Addiction specific substances

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

A person can meet criteria for abuse or dependence for one drug and not others, although there is concern about what has been referred to as cross-addiction. Cross-addiction means that a person who is dependent upon one substance may be dependent upon another, very similar one. An example might be a person who is diagnosed as dependent upon tranquilizers and who, you may fear, is also addicted to a similar substance such as alcohol. However, the research is not entirely clear on whether cross-addiction occurs, and I have known clients who had very specific problems with one substance who did not generalize into problems with other, similar substances. A person also may meet criteria for abuse or dependence for multiple substances generally, this is referred to more simply as substance abuse or substance dependence. 

A group of clinical researchers in New Hampshire, USA, who are highly experienced in the treatment of substance abuse in the severely mentally ill have identified certain key principles of management (Drake et al. 1993, 2001), which are shown in Table 7.4. They consider that a special approach is necessary because the severely mentally ill do not identify problems in the same way, they typically have difficulty with addiction treatment approaches such as group therapy, and there is an ever-present danger that this group fall between two sets of services. Their work is in a unit specifically for dual diagnosis patients. 

The fundamental axiom in Ainslie s theory is motivational inconsistency and ambivalence, and the theory describes the strategies people may use to handle the resulting problems. The theory therefore allows for more complex interactions between conflicting motives within the person than do the conventional utility calculus that Becker and Murphy apply. However, as opposed to Becker and Murphy, Ainslie does not base his addiction theory on any explicit assumptions about the properties of potentially addictive substances. The phenomena Ainslie describes in his addiction theory are quite general and not restricted to the addictions. Since potentially addictive substances clearly do have specific properties that other substances do not have, it would be of interest to apply Ainslie s scheme to a consumption good with such properties. 

A particularly important set of beliefs is the idea that a given substance is addictive. Once a behavioral pattern is conceptualized as an addiction, with the concomitant causal beliefs, it may change dramatically. An especially important belief is that addiction is, if not irresistible, at least very hard to resist, almost amounting to compulsive desire. Hence, to the causal beliefs about the effects of drug taking on the addict s body and socioeconomic status, we must add causa) beliefs about the effect of addiction on his will—specifically, on the ability to quit. Two opposite beliefs about this effect may have the same impact on behavior. Some addicts use their (usually self-deceptive) belief that they can quit at any time as an excuse for not quitting. Others use their (equally self-deceptive) belief that they are unable to quit as an excuse for not quitting. The belief that one is addicted may reinforce the addiction by the mechanism of dissonance reduction ... 

As piperazine abuse has been recognized only recently, specific detoxification, addiction, and rehabilitation programs have not yet been developed, nor are success rates known for specific treatments. Presumably, treatment protocols will follow general principles of other substance abuse programs and will include psychological counseling. 

There is increasing concern over the street abuse of dextromethorphan, which is available in a variety of products. There have been a few reports of abuse and a handful of case reports of overdose and death. Nevertheless, dextromethorphan was specifically left out of the Controlled Substances Act (CSA) of 1970 and has not been added to the Drug Enforcement Administration (DEA) scheduling process despite these reports. This decision was made because dextromethorphan is not considered a narcotic and is generally thought to have a low addiction potential. However, the DEA is monitoring dextromethorphan and may add it to its list of controlled substances at some point in the future. 

This chapter discusses specific organ systems that contact a variety of substances in the workplace environment (or due to drug abuse and addiction), leading to health hazards. Important organs discussed here include the skin, the respiratory system, the cardiovascular system, the renal system, and the central nervous system (CNS). In the United States and other countries of the world, the application of phenol is on the increase in the manufacture of aromatic compounds, explosives, fertilizers, paints, rubber products, wood preservatives, synthetic resins, drugs and pharmaceutical products, plastics, leather tanning and... 

Certain pharmaceutical drugs and other substances are classified as drugs of abuse because of the tendency for people to use (or overuse) these substances for other than their intended purpose and in some cases become addicted. Because of the adverse health, sociological, and other consequences of using these substances, availability and quantity of many - but not all - of these substances are controlled by regulatory agencies. This article surveys major classes and provides specific examples of drugs of abuse, the main adverse effects, treatments available in overdose situations, and withdrawal symptoms, if applicable. 

In addition to learning about his or her possible inherited predisposition to addiction, the boy or girl can become additionally mindful about substance use when parents describe what they know about the afflicted family member s experience with addiction when and how it may have started, troubles it may have caused over the years, how others may have been affected, and how recovery was gained, if it was. There is always a cautionary tale to he told, a specific family example the child can keep in mind as a familiar reference for the harm that substances can do. 

The key to successful confrontation is doing it with caring, with specificity, and with patience. This last quality is important because it can take numerous confrontations, if ever, before a substance-abusing or addicted person may be able to take that opportunity and admit the self-destructive pattern of behavior that has become established. 

Analytical results, with their frequently personal, juristic, social and economic consequences for the person to whom they relate, are very important, and stringent demands are made not only on the apparatus in the investigating laboratory but also on the investigating personnel themselves. A knowledge of the chemistry and pharmacokinetics, including metabolism and excretion, of the addictive substances, therapeutic medication, methods of sample preparation, and the specificity and limits of detection of the chosen analytical procedure... 

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