Drug Dependence and Addiction

LECTURE 6
 Drug Use
 Drug users are found in all occupations and
professions, at all income and social class levels,
and in all age groups.
 No one is immune to drug use, which often leads
to drug dependence. Thus, drug use is an equal-
opportunity affliction.

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 Drug Misuse
Drug misuse is the unintentional or inappropriate
use of prescribed or over-the-counter (OTC) types
of drugs.
OTC drugs are drugs that have been found to be
safe and appropriate for use without the
supervision of a health care professional such as a
physician, and they can be purchased by consumers
without a prescription.

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Six Examples of Drug Misuse

 Taking more drugs than prescribed

 Using OTC or psychoactive drugs in excess
without medical supervision
 Mixing drugs with alcohol or other types of
drugs
 Using old medicines to self-treat new
symptoms of an illness
 Discontinuing prescribed drugs at will
and/or against physician’s orders
 Administering prescribed drugs to a family
member without medical consultation and
supervision
 Erich Goode’s Four Types
of Drug Use

 Legal instrumental use—taking prescribed

drugs or OTC drugs to relieve or treat mental or
physical symptoms
 Legal recreational use—using licit drugs like
tobacco, alcohol, and caffeine to achieve a certain
mental state
 Illegal instrumental use—taking non-
prescribed drugs to achieve a task or goal
 Illegal recreational use—taking illicit drugs for
fun or pleasure
 Why Are People So Attracted to Drugs?

People use drugs as a means to temporarily:

 Experience pleasure or heighten good feelings
 Relieve stress, tension, or anxiety
 Forget one’s problems and avoid or postpone worries
 Relax after a tension-filled day of work
 Fit in with peers or as a rite of passage
 Enhance religious or mystical experiences
 Relieve pain and some symptoms of illness
 When Does Use Lead to Abuse?
 The amount of drug taken does not necessarily
determine abuse.
 The motive for taking the drug is the most
important factor in determining presence of abuse.
 Initial drug abuse symptoms include:
 Excessive use
 Constant preoccupation about the availability and supply of
the drug
 Refusal to admit excessive use
 Reliance on the drug
 TERMINOLOGIES
Increased drug seeking property or wanting of
CRAVING drug or desire to procure the drug
Primary reinforcing property of the drug, referred to as ‘Positive
EUPHORIA

Effective State’ and characterized by pleasant experience on usage

of a particular drug because of excitation related to orgasmic
pleasures.
It is medically recognized as a mental and emotional condition in
which a person experiences intense feelings of well-being, elation,
happiness, excitement, and joy.
DYSPHORIA

A negative reinforcing property where an individual derives relief

from unwanted effects. It is a state of feeling unwell or unhappy; a
feeling of emotional and mental discomfort as a symptom of
discontentment, restlessness, dissatisfaction, malaise, depression,
anxiety or indifference.
 TERMINOLOGIES
The recurrence of symptoms of a disease due to
REBOUND sudden cessation of the drug. Symptoms are
intense and appear to a greater extent.
Examples : Recurrence of Hypertension immediately after
discontinuation of Clonidine, a β-blocker
The recurrence of disease which has been successfully
treated earlier. This may occur with similar symptoms of
RELAPSE the disease after a gap of certain period due to
discontinuation of treatment.

DETOXIFICATION
It is one of the process of drug dependence treatment. It involves
administration of abused drug in reduced doses so that slow
withdrawal is possible.
TERMINOLOGIES: ADDICTION
Chronic use of drug leads to drug addiction. Drug addiction is
characterized by the following:
 The person aims to consume the drug at any circumstances.
 Procurement of the drug becomes a must for the person.
 Drug addiction leads to the development of tolerance.
 Tolerance development increases the effective dose
requirement production of normal therapeutic effect.
 Addicted people must use the drugs regularly to avoid
abstinence (self-restraint) syndrome.
 Discontinuation or cessation of the drug leads to relapse.
Examples : The drugs like Amphetamines, Lysergic Acid Diethylamide,
Cocaine, Cannabis and others are liable for addiction. These drugs
produce addiction without physical dependence.
 TERMINOLOGIES: HABITUATION
It is a state of mind of a drug abuser characterized
by the following features:
There is no compulsion to consume the drug.
Tolerance, withdrawal symptoms are developed to
a maximum extent.
Habituation is not harmful to society but is
problematic for an individual.
It is closely related to addiction.

