Drug Addiction

Drug Addiction

ALCOHOL

Substance dependence, commonly called drug addiction, is a drug user's compulsive need to use controlled substances in order to function normally. When such substances are unobtainable, the user suffers from substance withdrawal.

The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders (more specifically, the 2000 "text revision", the DSM-IV-TR) does not use the word addiction at all.

It explains: When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance abuse are considered Substance Use Disorders.

Causes

Drugs known to cause addiction include both legal and illegal drugs as well as prescription or over-the-counter drugs, according to the definition of the American Society of Addiction Medicine[citation needed].

Stimulants (psychical addiction, moderate to severe; withdrawal is purely psychological and psychosomatic) :

  • Amphetamine and methamphetamine
  • Cocaine
  • Caffeine
  • Nicotine

Sedatives and hypnotics (psychical addiction, mild to severe, and physiological addiction, severe; abrupt withdrawal may be fatal) :

  • Alcohol
  • Barbiturates
  • Benzodiazepines, particularly alprazolam, flunitrazepam, triazolam, temazepam, and nimetazepam Z- drugs like Zimovane have a similar effect in the body to Benzodiazepines.
  • Morphine and codeine, the two naturally occurring opiate analgesics
  • Semi-synthetic opiates, such as heroin (diacetylmorphine; morphine diacetate), oxycodone, buprenorphine, and hydromorphone
  • Fully synthetic opioids, such as fentanyl, meperidine/pethidine, and methadone
     

F10. –ALCOHOL (BEER, WHISKEY, RUM, GIN, VODKA, BRANDY, WINES)

F11. – OPIOIDS ( HAFFIM, INJ FORTWIN(PENTAZOCINE), DOODA , POSTA , NORPHINE INJECTION, SMACK , BROWN SUGAR, MORPHINE INJECTIONS,CODEINE, CAPSULE SPASMOPROXYVIN (DEXTROPROXYPHENE) )

F12. –CANNABINOIDS (BHANG, GANJA, CHARAS, MARAJUANA, HASH, GRASS, WEED)

F13. –SEDATIVE HYPNOTICS (SLEEPING TABLETS, DIAZEPAM, NITRAVET, ATIVAN, LARPOSE)

F14. –COCAINE

F15. –STIMULANTS, AMPHETAMINE, TEA AND CAFFEINE

F16. –HALLUCINOGENS

F17. –TOBACCO

F18. VOLATILE SOLVENTS (INK ERASERS)

 

ALCOHOL

(BEER, WHISKEY, RUM, GIN, VODKA, BRANDY, WINES)

Preparation of Alcohol      Concentration of             Absolute alcohol                 Standard Drink

alcohol by volume(gms/100ml)

(%ABV)

Beer (standard)                     3-4                                             2.3-3.1                           300-400 ml.

Beer (strong)                        8-11                                            6.2-8.6                           100-150 ml.

Wines                                   5-13                                            3.9-10.1                         100-250 ml.

Fortified Wines                   14-20                                          10.9-15.9                         60-90 ml.

Spirits (Whiskey, Rum, Gin, Vodka, Brandy etc)    
                                             40                                              31.2                                30 ml.

   Arrack                                  33                                            25.7                                           40 ml

The acute effects that commonly occur at increasing blood alcohol concentrations (BAC)

< 80                Euphoria, feeling of relaxation and talking freely, clumsy movements of handsand legs, reduced alertness but believes himself to be alert.

>80                     Noisy, moody, impaired judgement, impaired driving ability

100-200             Electroencephalographic changes begin to appear, Blurred vision, unsteadygait, gross motor in-coordination, slurred speech, aggressive, quarrelsome,talking loudly.

200-300               Amnesia for the experience – blackout.

