Polydrug addiction

Polynarcomania (poly-dependence) is a disease associated with the use of two or more narcotic drugs at the same time or in a certain sequence, and to all of them a dependence is formed.

ICD-10 code

E19 Mental and behavioral disorders caused by the simultaneous use of several drugs and the use of other surfactants.

Combined use of various surfactants changes the clinic of the disease, affects the rate of formation of the main symptoms and syndromes, leads to more severe medical and social consequences.

Most often, the first tried surfactants are alcohol and cannabis preparations. It was found that the majority of people with opioid addiction before the beginning of their use, as a rule, occasionally or, rarely, systematically took these substances. Sometimes drug addicts from the very beginning use several surfactants for a long time, in such cases it is not possible to identify the "preferred" drug (even at the time of AS formation), only the desire to change one's state and receive any, and not any specific euphoria-specific substance. At random reception of different drugs the character of euphoria depends on the basic preparation.

The timing of the formation of AS for polydrug use depends on the combination of the substances taken, their single and daily doses, the mode of administration. In general, the described patients found a relatively rapid development of the dependence syndrome. In particular, the fastest formation of all signs of the disease is noted in cases where the main substances are opioids. In the shortest possible time, the formation of AS occurs in patients with heroin-cocaine, heroin-amphetamine poly-dependence, which indicates a rapid progression of these forms of the disease.

Unlike patients with mononarhomonia, who seek to abstain from abstinence only by taking the usual substance and using others only in his absence, people with poly-dependence from the very beginning use any means available to alleviate the condition. Often alcohol is used for this purpose.

The clinical manifestations of withdrawal syndrome in the case of poly-dependence are manifold (especially in cases of initial intake of various drugs). However, if the basic substance belongs to opioids, the clinical picture of the abstinence state is mainly determined by it, and other intoxicants change only its individual features.

The most common are the following combinations of narcotic and intoxicating substances:

• alcohol with sedatives, less often with marijuana and cocaine;
• opioids with marijuana, cocaine and amphetamines, with alcohol.

Combined use of alcohol and sedatives

Most often with alcohol use tranquilizers, mainly benzodiazepine series. A large group of people combining drinking with the use of composite drugs containing barbiturates or antihistamines, which have a pronounced sedative effect.

Clinical manifestations of chronic alcoholism with combined use of ethanol and sedative-hypnotic drugs have a number of characteristics. The main motives for the initial intake of sedatives are withdrawal of alcohol intoxication, alleviation of symptoms of abstinence syndrome and normalization of sleep, and adolescents tend to change their mental state.

The transition from the abuse of alcoholic beverages to the reception of surfactant occurs in both periods of remission of chronic alcoholism, and against the background of prolonged use of alcohol. A characteristic feature of clinical manifestations of alcoholism in the majority of such patients is the constant type of primary pathological desire to change their mental state, realized in several ways.

The initial use of surfactants to achieve euphoria is one of the most frequent options. Changing the nature of alcohol intoxication, when alcohol loses its euphorizing and activating effect and causes pronounced dysphoric disturbances, aggressiveness, leads to the fact that patients with chronic alcoholism gradually increase the doses of alcohol used for revitalization of positive experiences. However, taking a large amount of alcohol only enhances affective and psychopathic symptoms and does not eliminate the emerging desire for intoxication. To achieve the desired effect, patients start using various sedative and hypnotic drugs.

The administration of surfactants with a therapeutic purpose during the remission of chronic alcoholism is another common cause of their abuse. Tranquilizers, barbiturates and other soothing drugs, alcoholics patients take but the appointment of a doctor to eliminate somato-vegetative disorders. Attacks of increased craving for alcohol can occur as "flashes" of dysphoria, increased irritability, anxiety, restlessness, feelings of unmotivated fear. Prescribed drugs for a while give a positive effect, but the gradual development of resistance to them requires an increase in single doses in 2-3 times. However, drugs in such quantities have an intoxicating effect on alcoholics, which can lead to dependence.

Admission with eating and hypnotics with a substitution goal to alleviate the manifestations of alcohol withdrawal syndrome can also serve as an excuse to abuse them. In connection with the increased resistance of patients to hypnotics, tranquilizers and other sedatives, therapeutic doses are not always effective, which requires their excess. Having a pronounced anxiolytic effect, these substances eliminate anxiety, anxiety, tension, feelings of guilt. Insomnia passes through the hypnotic and anticonvulsant action, the development of epileptiform seizures is prevented. There is a correction of somatovegetative functions: pain pains disappear in the region of the heart, tremor, hyperhidrosis decreases, feeling of weakness, lethargy is facilitated. However, the duration of action of drugs rarely exceeds 2-3 hours, after which again there are withdrawal disorders, which forces patients to take them repeatedly. It should be noted that in severe abstinence states, the use of drugs in doses exceeding the therapeutic levels in 2-3 times does not cause positive experiences. However, the easier manifestations of withdrawal syndrome, the stronger the euphoria. This feature serves as a basis for continuing the abuse of drugs and the formation of dependence.