Examples: Addiction to Tea, Coffee and other beverages, Alcoholism,

consumption of Soft Drinks, Cool Drinks, Energy Drinks, etc.,
Addiction to Tobacco in the form of Smoking Cigarettes, Chewing, etc.
DRUG DEPENDENCE OR SUBSTANCE
DEPENDENCE
Substance or Drug Dependence,
commonly called
as Drug Addiction, is
a compulsive need to use drugs in
order to function normally.

When such substances are

unobtainable, the user suffers
from withdrawal.
 DRUG DEPENDENCE
ACCORDING TO DSM-IV-TR-2000
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS

 When an individual persists in use of alcohol or

other drugs despite problems related to use of the
substance, Substance (Drug) Dependence may be
diagnosed.
 Compulsive and repetitive use may result in
tolerance to the effect of the drug and withdrawal
symptoms when use is reduced or stopped.
 This, along with Substance (Drug) Abuse are
considered Substance (Drug) Use Disorders.
DRUG ABUSE OR SUBSTANCE ABUSE
Substance abuse, also known as drug abuse,
is a patterned use of a substance (drug) in
which the user consumes the substance in
amounts or with methods neither approved
nor advised by medical professionals.
Substance/Drug abuse is not limited to
mood-altering or psycho-active drugs. If an
activity is performed using the objects
against the rules and policies of the matter
(as in steroids for performance
enhancement in sports), it is also called
substance abuse.
DRUG ABUSE OR SUBSTANCE ABUSE

 The mood-altering and psychoactive

substances are not the only types of drugs
abused.
 Using illicit drugs – narcotics, stimulants,
depressants (sedatives), hallucinogens,
cannabis (marijuana), even glues, paints,
lacquer paint solvents, turpentine, nail
polish removers, petrol etc. are also
considered to be classified as
drug/substance abuse.
 Substance abuse or Drug abuse often
includes problems with impulse control
and impulsive behavior.
 DEPENDENCE AND ABUSE
THE DIFFERENTIATION

The DSM-IV-TR identifies two different severities of Substance

Use Disorders. These are Substance Abuse and Substance
Dependence.

DRUG ABUSE
Substance Abuse is the less severe diagnosis.
It includes symptoms like:
The repeated and continued use of a substance despite
negative consequences (within a 12-month period) etc.
 Drug addiction is a chronic, relapsing
behavioral disorder

 First:It causes physical dependence. Body

builds tolerance for the drug requiring
addict to take more and more to get the
same effect. Followed by unpleasant
withdrawal symptoms
 Second: Emphasis on behavior because of
compulsive nature of addiction i.e. cravings.
 It is a chronic relapsing disorder with
periods of remissions and relapsing
Third: Drug use persists despite
serious harmful consequences
 DSM-IV TR distinguished between drug
abuse and drug dependence
 DSM-5 has removed this distinction and
only calls it a drug use disorder
 Drug Dependence
Both physical and psychological factors
precipitate drug dependence:
 Physical dependence refers to the need to
continue taking the drug to avoid withdrawal
symptoms, which often include feelings of
discomfort and illness.
 Psychological dependence refers to the need
that a user may feel for continued use of a
drug in order to experience its effects and/or
relieve withdrawal symptoms.
 Stages of Drug Dependence
 Relief—satisfaction from negative feelings in
using the drug
 Increased use—involves taking greater
quantities of the drug
 Preoccupation—consists of a constant concern
with the substance
 Dependency—a synonym for addiction, is
when more of the drug is sought despite the
presence of physical symptoms
 Withdrawal—the physical and/or
psychological effects from not using the drug
Costs of Drug Use to Society
 Illness
 Shortened lifespan
 Broken home
 Fetal alcohol syndrome
 Criminal behavior
 Drugs in the workplace etc.
 Holistic Self-Awareness Approach

• Holistic philosophy that advocates

that the mind, body, and spirit work
best when they are drug-free

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 Development & maintenance

1. Drug related factors

2. Risk factors
3. Protective factors
 Drug related factors

 Positive reinforcing factors of drugs

such as
 euphoria,
 relief from withdrawal symptoms,
 relief from anxiety
 functional enhancement i.e. increased
alertness
 Risk factors
 Drug addiction also depends on the amount
of stress and stress management skills
 Stress coping is taught to the addicts for
controlling drug use
 Presence of other psychological disorders
(comorbidity)
 Comorbidity with drug dependence is more
in females than males (Zilberman et al, 2003)
 Substance use disorder is a primary
diagnosis in men
 Familial risk factors: Alcoholic parents ->
alcoholic children (modeling)
 Other purposes that serve addicts:
 Socialfacilitation
 Escape from daily responsibilities
 Group solidarity within an ethnic group
 Genes also play a modulatory role i.e.
altering the receptors’ sensitivity to
neurotransmitters
 Protective factors

