Opioid cocaine and

Lthanol (or alcohol) is a two-carbon molecule that, in contrast to many other drugs of abuse, such as opioids, cocaine, and nicotine, does not bind to specific brain receptors. Nonetheless, alcohol affects a variety of neurotransmitter systems, including virtually all of the major systems that have been associated with psychiatric symptoms (Kranzier 1995). Alcohol affects these neurotransmitter systems indirectly by modifying the composition and functioning of... 

Dams, R. Murphy, C.M. Lambert, W.E. Huestis, M.A. Urine Drug Testing for Opioids, Cocaine, and Metabolites by Direct Injection LC/Tandem MS. Rapid Commun. Mass Spectrom. 2003,17, 1665-1670. 

R. Dams, C.M. Murphy, W.E. Lambert, M.A. Huestis, Urine drug testing for opioids, cocaine and metabolites by direct injection LC-AdS-ALS, Rapid Commun. Mass Spectrom., 17(2003) 1665. 

As well as the opioids cocaine and cannabis, polytoxicomane drug abusers also consume bromazepam, diazepam and flunitrazepam in high doses, and fatalities among drug abusers and substitution patients can often be blamed on the consumption of these substances, often in combination with alcohol [48]. Patients who suffer low-dose dependence, in addition to consuming the three above-named substances, also consume therapeutic amounts of dipotassium clorazepate, flurazepam, lorezepam, nitrazepam or oxazepam, sometimes also in combination with amphetamines or antihistamines. 

Fernandez P, Morales L, Vazquez C, Bermejo AM, Tabemero MJ (2006) HPLC-DAD determination of opioids, cocaine and their metabolites in plasma. Forensic Sci Int 161(l) 31-35... 

Gorodetzky, C.W. (1972) Sensitivity of thin-layer chromatography for detection of 16 opioids, cocaine and quinine. Toxicology and Applied Pharmacology, 23,511-518. 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

There is some evidence of a synergistic effect on reinforcement with concurrent administration of benzodiazepines and opioids (Walker and Ettenberg 2003). Cocaine abusers are less likely than opioid abusers to abuse benzodiazepines, preferring alcohol and opioids as secondary drugs of abuse. The most common pattern of benzodiazepine misuse in these individuals is intermittent use of therapeutic or supratherapeutic doses to counter unwanted effects of cocaine. 

Schmitz JM, Averill P, Stotts AL, et al Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Drug Alcohol Depend 63 207-214,2001 Schottenfeld RS, Pakes JR, Oliveto A, et al Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry 54 713-720, 1997... 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Several CM studies have explored interactions between medication and psychosocial treatments for substance use disorders. In a 12-week randomized, double-blind study of buprenorphine-maintained opioid- and cocaine-dependent patients, Kosten et al. (2003a) found that desipramine and CM together led to greater abstinence from cocaine and heroin and more consecutive weeks of abstinence than either treatment individually or placebo. A later... 

Many studies have examined the efficacy of a variety of psychosocial treatments for alcohol, cocaine, and opioid use disorders, alone and in conjunction with pharmacotherapy. However, only a handful of studies have explored how these two treatment approaches may interact. More research is needed to further explore the ways in which psychosocial interventions may be used in conjunction with pharmacotherapy to optimize outcomes for both treatments. Providing encouragement for abstinence, greater treatment retention, medication adherence, and coping with medication side effects are some potential applications of psychosocial therapies. 

Schottenfeld RS, Chawarski MC, Pakes JR, et al Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry 162 340-349, 2003 Smith JE, Meyers RJ, Delaney HD Community reinforcement approach with homeless alcohol-dependent individuals. J Consult Clin Psychol 66 341-348, 1998... 

Identify the typical signs and symptoms of intoxication associated with the use of alcohol, opioids, cocaine/amphetamines, and cannabis, and determine the appropriate treatment measures to produce a desired outcome following episodes of intoxication. 

Mello N.K., Negus S.S. Effects of kappa opioid agonists on cocaine- and food-maintained responding by rhesus monkeys. J. Pharmacol. Exp. Ther. 286 812, 1998. 

Interactions are seen between cocaine and the opioid system in analgesia. A synergistic effect occurs when cocaine is combined with a ju agonist (morphine) in the hot-plate test and a k agonist (U69,593) in the hot-plate test (Waddell and Holtzman 1999). Cocaine enhances morphine analgesia in several analgesic paradigms (e.g., formalin test, hot-plate test, and thermal tail-flick test)... 

Kauppila et al. 1992). The synergistic interaction between cocaine and opioid analgesia likely involves noradrenergic mechanisms, supraspinal ju and 5 receptors, and spinal ju receptors (Misra et al. 1987 Sierra et al. 1992). 

The addictiveness of a given substance goes beyond the chemical structure of the addictive drug itself (i.e., morphine, cocaine, or nicotine). The effects are also related to the dose and speed of delivery, as well as to other substances that might be part of the formulation. For example, just as the oral consumption of opioids and cocaine produce substantially less pronounced behavioral and physiological effects than intravenous or smoked consumption, slow release forms of nicotine produce generally less pronounced effects than smoked forms (Henningfield and Keenan 1993). Similarly, the free base or unprotonated forms of cocaine and... 

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