300-350               Coma

355-600May          cause or contribute to death

Danger sign: - fever, restrain required, tachycardia Alcoholic withdrawal are life threatening

DELIRIUM

  1. PSYCHOMOTOR ACTIVITY (patient is restless to the point might need to be tied to bed  )
  2. SLEEP (not slept for 2 to 3 days at a stretch )
  3. ATTENTION AND CONCERNTRATION
  4. CLOUDING OF CONCIOUSNESS(disoriented to time, place and person, hallucinations and illusions)
  5. EMOITONAL LAIBILITY ( fearful, crying, happy , anxious, aggressive and abusive)

OPIOIDS

HAFFIM, DOODA , POSTA , SMACK , BROWN SUGAR, CODEINE, SPASMOPROXYVIN (DEXTROPROXYPHENE)
INJECTIONS
INJ FORTWIN (PENTAZOCINE), NORPHINE INJECTION, MORPHINE INJECTIONS


Table 4: Doses and duration of action of various opioids


Compound                                   Dose (mg  )             Oral                        Duration of Action

Morphine                                        10                           60                                        4

Heroin                                             4                            30                                       3-4

Methadone                                     10                            20                                       6-24

Pethidine                                        100                          300                                        3

Codeine                                          30                            90                                         4

Dextropropoxyphene                      —                           200                                         8

Dihydrocodeine                              15                            45                                          4

Buprenorphine                                60                           180                                         3

Pentazocine                                        0.3                           0.8 (sublingual)                  7



Withdrawal
1.Yawning
2.Increased secretions from all opening of bodies nose, eyes, salivations, diarrhea and spontaneous erections
3.Pain in calf muscles


Treatment
Buprocare-n (buprenorphine and nalaxone ) 8 to 16 mg
Nalaxone for challenge test as it is dopamine antagonist short lasting only for few minute
Naltrexone for prophylaxis effective for three days but need to be given daily dosage 50mg daily for an year

CANNABINOIDS
(BHANG, GANJA, CHARAS, MARAJUANA, HASH, GRASS, WEED)



Forms                                                                                    THC content

Marijuana                                                                        1 – 3 % THC

Ganja(cultivated)                                                              6 – 20 % THC

Hashish (charas)                                                             10 – 20 % THC

Hashish oil                                                                      15-30% THC


Tobacco or Nicotine
Withdrawal Problems Suggested coping skills Cravings


The five D’s to handle Urges·

Strongest in the first week.

 Experienced in•

Delay until the urge passes—usually withinwaves, individual “cravings” last 30-90

3-5 minutes

seconds.

 Begin 6-12 hours after stopping,•

Distract yourself

peak for 1-3 days, and may last 3-4 weeks

.•Call a friend or go for a walk

As the days pass, the cravings get farther and•Drink water to fight off cravings

farther apart. Mild occasional cravings may•Deep Breaths—Relax! Close your eyes andlast for 6 months.take 10 slow, deep breaths

•Discuss your feelings with someone close

to you.

Difficulty in concentrating

usually begins                                       Taking a break: gazing into a photo or

within the first 24 hours,  peak              for the first looking out a window; closing         

                                                                        eyes and

1-2 weeks, and disappears within a month        .relaxing for ten minutes.

                                               Doing different tasks instead of focusing on

                                         any one activity for too long. Temporarily

                                                putting off work when feeling unable to do it.

Insomnia

Trouble falling asleep or disturbed sleep and      Avoiding coffee, tea, caffeinated drinks after

daytime drowsiness. Troublesome for the first6 pm. Drinking lots of fruit juices, and

1-2 weeks, and disappear within a month.water. Learning relaxation/meditation

techniques. Avoiding changes in sleep

routine: always getting up at the same timeevery morning.

Depression and tiredness

Mild feelings of depression may occur usuallyIdentifying specific feelings. Is one actually

within the first 24 hours,            continue in the firstfeeling tired, lonely, bored or hungry? Focus

1-2 weeks, and go away within a month on and address these specific needs.

Add up how much money you have saved

already by not purchasing cigarettes and

imagine (in detail) how you will spend your

savings in six months.

Call a friend and plan to have lunch, go to a movie.

Make a list of things that are upsetting to

you and write down solutions for them.

Irritability, Restlessness, Anger and Frustration

Taking short walks or exercising. Having a

Feeling more “edgy” and short-tempered ishot bath, using relaxation techniques.

common. These peak (stay high) the first     Taking regular 10 minute mental and

1-2 weeks, and disappear within a month.     physical breaks from whatever work one is doing to …walk, stretch, run.Keeping hands busy, like playing with a

rubber band or squeezing a rubber ball.

Increased Appetite and Weight Gain

More physical activities (e.g. take the stairs

Stronger and more frequent hunger pangs are instead of a lift, park further away from the experienced, and the sense of taste also improves.door to the office/shop etc.). Drinking more Weight gain most often due to eating morewater—especially before meals. Eating after is a common but temporary phenomenon.plenty of fresh fruit—carrying it to work

The five D’s to handle Urges·

Strongest in the first week.

