TOXICOMANIAS (Greek toxikon the employee for greasing of arrows, that is poisonous + mania madness, madness) — group of diseases which reason usual abuse of the substances causing short-term subjectively positive mental state is. T. are shown by the diverse mental and somatoneurologic disorders which are followed by a behavior disorder and social decrease.
The use of the term «toxicomania» was strengthened in a crust, time as a variety of the substances serving as an object of addiction does not keep within a framework of earlier existing concepts «drug addiction» and «medicinal dependence». It completely covers all existing forms of abuse of drugs sedative, including narcotic (see. Drug addiction ), the stimulating, mixed action for the purpose of intoxication, and also hallucinogens (see. Psychodisleptic substances ), alcohol, tobacco. The term «toxicomania» transfers essence of pathology — poisoning and an inclination to poisoning, but also, it is universal (any change of the drugs used for intoxication keeps within its framework).
The concept «toxicomania» is applied in a wedge, practice and sociology. In law also the term «drug addiction» in relation to abuse actually is kept by drugs (see). In pharmacology use names of private forms of abuse according to substances — objects of studying.
For the purpose of intoxication the substances differing on a range pharmakol are used. activities, on a chemical structure, for to-rykh the general the wedge, mental effect — euphoria is. The preference of these or those intoxicating substances is defined by an individual according to physiological tendency either to stimulators, or to sedative substances and belonging to certain social, professional and age groups. Besides, «fashion» for the intoxicating substances changes. Are most studied alcoholism (see), barbituratizm (see), hasheeshism (see), cocainism (see), a caffeinism (see. Kofein ), morphinism (see), an opiizm (see. Opium ).
Intoxication at T. is followed by euphoria and change in a varying degree of consciousness. As the substances serving as a subject of abuse on intensity and quality of euphoric action are not identical, they cause various feelings. One (hypnotic drugs) cause preferential corporal feelings, other (hallucinogens) — mental. At reception of a number of substances, napr, opiates, the mixed effect is noted. Nek-ry substances (caffeine, nicotine) cause euphoria indirectly as result of raising of the general psychophysical tone. Consciousness changes from devocalization (at effect of somnolent drugs, alcohol, gasoline) before intensive wakefulness (at action of stimulators); from narrowing of consciousness (at effect of morphine) to a twilight state (at action of Cyclodolum, Dimedrol). Disturbance of consciousness can be followed by hallucinations (e.g., at the use of so-called volatile solvents, a mescaline, psilocybin) or illusions (at the use of hashish), visualization of representations (at reception of opiates). Intoxication diethyl amide lysergic to - you (see. Psychodisleptic substances) the oneiric syndrome causes (see). Degree and a form of change of consciousness depend on a dose of substance, napr, alcohol in average degree of intoxication causes narrowing of consciousness, and with increase of intoxication — devocalization (see), a sopor, a coma (see); gashishny intoxication can be expressed by a delirious syndrome (see). Intensity of euphoria depends on a dose of substance. With the course of intoxication euphoria decreases, and stupefaction goes deep. The deeper stupefaction in an ebrietas is capable to cause substance, the big danger is created for society and the individual in connection with uncontrollable and his inadequate behavior. With increase of stupefaction the behavior is dictated by the pathological (internal) motives and affects which are often not connected with the existing situation or resulting from the distorted perceptions and estimates. With recession of euphoria affects of alarm, fear, rage often appear; these affects can be caused by contents illusions (see) and hallucinations (see). Got drunk it is capable to an agressive behavior, including and to an autoaggression, easily falls the victim of violence, accident. Disorganization of mental functions is found also in form and content of the speech (see) reflecting not only the broken affect, but also disorders of intelligence (disruptiveness, a gallop of the ideas, bystry change of superficial associations or, on the contrary, viscosity of thinking, etc.). The sequence and concentration of mental processes is lost, perception becomes accidental, superficial, insufficient and after escaping of intoxication gaps of memory, subjects big are found, than consciousness was broken more deeply (see Amnesia). Intoxication is followed by somatoneurologic disturbances — a vegetative irritation (change of size of pupils, disturbance poto-, salivary and a slezootdeleniya, vasomotor reactions), frustration cardiovascular, nervous, muscular and other systems. The nature of these disturbances, just as features of frustration of mentality (in particular, disorders of consciousness), allows to establish what substance caused intoxication. In difficult cases, at the mixed intoxication, the diagnosis is confirmed by data a lab. researches — a spectral analysis (see), liquid and gas chromatography (see) biol. liquids. Escaping of intoxication is characterized by decrease in working capacity, sleep disorders, appetite, secretory functions (e.g., a high diuresis), and also a postintoksikatsionny dysphoria (see).
