Substance abuse addiction

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...

The purpose of NCADD is to provide objective information (including statistics, expert opinion, and recommendations) to students, parents, the general public, and the media. It seeks to dispel the stigma attached to alcoholics and drug abusers and replace it with understanding. A variety of fact sheets are available relating to substance abuse, addiction, and effects—the focus is on alcohol but there is also information on other drugs. 

Drug Abuse and Addiction Signs, Symptoms, and Effects." Helpguide.org. Available online. URL http //www.helpguide. org/mental/drug substance abuse addiction signs effects treatment.htm. 

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Kranzler HR, Rosenthal RN Dual diagnosis alcoholism and co-morbid psychiatric disorders. Am J Addict 12 (suppl 1) S26—S40, 2003 Kranzler HR, Tinsley JA (eds) Dual Diagnosis Substance Abuse andComorbid Medical and Psychiatric Disorders, 2nd Edition. New York, Marcel Dekker, 2004... 

Therapeutic communities are supervised communal drug-free living situations for opioid and nonopioid drug abusers. Because substance abuse is viewed as a disorder of the whole person, the goal is a dramatic alteration of the addict s entire lifestyle (DeLeon 1985). Addicts are expected to five in these communities for 6—18 months. Therefore, they are not indicated for people who have a strong intimate relationship or stable employment. The community is a surrogate fam-... 

McLellan AT Psychiatric severity as a predictor of outcome from substance abuse treatments, in Psychopathology and Addictive Disorders. Edited by Meyer RE. New York, Guilford, 1986, pp 97-139... 

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. 

Ciraulo DA, Nace EP Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Greenblatt DJ, et al Abuse liability and clinical pharmacokinetics of alprazolam in alcoholic men. J Clin Psychiatry 49 333—337, 1988a... 

Posternak MA, Mueller TI Assessing the risks and benefits of benzodiazepines for anxiety disorders in patients with a history of substance abuse or dependence. Am J Addict 10 48-68, 2001... 

McCrady BS, Miller WR (eds) Alcoholics Anonymous Oppormnities and Alternatives. New Brunswick, NJ, Rutgers Center of Alcohol Studies, 1993 McCrady BS, Stout N, Noel N, et al Effectiveness of three types of spouse-involved behavioral alcoholism treatments. Br J Addiction 86 1415—1424, 1991 McKay JR, Alterman Al, McLellan AT, et al Treatment goals, continuity of care, and outcome in a day hospital substance abuse rehabilitation program. Am J Psychiatry 151 254-259, 1994... 

Individuals with a pattern of chronic use of commonly abused substances should be assessed to determine if they meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for substance dependence (addiction). 

The DSMIV notes the potential for caffeine to be abused and includes Caffeine Intoxication under the category of Substance Abuse Disorders.262 Despite this official classification, there continues to be controversy as to whether or not caffeine is actually a drug of abuse. Some researchers maintain that caffeine has very low, if any, potential for abuse,235 while others believe that it can be addictive and has characteristics similar to those of other addictive drugs.263... 

Kozlowski, L. T., Henningfield, J. E., Keenan, R. M., Lei, H., et al., Patterns of alcohol, cigarette, and caffeine and other drug use in two drug abusing populations. Special Issue Towards a broader view of recovery Integrating nicotine addiction and chemical dependency treatments. Journal of Substance Abuse Treatment, 1993 Mar-Apr Vol 10(2), 171-179, 1993. 

Slow-onset, long duration dopamine reuptake inhibitors with reduced potential for substance abuse have been suggested as therapies for psychostimulant addiction [33-35]. A series of slow-onset, long duration N-alkyl analogues of methylphenidate were recently reported to have enhanced selectivity for the dopamine transporter [34]. A representative compound is 13, an RR/SS diastereomer (DAT K, = 16nM, SERT K = 5900 nM, NET K-, = 840 nM). In a locomotor activity assay in mice, 13 has a slow onset of activity (20-30 min) with peak activity occurring between 90 and 120 min. In contrast, both methylphenidate and cocaine are active within 10 min and reach peak activity within 30 min. 

The recent approval of the SNRI duloxetine for the treatment of diabetic neuropathy reinforces the utility of this drug class in the treatment of neuropathic pain. Other largely untapped areas which remain to be exploited with this drug class include sexual dysfunction, such as premature ejaculation, irritable bowel syndrome, obesity, neurodegenerative diseases such as Parkinson s disease, restless leg syndrome, and substance abuse and addiction. It is apparent that considerable opportunities for drug discovery will exist in this area for some time to come. 

A person can meet criteria for abuse or dependence for one drug and not others, although there is concern about what has been referred to as cross-addiction. Cross-addiction means that a person who is dependent upon one substance may be dependent upon another, very similar one. An example might be a person who is diagnosed as dependent upon tranquilizers and who, you may fear, is also addicted to a similar substance such as alcohol. However, the research is not entirely clear on whether cross-addiction occurs, and I have known clients who had very specific problems with one substance who did not generalize into problems with other, similar substances. A person also may meet criteria for abuse or dependence for multiple substances generally, this is referred to more simply as substance abuse or substance dependence. 

Blume, A. W., Schmaling, K. B. (1998). Regret, substance abuse, and readiness to change in a dually diagnosed sample. Addictive Behaviors, 23, 693-697. 

Chiauzzi, E. J., Liljegren, S. (1993). Taboo topics in addiction treatment An empirical review of clinical folklore. Journal of Substance Abuse Treatment, 10, 303-316. 

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