 Experienced in•

Delay until the urge passes—usually withinwaves, individual “cravings” last 30-90

3-5 minutes

seconds.

 Begin 6-12 hours after stopping,•

Distract yourself

peak for 1-3 days, and may last 3-4 weeks

Call a friend or go for a walk

As the days pass, the cravings get farther and•Drink water to fight off cravings

farther apart. Mild occasional cravings may•Deep Breaths—Relax! Close your eyes andlast for 6 months.take 10 slow, deep breaths

•Discuss your feelings with someone close

to you.

Difficulty in concentrating

usually begins                                       Taking a break: gazing into a photo or

within the first 24 hours,  peak              for the first looking out a window; closing         

                                                                        eyes and

1-2 weeks, and disappears within a month        .relaxing for ten minutes.

                                               Doing different tasks instead of focusing on

                                         any one activity for too long. Temporarily

                                                putting off work when feeling unable to do it.

Insomnia

Trouble falling asleep or disturbed sleep and      Avoiding coffee, tea, caffeinated drinks after

daytime drowsiness. Troublesome for the first6 pm. Drinking lots of fruit juices, and

1-2 weeks, and disappear within a month.water. Learning relaxation/meditation

techniques. Avoiding changes in sleep

routine: always getting up at the same timeevery morning.

 Depression and tiredness

Mild feelings of depression may occur usuallyIdentifying specific feelings. Is one actually

within the first 24 hours,            continue in the firstfeeling tired, lonely, bored or hungry? Focus

1-2 weeks, and go away within a month on and address these specific needs.

Add up how much money you have saved

already by not purchasing cigarettes and

imagine (in detail) how you will spend your

savings in six months.

Call a friend and plan to have lunch, go to a movie.

Make a list of things that are upsetting to

you and write down solutions for them.

Irritability, Restlessness, Anger and Frustration

Taking short walks or exercising. Having a

Feeling more “edgy” and short-tempered ishot bath, using relaxation techniques.

common. These peak (stay high) the first     Taking regular 10 minute mental and

1-2 weeks, and disappear within a month.     physical breaks from whatever work one is doing to …walk, stretch, run.Keeping hands busy, like playing with a

rubber band or squeezing a rubber ball.

Increased Appetite and Weight Gain

More physical activities (e.g. take the stairs

Stronger and more frequent hunger pangs are instead of a lift, park further away from the experienced, and the sense of taste also improves.door to the office/shop etc.). Drinking more Weight gain most often due to eating morewater—especially before meals. Eating after is a common but temporary phenomenon.plenty of fresh fruit—carrying it to work

Cravings Difficulty in concentrating Depression and tiredness Irritability, Restlessness, Anger and Frustration Increased Appetite and Weight Gain

PSYCHOACTIVE SUBSTANCE USE DISIODERS



  • F10 - F19 MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
  • F10.- DISORDERS DUE TO USE OF ALCOHOL
  • F11.- DISORDERS DUE TO USE OF OPIOIDS
  • F12.- DISORDERS DUE TO USE OF CANNABINOIDS
  • F13.- DISORDERS DUE TO USE OF SEDATIVES OR HYPNOTICS
  • F14.- DISORDERS DUE TO USE OF COCAINE
  • F15.- DISORDERS DUE TO USE OF OTHER STIMULANTS, INCLUDING CAFFEINE
  • F16.- DISORDERS DUE TO USE OF HALLUCINOGENS
  • F17.- DISORDERS DUE TO USE OF TOBACCO
  • F18.- DISORDERS DUE TO USE OF VOLATILE SOLVENTS

F1x.0 Acute intoxication
G1. Clear evidence of recent use of a psychoactive substance (or substances) at sufficiently high dose levels to be consistent with intoxication.
G2. Symptoms or signs of intoxication compatible with the known actions of the particular substance (or substances), as specified below, and of sufficient severity to produce disturbances in the level of  consciousness, cognition, perception, affect or behaviour which are of clinical importance.
G3. Not accounted for by a medical disorder unrelated to substance use, and not better accounted for by another mental or behavioural disorder.
Acute intoxication frequently occurs in persons who have more persistent alcohol- or drug-related problems in addition. Where there are such problems, e.g. harmful use (F1x.1), dependence syndrome (F1x.2), or psychotic disorder (F1x.5), they should also be recorded too.

