Dependence on medications

Medication dependence is a condition in which a person has a physical and/or psychological need to take certain medications on a regular basis, regardless of whether or not there is a medical indication for their use. This can be the result of either long-term use of medications as prescribed by a doctor or misuse. Dependence can lead to many negative health consequences, including medication side effects, worsening of the underlying condition due to inappropriate treatment, and psychological and social problems.

The main factors that contribute to the development of addiction to medications include:

1. Long-term use of drugs with high addiction potential, such as opioids, benzodiazepines, and stimulants.
2. Psychological factors such as stress, anxiety, depression, which can lead a person to seek symptom relief through medication.
3. Inadequate monitoring of prescribing and use of medications, including self-medication and improper adherence to medication instructions.
4. Presence of chronic diseases that require long-term medication.

Treatment for drug dependence involves a comprehensive approach consisting of medical care to reduce physical dependence and psychotherapy to address the psychological aspects of dependence. It is also important to provide support from family and loved ones and, if necessary, social rehabilitation.

Medical professionals should be consulted for more detailed information and help with medication dependence.

Drugs that cause drug dependence

Dependence-inducing drugs can be categorized into groups based on their pharmacological action and potential to cause psychological and/or physical dependence. The following are the main groups of substances most commonly associated with the development of dependence:

Opioids

Includes both legal (prescribed for pain relief) and illegal drugs. Examples include morphine, heroin, oxycodone and fentanyl. Opioids are highly physically addictive and have a high risk of developing abuse.

Opioid dependence is a serious medical problem characterized by both a physical and psychological need to take opioid substances on a regular basis. Physical dependence on opioids can develop even after short-term use for pain relief associated with procedures, acute injuries or chronic conditions, and manifests itself through a range of symptoms that occur when opioids are discontinued or the dose is reduced.

Opioid withdrawal symptoms include, but are not limited to:

• Muscle spasms and bone pain
• Severe diarrhea
• Abdominal pain
• Excessive sneezing and runny nose
• Lacrimation and yawning
• Increase in blood pressure and heart rate
• Disorders of body temperature regulation
• Anxiety and agitation
• Insomnia and discomfort

These symptoms can significantly impair the quality of life of patients and put them at risk of reusing opioids to alleviate withdrawal. It is important to note that physical dependence and withdrawal symptoms can develop independently of the presence or absence of psychological dependence or opioid abuse.

Managing physical dependence on opioids requires a comprehensive approach, including medical care to alleviate withdrawal symptoms and psychological support to address the underlying causes of opioid use and prevent relapse.

Benzodiazepines

Used as sedatives and anxiolytics. Examples include diazepam (Valium), alprazolam (Xanax), and lorazepam (Atavan). Benzodiazepines can cause both physical and psychological dependence.

Dependence on benzodiazepines is a significant medical and social problem associated with the long-term use of these drugs. Benzodiazepine withdrawal syndrome is characterized by a wide range of symptoms that can range from mild to severe and can affect both physiological and psychological aspects of a person's health.

The symptomatology of benzodiazepine addiction includes, but is not limited to, the following manifestations:

• Sleep disorders, including insomnia and altered sleep patterns.
• Increased anxiety, irritability and tension.
• Panic attacks and exacerbation of existing anxiety disorders.
• Tremor of the hands, sweating and difficulty concentrating.
• Dry mouth, nausea and weight loss.
• Tachycardia, headaches, muscle aches and stiffness.
• Various perceptions including depersonalization, hypersensitivity to light, sound and tactile sensations.
• In extreme cases, seizures and psychotic reactions.

Physiologic dependence on benzodiazepines can develop after prolonged treatment, even at therapeutic doses. Particularly susceptible to withdrawal syndrome are patients taking drugs with a short half-life, whose administration has been abruptly discontinued or has been administered without adequate slow dose reduction.

It should be emphasized that withdrawal may not occur in all patients taking benzodiazepines and its severity may vary considerably. An important aspect of the treatment of benzodiazepine dependence is the gradual and controlled reduction of the dose of the drug under the supervision of a specialist, which helps to minimize withdrawal symptoms and facilitate recovery.

Prevention of dependence development consists in limiting the duration of benzodiazepines use and using minimally effective doses. In cases where prolonged treatment with benzodiazepines is unavoidable, careful monitoring of the patient's condition is necessary in order to detect signs of dependence in a timely manner.

