What is it?
Many of the substances that produce addictions today have been used for thousands of years by mankind for various purposes. Thus substances such as alcohol, certain hallucinogenic mushrooms (such as peyote), plant resins (such as hashish) and other stimulating and relaxing substances obtained from certain plants (cocaine, opium, etc.) have been used at certain times of history for religious, spiritual and medical purposes. In ancient times, and even today, in practically all the primitive societies that subsist, medicine, religion and spiritual rites have always been united, which meant that the sorcerer, the shaman or the priest knew the effects of these substances, and used them on specific occasions and for very specific purposes. In the industrial world, drugsthey are also used as a form of socially accepted leisure or not. The reason that the so-called drugs act in the way they do, producing disparate pleasurable effects, is that they reproduce in the brain the action of its own substances (called “ endogenous drugs ”), which the body uses to support the neurotransmission of experiences that reward certain essential behaviors for the life of the individual and the maintenance of the species. These ” endogenous drugs ” naturally secrete when you are satisfied or feel pleasure in their different forms. However, “ exogenous drugs ” (that come from outside the body) or drugsproper, they have a much higher potency than endogenous, and taken repeatedly end up seriously altering and inhibiting normal basic behaviors of those who consume them, to the point that they can only obtain satisfactions through these drugs and that their behavior ends for leading mainly or exclusively to achieve them. To a greater or lesser extent, all drugs produce:
- Tolerance , that is, the organism adapts to the amounts that circulate through the body and to achieve the effect, an increasing amount must be taken.
- Withdrawal syndrome , unpleasant physical or psychological symptoms when consumption is interrupted and that, in one way or another, force the individual to consume again to avoid them.
- Dependence , the dependence of a drug is a psychiatric diagnosis and can be presented and defined very differently depending on the substance and the type of patient. The following are common general symptoms of drug dependence : the person consumes more drugs than in principle he wishes; intends to control or suspend consumption but cannot; he has left it for a while but has been forced to resume it; he spends much of his time searching for the drug, or consuming it, or under its effects; their social, labor and leisure activities have been greatly reduced due to drug use; and persists in consumption despite medical problems caused by the toxic.
Drug abuse is a concept related to dependency but not the same. A person abuses a drug when, despite not having physical or psychological dependence, consumption exposes him to physical risks, or consumes in inappropriate situations (appears under the influence of a substance at work, or drives intoxicated , etc.); or has had legal problems because of the substance (fights under the influence of drugs , destruction of property, etc.); or; it has begun to present alterations in its daily functioning (it does not go to work after a great intoxication, etc.); or consumption persists despite the fact that people around him, family and friends insist that he leave it or the issue of drugsit causes him continuous disputes with the close ones. Substance abuse therefore has physical risks and is a path that leads directly to dependence.
One of the factors that most influence the rapidity of the development of a dependency is the route by which the substance is administered, which determines the speed with which the effects occur: the intravenous and smoked route are much faster and more addictive than the orally.
Although there are factors common to all drugs of abuse, each drug has a particularity because it activates a different section of the biological support of; the biological mechanisms of reward (or pleasure) of mammals. Some drugs are more potent and others less, some produce hallucinations – voices, visions or other perceptions without external stimuli that justify them – and alterations in the perception of things (such as the so-called “tripies”, the LSD, etc.), others they are psychostimulants (they activate producing an increase in activity, sensation of euphoria and potency (such as cocaine or amphetamines), others are relaxing and disinhibiting (such as alcohol and tranquilizers). the cases consume severalDrugs and their clinical characterization and treatment are often more difficult for obvious reasons.
The following describes some peculiarities of the most commonly used drugs of abuse and the health problems they cause.
Types of Drugs of Most Abuse
Alcohol is one of the substances that are most frequently abused and dependent, because of its accessibility and social permissiveness towards excessive consumption habits. Normally the person who depends on alcohol has been drinking for many years without developing dependence and did not give more importance to alcohol consumption until he began to abuse, the problems at work and in the family began. Then he continued drinking until he developed some form of dependence.