The following fifth character codes may be used to indicate whether the acute intoxication was associated  with any complications:

  • F1x.00 Uncomplicated
  • Symptoms of varying severity, usually dose-dependent.
  • F1x.01 With trauma or other bodily injury.
  • F1x.02 With other medical complications.
  • Examples are haematemesis, inhalation of vomit.
  • F1x.03 With delirium.
  • F1x.04 With perceptual distortions.
  • F1x.05 With coma.
  • F1x.06 With convulsions.
  • F1x.07 Pathological intoxication (applies only to alcohol).

F10.0 Acute alcohol intoxication
A.   The general criteria for acute intoxication (F1x.0) are met.

B.   Dysfunctional behaviour, as evidenced by at least one of the following:
(1) disinhibition;
(2) argumentativeness;
(3) aggression;
(4) lability of mood;
(5) impaired attention;
(6) impaired judgement;
(7) interference with personal functioning.

C. At least one of the following signs:
(1) unsteady gait;
(2) difficulty standing;
(3) slurred speech;
(4) nystagmus;
(5) decreased level of consciousness (e.g. stupor, coma);
(6) flushed face,
(7) conjunctival injection.

Comment: Acute alcohol intoxication when severe may be accompanied by hypotension, hypothermia, and depression of the gag reflex. If desired, the blood alcohol level may be specified by using codes Y90.0 - Y90.8. Code Y91 may be used  to specify the clinical severity of intoxication, where the blood alcohol level is not available.

F10.07 Pathological alcohol intoxication
Note:
The status of this condition is being examined. These research criteria must be regarded as tentative.
A.   The general criteria for acute intoxication (F1x.0) are met, with the exception that pathological intoxication occurs after drinking amounts of alcohol not sufficient to cause intoxication in most people.
B.   Verbally aggressive or physically violent behaviour that is not typical of the person when sober.
C.   Occurs very soon (usually a few minutes) after consumption of alcohol.
D.   No evidence of organic cerebral disorder or other mental disorders.

Comment : This is an uncommon condition. If blood alcohol levels are available, the levels found in this  disorder are lower than those which would cause acute intoxication in most people, i.e. below 40mg/100ml.


F11.0 Acute Opioid intoxication
A.   The general criteria for acute intoxication (F1x.0) are met.

B.   Dysfunctional behaviour as evidenced by at least one of the following:
(1) apathy and sedation;
(2) disinhibition;
(3) psychomotor retardation;
(4) impaired attention;
(5) impaired judgement;
(6) interference with personal functioning.

C. At least one of the following signs:
(1) drowsiness;
(2) slurred speech;
(3) pupillary constriction (except in anoxia from severe overdose when pupillary dilatation occurs)
(4) decreased level of consciousness (e.g. stupor, coma);
Comment : Acute Opioid intoxication when severe may be accompanied by respiratory depression (and hypoxia), hypotension and hypothermia.


F12.0 Acute cannabis intoxication
A.   The general criteria for acute intoxication (F1x.0) are met.

B.   Dysfunctional behaviour or perceptual disturbances which include at least one of the following:
(1)     euphoria and disinhibition;
(2)     anxiety or agitation;
(3)     suspiciousness or paranoid ideation;
(4)     temporal slowing (a sense that time is passing very slowly, and/or the person is experiencing a rapid flow of ideas);
(5)     impaired judgement;
(6)     impaired attention;
(7)     impaired reaction time;
(8)     auditory, visual or tactile illusions;
(9)     hallucinations with preserved orientation;
(10)    depersonalisation;
(11)    derealization;
(12)    interference with personal functioning.

C.   At least one of the following signs:
(1) increased appetite;
(2) dry mouth;
(3) conjunctival injection;
(4) tachycardia.

F13.0 Acute intoxication from sedative-hypnotic drugs
A. The general criteria for acute intoxication (F1x.0) are met.

B. Dysfunctional behaviour, as evidenced by at least one of the following:
(1) euphoria and disinhibition;
(2) apathy and sedation;
(3) abusiveness or aggression;
(4) lability of mood;
(5) impaired attention;
(6) anterograde amnesia;
(7)  impaired psychomotor performance;
(8) interference with personal functioning.