The term of development of a disease depends on the used substance; it fluctuates of 1 — 2 week up to 1 — 1,5 years.
The structure of a disease is presented by syndromes of narkomanichesky dependence: a syndrome of the changed reactivity, a syndrome of mental dependence and a syndrome of physical dependence (see. Drug addiction ). The syndrome of the changed reactivity consists of symptoms of change of tolerance (portability), a form of consumption of substance (irregular reception is replaced by systematic) and the forms of intoxication demonstrating that the organism reacts to administration of substance in a special way. The syndrome of mental dependence includes symptoms of an invincible inclination to substance, achievements of mental comfort at intoxication, testimonial that the mental condition of the individual is defined by presence or lack of the consumed substance at an organism. The syndrome of physical dependence is presented by a compulsive, uncontrollable (physical) inclination to substance, a possibility of physical comfort in a condition of intoxication and an abstinence syndrome (see. Abstinence ). Priority of emergence of syndromes and transformation of symptoms define stages of T. also allow to establish prescription of a disease. Besides, each T. is followed by the frustration inherent hron. intoxications this or that substance that allows to establish the diagnosis in the absence of objective anamnestic data. Degree of a zlokachestvennost of separate forms T. it is various. In some cases weight of a current hron. intoxications are advanced by development of narkomanichesky dependence.
For all forms T. the gradual power exhaustion which is shown exinanition, loss of intensity of actually toxicomaniac symptomatology is characteristic. Into the forefront defects of separate systems act, to-rye depend on properties of substance — a subject of abuse. So, substances of a promoting effect (see. Psychogogic means ) cause frustration of cardiovascular system, synthetic analgetics — frustration of parenchymatous bodies. At all T. mental disturbances are expressed. T are especially malignant., connected with the use of substances, to-rye cause stupefaction (e.g., somnolent drugs); at these forms 1 — 2 years later there are low-reversible disorders of intelligence (dementia with rough mnestichesky frustration, dysphorias, etc.), testimonial of existence of intoksikatsionny encephalopathy (see). For T. changes of the personality as there is a reorientation of vital values in connection with an inclination to intoxication, the aspiration to get the intoxicating substance at any cost are characteristic; at the same time the patient neglects affairs and the duties that he creates a conflict situation, the cut of the patient does not want escaping and cannot find. Disintegration of the personality involves antisocial behavior. The exception is made by socially admissible T., caused by the stimulating substances of small efficiency (e.g., the substances which are contained in coffee, tobacco); at these T. there is no contradiction between the personality and society, losses of working capacity and weak-mindedness; their harm is limited to loss of individual somatic health. Changes of the personality and way of life of the patient T. also societies in general serve as the reason of biological, moral and economic losses of the immediate environment (wellbeing and health of a family).
