• maladaptive pattern of use characterized by one or more of the following
  • role failure (ex: dad role)
  • hazardous situations (ex: drunk driving, promiscuity)
  • legal problems
  • interpersonal problems caused by or exacerbated by use

• Three or more of following
  • tolerance
  • withdrawal
  • loss of control of amount used
  • unable to quit, repeated desire to quit
  • much time spent to obtain, use, and recover
  • other activities given up
  • use despite knowledge of negative consequences

• increases norepi, vasopressin, beta endorphin, ACTH, cortisol causing overall CNS stimuation

1. intoxication
   1. relacation
   2. increased concentration
   3. anorexia
   4. increased BP
2. withdrawal
   1. irritability
   2. increased appetite

• avoid cues
• stress management
• excercies and other lifestyle changes

Pharmacologic treatments to quit smoking

• replacement therapy
• Bupropion (Zyban)
• Vareniclin (Chantix)

Effect of hypnotics, anxiolytics effects

• cross tolerant with, similar intoxication and withdrawal as with alcohol
• physical dependence can develop with therapeutic levels for several weeks

• abuse potential higher in compounds with shorter duration and onset of action
• must be tapered gradually (be aware of common signs of diversion and abuse)

Effect of opiate intoxication

• euphoria
• sedation
• miosis
• respiratory depression
• constipation

• dysphoria
• myalgias rhinnorhea
• diarrhea (flu like symptoms)
• autonomic hyperactivity

• symptomatic treatment of withdrawl
• agonist therapies

overdose

intravenous use

cocaine

methamphetamine

amphetamine

methylphenidate

Intoxication of stimulants

• euphoria
• increase vigilance
• anorexia
• mydriasis
• tachycardia
• hypertension
• arrhythmias
• auditory and tactile hallucinations
• psychosis
• agitation
• bruxism

• mimic major depressive disorder
  • suicidal ideation
  • suicide attempts
• hypersomnia
• dysphoria
• increase appetite
• irritability
• craving

• cocaine- prevent dopamine reuptake
• amphetamine- increase dopamine

• impaired memory
• impaired attention span
• impaird insight, judgement
• impaired coordination and sensory perception
• conjuctival infection
• tachycardia
• dry mouth
• increased appetite

• chronic pain
• appetite stimulant in AIDS patients
• antiemetic in chemotherapy

psychiatric disorders

amotivational syndrome

• acts on cannabinoid R (a GPCR)
• inh. adenylate cyclase
• inhibit hippocampus, basal ganglia, cerebellum

• acute psychosis
• agitation resulting in extraordinary violence
• nystagmus
• tachycardia
• hypertension

• antagonist of NMA receptor
• binds to sites located in cortex and limbic system
• effects biogenic amine release and reuptake in dose dependent manner
  • accounts for sympathomimetic effects
• indirectly affects GABA outflow in CNS

• increased libido
• acne
• male pattern baldness
• CV damage
• elevated liver enzymes
• deepen voice and hirsutism in females
• testicular atrophy
• irritability
• anger
• violence
• explosivity

Can occur months after stopping use.

• death due to respiratory depression especially when combined with alcohol
• deep sedation
• memory loss

TEN TIMES MORE POWERFUL THAN Benzodiazapeim

Intoxication of dextromethorphan

• euphoria
• manic like symptoms
• grandiosity
• paranoid delusions
• dissociation
• confusion

• medical supervsion when withdrawing from alcohol and BZP, barbituates
• treatment intensity depends on severity of dependence
• develop coping behaviors, life style, and social environment are crucial
• common course of recovery is relapse and remitting

• absense of psychiatric co morbidity
• good pre-morbidity functioning
• increasing age
• strong social support