Substance-abuse disorders withdrawal

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. 

Harper MH, Winter PM, Johnson BH, et al Withdrawal convulsions in mice following nitrous oxide. Anesth Analg 59 19—21, 1980 Hasin D,Nunes E, MeydanJ Comorbidity of alcohol, drug, and psychiatric disorders epidemiology, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 1-34... 

A number of medications have been studied to alleviate symptoms of stimulant withdrawal and the intense craving that may accompany it, but inconsistent results across controlled trials preclude any recommendations for their routine use. Patients with stimulant use disorders should be referred to substance abuse treatment because of the high risk for continued use either during or immediately following stimulant withdrawal. 

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)... 

In DSM-IV parlance, psychiatric illnesses that result from substance use are called substance-related disorders. Within this broad spectrum are two distinct categories substance use disorders and snbstance-induced disorders. The substance use disorders consist of abusive patterns of nse that produce a myriad of problems in relationships, employment, medical or physical well-being, and legal matters. There is no predefined amount or frequency of substance use that defines these disorders instead, they are diagnosed when the consequences of substance use include an adverse impact on other areas of life. As noted earlier, in some instances, substance nse disorders lead to physical dependence that is manifested by tolerance and the potential for withdrawal symptoms. When anyone talks about addiction, it is typically snbstance nse disorders to which they refer. 

In this chapter, we will focus primarily on treatments for the substance use disorders. However, because detoxification during a substance-induced withdrawal is often the first step in treating a substance use disorder, we will discuss withdrawal states to some extent. The substance use disorders include both substance abuse and the more serious substance dependence. Substance abuse consists of a pattern of misuse that causes recurring problems in at least one aspect of life. This can be a failure to fulfill responsibilities at home or work, reckless use of the substance such as drunken driving, repeated substance-related arrests, and ongoing substance use despite resulting problems in family relationships. See Table 6.1 for the diagnostic criteria for substance abuse. 

Within this Held, most of the research and results have been focused on the effects of drug therapy on the disorders induced by alcohol, and by the abuse of opiates. For a broader discussion of substance abuse see Chapter 18. In all instances of alcohol or drug abuse the first objective is to wean the patients from the addictive substance, treating or preventing the effects of withdrawal for those substances which cause physical dependence (alcohol, nicotine, opiates, caffeine, certain psychotropic agents such as benzodiazepines, possibly antidepressants). The second phase is the prevention of recurrence or relapse, which relies on a combination of social support, psychotherapy, and pharmacotherapy where available. In this respect, alcoholism is exemplary. 

The manner and severity of withdrawal symptoms varies according to the type of drug and the extent of physical dependence.50 Withdrawal after short-term benzodiazepine use may be associated with problems such as sleep disturbances (i.e., so-called rebound insomnia).34 62 As discussed earlier, withdrawal effects seem to be milder with the newer nonbenzodiazepine agents (zolpidem and zaleplon).34,62 Newer agents, however, are not devoid of these problems and care should be taken with prolonged use, especially in people with psychiatric disorders or a history of substance abuse.26... 

Substance-related disorders are divided in DSM-IV into dependence, abuse, intoxication, and withdrawal. In addition, each substance may have related disorders phenomenologically similar to other disorders delirium, dementia, amnestic, psychotic, mood, anxiety, sex, and sleep disorders. 

Psychosis—symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing sounds that do not exist), social withdrawal, clinging, strange behavior, extreme stubbornness, persistent rituals, and deterioration of personal habits. May be seen in developmental disorders, severe depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Alcohol (ethanol) is a water-soluble substance that is rapidly absorbed and readily crosses the blood-brain barrier. It is a CNS depressant and is metabolized by the liver. It is also a gastric irritant and is toxic to liver cells and neurons. Alcohol is probably the most-studied substance of abuse (and the most abused substance). It is associated with dependence, abuse, withdrawal, intoxication, delirium, dementia, amnesia, delusions, hallucinations, mood disorder, anxiety disordei sexual dysfunction, and sleep disorder. 

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