C.   At least one of the following signs:
(1) unsteady gait;
(2) difficulty standing;
(3) slurred speech;
(4) nystagmus;
(5) decreased level of consciousness (e.g. stupor, coma);
(6) erythematous skin lesion or blisters.
Comment: Acute intoxication from sedative-hypnotic drugs when severe may be accompanied by hypotension, hypothermia, and depression of the gag reflex.

F14.0 Acute cocaine intoxication
A.   The general criteria for acute intoxication (F1x.0) are met.

B.   Dysfunctional behaviour or perceptual abnormalities, as evidenced by at least one of the following:
(1) euphoria and sensation of increased energy;
(2) hypervigilance;
(3) grandiose beliefs or actions;
(4) abusiveness or aggression;
(5) argumentativeness;
(6) lability of mood;
(7) repetitive stereotyped behaviours;
(8) auditory, visual or tactile illusions;
(9) hallucinations usually with intact orientation;
(10) paranoid ideation;
(11) interference with personal functioning.

C.   At least two of the following signs:
(1)     tachycardia (sometimes bradycardia);
(2)     cardiac arrhythmias;
(3)     hypertension (sometimes hypotension);
(4)     sweating and chills;
(5)     nausea or vomiting;
(6)     evidence of weight loss;
(7)     pupillary dilatation;
(8)     psychomotor agitation (sometimes retardation);
(9)     muscular weakness;
(10     chest pain;
(11)    convulsions.

Comment : Interference with personal functioning is most readily apparent from the social interactions of the users,  which range from extreme gregariousness to social withdrawal

F15.0 Acute intoxication from stimulants other than cocaine
A. The general criteria for acute intoxication (F1x.0) are met.

B. Dysfunctional behaviour or perceptual abnormalities, as evidenced by at least one of the following:
(1)     euphoria and sensation of increased energy;
(2)     hypervigilance;
(3)     grandiose beliefs or actions;
(4)     abusiveness or aggression;
(5)     argumentativeness;
(6)     lability of mood;
(7)     repetitive stereotyped behaviours;
(8)     auditory, visual or tactile illusions;
(9)     hallucinations usually with intact orientation;
(10)    paranoid ideation;
(11)    interference with personal functioning.

C.   At least two of the following signs:
(1)     tachycardia (sometimes bradycardia);
(2)     cardiac arrhythmias;
(3)     hypertension (sometimes hypotension);
(4)     sweating and chills;
(5)     nausea or vomiting;
(6)     evidence of weight loss;
(7)     pupillary dilatation;
(8)     psychomotor agitation (sometimes retardation);
(9)     muscular weakness;
(10     chest pain;
(11)    convulsions.

Comment: Interference with personal functioning is most readily apparent from the social interactions of the users, which range from extreme gregariousness to social withdrawal.

F16.0 Acute hallucinogen intoxication
A. The general criteria for acute intoxication (F1x.0) are met.

B. Dysfunctional behaviour or perceptual abnormalities, as evidenced by at least one of the following:
(1)     anxiety and fearfulness;
(2)     auditory, visual or tactile illusions or hallucinations occurring in a state of full wakefulness and alertness;
(3)     depersonalisation;
(4)     derealisation;
(5)     paranoid ideation;
(6)     Ideas of reference;
(7)     lability of mood;
(8)     hyperactivity;
(9)     impulsive acts;
(10)    impaired attention;
(11)    interference with personal functioning.

C.   At least two of the following signs:
(1) tachycardia;
(2) palpitations;
(3) sweating and chills;
(4) tremor;
(5) blurring of vision;
(6) pupillary dilatation;
(7) incoordination.

F17.0 Acute nicotine intoxication
A. The general criteria for acute intoxication (F1x.0) are met.

B.   Dysfunctional behaviour or perceptual abnormalities, as evidenced by at least one of the following:
(1) insomnia;
(2) bizarre dreams;
(3)  lability of mood;
(4) derealisation;
(5) interference with personal functioning.

C.   At least one of the following signs:
(1) nausea or vomiting;
(2) sweating;
(3) tachycardia;
(4) cardiac arrhythmias.

F18.0 Acute intoxication from volatile solvents
A.   The general criteria for acute intoxication (F1x.0) are met.

