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Drugabuseanddependence - Learning Objective Drug abuse and...

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Learning Objective: Drug abuse and dependence – Sorry about the length, this was quite a broad LI! Definition: Drug abuse is a recurring pattern of harmful use of a substance despite adverse consequences to work, school, relationships, the legal system, and personal health. This may occur concurrently with or independently from substance dependence, in which the impairment or distress is more pervasive and that often (though not necessarily) includes physical dependence and withdrawal symptoms. Epidemiology: In 2009, an estimated 8.7 percent of the population aged 12 or older were illicit drug users. Marijuana was the most commonly used illicit drug (6.6 percent or 16.7 million) In 2009, 10.5 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. Predominant sex: Males > females Predominant age: May begin early in life: 8-10 yr Mean age of onset is: 25 yr for men and 30 yr for women Peak incidence for most substances: 15-30 yr General pathophysiology: Prolonged drug exposure in vulnerable persons causes neurons in key circuits to undergo molecular adaptations. Neurons in the locus coeruleus appear to adapt to prolonged opiate exposure The mesolimbic dopamine system provides powerful reinforcement behaviors with important survival value by producing a sense of euphoria or stimulation It is hypothesized that the drugs that produce these adaptive responses in the mesolimbic dopamine system cause the core symptoms of substance use disorders. When the drug is stopped, the person feels that the world is intolerable without it. Why some people become addicted and other do not is not fully understood. Factors that contribute to individual vulnerability are: genetics, developmental experiences, chronic pain, current levels of distress and complex social factors (family and peer relationships). Psychiatric disorders are a risk factor in substance use disorders. Most commonly abused substances: Alcohol Tobacco Cocaine, amphetamines, and other CNS stimulants: These act by increasing synaptic dopamine in the mesocoricolimbic dopamine system (dopamine neurons in the ventral tegmental area and its projections in the nucleus accumbens and prefrontal cortex) Repeated use of these drugs causes neuronal changes that lead to their compulsive use, as well as tolerance; and withdrawal symptoms when stopped abruptly Examples of these drugs are methylphenidate (Ritalin), phenmetrazine, Benzedrine,
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