General classification of psychoactive substances (PAS)
Since psychostimulants are one of the groups of psychoactive substances, it is important to understand their place in the general taxonomy. There is no single, exhaustive list of PAS, as they include illicit drugs, household chemicals, and legal stimulants (coffee, tobacco).
Depending on the predominant effect on the central nervous system, three main groups are distinguished:
- Stimulants: cocaine, amphetamines, ephedrine, caffeine.
- Sedatives: opioids, barbiturates, benzodiazepines, volatile solvents.
- Hallucinogens (psychodysleptics): LSD, cannabis products, mescaline, hallucinogenic mushrooms. They cause mental disorganization and distortion of reality.
Terminology: drug addiction and substance abuse
In international practice (ICD-10), the terms "drug addiction" and "substance abuse" are not used; instead, the concept of "Mental and behavioral disorders due to psychoactive substance use" is applied. However, in the Russian Federation, this distinction is retained due to legal nuances.
- Drug addiction (Narkomaniya): dependence on substances included in the official legislative list of narcotics of the Russian Federation (e.g., cocaine and amphetamines). Their turnover is strictly controlled or prohibited, and violation entails criminal liability.
- Substance abuse (Toksikomaniya): dependence on PAS not included in the list of narcotics (caffeine, nicotine, household chemicals). Their misuse carries only administrative liability.
Indirect signs of dependence
One can suspect the use of psychostimulants (and other PAS) by characteristic changes in behavior and mental state. These include:
- Sudden mood swings, outbursts of aggression, or conversely, depression.
- Increased secrecy, deceitfulness, loss of contact with loved ones.
- Drastic change in interests and social circle.
- Disturbances in the sleep-wake cycle.
- Decreased productivity at work or study.
- Changes in eating behavior (loss of appetite or sudden increase).
Briefly: answers to topical questions
Through which neurotransmitter systems is the action of psychostimulants mediated?
The action of psychostimulants is associated with monoaminergic systems, primarily the dopamine system. The general pathogenetic mechanism of action of PAS is realized through the pleasure centers—dopamine synapses and the endorphin system. Dopamine-activating PAS, such as cocaine, amphetamine, and ecstasy, can cause short-term psychosis resembling schizophrenia. For amphetamine, the release of dopamine, norepinephrine, and serotonin from presynaptic terminals is described, leading to the formation of a hyperadrenergic state. With repeated exposure, system depletion and a local dopamine deficiency occur, which is associated with irresistible craving.
What clinical manifestations are characteristic of withdrawal syndrome upon discontinuation of psychostimulants?
Withdrawal syndrome upon discontinuation of psychostimulants is characterized by a predominance of mental disorders; somatic manifestations are not pronounced and are not life-threatening. The clinical picture includes:
- initial stage: fatigue, emptiness, drowsiness, indifference, feeling of hunger;
- upon sudden cessation of cocaine use: depression, severe fatigue, burdensome mental state;
- formation of pronounced psychological dependence.
Which drugs are used to manage acute psychosis during psychostimulant intoxication?
Tranquilizers are used to manage psychomotor agitation and acute psychotic manifestations (delusions, hallucinations, aggression) during psychostimulant intoxication.
- Tranquilizers (diazepam) — administered at a dose of 10–20 mg, including intravenously (benzodiazepine tranquilizers).
Drug administration is continued for several days after the patient's condition stabilizes.
Class and exam questions
Is it permissible to prescribe stimulants and antidepressants at the beginning of addiction treatment?
No, in the initial period of detoxification, such drugs (e.g., piracetam) are undesirable. Their administration is safe only in the second week of abstinence.
What is the difference between "hard" and "soft" drugs?
This is a conventional, colloquial division. Legally, all drugs are recognized as dangerous to society, and illegal actions involving any of them entail criminal liability. So-called "light" drugs also cause severe dependence and can provoke psychoses.
How does the law apply in cases of substance abuse?
Substances causing substance abuse are not included in the list of narcotics, therefore their misuse is punishable administratively rather than criminally.
What else to study on this topic
- General principles of detoxification and management of the abstinence period
- Sensitizing and conditioned reflex therapy
- Stages and methods of psychotherapy in dependence
- Treatment of depressive symptoms and pathological craving
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Other topics in «Chapter 21. Disorders due to use of alcohol and other psychoactive substances»
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