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ETIOPATHOGENESIS AND SOCIAL CONDITIONS IN DRUG ADDICTIONAND DRUG DEPENDENCY OF CHILDREN AND ADOLESCENTS
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Th e authors continue the previous communication on the history of drugs and addictions concerning diff erent categories of herbal or chemical drugs.Th e current knowledge about the etiopathogenesis of drug addiction, which refers to the mechanisms of acquiring the eff ects of foreign and unusualsubstances in common use. We refer to absorption through increased permeability of the digestive system mucosa (oesophagus, stomach, intestines) ofthe respiratory mucosa (pharynx, trachea, bronchial and pulmonary alveoli) as well as the blood cells that carry the drugs assimilated by the mucosae oradministered intravenously or subcutaneously. Th e drugs are not processed in the hepatic, lymphatic or vascular wall tissues; they reach the CNS. Addictionis induced by the basal nuclei and cerebral cortical neurons, which are ancestrally pre-determined to become the seat of food and drugs addiction processes.We want to alert our specialists about a new emphasis in addiction to bionic devices, namely: international centres of study in these areas have found thatneither the screens nor the search for social communication produce pathological attractions. Addiction might be due to the electromagnetic radiation,which is received, possessed by the brain and programmed to produce addiction, that is, these radiations require to be repeated again and again. We believethat all the sources mentioned here converge towards the creation of dependencies on electronic devices. Dependencies have been found to be easier, evenfaster, in children and adolescents, as well as in people with cerebral dysfunctions or defi ciencies.
The possibilities of developing children’s and adolescents’ organisms to tolerate toxic substances from nature or external chemicals from the environment are limited. Nothing that is extra can pass without leaving traces-even injuries, especially if the “plus” is repeated with food (pepper, spices, salt, sugar – also called “white death”), alcohol, tobacco or with the majority of drugs and toxic substances that cause habit, toxicomania and addiction. The etiopathogenesis of toxicomania is due to genetic factors, brain deficiencies, socio-familial causes, institutional deficiencies in children’s care, and in juvenile and youth prisons.
The brain structures, the neural and biochemical circuits involved in the addiction process are deep structures: thalamus, hippocampus and tegmen tympany which, in combination with brain endorphins, associate with morphinic exo-substances and impose repeated demands that we call toxicomanias and addictions. Modern research with opiate-type products has led to the discovery of the interdependence between brain endorphins and opiates such as morphine, or the other drugs. The same mechanisms of dependency on medication and of other types exo-dependency occur in all vertebrates, especially in mammals. It is necessary to define the drug as the substance which, absorbed in the body, alters it in one or more functions: digestive, haematological, hepatic, biochemical and cerebral. These substances create habit, addiction and progressive mental disorders in perception, thinking, memory, behaviours, wills, personality, affectivity. Mostly, they are part of the psychotropic substances that address and injure the human psyche.
The drugs may be vegetal (mushrooms, toxic plants such as: absinthe, poppy, mushrooms, cocaine, caffeine, etc.), animal (toxins, poisons, extracts, etc.) and prepared by chemical synthesis including some drugs like phenobarbital, bromides, benzodiazepines, some antipsychotics, etc. Drug use and abuse leads to physical and mental harm, damaging the individual and affecting the community. By definition, repeated drug use leads to addiction.
Toxicomania is the need to consume drugs that are urgently required by brain centres and formations as well as the whole body, leading to a state of daily subordination and dependency.
The WHO definition of dependency is the mental and physical state that results from the interaction of a body with a substance, realizing the need to take the drug rhythmically, continuously and at short intervals to feel its psychic effects, and often to avoid somatic sufferings (predominantly pains) but also psychotrauma or mental illness (depression, anxiety, life deprivations, etc.).
In the 20th century, the use of classical drugs, I.e. psychotropic substances, was overcome, and man’s weaknesses of attachment and dependency extended to new targets. This evolution has not led to forgetting the existing drugs. Mechanical dependencies have arisen: little toy trains and cars, household appliances: pantographs, radios, grinders, etc.; and addicts have been called collectors, followed by a rapid cyberdependency that provides information, but also more and more catchy and harmful virtual traps, as they abolish direct human communication. Now, we are in the midst of more and more aggressive psychotropic drugs, which are rapidly creating addiction, doubled by virtual drugs.
In children and adolescents the attraction for card games has been surpassed and replaced by the game of roulette and the exciting “Monopoly”. Old games: hopscotch, the jump, the “blind old woman”, the whirligig, black-and-white, were replaced by pokemon, kendama and the mobile phone, TV, computer, etc. But recently the spinner has just emerged, a sort of three-petalled whirligig that rotates around a spindle, which the children turn from morning till night, specializing in mobility and skill. Experts warn that this hand mill has created addictions that are an obvious way of simplistic fixation of stereotypes, but it is announced as one of the means that turns small children into docile, “trained” and subject to the globalization system. According to the National Anti-drug Agency (NAA) national report on the drug situation in 2013, “drug consumption starts at lower and lower ages, even since the preparatory grade, and the number of drug addicts infected with hepatitis B and HIV has doubled”.
