The human body is able to adapt to many chemicals and drugs, while the intensity of the reaction decreases, physical and mental dependence, the need for an increase in dose, and withdrawal syndrome (withdrawal) can occur when the medication is stopped. Adaptation of this type is observed with repeated, prolonged intake of substances in the same or slowly increasing dose. Apparently, there is a limit of seemingly painless adaptation, the excess of which entails the breakdown of compensatory mechanisms, illness and death. The cessation of the intake of the corresponding substance causes a withdrawal syndrome, the severity of which is determined by the severity of the onset of organic toxic changes, and not only by the specific characteristics of the chemical agent. In some cases, with the withdrawal syndrome, disorders come to the fore mainly in the somatoneurological field, in others – in the neuropsychiatric. The first disturbances more often occur after taking substances, addiction to which occurs mainly at the organismic, metabolic level, without significant involvement of mental components in the process. The psychopathological component of the withdrawal syndrome in this case may be insignificant or completely absent, it is dominated by a feeling of malaise, weakness and some physical discomfort.
The second version of the withdrawal syndrome is observed when using substances with a psychotropic effect, the intake of which leads to a change in the mental state in the form of an improvement in overall well-being, the emergence of a sense of mental comfort, the alleviation of mental processes (mental operations, memory) and a surge of strength, relieve psychoemotional stress, the onset of internal peace of mind, bliss. We are usually talking about substances with analgesic, sedative, anxiolytic and, less commonly, psychostimulating components of the action.
In the withdrawal syndrome (withdrawal, abstinensin), usually both components are present – somatic and mental, but their severity is different. The prevailing clinical significance of one or the other is apparently determined primarily by the chemical properties, neuro- and psychotropicity of the toxic agent, as well as by a number of individual biological and psychological characteristics of a person.
A number of chemicals and drugs with psychotropic properties have a pronounced specific ability to form a pathological drive with withdrawal syndrome of psychopathological content, the most difficult and socially dangerous, therefore they are included in the list of drugs approved by the Unified International Convention on Narcotic Drugs (1961) and the order of the Ministry of Health of the USSR . Pathological addiction and attraction to them with withdrawal syndrome is defined as drug addiction. A similar addiction and attraction to other drugs and substances is diagnosed as substance abuse.
The list of drugs includes: 1) narcotic substances that are prohibited for use in medical practice, which are not to be included in prescription books and teaching aids: heroin, cannabis (marijuana, hashish), acetorphine, etorphine, lysergic acid and its preparations, mescaline, psilocin, psilocybin; 2) plants and substances classified as narcotic drugs and prohibited for use in medicine, namely: opium poppy, raw opium, industrial morphine, South Chuya, South Manchu and Indian hemp, hemp pollen and resin, hashish, anasha, marijuana; 3) narcotic drugs: dipidolor, codeine, cocaine hydrochloride, morphine, noxiron, omnopon, opium preparations, promedol, sombrevin, tecadine. Their use is under special medical and legal control (E. A. Babayan, M. X. Gonopolsky, 1981). The Criminal Code provides penalties for the illegal manufacture, purchase, storage, transportation, transfer or sale of narcotic substances, for the storage and sowing of seeds and the cultivation of forbidden crops containing narcotic substances, for the organization or maintenance of dens for the consumption of narcotic substances or the provision of premises for those same goals, for inducing the consumption of narcotic substances, for violation of the rules for the production, acquisition, storage, recording, dispensing, transportation or transfer of drugs substances. The use of narcotic substances is considered legal if certain requirements are met: as prescribed by the doctor, according to a prescription drawn up accordingly.
Socio-medical significance, etiology and pathogenesis of substance abuse and addiction
The socio-medical significance of substance abuse and addiction is determined by direct and indirect, direct and indirect damage to the health of the patient and others, as well as damage to the economic, social and psychological properties caused to oneself, the family, the production team, public order and society as a whole.
The prevalence and, consequently, the negative consequences of substance abuse and drug addiction are much greater in capitalist and some developing countries. This is the result of antagonistic relationships, thirst for profit, smuggling of drugs and the distribution of drugs, uncontrolled sale of drugs, the usual daily use of tranquilizers and sleeping pills.
In many countries, due to the implementation of a number of socio-economic, legal, health-improving measures, substance abuse and addiction are much less common. Based on our own clinical and expert experience, we believe that the cause of substance abuse and addiction is most often the beginning of substance intake by an unstable teenager under the influence of a yard authority (toxicomaniac), careless and prolonged prescription by a doctor of appropriate medications, self-medication of neuropsychic instability and insomnia. As a rule, a pathological attraction develops in neurotic and psychopathic subjects trying to compensate for neuropsychiatric insufficiency or social inability by taking drugs that increase self-esteem or relieve the feeling of mental discomfort.
Studies of the biological mechanisms of addiction made it possible to identify the presence of common and specific for each substance biochemical changes in the central nervous system and throughout the body. I.N. Pyatnitskaya (1981), noting the difficulty of isolating the leading link in the pathogenesis of drug addiction, points to the role of activation of detoxifying liver enzymes, changes in the metabolism of neuropeptides (endorphins, enkephalins) and cyclic nucleotides, and suppression of oxidative processes in tissues, especially in the brain. Apparently, of great importance is the violation of the metabolism of catecholamines: dopamine, norepinephrine, adrenaline, serotonin, acetylcholine, etc.
Pathogenetic mechanisms also consist in a deep restructuring of the premorbid personality characteristics at the individual psychological and socio-psychological levels, which is confirmed by the inadequacy of the therapeutic effect of biological treatment methods alone, instability of therapeutic remissions, if psychotherapeutic and social rehabilitation are not actively used ionic events.
Clinic and treatment of some substance abuse and addiction
Substance abuse includes abuse of drugs and products containing caffeine, other central nervous system stimulants (Sydnocarb, Sydnophene, Acefenum), analgesic (phenacetin, analginum, amidopyrine) and hypnotics (phenobarbital, barbital, barbamyl, bromizovylazolezom), , nosepam, nitrazepam, phenazepam, trioxazine, mprotan), antiparkinsonian drugs (cyclodol, parkopan, norakin, ridinol), antihistamines (diphenhydramine , Pipolfenom). Such intoxications are described in the works of I.V. Strelchuk (1956), G.V. Stolyarov (1964), E. A. Babayan, M. X. Gonopolsky (1981).