The substitutive (vicarious) episodic method for achieving the euphoria of hypnotics, tranquilizers and agents with sedative effect in doses exceeding the therapeutic dose does not cause dependence on them.

The timing of the dependence on sedatives and hypnotics in patients with alcoholism is significantly reduced and averages 2-3 weeks 3 4 months. Its formation is significantly influenced by premorbid features of the individual, the severity of the primary pathological desire for alcohol, narcotics, the dose and nature of the administration of surfactants.

The combined use of ethanol and sedatives increases the course of chronic alcoholism. First of all, they note an increase in tolerance to alcohol and a weighting of amnesia. Continuation of abuse leads to a deepening and lengthening of binges, the gradual approach of drunkenness to the constant. They note the weighting of the alcoholic AU - the predominance of psychopathological disorders, which is manifested by emotional disturbances with a melancholy, malicious mood, aggressiveness, anxiety, anxiety. Characteristic of a significant violation of sleep: patients can not sleep for a long time; sleep shortened to 2-3 hours, superficial, restless, with unpleasant, often nightmarish dreams. The frequency of suicidal attempts, epileptiform seizures, acute psychotic disorders increases. The duration of abstinence is 2-3 weeks.

In the transition from abuse of alcoholic beverages to sedatives and hypnotics, a gradual transformation of abstinence from alcohol into a withdrawal syndrome of hypnotics, tranquilizers is noted. In general, for the course of addictions from other surfactants against the background of chronic alcoholism, malignancy, rapid progression, early appearance of somatic, neurological, and psychiatric complications are characteristic.

Medico-social consequences also arise very quickly. Characteristic persistent psychopathological disorders: affective disorders in the form of dysphoria, with daily mood swings, often with suicidal behavior. At the same time, there is a deepening of intellectual-mnestic disorders: a sharp decline in memory, intelligence, attention, slowing down and difficulty of thought processes, impoverishment of vocabulary, mental exhaustion. There is a radical change in the personality, the patients become self-centered, deceitful, embittered, and lose the generally accepted moral and ethical norms. Formed organic dementia and complete social and labor disadaptation, which leads to disability.

[1], [2],

Combined use of opioids and alcohol

The coexistence of alcoholism and drug addiction is met very often in clinical practice. The early age of the onset of alcohol abuse is an unfavorable prognostic sign and a risk factor for the development of drug dependence in the future. Often, the first samples of opioids with alcohol dependence are formed to alleviate the hangover state. However, it is possible that the dependence on alcohol is a frequent consequence of opioid addiction, as patients begin to abuse alcohol in order to overcome withdrawal symptoms, as well as in remission.

The use of alcohol in patients with opioid dependence often leads to altered forms of intoxication with dysphoria and aggression. The most massive use of alcohol is noted in opium abstinence and in the post-abstinence period. Attraction to alcohol at this stage is due, as a rule, to the desire of patients to alleviate their physical and mental state. The development of alcoholism on the background of opioid dependence is fast-progressive, often lightning. The first signs of an alcohol withdrawal syndrome are noted in a few weeks, less often - months, after the onset of abuse. Characterized by its abnormal course: perhaps the prevalence of pain and vegetative disorders, the typical duration of the opioid withdrawal syndrome. And their subjective severity often serves as a reason for the resumption of drug use. The combined use of opioids and alcohol significantly worsens the somatic state of patients and indicates an unfavorable prognosis of the disease.

[3], [4], [5], [6],

Combined use of opioids and psychostimulants (amphetamines, cocaine)

The use of opioids together with psychostimulants, in particular amphetamines, is one of the frequent variants of polydrug use. Patients with opioid dependence most often use amphetamines, either in search of new sensations (wanting to compare the effects of drugs among themselves), or to ease the course of opium withdrawal.

The combined use of opioids and psychostimulants significantly changes the euphoria and clinical picture of intoxication. Amphetamines and cocaine reduce the dose of opioids necessary to obtain an effect. As a rule, the combined use of drugs is preceded by the stages of the use of one of the substances and the formation of dependence on it. Most often this substance is a drug of the opium group.

The clinical picture of mixed intoxication with intravenous injection of opioids and amphetamines consists of two successive phases.

