Drug misuse and dependence

Drug dependence is a term used when a person has a compulsion to lake a drug in order to experience iLs psychic effects, and sometimes to avoid tite discomfort of withdrawal symptoms. 

The likelihood of drug mi-susc leading to dependence dcpcnd.s on many factors, including Ihe ry/w of drug, the route admimstrutian, 

Drug dependence is often associated with tolerance, a phenomenon that may occur with chronic administration of a drug. It is characterized by Ihe necessity to progressively increase the dose of the drug to produce 

The mechanisms underlying opioid dependence and tolerance are unknown. Chronic administration does not affect opioid receptors, but changes in second messengers may be important, e.g. in the locax coeruteux. p-rccepior activaiion inhibits adenylyl cyclase activity, but with chronic opioid administration the activity of the enzyme increase.s. Withdrawal of the inhibitoty opioid then results in excessive cAMP production, which may contribute to the rebound (incieasc) of neuronal excitability. 

Lysergic acid diethylamide iLSD) and related drugs induce dramatic states of alleied perception, vivid and unusual sensory experiences and feelings of ecstasy. Occasionally, LSD produces unwanted effects, which include panic, frightening delusion.s and hallucinatians. Usually the bad trip fades away, but sometimes it returns later ( flashbacks ). 

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Department of Health (1991). Drug Misuse and Dependence Guidelines on Clinical Management. London HMSO... 

For a general account, see Drug Misuse and Dependence — Guidelines on Clinical Management. HMSO, London, 1999. 

Prud homme M, Cata R, Jutras-Aswad D (2015) Cannabidiol as an intervention for addictive behaviors a systematic review of the evidence. Subst Abuse 9 33-38 Reed K, Day E, Keen J, Strang J (2015) Pharmacological treatments for drug misuse and dependence. Expert Opin Pharmacother 16 325-333... 

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... 

Drug abuse and dependence Carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse of venlafaxine. 

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... 

Physical and psychological dependence Buspirone has shown no potential for abuse or diversion and there is no evidence that it causes tolerance or physical or psychological dependence. However, carefully evaluate patients for a history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse (eg, tolerance, drug-seeking behavior). 

This book is mainly concerned with the treatment of opiate misuse, for the simple reason that that is the form of drug misuse for which there are the most effective clinical approaches. As we have discussed, the treatment scene for opiate misusers, in contrast to other groups, is fundamentally altered by the widespread availability of the substitution option, in the form of methadone or alternative opioids. Physical dependence is part of the rationale for that approach, and the occurrence of clear-cut withdrawal symptoms also indicates the use of drugs such as lofexidine or clonidine, followed where possible by naltrexone. For reasons of severity of dependence and treatment options, it is therefore understandable that services are inclined to have caseloads dominated by opiate users. 

There have unfortunately been very few systematic examinations of treatment of benzodiazepine misuse or dependence in the illicit drug population, and knowledge on the subject has been rather static over the last decade or so. When special programmes are tried the difficulties which seem inherent in this area are still apparent, such as in the randomized controlled study of reducing benzodiazepine dosing and cognitive behavioural therapy versus standard treatment by Vorma et al. (2002). The subjects were outpatients in clinics... 

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