 Absence of all the factors mentioned

so far. For example:
 Absence of other psychiatric disorder
 Absence of problematic personality
traits
 Stable family without substance use
 Not belonging to drug promoting ethnic
group etc.
 Protective factors after abstinence
 There is always a chance of a relapse after
remission from drug use
 Positive life changes like marriage,
spiritual/religious experience
 Negative consequences of drug use i.e. health
problem, financial problem, loss of job, social
pressure etc.
 Moving to new area, new social relationships,
employment, substitute activities like exercise
etc.
 Psychological Factors Affecting
Drug Effect

 Individual’s mental set

 Mental sets represent a form of rigidity in which
an individual behaves or believes in a certain way
due to prior experience
 Placebo effects
 A beneficial effect produced by a placebo drug
or treatment, which cannot be attributed to the
properties of the placebo itself, and must
therefore be due to the patient's belief in that
treatment.
 Intended and Unintended
Effects of Drugs

 Intended responses
 reason for using the drug

 Unintended responses
 side effects

 The main distinction between intended

responses and side effects depends on the
therapeutic objective.
 Common Side Effects of Drugs

 Nausea or vomiting
 Changes in mental alertness
 Dependence
 Withdrawal

 Allergic reactions
 Changes in
cardiovascular activity

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Common Side Effects of Drugs
(continued)
 Potency vs. Toxicity

Potency
the amount of drug necessary to
cause an effect

Toxicity
the capacity of a drug to do damage/cause
adverse effects in the body
 Required Doses for Effects

 Threshold dose—the minimum amount of a

drug necessary to have an effect
 Plateau effect—the maximum effect a drug can
have regardless of the dose
 Cumulative effect—the buildup of drug
concentration in the body due to multiple doses
taken within short intervals
 Time-Response Factors

 The closer a drug is placed to the target area, the

faster the onset of action.
 Acute drug response
 Immediate or short-term effects after a single drug dose
 Chronic drug response
 Long-term effects after a single dose
DRUGS OF ABUSE: NICOTINE
Nicotine is obtained from Nicotiana tobaccum
to a maximum extent and is potent (persuasive),
toxic substance that exists in tobacco and is
responsible for drug dependence.
Addiction to nicotine has been increasing over
the past few years.
It is globally consumed in various forms;
smoked as cigars, cigarettes, beedi, hooka;
inhaled as snuff; chewed as jarda, khaini, gutka etc.
Apart from nicotine, smoke is known to
possess various irritant substances like
pyridine, ammonia, hydrogen cyanide, carbon
monoxide, carbon dioxide etc.
 NICOTINE PRODUCTS

CIGARETTE CIGAR BEEDI

SNUFF JARDA GUTKA

NICOTINE
MECHANISM OF ACTION

Nicotine acts on the acetylcholine receptors which

are present in cortex and hippocampus regions of
the brain at the presynaptic and postsynaptic areas.
Nicotine is involved in stimulation and
desensitization of acetylcholine.
Stimulation of acetylcholine causes excitation of
neurons, which leads to rapid neuronal
transmissions.
Chronic administration of nicotine desensitizes
acetylcholine receptors.
NICOTINE PHARMACOLOGICAL ACTIONS
1 ON CENTRAL NERVOUS SYSTEM
Nicotine stimulates CNS by stimulating acetylcholine receptors and the
resultant effect includes alertness, attention, decreased depression,
anorexia and improved memory. Stimulation of supra-optic nucleus causes
release of antidiuretic hormone. It inhibits spinal reflexes which causes
relaxation of skeletal muscles stimulating Renshaw cells of the spinal
cord. Excess intake of nicotine causes adverse effects like seizures, coma
and even death due to respiratory failure.

