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Drug Abuse

Disease Details

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Description: Drug abuse is the compulsive use of substances despite harmful consequences, leading to physical, psychological, and social impairments.
Type: Drug abuse is a complex condition influenced by multiple factors, including environmental, psychological, and genetic elements. However, it does not follow a simple Mendelian pattern of genetic transmission. Instead, it exhibits a polygenic mode of inheritance, meaning multiple genes may contribute to an individual's susceptibility to drug abuse, along with significant environmental influences.
Signs And Symptoms: Depending on the actual compound, drug abuse including alcohol may lead to health problems, social problems, morbidity, injuries, unprotected sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical dependence or psychological addiction.There is a high rate of suicide in alcoholics and other drug abusers. The reasons believed to cause the increased risk of suicide include the long-term abuse of alcohol and other drugs causing physiological distortion of brain chemistry as well as the social isolation. Another factor is the acute intoxicating effects of the drugs may make suicide more likely to occur. Suicide is also very common in adolescent alcohol abusers, with 1 in 4 suicides in adolescents being related to alcohol abuse. In the US, approximately 30% of suicides are related to alcohol abuse. Alcohol abuse is also associated with increased risks of committing criminal offences including child abuse, domestic violence, rapes, burglaries and assaults.Drug abuse, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. This can occur both in the intoxicated state and also during withdrawal. In some cases, substance-induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine abuse. A protracted withdrawal syndrome can also occur with symptoms persisting for months after cessation of use. Benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Both alcohol, barbiturate as well as benzodiazepine withdrawal can potentially be fatal. Abuse of hallucinogens, although extremely unlikely, may in some individuals trigger delusional and other psychotic phenomena long after cessation of use. This is mainly a risk with deliriants, and most unlikely with psychedelics and dissociatives.
Cannabis may trigger panic attacks during intoxication and with continued use, it may cause a state similar to dysthymia. Researchers have found that daily cannabis use and the use of high-potency cannabis are independently associated with a higher chance of developing schizophrenia and other psychotic disorders.Severe anxiety and depression are commonly induced by sustained alcohol abuse. Even sustained moderate alcohol use may increase anxiety and depression levels in some individuals. In most cases, these drug-induced psychiatric disorders fade away with prolonged abstinence. Similarly, although substance abuse induces many changes to the brain, there is evidence that many of these alterations are reversed following periods of prolonged abstinence.
Prognosis: Drug abuse, if left untreated, can lead to serious long-term health consequences including addiction, mental health disorders, cardiovascular disease, infectious diseases, and various organ damage. The prognosis varies depending on factors such as the type of drug, duration and intensity of abuse, overall health of the individual, and their access to effective treatment and support. With appropriate intervention, including behavioral therapies, medication-assisted treatment, and support systems, many individuals can achieve recovery and improve their quality of life. Early intervention typically leads to better outcomes.
Onset: Onset of drug abuse can vary widely depending on individual factors such as genetics, environment, and personal experiences. It often begins in adolescence or early adulthood but can start at any age. Early use, especially during the teenage years, is particularly concerning due to the vulnerability of the developing brain.
Prevalence: The prevalence of drug abuse varies by region, substance, and demographic factors. It is a significant public health concern worldwide, impacting millions of individuals. In the United States, for instance, the National Survey on Drug Use and Health (NSDUH) reported in 2020 that approximately 19.3% of people aged 12 or older had used illicit drugs in the past year. Globally, the World Drug Report 2021 by the United Nations Office on Drugs and Crime (UNODC) estimated that around 275 million people used drugs in the previous year. These figures underline the widespread nature of drug abuse across different populations.
Epidemiology: The initiation of drug use including alcohol is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from 2010 Monitoring the Future survey, a nationwide study on rates of substance use in the United States, show that 48.2% of 12th graders report having used an illicit drug at some point in their lives. In the 30 days prior to the survey, 41.2% of 12th graders had consumed alcohol and 19.2% of 12th graders had smoked tobacco cigarettes. In 2009 in the United States about 21% of high school students have taken prescription drugs without a prescription. And earlier in 2002, the World Health Organization estimated that around 140 million people were alcohol dependent and another 400 million with alcohol-related problems.Studies have shown that the large majority of adolescents will phase out of drug use before it becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents who meet criteria for substance abuse is significantly lower (close to 5%). According UN estimates, there are "more than 50 million regular users of morphine diacetate (heroin), cocaine and synthetic drugs."More than 70,200 Americans died from drug overdoses in 2017. Among these, the sharpest increase occurred among deaths related to fentanyl and synthetic opioids (28,466 deaths). See charts below.
Intractability: Drug abuse is often considered difficult to address because it involves complex interactions of psychological, biological, and social factors. While not entirely intractable, it requires a multifaceted approach for effective treatment, including medical interventions, behavioral therapy, and social support. Long-term management and relapse prevention are also critical components, indicating that while challenging, it is not impossible to treat with sustained effort and comprehensive care.
Disease Severity: Drug abuse can lead to a range of severe health consequences, depending on the substance involved, the duration and frequency of use, and individual factors. Potential severe outcomes include:

1. **Acute Health Risks**: Overdose, impaired motor skills, and increased risk of accidents.
2. **Chronic Health Issues**: Heart disease, liver damage, respiratory problems, and neurological impairments.
3. **Mental Health Disorders**: Anxiety, depression, psychosis, and increased risk of suicide.
4. **Social and Economic Consequences**: Strained relationships, job loss, financial difficulties, and legal issues.

The severity can vary significantly but often escalates without appropriate intervention and treatment.
Healthcare Professionals: Disease Ontology ID - DOID:302
Pathophysiology: Pathophysiology of drug abuse involves complex interactions between the drug, the brain, and the body's neurochemistry. Drugs of abuse typically target the reward system of the brain, particularly the mesolimbic pathway, by increasing levels of neurotransmitters such as dopamine. This leads to feelings of euphoria and reinforces drug-taking behavior. Over time, repeated drug use can cause changes in brain function and structure, contributing to tolerance, dependence, and addiction. Chronic use can also impair other neurochemical systems such as those involving serotonin and glutamate, further affecting cognition, mood, and behavior.
Carrier Status: Carrier status does not apply to drug abuse, as drug abuse is a behavioral condition rather than a genetic one.
Mechanism: Drug abuse typically disrupts normal brain function through its effects on neurotransmission. Different classes of drugs have varied mechanisms, but many lead to an increase in dopamine levels in the brain's reward pathway, which contributes to their addictive properties.

1. **Stimulants (e.g., cocaine, methamphetamine):**
- **Mechanism**: They increase the release or inhibit the reuptake of monoamines like dopamine, norepinephrine, and serotonin.
- **Molecular Mechanisms**: Cocaine blocks dopamine transporters, preventing dopamine reuptake and leading to excess dopamine in the synaptic cleft. Methamphetamine increases release and blocks reuptake of dopamine and other monoamines.

2. **Opioids (e.g., heroin, morphine):**
- **Mechanism**: They bind to and activate opioid receptors (primarily mu receptors) in the brain and other tissues.
- **Molecular Mechanisms**: Activation of opioid receptors inhibits adenylate cyclase, reduces cyclic AMP levels, and leads to decreased neurotransmitter release. This ultimately modulates pain, reward, and addictive behaviors.

3. **Cannabinoids (e.g., THC in marijuana):**
- **Mechanism**: They bind to cannabinoid receptors (CB1 and CB2) in the brain.
- **Molecular Mechanisms**: Activation of these receptors inhibits adenylate cyclase, reduces cyclic AMP levels, and modulates neurotransmitter release, impacting mood, memory, and perception.

4. **Alcohol:**
- **Mechanism**: It enhances the effect of the inhibitory neurotransmitter GABA and reduces the effect of the excitatory neurotransmitter glutamate.
- **Molecular Mechanisms**: Alcohol binds to GABA-A receptors, increasing chloride ion influx, and inhibits NMDA receptors, reducing excitation.

