Substance abuse alcohol

Mood disorders, hypochondriasis, personality disorders, alcohol/ substance abuse, alcohol/substance withdrawal, other anxiety disorders... 

Anxiety disorders (e.g., generalized anxiety disorder, obsessive-compulsive disorder) Substance abuse (alcohol or sedative-hypnotic withdrawal)... 

Is there an alcohol, drugs and substance abuse policy ... 

Check that there is an alcohol, drug and substance abuse policy that gives clear guidelines on handling the issues, dismissal, and rehabilitation. 

Benzodiazepines and other anxiolytics. Although benzodiazepines are widely used in the treatment of acute alcohol withdrawal, most nonmedical personnel involved in the treatment of alcoholism are opposed to the use of medications that can induce any variety of dependence to treat the anxiety, depression, and sleep disturbances that can persist for months following withdrawal. Researchers have debated the pros and cons of the use of benzodiazepines for the management of anxiety or insomnia in alcoholic patients and other substance abuse patients during the postwithdrawal period (Ciraulo and Nace 2000 Posternak and Mueller 2001). 

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... 

Cowley DS Alcohol abuse, substance abuse, and panic disorder. Am J Med 92(suppl) 41S 8S, 1992... 

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... 

Comparable findings for lifetime prevalence of psychiatric disorders were obtained in another study of 133 persons, which also found that 47% received a concurrent DSM-III diagnosis of substance abuse or dependence (Khantzian and Treece 1985). The most frequently abused substances were sedative-hypnotics (23%), alcohol (14%), and cannabis (13%). Similar rates of psychiatric disorders were found in other studies of drug abusers (Mirin et al. 1986 Woody et al. 1983). Although such diagnoses do not imply causality, and, in many cases, opioid dependence causes or exacerbates psychiatric problems, some causal link seems likely (Regier et al. 1990). 

Mirin SM, Weiss RD, Michael J Psychopathology in substance abusers diagnosis and treatment. Am J Drug Alcohol Abuse 14 139—157, 1988... 

Benzodiazepines have a low risk for abuse in anxiety disorder patients without a history of alcohol or other substance abuse. Among the benzodiazepines there may be a spectrum of abuse liability, with drugs that serve as prodrugs for desmethyldiazepam (e.g., clorazepate), slow-onset agents (e.g., oxazepam), and partial agonists (e.g., abecarnil) having the least potential for abuse. However, there is no currently marketed benzodiazepine or related drug that is free of potential for abuse. 

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... 

Chermack ST, Blow FC Violence among individuals in substance abuse treatment the role of alcohol and cocaine consumption. Drug Alcohol Depend 66 29—37, 2002... 

Olivera AA, Kiefer MW, Manley NK Tardive dyskinesia in psychiarric parienrs with substance abuse disorders. Am J Drug Alcohol Abuse 16 57-66, 1990 Palatini P, Tedeschi L, Prison G, er al Dose-dependent absorption and eliminarion of gamma-hydroxybutyric acid in healthy volunteers. Eur J Clin Pharmacol 45 3 53— 356, 1993... 

Alcohol Health Res World 22 122-123, 1998 Solhkhah R, Finkel J, Hird S Possible risperidone-induced visual hallucinations. J Am Acad Child Adolesc Psychiatry 39 1074-1073, 2000 Solhkhah R, Wilens TE, Prince JB, et al Bupropion sustained release for substance abuse, ADHD, and mood disorders in adolescents (NR31), in New Research Absrracts, Annual Meeting of the American Psychiatric Associarion. Washington, DC, American Psychiatric Associarion, 2001... 

Inhalation of other general anesthetics susceptible to abuse, such as ether and chloroform, appears to be limited to health professionals who have easy access to these compounds and who tend to use these dtugs in isolation. Recreational and social use of these substances has been somewhat limited by their high flammability and by frequent and intense undesirable adverse effects at moderate doses. It has been suggested that the abuse of ether or chloroform alone is a rare phenomenon (Delteil et al. 1974 Deniker et al. 1972), occurring usually in the context of dependence on othet substances, particularly alcohol (Krenz et al. 2003). 

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... 

She also had experimented with LSD and cocaine freebasing numerous times within the past 2 years. Throughout her history of substance abuse she experienced an increasing frequency of periods of dazed consciousness and blackouts multiple times yearly, while under the influence of alcohol. Further, she reported that other family members had chemical dependency problems, though her parents never abused drugs/a1cohol. 

Outpatient group members were very similar to the inpatient PCP abusers in most sociodemographic and drug-use characteristics. Their mean age was 29 years, educational level 12.6 years, and number of prior arrests 1.5. The majority of outpatients were black (83 percent), unmarried (67 percent), and unemployed (67 percent). Their mean duration of PCP use was almost 8 years, with, usually, no prior or recent substance abuse treatment. Thirty-seven percent used PCP at least daily, always by smoking. Like the inpatient PCP abusers, outpatients frequently (87 percent) reported abuse of other drugs alcohol (46 percent), marijuana (46 percent), and cocaine (37 percent). Several outpatients for whom cocaine was the preferred drug of abuse used PCP as a "cheaper high" when cocaine was not affordable. 

Refer the patient to substance abuse counseling for education about alcohol cessation if appropriate. 

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