Abstinenčné príznaky

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  • Přidal/a: anonymous
  • Datum přidání: 21. ledna 2007
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Příbuzná témata



Abstinenčné príznaky

Závislosť a abstinenčné príznaky

Kolibáš, Novotný:
"Alkoholizmus a drogové závislosti"
Nerad,Neradová:
"Některé aspekty problematiky závislosti na heroínu"
Užívanie heroínu sa spája s rizikom ťažkej závislosti, charakterizovanej silnou túžbou po užívaní opiátov, rýchlym vývojom tolerancie a zvyšovaním dávok, ťažkými abstinenčnými príznakmi. Vývoj závislosti trvá - pri pravideľnom užívaní heroínu - niekoľko mesiacov. Závislosť nevnikne u všetkých, ktorí začnú heroín užívať. Podobne ako pri iných drogách, niektorí jedinci si včas uvedomia nebezpečie vzniku závislosti a prestanú s užívaním drogy. Aj keď mnohí heroinisti nedokážu abstinovať, niektorí prekonajú abstinenčné príznaky bez lekárskej pomoci a dlhý čas alebo trvale abstinujú. Abstinenčné príznaky vznikajú 4-8 hodín po poslednej dávke heroínu. Patria k ním:
· túžba po opioidoch
· celková slabosť
· svalové a orgánové bolesti
· nepokoj, úzkostlivá nálada
· nechutenstvo, nauzea, zvracanie, hnačky
· potenie, slzenie, výtok z nosa
· triaška, pocity chladu a tepla
· husia koža
· mydriáza (rozšírené zrenice)
· zvýšený pulz a krvný tlak
Dva výrazy pôvodne anglicky (americky) hovoriacej toxikomanickej populácie sa vzťahujú k odvykacím príznakom a našli si cestu i do odbornej literatúry:
Výraz cold turkey sa vzťahuje:
· z vzhľadu pokožky: studeno sa potiaca "husia koža" pripomína na prvý pohľad kožu ošklbaného moriaka
· v širšom slova zmysle odvykanie "na tvrdo", tj. bez substitúcie
Výraz kicking the habit má tiež dvojitý význam:
· vzťahuje sa k svalovým zášklbom v dolných končatinách, ktoré niekedy nadobúdajú takej intenzity, že dochádza k náhlym, prudkým pohybom, podobným pohybu pri kopaní do fotbalovej lopty
· v širšom slova zmysle znamená tento výraz zanechať toxikomanie, prestať užívať drogy
Abstinenčné príznaky (kríza) vrcholia po 48 hodinách a v priebehu ďalších 2-3 dní ustúpia. Najdlhšie trvajú svalové bolesti, nastreknutie spojiviek, slzenie, nádcha a nespavosť. Pretrvávajúcimi príznakmi sú úzkosť, pocity neistoty, depresia. Môžu trvať aj niekoľko týždňov. Pri ťažkej závislosti sa na vrchole abstinenčných príznakov môže prejaviť aj porucha vedomia - strata pamäti alebo aj delírium. Čo sa týka samotného vzniku heroínovej závislosti, predpokladá sa, že rozhodujúcimi faktormi sú biologické mechanizmy. Ukazuje sa však, že dôležité sú aj psychické mechanizmy. Už sme spomínali riziko chýbania kompenzačnej anticipačnej reakcie v neznámom prostredí.

Naopak podanie placeba alebo len samotné vpichnutie striekačky vedie k zmierneniu abstinenčných príznakov. Naopak aj po niekoľkých týždňoch abstinovania sa môžu znova objaviť abstinenčné príznaky. Často sa objavia v prostredí, v ktorom závislý predtým pravideľne užíval drogu. Nerad a Neradová v tejto súvislosti upozorňujú na niekoľko mýtov o heroíne:
Prvým je mýtus o extrémnej nebezpečnosti heroínu. Citujú Skálu, podľa ktorého vzniká závislosť u všetkých ľudí, ktorí užívajú heroín. Vo Vietname užívalo dlhodobo a pravideľne asi 50% amerických vojakov, závislých bolo asi 20%. Po návrate domov len 7% užívalo príležitostne opiáty a z pôvodných 20% závislých ich pokračovalo v zneužívaní menej než desatina. Vietnamská vojna znamenala nový pohľad na heroínovú závislosť: do tej doby sa tradovalo, že táto závislosť je nevyhnuteľným dôsledkom pôsobenia drogy samotnej, že úporne pretrváva, keď sa raz rozvinula a že závislý sa jej nemôže sám zbaviť. Napriek tomu veľa vojakov, užívajúcich heroín vo Vietname, sa nestalo na ňom závislých a naviac sa ich drvivá väčšina heroinistov po návrate do USA k nemu už nevrátila. Z tohto príkladu je vidieť, akú dôležitú rolu tu hrali rôzne iné faktory:
· Psychologicky bolo významné vytrhnutie z bezpečného, rodinného prostredia s náhlym vystavením extrémne ohrozujúcou, vojnovou klímou. Drogy boli prostriedkom, ktorý "efektívne" pomáhal vysporiadať sa s pocitmi strachu, úzkosti, fyzickej únavy a nudy - čo sú typické symptómy vojnovej situácie. · Sociálne bola služba vo Vietname charakterizovaná vymiznutím dovtedy platných sociálnych a morálnych hodnôt a noriem (v normálnom živote znižujúcich pravdepodobnosť brania drog). Vojaci mali silnú tendenciu považovať "tour of duty" za niečo, čo bolo absolútne oddelené od normálneho, skutočného života. Naviac tu bol nesmierne silný sociálny tlak od spoluvojakov, drogy užívajúcich. Brať drogy bolo jednoducho sociálne vzaté samozrejmé. · Ľahká dostupnosť kvalitného a lacného heroínu. Nejde len o fyzickú (faktickú) dostupnosť drogy, ale aj o ďaľšie zložky: psychologickú, ekonomickú a sociálnu dostupnosť. A drogy boli vo Vietname dostupné vo všetkýc významoch tohoto slova, zatiaľ čo v Amerike nie. Ďalším je mýtus o extrémnej intenzite a nebezpečnosti abstinenčných príznakov. U väčšiny závislých sa dá intenzita abstinenčného syndrómu porovnať s ťažkou chrípkou. Napriek tomu, že je odvykací syndróm považovaný za krítérium telesnej závislosti, spoluúčastnia sa ňom v značnej miere i sociálne-psychologické faktory.

Príbehy o pekle odvykacích príznakov patria v úplnej väčšine do ríše fikcie, veľmi atrakívnej pre niektorých závislých (ktorí ich využívajú k manipuláciám) a pre masmédiá. URL: http://www.paranoia.com/drugs/opiates/withdrawal
príbeh metadonového abstinenčného syndrómu +
pojednanie o abstinenčných príznakoch

Presl:
"Drogová závislost"
Droga samotná prestáva byť v určitej fáze závislosti to najdôležitejšie. Zbaviť sa len jej nie je tak zložité, pretože pozitívny efekt tu už prakticky neexistuje. Oveľa zložitejšie je, zbaviť sa zažitého stereotypu života toxikomana. .

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