2 ON CARDIOVASCULAR SYSTEM
Nicotine stimulates autonomic ganglia and adrenal medulla
which results in vasoconstriction of peripheral regions and
the ultimate effect is tachycardia, increased cardiac output and
arterial pressure.
3 ON GASTROINTESTINAL TRACT
Salivary secretions are increased by stimulatory effects of nicotine. Other effects
on GIT include nausea, vomiting. Excess stimulation of GIT delays healing of
peptic ulcers, increased motor activity and diarrhoea are noticed.
NICOTINE
PHARMACOKINETICS
Nicotine is absorbed rapidly when it is inhaled in the form of
smoke. Cigarettes possess 0.8g of tobacco and 9-17g nicotine.
Cigar or pipe smoke gets absorbed rapidly from mouth to
pharynx. Absorption of nicotine from cigar occurs at slower
rate and lasts for longer duration.
Consumption of one cigarette increases about 15-30mg/ml of
nicotine concentration in the plasma within 10 minutes. The
obtained concentration reduces to half after another 10
minutes and slowly declines within 1 to 2 hours as it gets
distributed to tissues and blood.
Nicotine is metabolized by liver. Oxidation of nicotine takes
place and the oxidized metabolic product is cotinine, plasma
half-life of metabolic product is for longer duration.
NICOTINE
ADVERSE EFFECTS
1 RESPIRATORY DISORDERS
Chronic smokers have high risk of cancer attack. Occurrence of cancer in
lungs, upper respiratory tract, oesophagus, bronchi, larynx have been
noticed. Cancer is associated with symptoms like dyspnoea, wheezing
cough, chest pain, respiratory tract infections, etc. Risk of cancer is greater
in smokers when compared to non-smokers.
2 ON CARDIOVASCULAR SYSTEM
Thrombosis induced by smoking results in coronary heart
diseases. Hypertension and ischemia may also occur due to
excess release of catecholamine, antidiuretic hormone and fatty
substances in plasma
3 REPRODUCTIVE DISORDERS
Smoking may lead to several complications in pregnant
women such as premature delivery, spontaneous abortion and
placenta praevia. It may also show deleterious effects in the newborns
such as decreased birth weight, physical and mental abnormalities. It may
also lead to tachycardia in infants dependent on mother’s milk.
NICOTINE
DEPENDENCE & TOLERENCE

Nicotine activates the Reward-Reinforcement pathway by

increasing the dopamine levels. Prolonged use of nicotine
leads to desensitization of nicotinic acetylcholine receptors.
Nicotine stimulates autonomic ganglia in order to stimulate
postganglionic nerves. But higher doses of nicotine blocks
the ganglionic transmission by producing depolarization.
Tolerance is rapidly developed due to desensitization of
acetylcholine receptors because of chronic administration
of nicotine. The desensitization of acetylcholine receptors
is responsible for blockage of ganglionic stimulation.
The withdrawal symptom of nicotine is craving for
cigarettes. This symptom lasts for a month. Other
symptoms include anxiety, sleeplessness, restlessness, etc.
NICOTINE
TREATMENT
Nicotine dependence and withdrawal symptoms can be
treated by using nicotine substitutes and other suitable
antagonists for nicotinic receptors.
Nicotine Replacement Therapy is found useful in treating
nicotine dependence where a substitute to nicotine is
administered to the dependents which contain relatively
small amounts of nicotine.
Drugs for treatment of nicotine and tobacco dependence are:
Bupropion (Wellbutrin, Budeprion, Prexaton, Elontril, Aplenzin)
Rimonabant(Acomplia, Bethin, Monaslim, Remonabent, Riobant, Slim
ona,) Varenicline (Chantix, Champix) Clonidine (Kapvay,
Nexiclon)
DRUGS OF ABUSE