Two large classic types of alcohol abuse patterns are usually described: that of the continuous or daily drinker, who usually drinks wine and beer (fermentation alcohols) and does not usually show signs of intoxication (drunkenness), but who meets criteria of dependence or abuse (Mediterranean pattern); and that of the episodic drinker, generally younger, who consumes high-grade alcohol (distillation alcohols) in large quantities on weekends, with significant intoxications and alterations in its functioning the first days of the week (Anglo-Saxon pattern). Each of these types of abuse patterns corresponds to psychiatric social problems and even complications; different doctors (it is common, for example, for the drinker with a Mediterranean pattern to suffer mainly from the liver, and that of the Anglo-Saxon pattern of the pancreas). Medical problems derived from both types of consumption are important, from hepatitis or pancreatitis (inflammation), to cancer. The patient with a mild alcohol withdrawal syndrome is anxious, morning shaking and other symptoms that are relieved when he drinks alcohol in the morning ;; Delirium Tremens usually appears in severe alcohol withdrawal syndrome, which is a condition with sleep disturbance, high blood pressure tachycardia sweating and other symptoms that reflect sympathetic vegetative nervous system dysfunction, visual hallucinations (mainly small animals or terrifying animals), disorientation (does not know where it is; or what day or date it is), inability to concentrate and attend,
Medical prescription tranquillizers
The most commonly used tranquilizers in the world today are benzodiazepines (BZD) and barbiturates (these are now found less frequently). As stated, BZDs are drugs that are often used not only in psychiatry but in all medical specialties. The most frequent medical prescription of these drugs is made to help sleep in insomnia, in the treatment of anxiety and, although it seems paradoxical, in the treatment of addictions. The effects of benzodiazepines; they are, in some way, similar to those of alcohol: whoever takes them is less anxious, dares to do things that he could not not do without them because of anxiety and, as a consequence of all this, he feels a certain state of well-being. The danger of addiction to these substances always advises medical control when they are being consumed. The doses of benzodiazepines and the periods of time consumed must be carefully managed to avoid dependence. When deciding to withdraw them, it should not be done abruptly because after a long period of consumption (months) a withdrawal syndrome similar to alcohol withdrawal may occur. Sometimes it is difficult to suspend this medication because in doing so nervousness and difficulties in falling asleep appear, precisely the reasons that led to its prescription. Many people who regularly consume benzodiazepines for sleep have developed some degree of dependence on them.
Stimulants (cocaine and amphetamines)
Cocaine and amphetamines cause a state of excitement, with a feeling of euphoria and increased energy. Regular or compulsive consumption of both (see below); It is highly dangerous for physical and mental health ; even sporadic and moderate consumption occasionally results in physical or mental complications, especially in predisposed persons. Both drugs , therefore, and against the belief that persists in this regard in some social media, are highly dangerous.
Cocaine is mainly consumed by nasal inhalation or venous injection (the form called hydrochloride or coca powder) or smoked (basic forms such as “crack” and others); It can be consumed alone or mixed with opiates or alcohol. Amphetamines are consumed orally or intravenously. Both substances have cardiovascular effects that can cause serious complications (hypertension, myocardial infarction, cerebral infarction, etc.) and can produce psychiatric disorders (dependence, psychosis, mood disorders, etc.). There are two main forms of cocaine use: on a regular basis (every day) or in the form of compulsive consumption or “bingeing” (the consumption is not daily, but the day that is consumed cannot be stopped, and it is reached to consume large quantities,
In recent years, modified amphetamines called “design” (of which methylenedioximethamphetamine (MDMA or “ecstasy” is the most popular) have been introduced to the illegal market, which carry a health risk similar to that of other amphetamines.
Although caffeine is a drug that is abused very frequently, that produces withdrawal symptoms and that leads to dependence, it is a substance widely and legally used throughout the world. It has no such harmful effects on health as other substances of abuse, but it can cause anxiety, insomnia, and in people at risk it can contribute to developing high blood pressure, etc …
Cannabis is widespread throughout the world and is consumed mainly in two smoked forms: as resin (hashish, “porros”) or dried leaf (marijuana, “maría”). It can also be taken orally. The effect of a moderate amount of cannabis is usually the sensation of tranquility and discreet euphoria. It can also produce alterations in the senses (more vivid colors, feeling of hearing better, etc.). A cannabis withdrawal syndrome has not been described, but different symptoms may appear depending on the amounts consumed. As in the use of other drugsWith cannabis, various psychiatric disorders can occur. With the long-term use the appearance of the so-called amotivational syndrome is described, in which the consumer is apathetic, without wanting to do anything, etc. but it is discussed if this syndrome really exists as a consequence of the consumption of the toxic or if, rather, it is the consequence that people who for other reasons are less active and motivated by and consume cannabis tend to do so in greater quantity than other consumers .
