Pathophysiological essence
At the final stage, a fundamental restructuring of the body's reactivity occurs. Psychoactive substances (PAS) and their metabolites integrate into the metabolic processes of nervous tissue and organs, becoming mandatory regulators. The main changes include:
- Disappearance of protective reflexes (cough, gag reflexes).
- Encephalopathy, which leads to a decrease in substance tolerance.
- Cachexia — an extreme degree of physical exhaustion against the background of impaired digestion and metabolism.
Key syndromes
The clinical picture of the final stage is determined by five interrelated syndromes:
- Physical dependence — the metabolic need for psychoactive substances.
- Decreased tolerance — a transition to rare but mandatory administration of small doses to relieve withdrawal.
- Multiple organ dysfunction syndrome (MODS) — complex organ dysfunction.
- Personality degradation — loss of individuality and intellectual decay.
- Withdrawal syndrome — a severe condition upon cessation of the substance.
Somatic complications
The patient's body is in a state of decompensation. The most significant lesions include:
- Liver: development of fatty degeneration and cirrhosis, which impairs detoxification function.
- Cardiovascular and respiratory systems: progressive circulatory and respiratory failure.
- Immune system: pronounced immunodeficiency, paving the way for severe infectious diseases.
Briefly: answers to topical questions
What is the detailed pathogenesis of cachexia development in the final stage of substance use disorder?
Sources indicate cachexia in the final stage of drug and substance abuse as one of the key syndromes and as a manifestation of multiple organ dysfunction syndrome.
The following pathogenesis is described for multiple organ dysfunction syndrome:
- severe metabolic disorders;
- circulatory disorders;
- significant structural changes in organs and tissues.
The clinical complex of changes includes:
- progressive dyspeptic disorders: loss of appetite, vomiting, diarrhea, constipation;
- digestive disorders with the development of cachexia;
- circulatory failure;
- respiratory failure.
To memorize the 5 syndromes, use the mnemonic «PAD-MC»: Physical dependence, Abstinence (Withdrawal), Multiple organ dysfunction syndrome, Personality degradation, Cachexia.
Class and exam questions
Why does tolerance to psychoactive substances decrease at the final stage?
This is due to profound encephalopathy and the depletion of the body's compensatory reserves. Organs can no longer process previous doses, and the substance is required solely to maintain basic metabolism.
What are the main causes of death in substance use disorder?
Death most often results from heart or kidney failure, overdoses, or infectious complications developing against the background of immunodeficiency.
What is the difference between the final stage and previous ones?
The main difference lies in the transition from seeking euphoria to «survival» (avoiding withdrawal) and the development of irreversible multiple organ dysfunction and personality degradation.
What else to study on this topic
- Mechanisms of immunodeficiency development in chronic intoxication.
- Pathogenesis of fatty liver disease in substance-dependent individuals.
- Comparative characteristics of suicidal and accidental poisonings.
- The impact of psychoactive substance metabolites on the regulatory functions of the nervous system.
- Global mortality statistics resulting from the consequences of alcoholism.
Master the entire topic in the "Pathophysiology" course
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Other topics in «Chapter 18. Drug Addiction. Substance Abuse. Poisoning»
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