ALCOHOL
Alcohol beverages are widely
distributed and available globally.
Alcohol is one of the most abused
drugs. People prefer alcohol for
pleasure and euphoria.
The reinforcement of alcohol is high
as a result several people are currently
suffering from alcoholism.
Alcohol primarily acts as a CNS
depressant and gradually initiates
sedation.
ALCOHOL
MECHANISM OF ACTION
Chronic alcohol consumption produces various adaptive
neuronal changes in order to counter attack the acute
cellular effects produced by alcohol.
The density of GABAA receptors decreases up-regulation
of NMDA (N-methyl-D-aspartate) receptors and
propagation (proliferation) of Ca2+ Channels takes place.
Alcohol enhances the neurotransmitters of reward
pathway. It elevates dopamine, 5-HT, acetylcholine,
norepinephrine and other opioid receptors with a similar
mechanism as that of opioids i.e., enhances the drug
dependence activity since it produces pleasant feelings.
ALCOHOL ADVERSE EFFECTS
1 CNS MANIFESTATIONS
Initial effects include impairment of cognitive functions like ability to
learn, attention, contraction, slurred (inaudible) speech, euphoria, highly
excited nature, self confidence, sedation, ataxia (lack of coordination while
performing voluntary movements, appearing clumsy, inaccurate, or instable). Excess
alcohol results in melancholy, aggressive nature, mood disorders, impaired
sensory parameters, etc.
2 CARDIOVASCULAR MANIFESTATIONS
These include peripheral vasodilation, sweating, excessive
sweating, increased heart rate, flushing (sudden rush of feelings).
3 GASTROINTESTINAL MANIFESTATIONS
Alcohol enhances gastric acid secretions and results in
impairment of normal functioning of GIT.
4 RENAL MANIFESTATIONS
Diuresis due to inhibition of anti-diuretic hormone.
Hyperuricaemia (excess uric acid in blood) due to abnormal
excretion of uric acid.
ALCOHOL
CHRONIC TOXIC EFFECTS
Chronic alcohol consumption leads to
various neurological disorders such as –
a. Wernicke’s Encephalopathy (condition affecting brain)
b. Polyneuropathy (any of the several diseases involving several
peripheral nerves).
c. Karsakoff’s Neuropathy
d. Retrobulbar Neuropathy
e. Marchiafava Bignami Syndrome
f. Hepatic Encephalopathy
ALCOHOL
DEPENDENCE & TOLERENCE
Tolerance and dependence are also major problems.
They are a result of prolonged consumption of alcohol
which desensitizes and decreases GABAA receptors,
increases NMDA subtype glutamate receptors.
These changes play a vital role in development of
tolerance.
Cells and tissues function abnormally due to tolerance
development.
Elimination of alcohol at a faster rate is also one of the
reasons for tolerance development.
 ALCOHOL WITHDRAWAL SYMPTOMS
The withdrawal symptoms include seizures, sweating,
hyperthermia, delirium, hallucination, hyper-excitation and
neuro-toxicity. These are due to the effect of sudden
withdrawal of alcohol on Ca2+ ions. Increased Ca2+ ions cause
this.
1 CARDIOVASCULAR SYSTEM
Cardiomyopathy (muscular dysfunction not because of nerve disorder), cardiac
arrhythmias (irregular heart beat), abnormal metabolism, increase of
catecholamine, hypertension are some of the withdrawal
effects of alcohol.
2 GASTROINTESTINAL TRACT
Some effects of alcohol withdrawal on GIT are esophageal
reflux, Barrett’s esophagus, gastric pain, Mallory-Weiss
syndrome and oesophagal cancer. Excess alcohol consumption
affects gastric mucosa and causes gastric bleeding.
ALCOHOL
TREATMENT

Administration of glucose, thiamine and other electrolytes

reduces metabolic alterations like hypoglycemia and ketosis,
preventing respiratory depression hence treating alcohol
toxicity.
Administration of sedatives and hypnotics like
chlordiazepoxide and diazepam reduces withdrawal
symptoms to a certain extent, preventing seizures, delirium
and arrhythmias. β-Blockers like clonidine, propranolol are
helpful in inhibiting neurotransmitter release and controlling
sympathetic activity.
 TREATMENT

Aversion therapy is a primary approach in treating

alcoholism. Disulfiram (Antabuse, Antabus) is a
drug of choice used in the therapy, however it has
its own set of adverse effects.
Naltrexone (Revia, Depade, Vivitrol), an opioid
receptor antagonist is helpful in reducing the
craving for alcohol in addicts.
Acamprosate (Campral) is another preferred drug
for alcohol dependents. It has multiple effects on
various receptors and neurotransmitters.
DRUGS OF ABUSE

OPIOIDS
An opioid is any psychoactive chemical
that resembles morphine in its
pharmacological effects. Opioids work by
binding to opioid receptors, which are
found principally in the central and
peripheral nervous system and the
gastrointestinal tract.
Commonly abused opioids are morphine,
heroin, codeine, oxycodeine and
meperidine.
OPIOIDS
MECHANISM OF ACTION
Opioids act on G-protein coupled receptors μ, κ, δ which are
known to inhibit adenyl cyclase, cAMP, protein kinase A,
voltage gated CA2+ channels.
The inhibitory action of opioids leads to depression upon
mild exposure.
Prolonged exposure of opioids exert an opposite effect on the
G-protein coupled receptors resulting an increase in the
compensatory response element binding [(cAMP, adenyl
cyclase, protein kinase A) CREB].
The rise in CREB exert excitatory actions due to enhanced
Na+ channel functions and cAMP upregulation.
All these cellular effects not only decrease the inhibitory
actions of opioids but also lead to the development of
tolerance, dependence and withdrawal symptoms.
OPIOIDS
DEPENDENCE
Physical and psychological dependence develop in opioid
drug abusers.
Physical dependence develops to a greater extent that
compared to psychological dependence. Sudden withdrawal
of opioids may lead to death of individuals.
The symptoms of physical dependence include dysphoria, GI upset,
mydriasis, cough, hyperventilation, ocular discharge, diarrhea, yawning,
hyperthermia, piloerection, aggressiveness and emesis.

