Author: Adekola Taylor
For the subject of addiction recovery and addiction treatment to be efficiently dealt with, the effects of addictive drug substances on endocrine and central nervous system must be properly understood. Addiction has the tendency to cause changes to the endocrine system and autonomous nervous system. These changes may be anatomical, physiological, molecular, biochemical, genetic and cellular. Drugs of addiction are powerful and dangerous if not used as prescribed because of their ability to alter endocrine system and autonomous nervous system or the bodily functions. In other words, the use of drug can interfere with the body chemistry of the drug users which could lead to bodily functional and behavioral changes. There are diverse definitions for drugs based on their uses. A drug can be called a pharmaceutical preparation or a naturally occurring substance used primarily to bring about a change in the existing process or state (physiological, psychological or biochemical).
When drugs are used to treat diseased conditions, they improve health conditions to bring about physical or mental well-being. But if drugs are used other than for the medical purposes in such a way that affects mental or physical functioning, it is termed drug abuse. It is worth noting that any abuse can lead to addition. Drug addiction can also be referred to as chemical dependency or substance dependence, as a matter of fact it is a chronic diseased condition characterized by a compulsive pattern of drug abuse that significantly results to health problems involving withdrawal from or tolerance to the substance. It is a relapsing brain disease that makes the addicted individual to compulsively use drug notwithstanding devastating consequences attached to its usage.
Classification of Addictive Drugs
There are diverse classifications of drugs but most drugs that are highly abused fall into prescribed and recreational drugs. Users of these drugs can easily get addicted to them if they are not monitored. Below is a simple classification of addictive drugs.
- Depressants: Depressants slow down the functioning the central nervous system. Examples are alcohol, opioids, barbiturates, tranquilizers, opiates and benzodiazepines
- Cannabis: They produce mild euphoria with long-term decreased cognitive activities and psychosis Common names in this classification are Ganja / Marijuana or Hashish / Charas.
- Other drug classifications that are subject to abuse are anti-psychotics, anti-depressants, muscle relaxants, Pain killers and anti-emetics.
- Stimulants: These drugs speed up the central nervous system to cause excitation. Common drugs that fall in this classification are cocaine, nicotine, amphetamines and caffeine.
- Hallucinogens: Hallucinogens have profound effects on the mental processes, emotion and perception. Examples LSD (Lysergic acid diethylamide), this is orally taking, PCP (Phencyclidine) is being snorted or smoked, Mescaline, this is taking orally and Psilocybin which is being smoked.
Addiction and Its Effects on Endocrine System and Autonomic Nervous System
Receptors that opioid pepides (i.e. endorphins, enkephalins, dynorphins etc) interact with in the nervous system produce respiratory depression, analgesia, constipation, and euphoria. Opioid drug addiction is associated with heroin-like intoxication, withdrawal and tolerance. The addiction to opioid also leads to central suppression of hypothalamic secretion of gonadotropin-releasing hormone. This presents hypogonadism, a condition which is characterized by loss of libido, depression, loss of muscle mass, anxiety, infertility, fatigue, osteoporosis, menstrual irregularities and galactorrhea in women, impotence in men, and compression fractures in both women and men (Katz & Mazer 2009). The prolonged use of opioids adversely affects the endocrine system by reducing the levels of growth hormone, cortisol, dehydroepianadrosterone sulfate (DHEAS), and gonadal sex hormones.
Sex hormones in men are produced in the testes and are produced in ovaries in women. Testosterone is the principal sex hormone in men while in women it is estradiol. The two principal hormones in the anterior pituitary gonadotrophs that stimulate the production of these gonadal hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Opiate-induced sex hormone deficiency is primarily based on the suppression of the hypothalamic-pituitary-gonadal axis, the axis that regulates the production and secretion of sex hormone (Colameco and Coren 2009). The hypothalamus releases gonadotropin-releasing hormone (GnRH) which stimulates the secretion of LH and FSH. The secretion of testosterone by the testes and oestrogen by the ovaries are mediated by both LH and FSH. Addiction to opioids affects the hypothalamic-pituitary-gonadal axis, the axis thereby causing sexual dysfunction and endocrine deficiency.