B.   Behavioural changes which include at least one of the following:
(1) apathy and lethargy;
(2) argumentativeness;
(3) abusiveness or aggression;
(4) lability of mood;
(5)  impaired judgement;
(6) impaired attention and memory;
(7) psychomotor retardation;
(8) interference with personal functioning.

C. At least one of the following signs:
(1) unsteady gait;
(2) difficulty standing;
(3) slurred speech;
(4) nystagmus;
(5) decreased level of consciousness (e.g. stupor, coma);
(6) muscle weakness;
(7) blurred vision or diplopia.
Comment: Acute intoxication from inhalants other than solvents should also be coded here.
Acute intoxication from volatile solvents when severe may be accompanied by hypotension, hypothermia, and depression of the gag reflex.

F19.0 Acute intoxication due to multiple drug use and use of other psychoactive substances
This category should be used when there is evidence of intoxication caused by recent use of other psychoactive substances (e.g. phencyclidine) or of multiple psychoactive substances where it is uncertain which substance has predominated.

F1x.3 Withdrawal state
G1. Clear evidence of recent cessation or reduction of substance use after repeated, and usually prolonged and/or high-dose use of that substance.
G2. Symptoms and signs compatible with the known features of a withdrawal state from the particular substance or substances (see below).
G3. Not accounted for by a medical disorder unrelated to substance use, and not better accounted for by another mental or behavioural disorder.

The diagnosis of withdrawal state may be further specified by using the following fifth character codes:

  • F1x.30 Uncomplicated
  • F1x.31 With convulsions

F1x.1 Harmful use
A.   Clear evidence that the substance use was responsible for (or substantially contributed to) physical or  psychological harm, including impaired judgement or dysfunctional behaviour.
B.   The nature of the harm should be clearly identifiable (and specified).
C.   The pattern of use has persisted for at least one month or has occurred repeatedly within a twelve-month period.
D.   The disorder does not meet the criteria for any other mental or behavioural disorder related to the same drug in the same time period (except for acute intoxication F1x.0).

 

F1x.2 Dependence syndrome
A.   Three or more of the following manifestations should have occurred together for at least one month or if  persisting for periods of less than one month then they have occurred together repeatedly within a twelvemonth period.
(1) A strong desire or sense of compulsion to take the substance.
(2) Impaired capacity to control substance-taking behaviour in terms of onset, termination or level of use, as evidenced by: the substance being often taken in larger amounts or over a longer period than intended, or any unsuccessful effort or persistent desire to cut down or control substance use.
(3) A physiological withdrawal state (see F1x.3 and F1x.4) when substance use is reduced or ceased, as  evidenced by the characteristic withdrawal syndrome for the substance, or use of the same (or closely  related) substance with the intention of relieving or avoiding withdrawal symptoms.
(4) Evidence of tolerance to the effects of the substance, such that there is a need for markedly increased  amounts of the substance to achieve intoxication or desired effect, or that there is a markedly diminished  effect with continued use of the same amount of the substance.
(5) Preoccupation with substance use, as manifested by: important alternative pleasures or interests being givenup or reduced because of substance use; or a great deal of time being spent in activities necessary to obtainthe substance, take the substance, or recover from its effects.
(6) Persisting with substance use despite clear evidence of harmful consequences

F10.3 Alcohol withdrawal state
A.   The general criteria for withdrawal state (F1x.3) are met.

B.   Any three of the following:
(1) tremor of the outstretched hands, tongue or eyelids;
(2) sweating;
(3) nausea, retching or vomiting;
(4) tachycardia or hypertension;
(5) psychomotor agitation;
(6) headache;
(7) insomnia;
(8) malaise or weakness;
(9) transient visual, tactile or auditory hallucinations or illusions;
(10) grand mal convulsions.

Comment : If delirium is present, the diagnosis of alcohol withdrawal state with delirium ("delirium tremens") (F10.4) should be made.

F11.3 Opioid withdrawal state
A.   The general criteria for withdrawal state (F1x.3) are met. (Note that an opioid withdrawal state may also be  induced by administration of an opioid antagonist after a brief period of opioid use.)

B.   Any three of the following:
(1)     craving for an opioid drug;
(2)     rhinorrhoea or sneezing;
(3)     lacrimation;
(4)     muscle aches or cramps;
(5)     abdominal cramps;
(6)     nausea or vomiting;
(7)     diarrhoea;
(8)     pupillary dilatation;
(9)     piloerection, or recurrent chills;
(10)    tachycardia or hypertension;
(11)    yawning;
(12)    restless sleep.

