Alcohol Pharmacology and Pharmacotherapy of Alcoholism
Sahab Uddin, Rashid Mamunur in Advances in Neuropharmacology, 2020
Tolerance is the diminished social, behavioral, or physiological response to the corresponding dose of ethanol because of repeated use and characterized by downregulation of receptors. Acute tolerance is noted soon after alcohol intake (Tabakoff et al., 1986). Chronic tolerance occurs in long term and characterized by alterations in alcohol-metabolizing enzymes. Physical dependence is established by how the body experiences physiological adaptation of withdrawal syndrome on alcohol termination. Psychological dependence is characterized by craving and drug-seeking behavior (Baconi et al., 2015). The molecular mechanisms involved in tolerance and dependence include changes in synaptic and intracellular signaling due to changes in gene expression. Chronic actions of alcohol comprise alterations in glutamate and GABA receptor neurotransmitter signaling and downstream signaling pathways. For instance, hyperactivation of NMDA-receptors in chronic alcoholics attribute to the CNS hyper excitability and neurotoxicity during ethanol withdrawal (Becker and Redmond, 2002).
The practice of pain management
Nan Stalker in Pain Control, 2018
The social and psychological problems seen with street addicts of opioid analgesics are exceedingly rare in patients being treated with this class of drugs. However, the following characteristics of drug dependence can sometimes be observed. Physical dependence. This is characterised by tolerance to the drug and withdrawal symptoms when the drug is discontinued.Psychological dependence. This is characterised by a need for the drug to achieve emotional well-being. This most often arises due to the practice of under-medicating the patient, which leads to pain breakthrough. In this situation the patient only experiences pain relief after dose administration and this leads to ‘craving’ for the drug to bring about pain relief.
Cannabis
S.J. Mulé, Henry Brill in Chemical and Biological Aspects of Drug Dependence, 2019
Although the distinction between physical and psychological dependence implies a dichotomy between body and mind that is becoming increasingly untenable; it is traditional to consider the two types of dependence separately. There is clinical evidence for considerable difficulty in discontinuing regular use of high doses of cannabis without external restraint.17,18 Studies from the U.S. considering the effects of lower doses used for shorter time periods concluded there was no evidence of marked psychological dependence.134 In order to produce significant physical dependence to cannabis, it may be necessary to take enough to maintain a state of chronic intoxication during a major portion of each day. Such a sustained level of intoxication is necessary to demonstrate physical dependence to barbiturates.99 A single large daily dose or even two or three doses daily will not usually result in an abstinence syndrome. It is rare for a cannabis user in the U.S. to maintain a chronic intoxicated state.
The comparison of impulsivity and craving in stimulant-dependent, opiate-dependent and normal individuals
Published in Journal of Substance Use, 2018
Ali Mohammadzadeh, Vahid Khosravani, Rasoul Feizi
Craving as a powerful motivating variable in the intense tendency to drug use can stem from physiological or psychological effects of substance use (Addolorato et al., 2005). Our finding concerning more severe craving in stimulant-dependent patients than opiate-dependent ones was in line with Waldrop et al. (2010). These authors observed that symptoms of cocaine caused craving, anxiety, and cortisol release in cocaine users. Also, it was proven that craving played a role in stimulant substance use and relapses following treatment (Robinson & Berridge, 1993; Volkow et al., 2006) and it is necessary to evaluate dissimilarities across users. Our finding can be explained from the perspective of neurophysiological effects of stimulants. Stimulants cause dependence through short-term, severe, and frequent dopamine injections that alter the sensitivity of the brain toward a range of stimuli. Therefore, substance-specific stimuli will be very important, and irrelevant stimuli will lose their importance. This is why stimulant substances lead to psychological dependence rather than physical dependence. Psychological dependence is recognized through substance-seeking behaviors and craving (Sullivan & Hagen, 2002).
Haloperidol for the treatment of opioid addiction in advanced cancer patients: a case series
Published in Journal of Addictive Diseases, 2020
Alessandro Parisi, Maria Vittoria Pensieri, Alessio Cortellini, Carla D’Orazio, Corrado Ficorella, Lucilla Verna, Giampiero Porzio
Physical and psychological dependence are caused by a complex opioidinduced rush of dopamine in greater amounts than under normal stimulus, which pathologically intercept the brain mechanisms of reward and pleasure-related learning and memory.16 This complex reaction is located at the level of the mesolimbic system in an inter- action between dopamine-mediated neurons of the ventral tegmental area in the midbrain, the nucleus accumbens and the prefrontal cor- tex.17 Based on this, there is a strong rationale in using anti-dopaminergic drugs for treating addiction; along with approved standard of care drugs for this indication such as methadone, naltrexone and buprenorphine with or without naloxone and the concurrent management of psychological distress and psychiatric comorbidities.18
Drug dependence as a split object: Trajectories of neuroscientification and behavioralization at the Max Planck Institute of Psychiatry
Published in Journal of the History of the Neurosciences, 2023
Brengelmann defined drug dependence in his text as a multifactored phenomenon and emphasized the “phenomenon of multiple abuse,” which ranges from marijuana to hard drugs (Brengelmann 1973, 75). In doing so, he also referred to the “dual nature” of drug dependence by referring to physical and psychological forms. Unlike Matussek earlier, he did not directly criticize models of biological psychiatry but integrated them into his definition of substance dependence. Nevertheless, Brengelmann assigned his research to one side; according to him, psychiatry had focused too much on physical symptoms up to this point. The more difficult “elimination of psychological dependence” had, however, been neglected (Brengelmann 1973, 79). After criticizing the effectiveness of the psychotherapeutic methods available, Brengelmann suggested treating the problem of psychological dependence by using the new approach, at the time, of behavior therapy. In so doing, he followed the general trend of behavioral therapy methods developed in the United States, the United Kingdom, and South Africa, which were spreading to Germany and other European countries (Fichter 2006).
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