Treatment of T. it is carried out in specialized narcological hospitals (see. Narcological service ) in the conditions of long isolation. Duration of a disease and somatic trouble, a possibility of development of psychosis serve as the indication to gradual cancellation of the substance which is a subject of abuse; in other cases it is more preferable single-step otnyaty than the consumed substance. At dominance of symptoms of a hyperphrenia or at a depression and functional somatovegetativny weakness neuroleptics are shown (see). In all cases of T. appoint amino acids, vitamins, biostimulators. Constant overseeing by a condition of cardiovascular system is necessary, especially at patients 30 years are more senior. Neuroleptics should be replaced gradually with the drugs operating for century of N of page and physiotherapeutic procedures, corrective a mental state and nevrol. frustration. Myagkodeystvuyushchy neuroleptics, timoleitik (see. Timoleptichesky substances ) and hypnagogues (see) apply restrictedly because of danger of change of a form T. Exercise and mental stresses shall be entered gradually; any overload renews or aggravates symptoms T. Srok of stay in a hospital is defined by improvement of a mental state and maintenance that demands not less than 2 months of treatment. It is longest there are such symptoms as an adynamy (see. Asthenic syndrome ), frustration of a dream, mood swing, and also a persuasive inclination to intoxication. After an extract from the patient would have to be under observation in a narcological clinic, and in case of approach of a social decompensation — under control of bodies of militia, etc. (social control). Function of social control includes not only observation, but also employment, and also assistance to children of sick T. (the device in child care facilities, a material grant, etc.). The supporting treatment in a clinic is shown, and at a recurrence — repeated hospitalization is obligatory.
Prevention consists in a close check behind appointment and use of any means capable to cause subjectively pleasant mental effect. These means are contraindicated to the teenagers sick with neurosises (see), psychopathies (see), alcoholism, an oligophrenia (see). At treatment of such patients in a hospital reasonablly often to change similar drugs, without allowing accustoming. The patients receiving drugs with potentially eyforiziruyushchy action it is out-patient, transfers of medicine to other persons and especially to teenagers shall be prevented about inadmissibility of non-compliance with Regulations of Admission. Toxicomania results from medical appointments at prolonged, over necessary, reception or at any overestimate of a dose, upon transition of the patient to self-treatment.
The leading value in the prevention and restriction of distribution of T. primary prevention has (see Prevention primary). The main role is played at the same time by education of younger generation in traditions of a healthy lifestyle, the organization of cultural leisure of youth. Cases of T. shall come to light timely. Considerable danger is constituted by those forms T., at to-rykh substance — the subject of abuse is not to lay down. drug (gasoline, paint and varnish solvents, etc.). Secondary prevention consists in constant dispensary observation for the patient, hospitalization at a recurrence. Active observation is necessary within five years after the last recurrence, then the patient is struck off the active register. As the diseased, as a rule, does not address for medical aid, the problem of active identification is solved by administration of educational institutions and the enterprises, youth and public organizations, bodies of militia. Sick T. are, as a rule, united in groups; it facilitates their identification since at detection of one diseased the others are established in the place of study, work, a residence. The persons using eyforiziruyushchy substances are subject to obligatory medical survey in a narcological hospital where the issue of corrective actions and control is resolved: social if the disease did not develop, or medical if current-ikomanichesky dependence was already created. Sick T., evading from treatment, send to activity therapy dispensaries for addicts (see. Narcological service).
Bibliography: Alcoholism and toxicomanias, under the editorship of D. D. Fedotov, M., 1968; Clinical psychiatry, under the editorship of G. Grulle, etc., the lane with it., page 221, M., 1967; Pyatnitskaya I. N. Clinical narcology, L., 1975, bibliogr.; Stolyarov G. V. Medicinal psychoses and psikhomimetichesky means, M., 1964; And 1 I-gulander C. Dependence on sedative and hypnotic drugs, comparative clinical and social study, Acta psychiat. scand., suppl. 270, 1978; Drug problems in the sociocultural context, ed. by G. Edwards a. A. Arif, Geneva, 1980; Handbook on drug abuse, ed. by R. L. Du Pont a. o., Washington, 1979; Swinson R. Eaves D. Alcoholism and addiction, L., 19 78; W i k 1 e r A. Opioid dependence, mechanisms and treatment, N. Y., 1980.
And. H. Pyatnitskaya.