Drug dependence definitions

Subsequently, a committee composed of representatives from the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine have developed a definition that includes typical behavioral changes, as well as the concept of denial ( 387). They characterized alcoholism as the following ... 

A common vocabulary has not been established in the field of prescription drug abuse. Because much of the survey data collected in this area refer to nonmedical use of prescription drugs, this definition of abuse, rather than that of the Diagnostic and Statistical Manual of Mental Disorders (DSM), is used. Also, because physical dependence to prescription medications can develop during medically supervised appropriate use, the term addiction is used to reflect dependence as defined by the DSM. 

Definition A drug psychosis, drug dependence, non-dependent drug abuse and accidental poisoning caused by use of opiates, cocaine, stimulants, cannabis or hallucinogens. 

Psychosocial and environmental factors play a major role in the development and recovery from opioid dependence however, a detailed discussion is beyond the scope of this chapter. In general, the use of such drugs as marijuana and alcohol precedes the use of opioids (Clayton and Voss 1981 Kandel and Faust 1975). Although one cannot predict definitively which users will proceed to opioid use, those who do generally have low self-esteem, disrupted families, and/or difficult relationships with their parents. The increased availability of opioids in inner cities of major urban centers contributes to initiation of use and relapse. It is particularly difficult to avoid use and relapse in areas with high unemployment, poor school systems, and high crime rates, because living in such an area may contribute to the very affects opioid use temporarily reheves. 

Bioavailability depends not only on having the drug in solution, but also on the drug s permeability. A jejunal permeability of at least 2-4 x 10 4cm/s, measured in human subjects by intubation, is considered high [97]. For many drugs and other substances, this permeability corresponds to a fraction absorbed of 90% or better. Amidon et al. [97] thus proposed a Biopharmaceutics Classification System (BCS) for drugs based on the above definitions of these two parameters. Table 3 defines the BCS and includes some drugs representative of each class. 

Similarly opioid peptides are important in nicotine addiction and may have a role in causing nicotine withdrawal symptoms in some smokers [35]. Opioid antagonists such as naltrexone are licensed treatments for dependence syndromes arising from other addictive drugs and could also be of use in some smokers to aid nicotine withdrawal [59] although there is no definitive evidence overall that they are beneficial [60]. 

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