Drug cravings

When patients elect detoxification from maintenance, a very gradual reduction of dosage is preferred, with careful monitoring of drug craving and withdrawal symptoms. Three to 6 months is recommended for most elective detoxifications. As many as one-third of methadone maintenance clients have been found to have a marked fear of detoxification (Milby et al. 1986). 

Robinson TE, Berridge KC The neural basis of drug craving an incentive-sensitization theory of addiction. Brain Res Brain Res Rev 18 247—291, 1993 Rosenberg J Brain damage and epilepsy in a sailor on a ship with chemicals. Tidsskr Nor Laegeforen 102 576-577, 1982... 

Self DW (1998). Neural substrates of drug craving and relapse in drug addiction. Annals of Medicine, 30(4), 379-389. 

Natural reinforcers and drugs of abuse use similar circuits 912 The neuronal circuitry underlying drug craving has been intensely studied to develop strategies for preventing relapse 912... 

Symptoms of withdrawal include depression, altered mental status, drug craving, dyssomnia, and fatigue. Duration of withdrawal from methamphetamine ranges from 3 to 24 days, but these individuals are usually not in acute distress. Occurrence of delirium suggests withdrawal from another drug (e.g., alcohol). 

Markou A, Weiss E, Gold LH, Caine B, Schulteis G, Koob GE (1993) Animal models of drug craving. Psychopharmacology 112 163-182... 

The continued use of opioids results in the development of physical dependence, as demonstrated by the appearance of a characteristic abstinence syndrome upon interruption or cessation of use. The symptoms of withdrawal include hyperactivity, anxiety, restlessness, yawning, diarrhea, vomiting, chills, fever, lacrimation, and runny nose. Piloerection (gooseflesh or cold turkey), mydriasis, increased blood pressure and heart rate, and hyperpyrexia may be observed. Tremors, abdominal cramps, and muscle and joint pain may be present. Drug craving is an important feature of opioid withdrawal. In contrast to some other drugs of abuse, withdrawal is not life threatening. 

Withdrawal symptoms, more commonly seen in individuals who chronically abuse high doses of stimulants, include increased sleep with vivid dreams, increased appetite, fatigue, and drug craving. 

Case Example Zolpidem was abused by a 33-year-old man who had been prescribed 10 mg/day for insomnia associated with depression. The patient took 30 mg and noticed improvement of depressive symptoms. With continued escalated doses (up to 150 to 280 mg/day), tolerance developed. He occasionally noticed signs of intoxication with severe ataxia after doses of 80 to 100 mg but never experienced the more common side effects of high-dose zolpidem. Dose reduction caused depressive mood recurrence with apathy and drug-craving. A grand mal seizure after ingesting 60 to 80 mg resolved without supportive measures (155). 

Gardner, Eliot L., and Joyce H. Lowinson. 1993. "Drug Craving and Positive/ Negative Hedonic Brain Substrates Activated by Addicting Drugs." The Neurosciences 5 359-68. 

---