Alcohol misuse/dependency

Alcohol or drug misuse/dependence (including prescribed e.g. benzodiazepines)... 

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Williams H, Oyefeso A, Ghodse AH Benzodiazepine misuse and dependence among opiate addicts in treatment. It J Psychol Med 13 62-64, 1996 Wiseman SM, Spencer-Peet J Prescribing for alcoholics a survey of drugs taken prior to admission to an alcoholism unit. Practitioner 229 88—89, 1985 Wolf B, Grohmann R, Biber D, et al Benzodiazepine abuse and dependence in psychiatric inpatients. Pharmacopsychiatry 22 54—60, 1989 Wood MR, Kim JJ, Han W, et al Benzodiazepines as potent and selective bradykinin B1 antagonists. J Med Chem 46 1803—1806, 2003 Zawertailo LA, Busto UE, Kaplan HL, et al Comparative abuse liability and pharmacological effects of meprobamate, triazolam, and butabarbital. J Clin Psycho-pharmacol 23 269-280, 2003... 

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. 

Gossop M, Marsden J, Stewart D Kidd T (2002a). Changes in use of crack cocaine after drug misuse treatment 4-5 year follow-up results from the National Treatment Outcome Research Study (NTORS). Drug and Alcohol Dependence, 66, 21-8... 

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer s disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette s syndrome) and mental retardation (learning disabilities). 

Davis WR, Johnson BD. Prescription opioid use, misuse, and diversion among street drug users in New York City. Drug and Alcohol Depend 2008 92 267-276. 

Seek urgent advice from addictions services. Alcohol detox carries more risks in pregnancy, but is safer than sudden, unassisted withdrawal or continued heavy use. Addictions may recommend an inpatient detox for alcohol-dependency. For opiate misuse, they may aim for substitute prescribing during pregnancy, rather than total withdrawal. 

Don t keep Chrissie waitii - if withdrawn, she ll become increasii ly uncomfortable and frustrated. Attend swiftly if you suspect alcohol or GBL withdrawal, as these can be fatal. Only prescribe opiate substitutes if clear evidence of dependence opiate withdrawal is unpleasant, but opiate overdose kills. Polysubstance misuse is veiy common don t hesitate to seek specialist advice, especially riien multiple drugs are involved. 

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