Due to suppression of needs → discomfort → psychoactive substances and activities to reduce need ( but not satisfy them )

Etiology:

Genetic predisposition
Unsatisfied needs

Types of addiction ( to reduce discomfort )

1. Activities:
Work
Sex

2. Pathological activities:
Gambling

Computer games

Internet


3. Psychoactive substances
• Opiods – morphine, Promadol, Heroin, Methadon
• Alcohol
• Hallucinogens – LSD, Silosibin, Mescalin
• Hashish
• Amphitamines ( psychostimulators )
• Cocaine
• Ephedrine
• Ecstasy, speed ( arab cultures )
• Nicotine, smoking
• Caffeine
• Tranquiliozers ( BDZ )
• Barbiturates
• Valocardin , Carbolol ( for sedation , sleep, ↓ heart pain )

There are 2 types of addiction:

a) Psychological: Including of substance in the persons psychological metabolism. The person needs substance for psychological comfort.

b) Physiological: opiates cause this type of addiction even with one injection. The substance becomes a part of his physical metabolism and needs it.

Development of dependency is gradual and has grades. Eg in Alcohol addiction

1st grade: Psychological dependency;
Using of substance becomes significant part of life. To reduce emotional discomfort.
The person needs more and more each day as the tolerance increases each day.
Need to drink maybe so significant that he may lose situational or quantity control ( eg driving )
Vomiting reflex disappears, even though with increase in dosage due to dependence

2nd grade: Physiological dependency
Absence of alcohol in the organism lead to physical disturbance – with drawal syndrome ( Abstinence )
Tolerance increases more significantly and may reach up to 1 – 3 liters ( whisky, vodka )
Person begins to drink alcohol constantly.

3rd grade: Encephalopathy

Symptoms of withdrawal syndrome ( last for 3 – 7 days )
1. Anxiety
2. Irritativeness
3. Tremor
4. Sweating
5. Palpitations
6. ↑ BP
7. Headache, chest pain
8. Nausea and vomiting

All these symptoms are similar to an increase dosage of alcohol ( sate of intoxication )

Complications of Withdrawal syndrome

1. Neurological disorders – Epileptic syndrome
2. Alcohol withdrawal psychosis
a) Delirium
b) Paranoid
c) Hallucinations
3. Acute alcohol encephalopathy
a) Hyneverdicin psychosis
b) Korsikov psychosis
4. Somatic disorders
a) Hypotonic crises
b) Pancreatitis
c) Peptic ulcers
d) Myocardial infarction

• Acute alcoholic Hallucinosis
Starts after some days
Hear auditory hallucinations and connected with alcohol, suggesting to him to drink or voices criticing him
It may last for more than delirium, from several days to several weeks.
It may also transform to chronic

• Acute alcoholic Paranoid
Fear, anxiety, see that people around him have a negative attitude, wanting to harm him or kill him
Consiousness is not disorganized

Encephalopathy
Results from chronic alcohol intoxication. Leads to changes in all tissues and brain too. But they are very rare cases. It may develop acutely or gradually

Acute:

Korsekov psychosis or encephalopathy of Heir Wernikov.
Develops on 2nd stage of addiction, Patient may have delirium and if he survives he has encephalopathy.

Gradual:

Year by year. Begins with personality changes, aggressive, irritable, changes attitudes to relatives.
Memory and intellect decrease gradu7ally
Tolerance usually decrease, person needs less amount of alcohol. He may drink all day
Chronic alcoholic psychosis may develop in this stage, resulting from organic brain lesions due to encephalopathy

Opiod withdrawal syndrome
• Pain in the muscles
• Rhinorrhoea
• Nausea and vomiting
• Palpitations
Psychosis is not typical even though behavior maybe aggitative and irritable

Treatment of addiction

Very difficult as results are low. Patients who have addiction of 2nd stage will never be healthy and he will have only remission. Quantity of treatment depnds on length of remission
Alcohol : 30 - 50 %
Heroin :10 – 30 %
In many European countries, Methadil ( opiod ) in tablests are prescribed and its free of charge, and the doctor gives his daily dose, but this is not treatment it is only harm reduction.

Treatment is based on psychotherapy mostly
Treatment is based on principle of the AA ( Alcoholics anonymous ) – USA. And includes several stages to pass through.

Pharmacological – used for detoxication, withdrawal state and for treatment of complications of the withdrawal symptoms

Acute alcoholic psychosis:
Detoxication
Tanquilizers

Acute alcoholic encephalopathy:
Detoxication
Vitamins
High doses of nootropics

Chronic alcoholic psychosis:
Nootropics
Neuroleptics
Vitamins
Haloperidol – for hallucinations, paranoid
Psychotropic drugs – BDZ, Rilanium 6ml/day, Phenozepam