Psychological dependence is characterized by craving. The

enhanced dopamine levels enhance the craving effect.
Sudden withdrawal effects are termed noradrenergic storm
due to increased release of norepinephrine.
OPIOIDS
TOLERANCE

Desensitization of opioid receptors, increased CREB

(compensatory response element binding), reduced receptor-
effector coupling mechanism are the various changes
produced due to chronic administration of opioids.
All these changes lead to the development of
tolerance.
Tolerance is developed to euphoria, respiratory
depression, sedation and emetic actions.
Tolerance to euphoria develops at a faster rate.
Cross tolerance to opioid agonists is also developed.
OPIOIDS
TREATMENT
Replacement therapy is found useful in treating opioid
dependence. Long acting drugs are administered in
place of short acting drugs.
Methadone (Symoron, Dolophine, Amidone,
Methadose, Physeptone, Heptadon), levo-α-acetyl
methanol, buprenorphine are known to be potent
opioid replacement agonists.
Opioid agonist like Naltrexone (Revia, Depade,
Vivitrol) is effective against euphoria and withdrawal
symptoms of opioids.
Lofexidine, an α-2-adrenergic receptor agonist is also
effective against withdrawal effects of opioids.
DRUGS OF ABUSE
BARBITURATES & BENZODIAZEPINES

Barbiturates and benzodiazepines are

known to have similar
pharmacological actions.
The use of barbiturates has decreased
because more beneficial drugs with
higher safety margins have been
introduced.
Benzodiazepines and Barbiturates are
sedative-hypnotics used in the
treatment of anxiety, insomnia.
BARBITURATES & BENZODIAZEPINE PRODUCTS
BARBITURATES & BENZODIAZEPINES

MECHANISM OF ACTION

Barbiturates and benzodiazepines are known to

enhance the inhibitory actions of GABAA receptors by
facilitating the opening of chloride-ion channels.
BARBITURATES & BENZODIAZEPINES

DEPENDENCE & TOLERANCE

Benzodiazepines develop little tolerance but the drug dependence
and withdrawal effects are common for both barbiturates and
benzodiazepines.
The abuse of benzodiazepines is mostly seen in alcohol consumers.
Tolerance is developed to sedation after prolonged use of these
drugs.
Withdrawal symptoms include insomnia, irritation, depression,
muscle cramps, seizures, dizziness and anxiety.
 BARBITURATES &
BENZODIAZEPINES TREATMENT

Replacement therapy is found useful, short acting

drugs like phenobarbital are used to substitute long
acting barbiturates and benzodiazepines like
pentobarbital or secobarbital.
Detoxification is also useful, osmotic diuretics along
with sodium bicarbonate is used for detoxification of
barbiturates.
Flumazenil (Anexate, Lanexat, Mazicon, Romazicon) is
an effective benzodiazepine antagonist.
Diphenhydramine (Benadryl, Dimedrol, Nytol) is
suggested for habituated withdrawal symptoms.
INHALANT ABUSE
Exposure to various volatile
substances for recreational
purposes is termed as Inhalant
Abuse.
The volatile substances in crude
chemical vapour like nitrates,
kerosene, toluene, gasoline,
carbon tetra cholride, nitrous
oxide, amyl nitrate, aliphatic &
aromatic hydrocarbons are known
to produce psychological changes.
 INHALANT ABUSE
Inhalation of substances from open
SNIFFING containers is called sniffing.

Inhalation of cloth or any other substance after

HUFFING soaking it in volatile substance.
Inhalation of substances which are present
BAGGING (collected or stored) in bag or paper.

The abuse of inhalants begin with sniffing, slowly

progresses to huffing and bagging which results in
addiction.
There is no specific treatment for inhalant abuse. Creating
awareness and rehabilitation is beneficial.