Hallucinogens are substances that produce hallucinations and other curious alterations of the senses (the perception of the qualities of things is affected; and synesthesia occurs: for example colors are heard and words are visualized, etc.). There are many hallucinogenic substances in nature and as a result of chemical synthesis but the best known belong to the family of indoles (such as LSD) or phenylethylamines (such as mescaline and many; of the so-called “pills”, including methylenedioxyantetamine and methylenedioxymethamphetamine or “ecstasy” that have a discreetly hallucinogenic effect, in addition to the main stimulating effect). Some hallucinogens are also potent brain toxins. The experience you have after the use of hallucinogens depends a lot on neurobiology and personality and; biography of each person, the environment that surrounds them, the purpose of consumption and the expectations that are consumed. Occasionally there is what is called a “bad trip” which is a terrifying hallucinatory experience after consumption. Although there is no evidence that LSD and other similar hallucinogens give rise to dependence or withdrawal syndrome, if they sometimes produce reviviscences or flashbacks ,; very vivid reminders of the experiences during consumption that can be very distressing for those who suffer them. Occasionally there is what is called a “bad trip” which is a terrifying hallucinatory experience after consumption. Although there is no evidence that LSD and other similar hallucinogens give rise to dependence or withdrawal syndrome, if they sometimes produce reviviscences or flashbacks ,; very vivid reminders of the experiences during consumption that can be very distressing for those who suffer them. Occasionally there is what is called a “bad trip” which is a terrifying hallucinatory experience after consumption. Although there is no evidence that LSD and other similar hallucinogens give rise to dependence or withdrawal syndrome, if they sometimes produce reviviscences or flashbacks ,; very vivid reminders of the experiences during consumption that can be very distressing for those who suffer them.
To this group of drugs belong heroin, methadone, codeine, morphine, bupremorphine, and many others. They are drugs that are abused and dependent, but also very useful medicines in the treatment of pain, cough, diarrhea, etc …
The opioid most used as a drug of abuse is heroin, a very addictive toxic that is used intravenously or smoked and produces an initial feeling of euphoria and a subsequent feeling of tranquility with a feeling of well-being and emotional indifference to the environment. Its regular consumption produces tolerance, dependence and a quite known and unpleasant withdrawal syndrome that initially produces sweats, restlessness, “chicken meat”, runny nose, and that if not thirsty treats it evolves to pain, agitation, violent tremors, muscle cramps, etc. . Heroin use is also associated with many medical problems, derived from the use of the toxic; and intravenous injections without hygiene (AIDS, infections, kidney problems, etc …).
Inhalants are a heterogeneous group of volatile substances such as paints, glues, glue, varnishes and fuels, which are consumed by inhalation and cause feelings of unreality, dizziness, euphoria, etc., They are usually used by young people with few economic means. They are usually toxic substances and the regular consumption of many of them is associated with brain, kidney, lung and liver damage.
It is another substance of abuse of wide global use, clearly harmful, for well known problems (lung cancer, bronchitis and other pulmonary and cardiovascular problems). It is a very addictive substance that creates tolerance, dependence and withdrawal symptoms, although milder than with other toxins.
There are other substances of abuse, although not all produce dependence or withdrawal, but their excessive use is harmful. It is anabolic, food supplements, homeopathic products, nasal sprays for the cold, etc …
A significant percentage of patients who have addictions to drugs have other psychiatric disorders, as appropriate, can be seen as a cause or consequence of addiction. There is growing scientific evidence that some drug- addicted patients with psychiatric comorbidity (that is, in addition to addiction other psychiatric disorders such as mood disorders, anxiety disorders, psychosis, brain injury disorders, etc.) may have a common vulnerability (genetic or otherwise) for both disorders. This fact should not be surprising; if you know that drugs Abuse acts all in brain areas whose dysfunction (studied with modern neuroimaging techniques and with others) results in characteristic symptoms of psychiatric disorders now well known and defined.
The treatment of addictions is possible, although sometimes it is long and difficult. Many patients with; Drug addiction problems take a long time to ask for help and when they do the usual thing is that drugs have already produced repercussions on family, social and work life that are sometimes irreversible or difficult to invest. These facts are usually a consequence of the prolonged denial that many patients make of their dependence when, in medical terms, it is already well established and is a treatment subsidiary.
Any drug user should consider that it is very likely that he already has a substance abuse problem with medical psychiatric repercussions when he has observed any of the following facts or circumstances in his life:
- Some relatives have urged him on occasion to abandon consumption.
- He has felt criticized or upset by the comments of some acquaintances about the quantity, form or consequences of drug use he does.
