بسم هللا الرحمن الرحيم
• The non - medical use of drugs is a
worldwide problem that has reached
almost epidemic proportions.
• A drug is any substance that, when
introduced into the living organism, may
modify one or more of its function.
• However, the non-medical use of certain
groups of drugs, particularly those to
which dependence will develop, is a major
problem of concern.
• The health of the drug dependant will be
adversely affected and his behavior may
become antisocial and bring him into
conflict with the law.
• Drug dependence is one aspect of the
wider problems of non-medical use of
drugs and is a problem with serious
implications for the user and the society in
which he lives.
• Drug dependence is best defined as a
physical and psychic state resulting from
the repeated (chronic) interaction
between a living organism and a drug,
1- Irresistible desire to take the drug.
3- Physical and physiological dependence
4- Withdrawal symptoms .
5- Harmful effects to the individual and
• A condition in which the individual feels a
desire for the drug, without suffering any
ill-effects when such drug is not taken.
Thus in case of habituation the desire is
only emotional (psychic), there is no
withdrawal symptoms, no tolerance and
no physical dependence on the drug.
Diagnosis of dependence
1- History from the addict, his relatives or
2- Drowsiness, inability to concentrate and
sometimes itching over the injection sites.
3- Scars of injection along the veins of
forearm, abscesses, ulcers and
4- Appearance of withdrawal symptoms if
the drug was not taken in the last 24 Hs.
5- Constriction of the pupils in case of
opiates or dilatation after amphetamine
6- Nalline test for opiates: Injection of 3 mg
Nalline leads to rapid dilatation of pupils.
7- Urine and blood analysis for the detection
of the drug.
• The ability of one drug to suppress
the manifestations of physical
dependence produced by another and
to maintain the physically dependent
state. It may be partial or complete
and the degree is more closely
related to pharmacological effects
than to chemical similarities.
Drugs causing dependence
* Drug to which dependence may develop
all act on the central nervous system,
some are more depressant, others more
stimulant. The drugs include:
• Opiates and their synthetic analogues
• Coca leaves and cocaine.
• Ethyl alcohol.
• Barbiturates and other sedatives
Drugs causing dependence
• Amphetamine and related
• Volatile solvents e.g. acetone,
toluene and carbon tetrachloride.
• Anabolic-Androgenic Steroids
• Designer drugs .
1- Opium dependence
• The condition may follow the repeated medicinal
use of the drug. Addicts take the drug either by
mouth, by smoking or by injection.
• The patient becomes careless, unreliable
and dishonest, but no much harm results
• Loss of weight, anorexia and chronic
• They usually start after 12-24 hours from
the last dose, and then the symptoms
disappear gradually within 7-10 days.
They disappear on the spot if morphine is
• Increased secretions
• Increased respiratory and pulse rate.
• General muscular twitches and abdominal
• Neonates from drug-dependent mothers
may show withdrawal symptoms up to 56
hours from birth and will require therapy.
• The addict should be treated as a patient not
as a criminal .
• Needing careful and continuous medical
attention for several months in special hospitals
• The success of treatment of addiction in
general depends on the patient's intention and
• Gradual withdrawal :
• Abrupt withdrawal :
• Symptomatic treatment :
• Psychiatric therapy:
• Social measurements
2- COCAINE DEPENDENCE
• Clinical picture
1-Anorexia, vomiting and loss of weight.
2- Tremors, convulsions and toxic psychosis.
3- Nasal septal perforation if taken as snuff.
4- Tactile hallucinations
Methods of uses
Cerebral hemorrhage due to cocaine dependence
3- ALCOHOL DEPENDENCE
1- General appearance
2- Conjunctivitis and bronchitis
3- Chronic gastritis with hypochlorhydria
4- Liver cirrhosis
5- Fine tremors and sensory neuritis.
6- Alcoholic paranoid states & Korsakoff's psychosis.
7- The addict becomes selfish and jealous
• Diazepam or chlorpromazine if there is convulsion.
• Mannitol for cerebral edema
• Lumbar puncture for delirium tremens
• Ant abuse (disulfuram):
• Vitamin B and liver supports.
Alcoholic Liver cirrhosis
• Short acting barbiturates are used by the
addicts due to rapid effect
• Barbiturates dependence is very serious as
1- Physical signs:
• Renal manifestation.
2- Neurological signs :
• Thick slurred speech.
3- Mental disorders :
• Poor memory
• Mental confusion.
• Negligence of personal appearance.
* Abrupt withdrawal is dangerous.
* Gradual withdrawal is the ideal method.
complete in 2-3 week
5- AMPHETAMINES DEPENDENCE
• marked stimulant effect on the CNS including
a sense of alertness and well -being.
• Tremors .
• Visual and auditory hallucinations.
• Shock or collapse
• antisocial activities.
• Sever fatigue.
• Risk of suicide.
• Abrupt withdrawal.
• Sedation with phenobarbitone or chlorpromazine.
6- TRANQUILIZERS DEPENDENCE
• Prolonged use of minor tranquilizer may lead to
addiction e.g. valium .
** Clinical Picture
• Masked Face, and
• Dry Mouth
• Dilated pupils
7- VOLATILE SOLVENT INHALATION
• Solvent abuse,
• Solvent sniffing
• Glue sniffing
** The inhalation of volatile organic solvents
Acetone, carbon tetrachloride, chloroform,
ether, Toluene, n-Hexane) for pleasurable
effects is most commonly in poor.
Why there is a rapid effects ?
• These compounds are highly lipid soluble
and therefore have marked effects on
nervous tissue .
• Snuffers are unlikely to come to medical
attention but they develop some serious
acute complication such as deep coma.
THEY MAY PRESENT LATER WITH:
• Renal failure
• Acute encephalopathy
• Cerebellar degeneration.
• Mixed polyneuropathy.
• Stopping solvent inhalation.
• Sedation in a state of panic.
• Patient in coma require supportive
• Renal and hepatic damage may be
reversible but neurological no improve
• Abstinence from further solvent abuse is
Other abused substances
9- DESIGNER DRUGS