Modern medicine and pharmacology continue to explore alternative treatments for anxiety disorders and insomnia aimed at reducing the risk of developing dependence and withdrawal associated with the use of benzodiazepines. It is important to continue research in this area to develop new therapeutic approaches that are safe and effective for patients.

Stimulants

Include medications prescribed for ADHD (e.g., amphetamines such as Adderall) as well as illegal drugs such as cocaine and methamphetamine. Stimulants are psychologically addictive and can lead to serious side effects.

Stimulant dependence is characterized by a complex combination of neurobiological, psychological, and social factors. Studies have identified the various symptoms and underlying brain abnormalities associated with stimulant dependence, as well as possible treatment approaches:

1. Brain abnormalities in stimulant dependence: Neuroimaging studies show a persistent decrease in gray matter in areas of the prefrontal cortex in stimulant-dependent individuals that are associated with self-regulation and self-awareness. This raises questions about whether these brain abnormalities predispose these individuals to developing drug dependence or are the result of drug exposure (Ersche, Williams, Robbins, & Bullmore, 2013).

2. Symptoms and treatment approaches:

   • Depression and Stimulant Dependence: Depression is a significant symptom in stimulant-dependent individuals, potentially due to common neurochemical changes in serotonin, dopamine, and peptide systems such as corticotropin releasing factor (CRF) and neuropeptide Y (NPY) (Kosten, Markou, & Koob, 1998).
   • Treatment of stimulant dependence: Advances in understanding the neurobiology of stimulant dependence have identified medications whose pharmacologic effects suggest that they may help patients initiate abstinence or avoid relapse. Combining effective medications and empirically tested behavioral interventions is likely to yield the best results (Kampman, 2008).
   • Agonist replacement therapy: Appetite-reducing agents that act as dopamine and serotonin releasing agents have been proposed as a treatment for stimulant dependence to normalize neurotransmitter deficits during withdrawal (Rothman, Blough, & Baumann, 2002).

3. Withdrawal symptoms of different classes of drugs: Withdrawal from stimulants can lead to mood and sleep disturbances, with the specifics varying from substance to substance. Understanding these symptoms is critical to effectively addressing stimulant dependence (West & Gossop, 1994).

In conclusion, stimulant addiction involves significant brain abnormalities and a range of symptoms that complicate treatment. Emerging research suggests combining pharmacological treatments with behavioral interventions and exploring agonist replacement therapy as potential strategies for effective management of stimulant addiction.

Cannabinoids

Marijuana is the most commonly used substance in this group, which can be psychologically addictive and addictive.

Cannabinoid dependence is a significant medical and social problem, causing a range of symptoms when cannabis use is discontinued. Some of the most commonly reported symptoms of cannabis withdrawal include:

• Irritability
• Restlessness and anxiety
• Desire for marijuana use
• Deterioration in the quality and quantity of sleep
• Change in appetite, weight loss
• Physical discomfort
• Emotional and behavioral symptoms

The basis for the development of cannabis withdrawal is the disruption of the endogenous cannabinoid system, in particular through interaction with the CB1 and CB2 cannabinoid receptors. It has been suggested that the use of bioligands acting directly on cannabinoid receptors may have a therapeutic effect on withdrawal symptoms associated with cannabis dependence (Ferreira et al., 2018).

Discontinuation of chronic cannabinoid use may not cause spontaneous withdrawal reactions in most cases, possibly because of the pharmacokinetic characteristics of cannabinoids. However, such reactions may be induced following blockage of cannabinoid CB1 receptors in animals habituated to cannabinoids. Withdrawal symptoms include mainly somatic signs and changes in various molecular processes affected during withdrawal from other drugs, although the magnitude of these changes is usually lower in the case of cannabinoids (González et al., 2005).

These data emphasize the importance of further research to develop effective treatments for cannabis dependence, including the possible use of cannabinoid agonists as part of a comprehensive therapy.

Hallucinogens

Substances that cause changes in perception, thinking, and emotional state. Examples include LSD and psilocybin. Although physical dependence on hallucinogens is less common, psychological dependence or addiction can develop.