F12.3 Cannabis withdrawal state
Note: This is an ill-defined syndrome for which definitive diagnostic criteria cannot be established at the present time. It occurs following cessation of prolonged high-dose use of cannabis. It has been reported variously as lasting from several hours to up to seven days. Symptoms and signs include anxiety, irritability, and tremor of the outstretched hands, sweating, and muscle aches.

F13.3 Sedative-hypnotic withdrawal state
A.   The general criteria for withdrawal state (F1x.3) are met.
B.   Any three of the following:

(1)     tremor of the outstretched hands, tongue or eyelids;
(2)     nausea or vomiting;
(3)     tachycardia;
(4)     postural hypotension;
(5)     psychomotor agitation;
(6)     headache;
(7)     insomnia;
(8)     malaise or weakness;
(9)     transient visual, tactile or auditory hallucinations or illusions;
(10)    paranoid ideation;
(11)    grand mal convulsions.
If delirium is present, the diagnosis of sedative-hypnotic withdrawal state with delirium (F13.4) should be  made.

F14.3 Cocaine withdrawal state
A.   The general criteria for withdrawal state (F1x.3) are met.
B.   Dysphoric mood (for instance sadness or anhedonia).
C.   Any two of the following symptoms and signs:

(1) lethargy and fatigue;
(2) psychomotor retardation or agitation;
(3) craving for cocaine;
(4) increased appetite;
(5) insomnia or hypersomnia;
(6) bizarre or unpleasant dreams.

F17.3 Nicotine withdrawal state
A.   The general criteria for withdrawal state (F1x.3) are met.

B.   Any two of the following symptoms and signs:
(1) craving for tobacco (or other nicotine-containing products);
(2) malaise or weakness;
(3) anxiety;
(4) dysphoric mood;
(5) irritability or restlessness;
(6) insomnia;
(7) Increased appetite;
(8) increased cough;
(9) mouth ulceration;
(10) difficulty concentration

Dependence Syndrome
Definitive diagnosis is made only if at least 3 of the following have been experienced-
1. Tolerance
2. Withdrawal symptoms
3. Difficulties in controlling substance taking behaviors
4. The substance is taken in large amounts or over a longer period than intended
5. Neglect of alternative pleasures
6. Persistent use of substance despite clear evidence of harmful consequences
7. Strong desire or compulsion to take the substance

Stages of Change
In the Transtheoretical Model, change is a "process involving progress through a series of stages:

  • Precontemplation (Not Ready)-"People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic"
  • Contemplation (Getting Ready)-"People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions"
  • Preparation (Ready)-"People are intending to take action in the immediate future, and may begin taking small steps toward behaviour changeAction – "People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours"
  • Maintenance – "People have been able to sustain action for awhile and are working to prevent relapse"
  • Termination – "Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of copingIn addition, the researchers conceptualized "relapse" (recycling) which is not a stage in itself but rather the "return from Action or Maintenance to an earlier stage.

                                                   
Stage 1: Precontemplation (Not Ready)

People at this stage do not intend to start the healthy behavior in the near future (within 6 months), and may be unaware of the need to change. People here learn more about healthy behavior: they are encouraged to think about the pros of changing their behavior and to feel emotions about the effects of their negative behavior on others.
Precontemplators typically underestimate the pros of changing, overestimate the cons, and often are not aware of making such mistakes.
One of the most effective steps that others can help with at this stage is to encourage them to become more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behavior.

Stage 2: Contemplation (Getting Ready)
At this stage, participants are intending to start the healthy behavior within the next 6 months. While they are usually now more aware of the pros of changing, their cons are about equal to their Pros. This ambivalence about changing can cause them to keep putting off taking action.
People here learn about the kind of person they could be if they changed their behavior and learn more from people who behave in healthy ways.
Others can influence and help effectively at this stage by encouraging them to work at reducing the cons of changing their behavior.

Stage 3: Preparation (Ready)
People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make the healthy behavior a part of their lives. For example, they tell their friends and family that they want to change their behavior.
People in this stage should be encouraged to seek support from friends they trust, tell people about their plan to change the way they act, and think about how they would feel if they behaved in a healthi