At present, the youngest Romanian drug addict is only 6 years old. “He started, like many others, with the existing drugs in the family”. Consumption of toxic substances and drugs evolves into the pathology of chronic intoxication, which suddenly or progressively alters the state of health. There is little information about the sacrifice of drug-producing people. Generally, growers and those who harvest the drug plants: cannabis, poppy juice, coca leaves, mescaline solutions, etc. are also consumers. In countries such as Afghanistan, India, Iraq or Mexico, Venezuela, Bolivia, there are countless people and children who are drugged with their own products. These drug addicts can easily be used as executors, being found in armies of terrorists or as suicide bombers. Another known example is that of the workers who handle nitroglycerin in military or pharmaceutical industries who suffer from heart attack, often fatal, when they suddenly stop using nitroglycerin (a vasodilator) daily. We know tod ay that combining drugs, such as alcohol, with psychotropic substances, or the combination of “CRACK” (heroin and cocaine) greatly shortens the installation of addiction. The history of inhalers of smoke (incense, fir, wormwood, sage, fern smoke etc.) or of volatile substances refers to vulnerable children and adolescents who become rapidly addicted to these substances.
In our country, we know the dependency on nitro-solvents, which many children and young people have inhaled in the conditions of forced desinstitutionalization in 1992-1995, which were seen in the street without home and without income. They turned to the “drug of the poor” and soon became addicted, being nicknamed “Aurolaci” in those years because they were inhaling nitro-diluents from bags filled with a preparation of colloidal “gold” (bronze). Then it was also the inhalation of petrol vapours, kerosene, butane gas from small tourist flasks. It is said that the practice of inhaling these solvents started from Cluj, where Hungarian tourists brought it, this ritual spread rapidly to Oradea, Bucharest, Timisoara, Galati, Constanta, because the “aurolaci” travelled around the country by train.
Family genetic aspects of drug use are known from population cohort studies, proving that 5% of the descendants of a drug addict (alcohol, drugs, opiates) and 20% descendants of both narcomandrogophilic parents inherit or learn dependency and addiction. The safest are studies on alcoholics. Alcohol is the oldest known drug. In the first uses it gives the feeling of physical and mental comfort of short duration followed by negative effects due to the disinhibition produced by this drug. Children or adolescents are most vulnerable (lat: vulnus = wound) in engaging in alcoholic beverages because consumption of alcohol and tobacco gives them the impression they are mature. Addiction also arises from young people’s parties, where about twenty drink alcohol, then just one or two drink the second and third day, too, etc. They have brain mechanisms to challenge drug recognition centres and to meet endorphins with alcohol. Further repeated drinking and smoking may be followed by combination with other drugs. Street children, children who stray, use alcohol as food, as sedative-soothing and for heating-heat sensation.
They respond to invitations to “drink something for annoyance” or “to honour joy”. But let us remember the statistical findings: that children’s attitude towards alcohol is learned in the family, that fathers have a greater influence on them, and alcoholic adults invite children to have alcohol with them. Adolescents’ specific group: Street or neighbourhood “gang” is found in large cities in all countries. They meet in visible places where they can receive an “honour”, or in the pubs (bars, dancing, clubs) where drugs are also offered. The effects of repeated alcohol consumption are: demand for alcohol, irritability, fatigue, lack of appetite, loss of performance, at school, housework or at work, violence, aggression and crime. But alcohol and drugs may also lead minors to delinquency, that is to say, criminal offense for which they are forensically investigated for the discernment, without considering alcohol or other drugs. So, they come to the juvenile judges who have child and adolescent protection and defence missions - or they fit into legal articles that place them in correctional institutions. It is statistically known that over 50% of the deaths of young people aged 15-19 are due to alcohol (traffic accidents, suicides, crimes).
Alcohol (alcoholism) is the fourth public health problem after cardiovascular disease, mental illness and cancer. Jellinek (1960) developed certain studies on alcoholism or on the alcoholic and identified alcoholism categories that valid for adolescents, too:
-Alpha alcoholism (α) found in neurotic, axiomatic, depressing personalities who adapt to substances with a rapid relieving effect;
- Beta alcoholism (β) refers to those forms that develop over a long period of alcohol intake: tasters, daily consumers in France suffering from cirrhosis, those with nutritional deficiencies, or those with a social habit of consuming wine, whisky, brandy, vodka etc.
