Substance abuse dependence

Group therapy for substance abuse/dependence includes more than three people (ideally 8 to 10) who interact in the same room for 90 to 120 minutes. Group therapy provides patients with the opportunity to bond with others and the advantages of this can be mutual identification dealing with... 

Important outcome indicators to evaluate postintoxication and/or postwithdrawal treatment of substance abuse and dependence can be divided into three major groups decreased consumption of substances, decreased problems associated with substance use, and increased psychosocial functioning. Although it is less commonly employed, a quality-of-life scale can help determine how substance abuse/dependence treatment has affected your patients lives. If you are involved in the cost-justification of services, a cost-benefit analysis could also become important, although this is more often used at the administrative level,... 

It is estimated that 25-50% of patients in long-term care facilities suffer from neuropsychiatric disorders that are functionally impairing/ At least 26% of incarcerated adults and 52% of children in the juvenile justice system meet criteria for a DSM-IV-TR disorder/ When substance abuse/dependency is included in the adult population, the incidence rises to 71%. Psychiatric pharmacist specialists can provide consultation on optimizing drug therapy for patients in these settings. 

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... 

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). 

Jaffe JH Drug dependence opioids, nonnarcotics, nicotine (tobacco), and caffeine, in Comprehensive Textbook of Psychiatry, 5th Edition, Vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams c Wilkins, 1989, pp 642-686 Jaffe J, Knapp CM, Ciraulo DA Opiates clinical aspects, in Substance Abuse A Comprehensive Textbook. Edited by Lowinson JH, Ruiz P, Millman RB, et al. New York, Lippincott Williams and Wilkins, 2004, pp 158—165 Jarvis MA, Schnoll SH Methadone use dming pregnancy. NIDA Res Monogr 149 58— 77, 1995... 

Limited results from clinical laboratory evaluations suggested that the GABAj l agonists zaleplon (Rush et al. 1999b) and Zolpidem (Rush et al. 1999a) produce effects that are consistent with abuse potential comparable to that of the benzodiazepine triazolam. The reported incidence of dependence on Zolpidem in the medical literature is low, compared with that for benzodiazepines, and is characterized by use of high doses, often in individuals with a history of substance abuse (Hajak et al. 2003 Vartzopoulos et al. 2000). 

Dependence on barbiturates has declined in recent years as physicians have substituted benzodiazepines for the treatment of many of the conditions for which barbiturates were formerly used. Clinicians will still see cases of abuse and dependence among medical patients receiving barbiturates or barbirurate combination products (e.g., Fiorinal) and in substance abusers (Silberstein and McCrory 2001). 

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... 

J Consult Clin Psychol 61 1100—1104, 1993 Stephens RS, Roffman RA, Simpson EE Treating adult marijuana dependence a test of the relapse prevention model. J Consult Clin Psychol 62 92—99, 1994 Stephens RS, Roffman RA, Curtin L Comparison of extended versus brief treatments for marijuana use. J Counsul Clin Psychol 68 898—908, 2000 Substance Abuse and Mental Health Services Administration The BASIS Report Marijuana Treatment Admissions Increase 1993-1999. Rockville, MB, Substance Abuse and Mental Health Services Administration, 2002a Substance Abuse and Mental Health Services Administration Results from the 2001 National Household Survey on Brug Abuse Vol I. Summary of National Findings. Rockville, MB, Substance Abuse and Mental Health Services Administration, 2002b... 

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... 

Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P Treatment for amphetamine dependence and abuse. Cochrane Database Syst Rev 4 CD003022, 2001 Srisurapanont M, Ali R, Marsden J, et al Psychotic symptoms in methamphetamine psychotic in-patients. Int J Neuropsychopharmacol 6 347-352, 2003 Substance Abuse and Mental Health Services Administration Overview of Findings From the 2002 National Survey on Drug Use and Health (DHHS Publ No SMA 03-3774). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2003... 

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... 

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. 

Abused drugs generally produce pleasant effects that are desired by the user. However, while most individuals will experience these pleasant effects, not everyone abuses these drugs, and not everyone who abuses them becomes dependent on them. Why some persons abuse drugs while most people do not is a complex area of research. It appears that genetic, environmental, and cultural factors may all interact to predispose some individuals to substance abuse and subsequent dependence. The initial hedonic experiences secondary to use of drugs appear to be primarily due to their ability to activate the primary reward circuits in the brain. These same reward circuits operate under normal circumstances to reinforce certain activities that promote survival, such as food, social affiliation, or sexual activity. 

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