Alcohol abused substance

Cowley DS Alcohol abuse, substance abuse, and panic disorder. Am J Med 92(suppl) 41S 8S, 1992... 

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Comparable findings for lifetime prevalence of psychiatric disorders were obtained in another study of 133 persons, which also found that 47% received a concurrent DSM-III diagnosis of substance abuse or dependence (Khantzian and Treece 1985). The most frequently abused substances were sedative-hypnotics (23%), alcohol (14%), and cannabis (13%). Similar rates of psychiatric disorders were found in other studies of drug abusers (Mirin et al. 1986 Woody et al. 1983). Although such diagnoses do not imply causality, and, in many cases, opioid dependence causes or exacerbates psychiatric problems, some causal link seems likely (Regier et al. 1990). 

Mirin SM, Weiss RD, Michael J Psychopathology in substance abusers diagnosis and treatment. Am J Drug Alcohol Abuse 14 139—157, 1988... 

Olivera AA, Kiefer MW, Manley NK Tardive dyskinesia in psychiarric parienrs with substance abuse disorders. Am J Drug Alcohol Abuse 16 57-66, 1990 Palatini P, Tedeschi L, Prison G, er al Dose-dependent absorption and eliminarion of gamma-hydroxybutyric acid in healthy volunteers. Eur J Clin Pharmacol 45 3 53— 356, 1993... 

The abused substances covered in this chapter include nicotine, alcohol, cocaine, amphetamines, cannabis, and opioids. While many more substances can be and have been abused, these drugs are among the most popular. 

While initiation of the use of substances is often in middle and high school, chronic use may be established in young adulthood. The National Alcohol Epidemiologic Survey reported that 16.2% of its 18- to 29-year-old sample met criteria for alcohol abuse or dependence.3... 

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

Gilliland, K., Bullock, W., Caffeine A potential drug of abuse. Advances in Alcohol and Substance Abuse 3(1-2), 53-73, 1984. 

It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect, and lack of efficacy for comorbid depressive and anxiety disorders (e.g., panic disorder or SAD). It is the agent of choice in patients who fail other anxiolytic therapies or in patients with a history of alcohol or substance abuse. It is not useful for situations requiring rapid antianxiety effects or as-needed therapy. 

Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer prognosis. 

Epidemiological research suggests that probably 10 to 20% of the population of the United States may have problems related to substance use, with approximately 5 % of the population having problems with drugs other than alcohol (Substance Abuse and Mental Health Services Administration [SAMHSA], 2003). The most widely abused substances in the United States are alcohol, tobacco, and marijuana, but the typical pattern is for a person to abuse more than one substance at a time. An example might be that a person may smoke both cigarettes and marijuana, or may use both cocaine and heroin. 

As for abused substances, the question is usually, Which came first Is the alcoholic depressed because of his drinking or does he drink because he is depressed The answer is usually both. The key is that to treat one you must treat the other. Simply giving an antidepressant to a depressed substance abuser accomplishes little. 

Abuse. We have all heard the terms substance abuse, drug abuse, alcohol abuse, cocaine abuse, and so on. In one sense, any illicit use of a substance is abuse. For example, from the legal point of view, whenever someone smokes crack (even if it is the only time), (s)he has broken the law and abused cocaine. Likewise, if you borrow a prescription sedative or pain reliever from a friend, then you have similarly abused that medication. That is an appropriate use of the term in many cases, but this is not customarily the way that mental health specialists use the term. From our perspective, substance abuse involves a pattern of repeated use over time that results in problems in one or more areas. These include compromised physical health and well-being, legal proceedings, job status, and relationships as well as overall day-to-day functioning. 

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. 

Other important components of the initial evaluation include a medical evaluation including both a medical history and physical examination. This can identify medical consequences of substance abuse, such as liver impairment from chronic alcohol abuse or sinus complications from cocaine use, as well as reveal needle tracks from a variety of self-injection sites that might not be readily apparent to casual observation. 

Naltrexone is prescribed at a dose of 50 mg once per day for at least 12 weeks as part of a comprehensive alcohol treatment program. Like all treatments for substance use disorders, it works only as well as the addict allows it to work. This is why it is important to use it as a component of an overall treatment plan. Otherwise, poorly motivated alcohol abusers will seldom remain adherent with naltrexone and it will have little chance of providing benefit. A long-acting depot formulation of naltrexone currently in development might improve these compliance problems. 

There are major consequences of alcoholism, from child abuse to domestic or public violence to traffic accidents and from cirrhosis to hypertension. Mean life expectancy of alcohol abusers is around 55 years. Alcohol seems involved in several hundred thousand deaths each year in Europe, with considerable added social and health care costs. This is in clear contrast with the little attention paid to the treatment of alcohol dependence and abuse. It is important to note that there is an increasing knowledge of similar effects on driving etc. from other psychoactive substances, particularly from the seda-tive/tranquillizer drugs and antihistamines. 

The development of alcoholism is often insidious, proceeding from frequent drunkenness to dependence over years. Since this is so, and since alcohol may interact with other treatment (other psychoactive substances and via its effects on the liver), a careful check of a patient s intake is an important part of the medical history. It is vital to know about alcohol abuse before anaesthesia, since it may make the anaesthetic difficult and alcohol withdrawal may complicate the recovery period. 

Fames, S. L., J. Westermeyer, and R. D. Crosby. Substance use and abuse among patients with comorbid dys-thymia and substance disorder. Am J Drug Alcohol Abuse 1998 24(4) 541-550. 

Kolar, A.F., Brown, B.S., Haertzen, C.A. and Michaelson, B.S. (1994) Children of substance abusers the life experiences of children of opiate addicts in methadone maintenance. American Journal of Drugand Alcohol Abuse 20, 2, 159-171. 

Liddle, H.A., Dakof, G.A., Parker, K., Diamond, G.S., Barett, K. and Tejada, M. (2001) Multidimensional family therapy for adolescent substance abuse results of a randomised clinical trial. American Journal of Drugand Alcohol Abuse 27, 4, 651-688. 

The neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) is widely distributed in the CNS, subsuming a variety of functions including drive satiety, mood, aggression, anxiety, and compulsive and impulsive behaviors. It may be an important neurotransmitter in psychiatric symptoms commonly associated with PTSD such as aggression, obsessive/intrusive thoughts, alcohol and substance abuse, and suicidal behavior (Friedman, 1990). Suicidal behavior is known to be associated with both childhood maltreatment and low 5-HT functioning (Van der Kolk et ah, 1991 Benkelfat,... 

PTSD. The SSRIs may be useful in pediatric PTSD because of the variety of symptoms associated with serotonergic dysregulation including anxiety, depressed mood, obsessional thinking, compulsive behaviors, affective impulsivity, rage, and alcohol or substance abuse (Friedman, 1990). 

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