the liver and inhibition of hematopoiesis. For this reason, you should not exceed the dosage indicated in the instructions, and also take these drugs if you suspect these diseases.

Abdominal pain cannot be treated with such medications - there is always a risk of worsening your condition. Various dosage forms of NSAIDs have been invented to improve their effectiveness in each specific situation and reduce potential health harm.

Classification of NSAIDs

Chemical structure

Based on their chemical structure, non-steroidal anti-inflammatory drugs are classified.

Acids (absorbed in the stomach, increase acidity):

salicylates:

pyrazolidines:

indoleacetic acid derivatives:

phenylacetic acid derivatives:

oxicams:

propionic acid derivatives:

Non-acidic derivatives (do not affect the acidity of gastric juice, are absorbed in the intestine):

alkanones:

sulfonamide derivatives:

By impact on COX-1 and COX-2

Non-selective - inhibit both types of enzyme, most of the NSAIDs belong to them.

Selective (coxibs) inhibit COX-2, do not affect COX-1:

Celecoxib;

Rofecoxib;

Valdecoxib;

Parecoxib;

Lumiracoxib;

Etoricoxib.

New generation drugs

The new generation includes not only selective, but also some non-selective NSAIDs, which have pronounced effectiveness, but are less toxic to the liver and hematopoietic system.

New generation non-steroidal anti-inflammatory drugs:

Movalis– has an extended period of validity;

Nimesulide– has the strongest analgesic effect;

Xefocam– extended period of action and pronounced analgesic effect (comparable to morphine);

Rofecoxib– the most selective drug, approved for patients with gastritis and peptic ulcer without exacerbation.

Non-steroidal anti-inflammatory ointments

The use of NSAID drugs in the form for local use (ointments and gels) has a number of advantages, primarily the absence of a systemic effect and a targeted effect on the site of inflammation. For diseases of the joints they are almost always prescribed. The most popular ointments:

Indomethacin;

Diclofenac;

Piroxicam;

Ketoprofen;

Nimesulide.

NSAIDs in tablets

The most common dosage form of NSAIDs is tablets. Used to treat various pains, including joint pain.

Among the advantages, they can be prescribed to treat manifestations of a systemic process involving several joints. The disadvantages include pronounced side effects. The list of NSAID drugs in tablets is quite long, they include:

Ibuprofen;

Indomethacin tablets;
Analgin;
Acetylsalicylic acid (rarely prescribed for joint diseases);
Rofecoxib (Denebol).

The mechanism of the analgesic action of non-narcotic analgesics.

Inhibition of cyclooxygenase → inhibition of the synthesis of prostaglandins PG E 2, PG F 2α, PGI 2 → prostaglandins that cause hyperalgesia (increased sensitivity of nociceptors to chemical and mechanical stimuli) are not synthesized → prevention of hyperalgesia, increasing the threshold of sensitivity of neurons to painful stimuli.

The mechanism of antipyretic action of non-narcotic analgesics.

Inhibition of cyclooxygenase COX-2 → inhibition of the synthesis of fever mediators (mainly PG E 1) → reduction of the pyrogenic effect of fever mediators on the thermoregulation center of the hypothalamus → antipyretic effect

In what cases are non-steroidal anti-inflammatory drugs used?

Non-steroidal anti-inflammatory drugs are used as antipyretics for:

Treatment of fever due to various diseases in children and adults

As anti-inflammatory drugs, NSAIDs are used to treat:

Diseases of the musculoskeletal system (arthritis, osteochondrosis, herniated disc, myositis, bruises and sprains)

Non-steroidal anti-inflammatory drugs are used as pain relievers in the treatment of:

Migraines and other headaches, pain during menstruation and some gynecological diseases, in the treatment of biliary or renal colic, etc.

Non-steroidal anti-inflammatory drugs are used as an angioplatelet to treat:

Coronary heart disease, prevention of heart attack and stroke.