Terminology and legal control
According to WHO guidelines, psychoactive substances (PAS) are capable of causing euphoria, altering mental state, and forming pathological addiction. These include opium, cocaine, amphetamines, ethanol, as well as certain medications and household chemicals.
In Russian medical practice, key diagnoses are separated legislatively:
- Drug addiction (Narkomaniya) — a diagnosis denoting dependence on a substance officially included in the state list of prohibited narcotics.
- Substance abuse (Toksikomaniya) — dependence on medications or chemical agents not included in this list.
- Alcoholism and nicotine dependence are not considered drug addictions in the legal sense, although they belong to the general class of F1 disorders according to ICD-10.
Clinical manifestations of dependence
Regardless of the specific substance, the overall pattern of dependence formation includes several mandatory components:
- Psychological dependence — a pathological craving that dominates the patient's entire mental life. It includes obsessive thoughts about the substance and the pursuit of the psychoactive agent.
- Physical dependence — severe homeostatic disturbances upon cessation, manifesting as withdrawal syndrome (abstinence syndrome).
- Tolerance — a change in substance tolerance (most often an increase) and failure of the body's protective mechanisms.
- Personality changes — loss of moral and ethical self-control, reassessment of values, and anosognosia (complete lack of insight into one's condition).
Stages of alcoholism
The Russian addiction medicine school distinguishes stages of alcohol dependence development, differing in the depth of impairment and clinical presentation:
- Stage I (compensated): Transition from everyday drinking to dependence. Characterized by obsessive craving, increased tolerance, loss of quantitative control, and amnestic forms of intoxication (alcoholic palimpsests). Social connections are still preserved, but insight into the disease is lost.
- Stage II (subcompensated): Developed stage of the disease. The core component becomes severe withdrawal syndrome, and the craving acquires a compulsive (irresistible) character. It is at this stage that dangerous complications arise in the form of alcohol psychoses, such as delirium.
Nicotine dependence
In addition to alcohol and hard drugs, nicotine addiction occupies a separate place in addiction medicine. The substance affects the dopamine system, exerting stimulating and tranquillizing effects.
- Formation: Tolerance quickly stabilizes at a level of up to 40 cigarettes per day. The main clinical marker of established dependence is morning smoking on an empty stomach.
- Withdrawal syndrome: Cessation of use causes anxiety, irritability, sleep disturbances, headache, and increased appetite.
- Consequences: Chronic smoking takes a toll on the respiratory, cardiovascular, and digestive systems, provoking the development of oncological diseases.
Drug addiction is a strictly legal term for prohibited substances, whereas substance abuse is used for non-prohibited chemicals.
Class and exam questions
What is the main difference between drug addiction and substance abuse in Russian practice?
The difference lies in the legal status of the substance. Drug addiction is diagnosed when there is dependence on a substance included in the official list of prohibited narcotics, while substance abuse is diagnosed when using substances not included in this list.
What are the primary and secondary forms of pathological craving?
Primary craving persists in the patient even against the background of prolonged abstinence from PAS use. Secondary craving arises directly upon returning to use, and the first dose does not relieve it, but only enhances and exacerbates it.
Which sign indicates the transition of alcoholism to the second stage?
The main diagnostic criterion for the transition to the second stage is the appearance of severe alcohol withdrawal syndrome and the potential development of alcohol psychoses, such as delirium.
What else to study on this topic
- Historical aspect of society's and medicine's attitude towards dependence
- Bénédict Morel's theory of degeneration
- Types and symptoms of alcohol psychoses
- Psychotherapy and pharmacotherapy methods for smoking cessation
- Somatic consequences of alcohol and PAS abuse
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Other topics in «Chapter 21. Disorders due to use of alcohol and other psychoactive substances»
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