Addiction Dependence Withdrawal

Buspirone. Several comparative studies of buspirone and benzodiazepines have reported comparable efficacy in reducing symptoms of anxiety. However, in contrast to benzodiazepines, buspirone is devoid of significant sedative or euphoric effects. Treatment with buspirone and other azaperones, such as gepirone, ipsapirone, and tandospirone, does not result in abuse, addiction, dependence, or withdrawal symptoms [Keppel Hesselink 1992). Buspirone also spares both cognitive and psychomotor performance [N. Sussman 1994). 

In this chapter we have attempted to emphasize the psychopharmacological mechanisms of the actions of dmgs of abuse and have used these mechanisms to describe dmg dependence as well. We have attempted to define the terms frequently used in describing drug abuse and dependence, including abuse, addiction, dependence, reinforcement, tolerance, cross-tolerance and cross-dependence, withdrawal, relapse, and rebound. 

Physical dependence is usually defined as the onset of withdrawal symptoms when the drug is abruptly removed. Withdrawal syndrome from opioid dependence is associated with a number of obvious and unpleasant symptoms (Table 14—3). In severe dependence, withdrawal symptoms become evident within 6 to 10 hours after the last dose of the drug, and symptoms reach their peak in the second or third day after the drug has been stopped. Withdrawal symptoms last approximately 5 days. This does not necessarily mean that the individual no longer desires the drug, only that the physical symptoms of withdrawal have ceased. Indeed, an addict may continue to crave the drug after months or years of abstinence. 

There are no specific antidotes for ecstasy or LSD. Treatment is supportive and includes fluid replacement, seizure, and temperature control. Keeping patients in a dark quiet room with decreased stimulation may help lessen anxiety. The risk of longterm dependence, addiction, or withdrawal of MDMA is unclear. Growing evidence is that MDMA can affect memory. LSD is not known to be addicting and is not known to cause withdrawal. 

Both Ketamine and PCP can be life threatening. There is no antidote. Treatment is dependent on symptoms and may require hospitalization. PCP is addictive and withdrawal can cause drug-seeking cravings, fatigue, irritability, and depression. 

About 5.2 mg. of codeine are required per milligram of morphine to support an addict dependent on morphine. Satisfaction by codeine of physical dependence on morphine is not complete. The difference in intensity of the abstinence syndromes on codeine and morphine withdrawal would appear to be due in part to the loss of physical dependence which occurred chiefly in the transition period (66). The forced excretion of morphine by codeine (66) leading to a partial morphine withdrawal and the time required to build up body stores of codeine to a maintenance level are also involved (47a, 48). 

The approach considered for drug addiction intervention is to treat the addict, after withdrawal, to prevent recurrence of active dependency. An effective drug is the narcotic antagonist naltrexone. Two nanograms per milliliter of this drug in the blood plasma can block the action of a 25 mg dose of heroin and deter recurrence of active dependency. 

Tolerability, reduction of adverse events in recommended doses, acetaminophen does not irritate the lining of the stomach, affect blood coagulation as much as NSAIDs or affect the fimction of the kidneys. It is safe in pregnancy and does not affect the closure of the fetal ductus arteriosus as NSAIDs can. Unlike aspirin, acetaminophen is safe in children as it is not associated with a risk of Reye s syndrome in children with viral illnesses. Unlike opioids, acetaminophen does not cause euphoria, alter mood, or pose a risk of addiction, dependence, tolerance, and withdrawal. 

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To facilitate recovery from addiction it is necessary to utilize a comprehensive biopsychosocial assessment that includes the motivation for change. Pharmacologic treatments are always adjunctive to psychosocial therapy. It is important to remember that mere treatment of withdrawal is not sufficient treatment of DSM-IV-TR dependence (addiction), and that medications are always adjunctive to psychosocial therapy. Comorbid psychiatric... 

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