Drug abuse/addiction withdrawal

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

Klein E, Uhde TW, Post RM Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal. Am J Psychiatry 143 235—236, 1986 Kouyanou K, Pither CE, Wessely S Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res 43 497-304, 1997 Kryspin-Exner K [Misuse of bezodiazepine derivatives in alcoholics] (German). Br J Addict Alcohol Other Drugs 61 283-290, 1966 Kryspin-Exner K, Demel 1 The use of tranquilizers in the treatment of mixed drug abuse. Int J Clin Pharmacol Biopharm 12 13-18, 1973... 

Fig. 22.1 Mechanisms underlying substance abuse. Addictive behavior is seen as a cyclical process where anticipation of the pleasure resulting from use of the drug leads to failure of the psychological mechanisms that usually control consumption. Excess quantities of drug are taken and an unpleasant withdrawal state arises when drug levels fall. This leads to...

Within this Held, most of the research and results have been focused on the effects of drug therapy on the disorders induced by alcohol, and by the abuse of opiates. For a broader discussion of substance abuse see Chapter 18. In all instances of alcohol or drug abuse the first objective is to wean the patients from the addictive substance, treating or preventing the effects of withdrawal for those substances which cause physical dependence (alcohol, nicotine, opiates, caffeine, certain psychotropic agents such as benzodiazepines, possibly antidepressants). The second phase is the prevention of recurrence or relapse, which relies on a combination of social support, psychotherapy, and pharmacotherapy where available. In this respect, alcoholism is exemplary. 

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. 

For amphetamine addicts and drug abusers, the controlled, therapeutic environment of residential rehab provides a safe place to learn new behaviors and explore the emotional issues behind their drug use. And for patients experiencing amphetamine or other drug withdrawal symptoms, an inpatient facility is the best option for a safe and gradual detoxification from the drug. 

Narcotics addiction provides the classic model of drug dependence, and many of our current notions of drug abuse are based on it. For example, the fundamental principle that addiction con= sists of three features — craving for the drug, tolerance, and withdrawal — developed from observations of opiate addicts. Many popular beliefs about narcotics are untrue, however, and the whole subject is highly contaminated by prejudice and emotion. 

Most inhalant abusers have tried to but are unable to quit, and have reported this to treatment facilities. In spite of knowing the adverse consequences of their continued use, addicted individuals continue using inhalants. Relapse into use of the drug because of withdrawal symptoms and desire for the drug can prevent addicted users from quitting. 

Wellbutrin may also be able to aid people who are addicted to more serious drugs than nicotine. A possible use of Wellbutrin in the future will be to wean cocaine abusers off their addiction. Since Wellbutrin, like cocaine, blocks dopamine uptake it can be used to ease withdrawal symptoms and perhaps soften drug cravings. Also, because Wellbutrin has been shown to be non-addictive, there is little chance that drug abusers will become dependent on it. 

Treatment of drug addicts can be sqDarated into two phases detoxification and relapse prevention. Detoxification programs and treatment of physical withdrawal symptoms, respectively, is clinically routine for most drugs of abuse. However, pharmacological intervention programs for relapse prevention are still not veiy efficient. 

Kleber HD, Weissman MM, Rounsaville BJ, et al Imipramine as treatment for depression in addicts. Arch Gen Psychiatry 40 649-633, 1983 Kleber HD, Riordan CE, Rounsaville BJ, et al Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42 391-394, 1983 Kleber HD, Topazian M, Gaspari J, et al Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13 1-17, 1987 Kornetsky C. Brain stimulation reward, morphine-induced stereotypy, and sensitization implications for abuse. Neurosci Biobehav Rev 27 777-786, 2004 Kosten TR, Kleber HD Buprenorphine detoxification from opioid dependence a pilot study. Life Sci 42 633-641, 1988... 

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