Psychological dependency

Dependence is a somatic state which develops after chronic administration of certain dtugs. This condition is characterized by the necessity to continue administration of the drug to avoid the appearance of withdrawal symptoms. Withdrawal symptoms are relieved by the administration of the drug upon which the body was dependent . Psychological dependence is due to (e.g., social) reinforcement processes in the maintenance of drug-seeking behavior. 

Controlled substances are the most carefully monitored of all drugs. These drags have a high potential for abuse and may cause physical or psychological dependence Physical dependency is a compulsive need to use a substance repeatedly to avoid mild to severe witii-drawal symptoms it is die body s dependence on repeated administration of a drug. Psychological dependency is a compulsion to use a substance to obtain a pleasurable experience it is die mind s dependence on the repeated administration of a drag. One type of dependency may lead to die odier typa... 

The Controlled Substances Act of 1970 regulates die manufacture, distribution, and dispensing of drugs that have abuse potential (see information under Federal Drag Legislation and Enforcement in diis chapter). Drag under the Controlled Substances Act are divided into five schedules, based on their potential for abuse and physical and psychological dependence Display 1-2 describes the five schedules. 

Potential for high abuse with severe physical or psychological dependence... 

Like the barbiturates, the miscellaneous drugp sedative or hypnotic effects diminish after approximately 2 weeks. Ffersons taking these dragp for periods longer than 2 weeks may have a tendency to increase the dose to produce the desired effects (eg, sleep, sedation). Physical and psychological dependence may occur, especially after prolonged use of high doses. However, their addictive potential appears to be less than that of the... 

The amphetaminesand anorexiants have abuse and addiction potential. Long-term use of amphetaminesfor obesity may result in tolerance to the drug and a tendency to increase the dose. Extreme psychological dependency may also occur. 

Warns about possible addiction, drug tolerance, and psychological dependency. 

Finally, there is little or no clinical evidence that morphine causes psychological dependence or drug-seeking behaviour, tolerance or problematic respiratory depression in patients. These events simply do not occur when opioids are used to control pain. The reason is likely to be that the actions of morphine and the context of its use in a person in pain are neurobiologically quite different from the effects of opioids in street use. These actions of opioids are described in more detail in Chapter 23. 

Figure 23.1 The diagram shows the stages that may occur after administration of a non-medical drug. The details of each of the potential consequences are given in the text but note that whereas all drugs must have some psychological effect and so may trigger psychological ( ) dependence, physical dependence is only obvious with depressant drugs...

Drug Psychological dependence Physical dependence Physical withdrawal symptoms Tolerance... 

Like LSD, tolerance develops very rapidly so the next day it might take twice as many liberty caps to repeat the experience and so most users only use mushrooms occasionally. Physical dependence and withdrawal symptoms do not result from regular use though some people may become psychologically dependent and feel a desire to use on a regular basis. At present there is no evidence of serious health damage from longterm use. 

We found only one published systematic study of outpatient treatment for PCP abusers, involving 158 patients (73 percent male) of a private clinic (Bolter et al. 1976). This study gave no treatment outcome data, but the authors did comment that treatment was difficult because of the patients strong psychological dependence on PCP. 

The existential state of being a patient is perhaps an even more immediate domain of the moral. The loss of autonomy, the fear of the unknown, the dissolution of identity accompanying pain in its multifarious forms, the dehumanization of being subjected to the administrative processes of healthcare, and the psychological dependence each of these challenges fosters combine to make the physician the patient s advocate in a different way to the social one described above. Here, individual concerns are paramount, and the most immediate response must be a humane one. 

Another way to conceptualize drug problems is to examine psychological versus physical dependence on a substance. Psychological dependence is defined by beliefs A person thinks he or she needs the substance in order to cope. Physical dependence, on the other hand, is defined by actual physical changes related to drug use that may result in withdrawal symptoms and tolerance. However, to confuse matters, recreational users also may experience tolerance and withdrawal, so it is important to be careful when using these distinctions to define whether a person has a drug problem. 

Schedule III—The drug or other substance has (1) a potential for abuse less than the drugs or other substances in Schedules I and II, (2) a currently accepted medical use in treatment in the United States, and (3) abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence. Examples ketamine, anabolic steroids, some barbiturates. 

It is important to recognize that someone can be physically dependent on a substance but not addicted that is, (s)he would not meet the psychiatric dehnition of substance dependence. On the other hand, someone can be psychologically dependent but yet not physically dependent. 

Tolerance is an adaptation to a drug, leading to a need to increase the dose required to produce a given physiological effect. It can develop rapidly and often precedes development of physical dependence. Dependence is a different phenomenon, much more difficult to define and measure, which involves two separate components, namely physical and psychological dependence. 

Psychological dependence is an intense craving for the drug, especially for a drug that induces pleasurable effects on the body. 

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