- Gamma alcoholism (γ) is a serious form of adapting cellular mechanisms to daily doses of alcohol becoming addiction, which through search behaviours leads to aggression and criminal acts. These situations require rehabilitation in specialized hospitals.
- Delta alcoholism (d) consists of gamma alcoholism plus the impossibility of reducing or stopping alcohol consumption for at least a day or two days.
- Epsilon alcoholism (ε) is a serious form with dipsomania.
All five forms are due to brain defects in the cerebral centres: the thalamus, the hypothalamus, the cerebral tegmen, and the frontal lobes; this is a genetic framing or assimilated in life, or both etiologies described here.
Standard rules on the effects of alcohol consumption, known in international law, contain the following specifications:
a) Blood alcohol level less than 0.5gr ‰ (per liter) causes a decrease in attention and induces psychomotor sluggishness, this being a subclinical situation;
b) At a concentration of 0.5gr-1gr ‰ there is a noticeable decrease in performance, altered judgment and switching to compulsive acts;
c) The state of drunkenness is installed at the concentration of 1.5gr ‰ in which neurons are narcotised, euphoria, cerebellar disorders, lack of control of speech, of gestures and of self-criticism occur;
d) Blood alcohol level of 2 gram ‰ induces profound motor and mental deterioration;
e) The state of pre-coma is found in blood alcohol level of 3gr ‰;
f ) Blood alcohol level 4 gr ‰ causes varying degrees of coma;
g) Death is established at the concentration of 5gr‰.
No delirum tremens is described in children and adolescents. This list can be used by ATI and neuroscience and child and adolescent psychiatry specialists in diagnosis, first aid and resuscitation, as well as in juvenile forensic expertise.
We enumerate other effects of alcoholism and other harmful influences on embryo-fetal life and children.
- Alcoholic embryofetopathy caused by alcoholic mothers or by those who use alcohol during the first three months of pregnancy consists of malformed children with microcephaly, flared nostrils, microphtalmia and psychomotor retardation.
- Amyloid embryofetopathy is known after the thalidomide sleeping pill, which was used by pregnant mothers during embryogenesis. It resulted in children without upper and / or lower limbs.
- Embryofetopathies with multiple malformations are found in the pregnancies exposed to irradiation in factories, radioactive mines, exposures to Rontgen or nuclear explosions in Japan or Chernobyl.
The interests and quests of adolescents for intense feelings and sensations also turned them to ethnobotanics. Ethnobotanic combinations have been in use for many years. There is an old teenage game to make corn silk cigarettes wrapped in corn leaves called “şuşorci” in Romanian. This use would be an entry into the world of smokers, so it would be the adult game. A thick cigarette (a kind of cigar) is made whose sour smoke produces coughs, dizziness, headaches, lacrimation. After 1990, the interests of pupils and young people turned to ethnobotanics in particular. Offers have penetrated schools, dormitories and boarding schools. These preparations can be made at home with recipes from the internet. The new euphoric boasts banana shells cooked in acetone, musk and lichens from trees, added to the “classic” formulas. The recipe “Headshot khill” also contains many vegetables, plus rats with rat poison. The producer in Cluj with masked name “O.S.” sells Ethnobotanic drug recipes on “Blogspot.ro”, and the “Ethnobotanic
Pressalert Archive” informs us that Timisoara holds the record of the number of young people who have arrived at the Emergence department in hospitals after the consumption of “doubled” ethnobotanics. Current pharmaco-medical treatments, in conjunction with psychological and social forms of childhood-adolescent support, use methadone and buprenorphine treatments, which in turn are risky exo – substances.
Anti-drug strategies: Possible anti-drug measures begin as early as information campaigns, alerting and educating parents, knowing that children are the most exposed, especially those from families who practice smoking, alcohol use, or using drugs.
Primary children need to be warned, can get explanations about the dangers of trying to use cigarettes, attempting to imitate or play smoking cigarettes, consuming alcoholic beverages or drugs.
Incorporating into scientific, sporting activities (running competitions, table sports, training and team games etc) including exercises with anti-drug glasses. It is logical to work with the National Antidrug Authority (NAA), which would lead to real prevention possibilities.
At present, addictive behaviours are treated with substitution drugs in outpatient networks or in semiopen circuit specialized sections. This system is applicable in large cities, in the few centres for addicts. Because the concerns and possibilities of society and the state to avoid drug trafficking are active, but insufficient, mental health specialists and childadolescent psychiatry can constantly contribute to anti-drug action.
Carol Davila said at the beginning of the 20th century that “Our society is not prepared to accept street children and drug addicts. They can become criminals, and Social Assistants are paid but can not do anything.” This appreciation is still valid today. We consider that the presentations of this material can be used by paediatric specialists, paediatric neuro-psychiatrists, child and adolescent care staff, psychiatric juvenile forensic services as information and options in prevention and the treatment of drug consumption.