- He has felt guilty after having consumed or taken any action under the influence of the drug that made him feel guilty.
- Feel the need to consume early in the morning to “start working.”
- He abuses a drug and in his family there are parents, brothers or uncles who are or have been dependent (since for some addictions it has been shown that there is a genetic component that clearly predisposes them in case of consumption).
The treatment of addictions is not possible if the affected person does not want to do it, and it is not easy if he is not sufficiently motivated. In the latter case, a specific motivating job and commitment to the treatment of the patient and family members is usually required. Although in the most advanced cases it is often a long and difficult road for all the benefits of the results, they can more than compensate for the difficulties and efforts of the first moments.
Almost all treatments usually have two stages. The first is usually called; Detoxification of the substance and the priority in it is to prevent withdrawal symptoms (especially in addictions to opiates, alcohol and other substances that have a marked withdrawal syndrome). In the treatment of withdrawal syndromes, prescription drugs are sometimes used substances capable of generating dependence (including benzodiazepines); and other problems, so it is important to follow the instructions of an expert doctor about it.
After the detoxification comes the stage of detoxification, which is much longer and normally difficult, and in which it is necessary to anticipate that the desire to consume again will appear, that psychiatric problems usually appear that the dependence concealed or distorted, that the patient will recover habits associated with consumption in the past and that, after a few months, you can forget that you are still a sick person (although your illnesstake asymptomatic months or even years). It is not uncommon for a person who has consumed and developed a dependency for many years, to consume again once the treatment has started. The important thing is the identification; early relapse and return to treatment, recognizing the seriousness of the matter but without being discouraged. The basic information that the patient and family members or relatives involved in the treatment should keep in mind is that a very broad investigation supports the return to consumption of the; drug whose dependence is being treated, even if only once, a relapse must be considered clinically. In these cases, without more drama than justified by the immediate consequences of the relapse in question,
The modalities of drug dependence treatment vary greatly depending on the drug in question and other clinical variables. Thus, for alcoholism there are medications that try to reduce the desire to consume; others that have an aversive or disabling behavior modifying effect (medications that modify the normal metabolism of alcohol in the liver resulting in toxic substances with unpleasant and dangerous effects such as facial redness, itching, shortness of breath, restlessness, etc. and in severe cases edema of glottis and other severe symptoms), facilitate the drinker (previously informed and after accepting the treatment and its consequences) abstinence for fear of presenting the aforementioned reaction. For other substances antagonists are available, that is,drugs and that compete with them, preventing the drug from producing its effect, so that who consumed drugs at the same time that a sufficient dose of an antagonist of the same would not obtain any effect (in the case of naltrexone, an antagonist of recipients of; opiates in the central nervous system, which is used in the treatment of dependence on heroin and other opiates and even in dependencies on other non-opioid substances). Other drugs, called complete opioid agonists (such as methadone) act to produce an effect quite similar to heroin and serve as substitutes for this drug in maintenance treatments; oral administration of methadone, free dose control and other health measuresthat are carried out in methadone maintenance programs alleviate the clinical and social situation of many patients in whom the goal of withdrawal fails or cannot be considered at the outset. The so-called partial opioid agonists (such as bupremorphine) produce a less intense and somewhat different effect that also has specific utility in the treatment of some opioid addictions.
The usefulness of both drugs and psychotherapies that have demonstrated their effectiveness in the treatment of drug dependence depend on their correct application. For this, most patients require living conditions in which the possible access to drug use is effectively controlled and, at least initially, impossible. Sometimes these conditions are only obtained on a residential basis. Self-help groups of the type “Alcoholics Anonymous” offer invaluable help to many patients.
In general terms, patients should know that any psychiatric disorder worsens almost systematically with the use of any drug of abuse, that the use of these drugs can also cause the appearance of previously non-existent psychiatric disorders, and that the mere fact of abstaining from a Toxic previously consumed causes almost always improvement of mood, sleep, food, etc …
What are they?
Food, as a function of vital importance for animals is governed by a powerful set of biological and psychological mechanisms that we call survival instinct. The body has developed signals (hunger and physiological signals that indicate hunger) and behaviors associated with those signals that propel the animal to seek and take food when necessary. However, food has also acquired other functions in the long evolutionary path of the human being (social, pleasant functions, etc.). Many people in developed countries today debate between the ideal of beauty in force, basically associated with thinness and concern for obesity, and varied and easy to obtain food availability, typical of consumer societies, in which, for obvious reasons , Many;
Although obesity is not considered a disorder in the current classifications of psychiatric disorders, it is, in itself, the cause of physical disorders and often psychic distress: Obesity can be, on the other hand, a consequence of some psychiatric diseases , and also a side effect of some psychoactive drugs.
