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In connection with the use of illegal drugs, the ICD-10 applies the same criteria as for alcohol when it comes to the diagnosis of abuse or addiction. But the physical and mental effects and the withdrawal symptoms are different.

It also applies to the emergence of drug addiction that there is a multifactorial set of conditions between person, drug and environment. In many cases today, as in the case of alcohol addicts, other psychiatric diagnoses are made in addition to drug addiction.

These comorbidity problems have increased over the past decades. It is assumed that the mental disorder either existed before the development of the addiction problem and is a factor in the conditional structure of the addiction development or that it arose as a result of the addiction disease. The latter is mainly observed among cocaine and crack users, who are increasingly conspicuous in the facilities due to their aggressive behavior, psychoses and paranoid fears. The following psychiatric diagnoses are more common in connection with drug addiction:

  • Neurotic stress and somatoform disorders, e.g. B. Anxiety disorders, phobias
  • Mood disorders, especially depression
  • Schizophrenia
  • Eating disorder
  • Personality disorders (…)

Prehistory

In the past, particular attention is paid to risk factors that could have favored drug use. But the road to drug addiction is more than the sequential emergence of a series of risk factors. The life and medical stories are made up of stressful and protective experiences and the traces that they have left in the inner world of people: the importance of drugs for the consumer, their effects, their social consequences and additional external conditions.

For drug addicts. For example, the history of crime and criminalization is a specialty that brings with it specific problems and also influences the course of treatment and the conditions of treatment.

Risk behavior

Adolescent risk behavior between the ages of 15 and 18 also develops very differently: The later addicts stated more often than the others that they had gotten into trouble because of their behavior. Here, too, there are interactions between this behavior and the reactions of the environment. As a result of the disadvantages in childhood, fewer resources have been acquired and made available, and it has become difficult to make social compensation for such experiences of deficiency. Then there is unemployment and a lack of hope for a better future.

Illegality

Illegality has a special place in life and medical history. It already plays a role in the decision to consume, especially among young people who are grappling with family and social norms and rules. Illegality influences the self-image of the respective subcultures determines the consumption patterns leads to special forms of procurement, criminal prosecution and judicial interference in the life of the addict, social networks and helpers are also affected.

Illegality is also related to the particular health risks that drug users expose themselves to: the substances sold on the black market are not controlled and can be life-threatening due to admixtures, there is hardly any knowledge about less dangerous and less health-damaging uses. Unsanitary conditions in prison or on the scene are associated with dangerous risks of infection.

Drugs and their effects

The pharmacological effects of the various psychotropic substances, their effects on the body and soul, their potential for addiction, their toxic effects are a decisive factor in the complex set of conditions in the development of problematic consumption and medical histories.

People want to change their self and world experience depending on their needs – either calm down, stimulate or move into a different state of consciousness. These are the three main effects that are being sought. Each group of substances has its own spectrum of effects and side effects. The type and strength of withdrawal symptoms also vary widely.

Harmful use

Whether physical harm occurs when hard drugs are used depends primarily on the type of consumption and the purity of the substance: Serious illnesses such as HIV infection and AIDS and hepatitis B and C infections are caused by the use of hypodermic needles. Intravenous use of heroin is more harmful to health than smoking or sniffing the substance on foil, the form of consumption that the Dutch and English predominantly practice.

It is the same as cocaine. Here, too, there are different risky forms of use: the intravenous injection and smoking of crack are more dramatic in their effect than drawing it in through the nose. In cannabis, it is the tar, which is inhaled when smoking, in particular, which can cause lung diseases.

Medical treatment

Detoxification

Detoxification is usually carried out on an inpatient basis. In a psychiatric clinic in Islamabad, there are special detoxification centers for drug addicts. Withdrawal symptoms are generally not life-threatening (it is more likely to be the case with alcoholics), but they are very uncomfortable and painful and, moreover, complicated by previous polytoxicomaniac use.

The withdrawal syndrome with heroin and methadone includes, in various forms, opiate hunger, an intense general feeling of illness, cold and shivering, depression up to suicidality, loss of appetite, motor restlessness, aggressive irritability, insomnia, lower back and calf pain, pupil dilation, yawning, and tearfulness Nasal flow, pulse and blood pressure increase, hot flashes, sweating, fever, abdominal pain, goosebumps, nausea, vomiting.

Substitution

Substitution has long been controversial because it was seen as an addiction extension that turned the ideal way to abstinence. The rapid increase in the spread of HIV infection among drug addicts eventually led to a rethink.

The opiate methadone and the opiate agonist Subutex® are mainly used as substitution drugs today. In contrast to the other opiates, both substances do not cause euphoria. Methadone is also addictive, Subutex® should not be addictive.

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