Alcohol and Drug

Consumption of alcohol and other drugs is closely linked to developmental processes. Not surprisingly, therefore, it unfolds in a more or less regular order. Typically, consumption begins with licit compounds (alcohol, tobacco) and progresses, if at all, to the use of illicit drugs. Although much has been written about the gateway hypothesis, in which drug use staging is presumably influenced by prior history of drug use (Kandel, 1975), the evidence to support this speculation is at best...

Discontinuation of Benzodiazepine

Discontinuation of sedatives and hypnotics, including the benzodiazepines, can be divided into three categories (1) long-term low-dose benzodiazepine use, (2) high-dose benzodiazepine abuse and multiple drug abuse, and (3) high-dose abuse of nonbenzodiazepine sedatives and hypnotics (especially intermediate-acting barbiturates). The first group of patients can usually be discontinued on an outpatient basis. Some of the second and even the third group can be treated as outpatients, but most will...

Anxiety Disorders

Compared to depressive disorder, it is usually easier to determine whether or not an anxiety disorder is independent of alcohol use. For example, posttrau-matic stress disorder (PTSD) does require a specific traumatic event. Panic attacks are typically clearly recalled by individuals and are therefore easier to separate from possible anxiety symptoms that have resulted from alcohol use, intoxication, or withdrawal. There is a strong comorbidity between alcohol use disorders and anxiety...

Alcohol Induced Sleep Disorder

Alcohol consumed at bedtime may decrease the time required to fall asleep but typically disrupts the second half of the sleep cycle, resulting in subsequent daytime fatigue and sleepiness. Even a moderate dose of alcohol consumed within 6 hours prior to bedtime can increase wakefulness during the second half of sleep (Vitiello, 1997). Alcohol use prior to bedtime will also aggravate obstructive sleep apnea, and heavy drinkers or those with alcoholism are at increased risk for sleep apnea....

Endocrine System

Alcohol interferes with gonadal function even in the absence of cirrhosis by inhibiting normal testicular, pituitary, and hypothalamic function. Testicular atrophy, low testosterone levels, decreased beard growth, diminished sperm count, and a loss of libido result. However, testicular atrophy does not occur in all male alcoholics but is associated with alcohol dehydrogenase polymorphism in the testes, as reflected by the genetic variant of an increased frequency of the ADH21 allele (Yanauchi...

Pathological Gambling and Other Behavioral Addictions

Several disorders, particularly those formally categorized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as impulse control disorders (ICDs) not elsewhere classified, have been described as behavioral addictions (American Psychiatric Association, 2000). The ICDs include pathological gambling (PG), kleptomania, intermittent explosive disorder, trichotillomania, and pyromania, and diagnostic criteria for compulsive computer use, compulsive sexual...

Sedatives Hypnotics and Benzodiazepines

The sedatives and the hypnotics, especially the benzodiazepines, are widely used in medical practice in the treatment of anxiety, insomnia, epilepsy, and for several other indications (Baldessarini, 2001). The combination of abuse by alcoholics and drug addicts, and the withdrawal symptoms on discontinuation leads to the view that these are addictive drugs (DuPont, 2000 Juergens & Cowley, 2003). The pharmacology and the epidemiology of sedatives and hypnotics are reviewed in this chapter,...

History Of Substance Abuse Treatment

Historical and literary accounts have long documented individual attempts to draw back from the abyss of alcohol and drug abuse. At various times autobiographical, biographical, journalistic, and anecdotal, these descriptions list centuries-old recovery methods still employed today in lay and professional settings. Modalities include gradual decrease in dosage symptomatic use of nonad-dicting medications isolation from the substance relocation away from fellow users religious conversion group...

Drug Tolerance Dependence And Withdrawal

From a clinical standpoint, withdrawal can be one of the most powerful factors driving dependence and addictive behaviors. This seems particularly true for opioids, alcohol, benzodiazepines, nicotine, and to a lesser extent stimulants such as cocaine. For hallucinogens, cannabinoids, or inhalants, withdrawal symptoms seem of more limited importance. Treatment of the patient's withdrawal symptoms is based on understanding how withdrawal is related to the brain's adjustment to these drugs after...

Mussen 1997 On Drug Abuse

MDMA, ketamine, and GHB are by no means the only drugs found at clubs, raves, or circuit parties. They are, however, the most emblematic. Attendees also use more traditional drugs, such as LSD and other hallucinogens. Marijuana is perennially popular, and alcohol use is also common. Furthermore, each week seems to bring a report of some new drug of abuse. Often this is just an older, well-known drug, packaged differently or with a new name, but the effect on a new generation of users will be...

Other Sedatives and Hypnotics

Over the course of the 20th century, several medicines with diverse structures were used as sedatives and hypnotics. In general, the pharmacological proper ties of these medicines resembled the barbiturates. They produced profound CNS depression, with little or no analgesia. Their therapeutic index was low and their abuse potential was high, similar to the barbiturates. Chloral hydrate (Noctec), ethchlorvynol (Placidyl), ethinamate (Valmid), glutethimide (Doriden), meprobamate (Miltown,...