5. **Nicotine:**
- **Mechanism**: It binds to nicotinic acetylcholine receptors, particularly in the brain's reward circuits.
- **Molecular Mechanisms**: Activation of these receptors increases dopamine release, enhancing reward pathways.

The common pathway for the addictive properties involves the mesolimbic dopamine system, primarily affecting the ventral tegmental area (VTA) and the nucleus accumbens (NAc). Over time, drug abuse can lead to neuroadaptive changes in the brain, reinforcing compulsive drug-seeking behaviors and addiction.
Treatment: Treatment for drug abuse typically involves a combination of approaches to address the physical, psychological, and social aspects of addiction. These can include:

1. **Detoxification**: Medically supervised detox to manage withdrawal symptoms.
2. **Therapy and Counseling**: Behavioral therapies such as Cognitive Behavioral Therapy (CBT), individual counseling, and group therapy sessions.
3. **Medication-Assisted Treatment (MAT)**: Use of medications like methadone, buprenorphine, or naltrexone to reduce cravings and withdrawal symptoms.
4. **Support Groups**: Participation in support groups such as Narcotics Anonymous (NA) for peer support.
5. **Inpatient or Residential Treatment**: Intensive, structured programs that include medical care, therapy, and support in a live-in facility.
6. **Outpatient Programs**: Less intensive programs allowing individuals to continue with daily activities while receiving treatment.
7. **Aftercare and Relapse Prevention**: Ongoing support and planning to prevent relapse after the initial recovery phase.

Treatment plans are tailored to each individual's needs and often involve continuing care to maintain sobriety and address any co-occurring mental health conditions.
Compassionate Use Treatment: Compassionate use treatment involves providing patients with access to investigational drugs outside of clinical trials when no comparable or satisfactory alternative therapy options are available. For drug abuse, compassionate use might be considered for individuals who have not responded to standard treatments.

Off-label treatments for drug abuse refer to the use of approved medications for purposes not specified in the FDA-approved labeling. For example, some medications approved for other conditions, such as certain antidepressants or antipsychotics, may be used off-label to manage symptoms of drug addiction or withdrawal.

Experimental treatments are therapies still in the research phase and not yet approved for general use. In the context of drug abuse, these might include novel pharmacological agents, neuromodulation techniques like transcranial magnetic stimulation (TMS), or innovative behavioral therapies being tested in clinical trials.
Lifestyle Recommendations: For individuals dealing with drug abuse, several lifestyle recommendations can support recovery and improve overall well-being:

1. **Seek Professional Help**: Engage in therapy or counseling, and consider treatment programs.
2. **Build a Support Network**: Surround yourself with supportive friends and family, or join support groups like Narcotics Anonymous.
3. **Healthy Diet**: Maintain a balanced diet to help restore physical health.
4. **Exercise Regularly**: Engage in physical activities to boost mood and overall health.
5. **Avoid Triggers**: Stay away from environments or people that may encourage drug use.
6. **Develop New Hobbies**: Find new interests and activities to fill time previously spent on substance use.
7. **Practice Stress Management**: Use techniques like mindfulness, meditation, or yoga to manage stress.
8. **Establish a Routine**: Create a structured daily schedule to provide stability.
9. **Get Adequate Sleep**: Ensure consistent and adequate sleep to aid recovery.
10. **Stay Hydrated**: Drink plenty of water to help detoxify the body.