Studies of hallucinogen addiction and related symptoms show that hallucinogens, including both natural substances such as psilocybin and synthetic substances such as LSD, cause profound changes in perception, mood, and thought processes. Here are some key findings from the literature:

1. Experiencing hallucinogens: Hallucinogens cause convincing changes in experience, including altered perception of one's own body and enhanced sensory experiences. People may experience that colors become brighter, music evokes stronger associations, and hallucinations may occur (Mowbray, 1970).
2. Psychotic symptoms: A study found that between 27.8% and 79.6% of amphetamine, cannabis, cocaine and opioid users experienced psychotic symptoms, such as delusions and hallucinations, in the context of using or withdrawing from these substances. The risk of psychotic symptoms increases with the level of dependence on the substance (Smith et al., 2009).
3. Research on the effects of psilocybin on alcohol dependence: A preliminary study has shown that psilocybin can reduce alcohol use in people with alcohol dependence. Study participants experienced decreased alcohol consumption and increased periods of abstinence after taking psilocybin under controlled conditions (Bogenschutz et al., 2015).
4. Difficult experiences with hallucinogens: Research has described "difficult" or disturbing experiences ("bad trips") that can occur with classic hallucinogens such as psilocybin. Such experiences can include feelings of fear, isolation, physical discomfort, and paranoia, but can also be accompanied by positive changes in well-being and perception of the world (Barrett et al., 2016).

These studies emphasize the complexity of human exposure to hallucinogens, the variability of individual responses, and the potential of some hallucinogens to treat addictions and other psychological conditions.

Alcohol

Although alcohol is legal in most countries, it can be both physically and psychologically addictive and is associated with a wide range of health and social problems.

Different substances cause addiction in different ways, depending on the mechanism of action in the body and the way they affect the brain. Addiction treatment requires a comprehensive approach, including medical care and psychotherapy, to address both the physical and psychological aspects of addiction.

Physical dependence on medications

Physical dependence on medications occurs when the body becomes accustomed to the constant presence of a substance and its absence causes physical withdrawal symptoms. This condition can develop with long-term use of many types of medications, especially those that affect the central nervous system. Below are some categories of physically addictive medications, with examples and references to sources:

1. Opioids (e.g. Morphine, codeine, oxycodone, heroin): Opioids are widely used for pain relief but can cause severe physical dependence and withdrawal when discontinued.
2. Benzodiazepines (e.g. Diazepam, alprazolam, lorazepam): Benzodiazepines are used to treat anxiety, insomnia, and seizures. Withdrawal after prolonged use may cause withdrawal symptoms including anxiety, tremors, and seizures.

Each of these substances affects different systems and receptors in the brain, resulting in different mechanisms of dependence and withdrawal. For example, opioids affect opioid receptors, while benzodiazepines affect the GABAergic system.

Medication Dependence Treatment

Treatment of drug dependence involves a combination of psychological, social, and pharmacologic approaches aimed at reducing physical withdrawal symptoms, reducing cravings, and preventing alcohol relapse. Recent years have shown that adjuvant pharmacotherapy is particularly effective in rehabilitation programs for alcohol-dependent patients. Adaptive changes in amino acid neurotransmitter systems, stimulation of dopamine and opioid peptide systems, and changes in serotonin activity are involved in the development of alcohol dependence. Disulfiram, naltrexone, and acamprosate are approved for the treatment and maintenance of withdrawal. New compounds are being investigated (Kiefer & Mann, 2005).

Corticotropin-releasing factor (CRF), a central stress response neuropeptide, may be a clue to the relapse cycle. CRF is hypothesized to be involved in mediating the heightened anxiety and negative emotional states that occur during addiction development, which stimulates drug seeking through negative reinforcement mechanisms. CRF receptor antagonists, by reducing the motivational effects of drug withdrawal and prolonged abstinence, have been proposed as novel therapeutic targets for the treatment of substance abuse and addiction (Logrip, Koob, & Zorrilla, 2011).

An important component of all addiction therapies is some form of behavioral intervention, which is the cornerstone of therapy. Therefore, a comprehensive addiction treatment program should include the option to use medication as indicated. In addition, the most cost-effective approaches to addiction treatment in large populations may be those that integrate psychotherapeutic and medication approaches according to the needs of individual patients (Henningfield & Singleton, 1994).

These findings emphasize the importance of further research to develop new therapeutic strategies in the treatment of drug dependence, suggesting new treatment goals and approaches.