Periodic abstinence

The primary difficulty with periodic abstinence is the month-to-month variation in the time of ovulation. Whereas the ovum can only be fertilized during the first 12 to 24 hours after its release from the ovary, sperm remain viable longer in the female reproductive tract, able to fertilize an ovum for 5—7 days and perhaps longer. Thus, intercourse several days prior to ovulation can result in pregnancy. 

Sterilization Oral contraceptive Condom Spermicide Withdrawal Diaphragm Periodic abstinence Intrauterine device (IUD) Douche... 

Commonly used methods of reversible contraception include oral and transdermal contraceptives, long-acting injectable estrogens and progestins, implantable progestins, condoms, spermicides, withdrawal, the diaphragm, periodic abstinence, and the intrauterine device. These methods differ in their relative effectiveness, safety, and patient acceptability." ... 

In order to avoid conception, abstinence from sexual intercourse during the fertile period of the menstmal cycle must be practiced (77,104). It has been deterrnined that the fertile period in women occurs before menstmation (105,106), and formulas have been developed to determine the fertile and infertile days of the menstmal cycle. Ovulation has been linked to a cycHc shift in basal body temperature (107), which can be used retrospectively to determine the time of ovulation. 

Chick et al. (2003) conducted a meta-analysis that included data from 15 studies of acamprosate in an effort to determine whether acamprosate reduces the severity of relapse for patients in abstinence-oriented treatment who fail to abstain completely. Among patients who relapsed to drinking, acamprosate was significantly associated with less quantity and frequency of drinking, compared with placebo, at each of four follow-up periods (i.e., at 30, 90, 180, and 360 treatment days). During each of these periods, there were also fewer acamprosate-treated patients who drank an average of five or more drinks per day. 

Although their results were encouraging, these studies demonstrated how difficult it is to treat cannabis dependence. Experience with treating tobacco dependence has revealed that a combination of various psychotherapeutic techniques and pharmacotherapies is more effective than either approach alone in producing and maintaining cessation. Thus, the use of medication during the cessation period may significantly improve quit rates and maintenance of abstinence. 

Stimulants induce both tolerance and sensitization to their behavioral effects. Tolerance develops to the anorectic and euphoric effects of stimulants (Schuster 1981) however, chronic intermittent use of low doses of stimulants delays the development of tolerance. With the doses commonly used in clinical practice, patients treated for narcolepsy or for depressive or apathetic states find that the stimulant properties usually persist without development of tolerance however, the persistence of antidepressant effects remains a matter of controversy. Sensitization has been linked to the development of amphetamine-induced psychosis (Yui et al. 1999). Sensitization to the induction of psychosis is suggested because psychosis is induced by progressively lower doses and shorter periods of consumption of amphetamine following repeated use over time (Sato 1986). Sensitization for amphetamine-induced psychosis may persist despite long periods of abstinence. 

There are currently no systematic data to guide a decision on inpatient vs. outpatient treatment. However, the cheap and easy availability of PCP reported by outpatients in their living environments, and the frequent continued use of PCP by outpatients suggest that a brief period of inpatient treatment might be useful in initiating drug abstinence. There is clearly a strong need for research on specific treatment modalities for PCP abuse. 

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