Marijuana and its active component (Tetrahydrocannabinol) elicit their effects on the endocrine system by activating hypothalamic-pituitary-adrenal axis (HPA) and by suppressing the growth hormone, sex hormones, prolactin, and the thyroid axis. Like that of opioid addiction, marijuana addiction causes sexual hormone dysfunction. Studies have shown that Terahydrocannabinol (THC) and marijuana directly cause reduction in testicular sizes in dogs, a condition that may be explained by the degeneration of seminiferous tubules (Dixit et al. 1977). The adrenal gland secretes glucocorticoids which play vital roles in lipid, carbohydrate, and protein metabolism; immunological action; and cardiac and renal functions.
Adrenocorticotropic hormone (ACTH) released by the anterior pituitary is responsible for the regulation of glucocorticoids while ACTH secretion is regulated by Corticotropin-releasing hormone (CRH) being synthesized in the hypothalamus. Hypothalamic transmitters such as dopamine, catecholamines, and serotonin have direct effects on Corticotropin-releasing hormone. HPA function is altered by cannabinoids by modulating either indirectly through other hypothalamic pathways or directly through CBl-mediated effects on CRH neurons in the paraventricular nucleus (Brown and Dobs 2002).
Moreover, cannabinoid inhibits growth hormone (GH) secretion by stimulating somatostatin. Catecholamines in the ventromedial nucleus influence, dopamine in the arcuate nucleus, and serotonin from the limbic system influence GH secretion by enhancing growth hormone-releasing hormone (GHRH). Therefore addiction to marijuana has been shown to cause growth hormone deficiency characterized by decreased muscle mass and increased fat mass, reduced cardiac performance, reduced bone mineral density, and impaired sense of well-being (Wenger et al. 1988).
Addiction Treatment and Addiction Recovery
Addiction training for primary care physicians cannot be underestimated because most of the cases of addiction have their source from the grassroots. Most addicted patients may be unwilling to cooperate and it would take highly trained primary care physicians to help in such cases. The good news is that patients with addictions can be treated effectively and can recover. Usage of substitution medication has proven to be an effective method of detoxification. The method of detoxification has proven to be only useful in patients with addictions to alcohol, sedative-hypnotics, nicotine and opioids (Hayner 1993). It is very important that withdrawal in patients with addictions to alcohol or sedative-hypnotic drugs should be supervised because unsupervised withdrawal from these drugs can lead to significant mortality and morbidity. Conversely withdrawal from nicotine or opioids is not likely to cause mortality or morbidity, though it may be very unpleasant.
There are stages of withdrawal based on severity. Patients addictions categorized as stage III should be treated as in an inpatient intensive care unit. The approach to outpatient treatment should be based on the stages of withdrawal. However, patients presented in stage II of withdrawal can be treated in an outpatient unit. Outpatients Addiction treatment for primary care physicians is very crucial because it takes highly trained medical personnel to identify stage II withdrawal because most patients in this category may be unwilling to reveal necessary information about delirium and hallucinations if not professionally handled. If patients have not progressed to higher withdrawal stage or not presently in stage III withdrawal they are permitted to undergo detoxification in an outpatient unit.
Having completed successfully the process of withdrawal, the physician needs to assist to diagnose and treat any personality and medical disorders, comorbid psychiatric disorders, and he should tackle environmental and social obstacles to continuing recovery. Treatment of comorbid psychiatric disorder is very crucial to curb the patients from self-medication in an attempt to treat their mood disorders by themselves. Untreated bipolar disorder, depression, and anxiety may the patients resume to addiction again. The physician must also be observant early enough to detect any symptoms of relapse in a patient.
In conclusion, drug treatment for addiction and protection from relapse can be aided if patients get involved in activities that can add meaning to their lives. They can pick up new hobbies, adopt pets, get involved in their community activities, and also set meaningful goals. They can devote more time to look after their health through regular exercise, healthy eating and adequate sleep. These will be helpful in overcome negative emotional stress and physical discomfort.
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