The two specific disorders of eating clearly psychiatric most frequent and important today are Anorexia and Bulimia Nerviosas.
What is it?
Mental anorexia is one of the psychiatric disorders that currently cause more concern in developed countries. The media refer to them frequently and regularly. As in the rest of the disorders exposed so far, the cause of anorexia nervosa is not entirely clear. The importance of social and cultural factors is evident, although there seems to be also organic, psychological and family factors involved in the clinical picture.
It is a diseaseIt affects mostly women, although the percentage of men affected seems to have grown in recent years. The characteristic of the disorder is the exaggerated fear of gaining weight, excessive weight loss and the alteration of body image that leads to looking fat even though extreme thinness is evident to everyone. Concern for certain areas of the body is clearly distorted and the patient may continue to consider areas where there is little more than the skin above the bone full of fat. The affected person usually ignores the problems caused by his low weight, and continues to lose weight until his life is in danger. As you lose weight, other symptoms appear: disappearance of menstrual cycles, abdominal pain, dry skin, decreased cold tolerance, constipation, the appearance of a dark body hair called lanugo, and even more serious ones such as cardiac arrhythmias, or alterations in electrolytes (such as sodium or potassium) whose correct balance is essential for life. Although the term anorexia literally means lack of appetite, anorexics, especially at the beginning, tend to be hungry but repress or hide it for fear of gaining weight; The digestive symptoms that occur when you lose weight tend to perpetuate anorexic behavior. they are usually hungry but they repress or hide it for fear of getting fat; The digestive symptoms that occur when you lose weight tend to perpetuate anorexic behavior. they are usually hungry but they repress or hide it for fear of getting fat; The digestive symptoms that occur when you lose weight tend to perpetuate anorexic behavior.
There are two great types of anorexic behaviors, although they can occur mixed in the same person: restrictive and; purgative Restrictive anorexia is characterized by behaviors that tend to prevent the entry of food, such as fasting, an excessive concern for the diets and control of the calories that each food has through complex rituals that are displayed at mealtime. This type is usually associated with obsessive personality traits such as excessive tendency to order, perfectionism, routine, etc. Purgative anorexia is characterized by behaviors such as vomiting after meals, abuse of laxatives or diuretics, unrestrained exercises after intake, etc. These are more impulsive patients, and it is not uncommon for drug abuse to coexist in them .
The treatment of anorexia nervosa is complex. Sometimes the patient goes to a health service for the first time in conditions of true vital risk and, generally, against her will, because the disorder prevents her from becoming aware that she is ill. Therefore, in these first moments the main thing is the vital support that may require nutrition by nasogastric tube, which usually causes anguish to these patients, who feel “as if they were being primed to gain weight”. When possible the collaboration of the patient can be introduced in principle liquid diets in which it is easier to control the caloric intake, and are better accepted than solid diets, to which it is progressively passed. The treatment of more widespread anorexia has an important psychotherapeutic basis; behaviorist, at least in the first moment of hospital admission: the patient, for example, is getting privileges (scaling, visits, leisure and exercise possibilities, etc.) as she gains weight. The treatment is complicated and requires extreme vigilance, since the patient tends to hide food instead of taking it, to vomit secretly and falsify her weight through the most unthinkable tricks.
What is it?
The characteristic of bulimia nervosa is the compulsive intake of food in the form of uncontrollable binge eating of variable duration, which ends with a great sense of guilt; they often compensate for this vomiting intake, or through other purging behaviors. The foods chosen for these binge eating are usually precisely the most fatty or sweet, and of low nutritional value. The patient also has a great concern for personal image and weight control. Binge eating occurs frequently in times of anxiety that does not distinguish well from hunger, as a way to end it; Immediately afterwards, a feeling of almost invariable guilt follows. There are also purging behaviors that end up producing organic lesions due to acid vomiting (dental erosions, inflammation of the salivary glands, esophageal ulcers, etc.). If there are no purgative behaviors, the usual complication is obesity. Patients who vomit after compulsive intake develop the ability to vomit at will and without stimulating the reflex.
The treatment of bulimia nervosa is also long, complex and basically psychotherapeutic but they are also used, in some cases, selective serotonin reuptake inhibitors, as it has been proven that some of them are useful for reducing impulsivity.