Treatment Considerations

At its simplest, treatment of patients with chronic multiple SUDs requires a focus upon each disorder separately, in addition to providing patients with a coherent overall rationale and approach to addiction treatment. Although multiple SUDs have a net negative impact on treatment outcome, Abellanas and McLellan (1993) have shown that patients with multiple SUDs report generally similar motivation for change across drugs of abuse, meaning that their desire to modify their substance use remains...

Medical Complications Of Alcoholism Gastrointestinal Tract and Pancreas

Secondary to vitamin deficiencies, alcoholics suffer from inflammation of the tongue (glossitis), inflammation of the mouth (stomatitis), caries, and perio-dontitis. A low-protein diet, associated with alcoholism, can lead to a zinc deficiency, which impairs the sense of taste and further curbs the appetite of the alcoholic. Parotid gland enlargement may be noted. Alcohol causes decreased peristalsis and decreased esophageal sphincter tone, which leads to reflux esophagitis with pain and...

Social Adjustment

Social adjustment is defined as the individual's success at fulfilling age-appropriate roles according to expectations (Barrabee, Barrabee, & Finesinger, 1955). The measurement domains encompass social support, social roles, social skills, peer affiliations, school and vocational adjustment, and recreation and leisure activities. As previously discussed, the Addiction Severity Index (McLellan et al., 1980) profiles the individual's problems, including social support, along with...

Sequential Parallel and Integrated Treatment Models

There are three major models in which dually diagnosed patients are treated sequential, parallel, and integrated treatment. Each is discussed below. In sequential treatment, the more acute condition is treated first, followed by the less acute co-occurring disorder. The same staff may treat both disorders, or the less acute disorder may be treated after transfer to a different program or facility. For example, a manic patient with a cocaine use disorder needs mood stabilization before...

Course

Many complex factors influence the natural history of opioid addiction. Overall, the course is one of relapse and remission. Attempts to define opioid abusers as a group have been limited, because long-term contact with these frequently itinerant persons is difficult, and only a minority of opioid abusers can be studied effectively i.e., those who elect to enter treatment . Given these obstacles to accurate understanding, some generalizations can still be made. The vast majority of active...

Medical Complications Direct Results of Cocaine

Medical consequences of acute and chronic cocaine abuse may be categorized as those caused directly by cocaine, those due to adulterants, and those related to route of administration. The most common direct medical consequences of cocaine use include cardiovascular and CNS difficulties. Cocaine use may account for up to 25 of cases of acute myocardial infarction among patients 18-45 years of age Weber, Hollander, Murphy, Braunwald, amp Gibson, 2003 . Upon acute administration, cocaine increases...

The Neurobiology of Substance Dependence

GEORGE HERBERT D. KLEBER Tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic substance abuse and involve different brain pathways than those subserving acute drug reinforcement. Acute drug reinforcement appears to share a final common dopaminergic pathway from the ventral tegmental area of the brain to the nucleus accumbens. These acute processes are relatively unimportant for pharmacotherapy of dependence and addiction...

Adult Smoking Cessation

Of the many nonpharmacological approaches to smoking cessation, here, behavioral approaches are the most germane. They have undergone the most extensive experimental study, are suitable for office and clinic-based physician interventions, and often are used in combination with pharmacological ap proaches to smoking cessation Fagerstrom, 1988 Hymowitz, 1999 . Multi-component behavioral programs, whether in group, individual, or self-help formats, typically include a number of strategies...

Treatment Priorities

Establishing a trusting therapeutic relationship is integral to treating the alcoholic patient. A psychiatrist is in a strong position to develop a nonjudgmental, empathic relationship with alcoholic patients but, in addition, must be prepared to challenge denial and confront pathological behavior or regression. The physician's awareness of the continuing incentive to drink, mediated by chronic stimulation of dopamine-rich pathways in the mesocortical system, will assist him or her in...

Stephen L Dilts Jr Stephen L Dilts

Opioids constitute the group of compounds whose pharmacological effects duplicate those of morphine. They are commonly used medically as an adjunct to anesthesia, for the relief of pain, for the prevention of an abstinence syndrome, and for cough suppression. Opioids also are abused for their intoxicating effects. The history of opioid use goes back thousands of years in human history. The Ebers Papyri from approximately 7000 B.C. refer to the use of opium in children suffering from colic...

Diagnosis

In the framework provided by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR American Psychiatric Association, 2000 , the problem of opioid misuse is divided into four categories, among which there may be some overlap. Opioid intoxication and opioid withdrawal are specifically defined in DSM-IV-TR. Facility in making these diagnoses requires a clear understanding of the clinical features associated with opioids, as discussed later in this chapter. In...

Contributors

Acosta, PhD, Department of Psychiatry, St. Luke's-Roosevelt Hospital Center, New York, New York D. Andrew Baron, PhD, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania David A. Baron, DO, MSEd, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania Steven H. Baron, PhD, Department of Social Sciences, Montgomery County Community College, Blue Bell, Pennsylvania Judith S. Beck, PhD, Beck Institute...