1. The first phase (the so-called parish) is sharply strengthened, more prolonged than from the action of each drug alone, its duration in the middle of 4-10 minutes.
2. The second phase (intoxication). Characterized by an elevated mood with complacency, pleasant relaxation and languor, a feeling of complete peace and indifference to everything, bliss, i.e. Sensation peculiar to opium intoxication, but with mixed intoxication, patients additionally experience a surge of energy, a sense of activity, of their own omnipotence. They are excited (including sexually), strive for activity, to communicate with each other, feel the extraordinary clarity and clarity of thoughts, while feeling the ease and flight feel the pleasant weight of their own body.

A characteristic euphoria often serves as a stimulus for continuing the continuous use of drugs for several days. Within this interval, there is a rapid development of mental dependence on a new substance, the growth of single and daily doses, an increase in the frequency of administration. Continuous use of psychostimulants can lead to depletion of patients, which causes a short-term decrease in tolerance to opioids. However, with their further use, stability again rapidly increases and reaches its initial values. One of the characteristic features of the action of amphetamines is the ability to alleviate the course of opium abstinence syndrome. And there is a complete elimination of pain, general weakness, feelings of weakness, patients feel the rise of mood, a surge of strength, vivacity. They note the persistence of some symptoms of opioid withdrawal, primarily expressed mydriasis, sleep disturbances, motor anxiety, and certain vegetative disorders. Amphetamines also reduce the hypotension and hypochondria characteristic of patients with opioid dependence when they are withdrawn. Attraction to opioids is not suppressed, but at the height of intoxication psychostimulants lose its relevance.

Gradually, patients start taking drugs, randomly intermixing or combining, it is impossible to identify the prevailing substance. Moreover, the attraction to opioids persists, especially if they are available or if there are no psychostimulants.

In the case of the termination of the combined use of narcotic substances 12 hours after the last reception, the development of the withdrawal syndrome is noted. Its manifestations are very diverse, and the severity of these or other symptoms depends on which of the two drugs the patient has favored in recent times. If opioids dominated, then in the structure of AS prevalent pain and vegetative disorders, if predominantly used astheno-depressive psychostimulants. In patients, the mood worsens, they become listless, apathetic, an unstable emotional background with frequent, rapidly dwindling outbursts of irritability, rapid exhaustion of mental processes, slowing of thinking, drowsiness is characteristic. After 1-2 days drowsiness gradually gives way to insomnia: patients can not fall asleep without sleeping pills; sleep superficial, with frequent awakenings; dreams are nightmarish or narcotic. Characteristic early awakening and lack of rest after sleep, as well as a perversion of the rhythm of sleep and wakefulness (patients are drowsy during the day and can not sleep at night). There is a gradual increase in irritability and dysphoria, possibly the emergence of unmotivated anxiety, internal stress, an increase in sensitivity to external stimuli. Appetite does not suffer. The use of psychostimulants significantly increases the likelihood of developing delusional disorders (they are almost never seen with an isolated opium AS).

After the passage of acute withdrawal symptoms, affective disorders are revealed for a long time-a reduced mood background, emotional instability, weak-hearted reactions, rapid exhaustion of mental processes, poor concentration of attention, attraction to the drug. In general, combined abuse of opioids and psychostimulants worsen the course of drug dependence: the number of severe somatoneurological complications is increasing. Quickly come changes in personality.

[7], [8]

Combined use of opioids and tranquilizers

More often, narcotics and tranquilizers are used by patients with already formed dependence on opioids. The reason for this is the development of resistance to the narcotic substance and the loss of its euphorizing effect. Accession of tranquilizers allows patients to reduce the euphoric dose of opioids. Thus, for some time, the effect of stopping the growth of drug resistance has been observed. With the combined use of opioids and tranquilizers, the picture of intoxication changes:

• The first phase of euphoria ("arrival") becomes more "soft" and prolonged;
• the second phase (intoxication) observed a decrease in the stimulating effect. Characteristic for the formed dependence on opioids.

Later, as the dependence on tranquilizers is formed, patients lose the ability to experience pleasant sensations from some opioids (even with very high doses), and against the background of opium intoxication, individual symptoms of sedative drug withdrawal appear. In the overwhelming majority of patients in the condition of AS, a morose-depressed mood predominates with irritability, a tendency to dysphoric reactions and a hyperacostic. Many patients complain of anxiety, internal anxiety. A significant part in the state of abstinence is observed motor anxiety. Often the patients, along with irritability and anxiety, note in their indifference to everything, the lack of desires, motivations, interests. Psychopathological disorders with withdrawal of drugs accompany severe sleep disorders (they are observed in almost all patients, in some of them they reach the degree of insomnia). Combined use of tranquilizers and opioid significantly increases the risk of drug overdose, which may require emergency medical attention.

[9], [10], [11], [12], [13]