Consistently applying these recommendations can contribute significantly to the recovery process.
Medication: A number of medications have been approved for the treatment of substance abuse. These include replacement therapies such as buprenorphine and methadone as well as antagonist medications like disulfiram and naltrexone in either short acting, or the newer long acting form. Several other medications, often ones originally used in other contexts, have also been shown to be effective including bupropion and modafinil. Methadone and buprenorphine are sometimes used to treat opiate addiction. These drugs are used as substitutes for other opioids and still cause withdrawal symptoms but they facilitate the tapering off process in a controlled fashion. When a person goes from using fentanyl every day, to not using it at all, they will experience a point where they need to get used to not using the substance. This is called withdrawal.Antipsychotic medications have not been found to be useful. Acamprostate is a glutamatergic NMDA antagonist, which helps with alcohol withdrawal symptoms because alcohol withdrawal is associated with a hyperglutamatergic system.
Repurposable Drugs: Repurposable drugs for drug abuse treatment primarily include medications originally developed for other conditions but found to be beneficial in addressing substance abuse. These may include:

1. **Naltrexone**: Initially used for opioid and alcohol dependence, it can help reduce cravings and prevent relapse in other substance use disorders.
2. **Bupropion**: Primarily an antidepressant and smoking cessation aid, it has potential in treating methamphetamine and cocaine dependence.
3. **Gabapentin**: Initially for epilepsy and neuropathic pain, it shows promise in reducing alcohol and cocaine use.
4. **Modafinil**: Originally for narcolepsy, it is being studied for its potential to reduce cocaine and methamphetamine cravings.
5. **Disulfiram**: Used to treat chronic alcoholism, it is being researched for its effectiveness against cocaine addiction.

These drugs are part of ongoing research, and their full potential and mechanisms in treating various forms of drug abuse are still being explored.
Metabolites: The metabolites of drugs of abuse are the substances that result from the body's chemical processing of a drug. These metabolites can be detected in various body fluids and tissues and are often used in drug tests to determine recent drug use. Examples of common drugs of abuse and their primary metabolites include:

1. **THC (from cannabis)**: Primary metabolite is 11-nor-9-carboxy-THC (THC-COOH).
2. **Cocaine**: Primary metabolite is benzoylecgonine.
3. **Heroin**: Metabolized to 6-monoacetylmorphine (6-MAM) and then to morphine.
4. **Methamphetamine**: Metabolized to amphetamine.
5. **MDMA (Ecstasy)**: Metabolized to MDA (3,4-methylenedioxyamphetamine).
6. **Morphine**: Metabolites include morphine-3-glucuronide and morphine-6-glucuronide.

Testing for these metabolites helps confirm the presence of the parent drug and can provide insights into the timeframe of drug use.
Nutraceuticals: Nutraceuticals refer to products derived from food sources with extra health benefits in addition to basic nutritional value. They are often marketed as preventing chronic diseases, improving health, delaying the aging process, or supporting the structure or function of the body.

In the context of drug abuse, nutraceuticals can play a supportive role in recovery and management by potentially helping to repair the damage caused by substance abuse, boosting the immune system, and improving overall mental and physical health. However, they are not a substitute for medical treatment or rehabilitation programs specifically designed to treat substance use disorders.

When referring to "nan," if it's short for "nanotechnology" in the context of drug abuse, it’s a different concept. Nanotechnology involves manipulating matter at an atomic or molecular scale. Potential applications in drug abuse treatment include targeted drug delivery systems that can enhance the efficacy and minimize the side effects of drug addiction treatments, such as better delivery of medication to the brain or other affected areas.

It's important to consult healthcare professionals for appropriate treatment options, as these areas are supplementary and currently under research for efficacy and safety in the context of drug abuse treatment.
Peptides: Peptides are short chains of amino acids linked by peptide bonds and have various biological functions, including neurotransmission and hormonal regulation. In the context of drug abuse, some peptides are being studied for their potential therapeutic effects in treating addiction. These peptides can influence the brain's reward system and potentially reduce cravings and withdrawal symptoms.

"Nan" in the context of drug abuse refers to nanoparticles, which are extremely small particles between 1 and 100 nanometers in size. Nanotechnology is being explored for its potential to improve drug delivery systems. For instance, nanoparticles can be used to deliver medication more effectively to the brain, potentially offering new treatments for addiction by targeting specific pathways involved in substance abuse with greater precision and fewer side effects.