Substance abuse opiates

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... 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

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. 

Kolar, A.F., Brown, B.S., Haertzen, C.A. and Michaelson, B.S. (1994) Children of substance abusers the life experiences of children of opiate addicts in methadone maintenance. American Journal of Drugand Alcohol Abuse 20, 2, 159-171. 

Gerra G, Marcato A, Caccavari R et al. (1995). Clonidine and opiate receptor antagonists in the treatment of heroin addiction. Journal of Substance Abuse Treatment, 12, 35-41. 

The emphasis here is on families with a member addicted to opiates. However, similar principles apply to families with other substance abuse problems. 

Substance abuse has been the subject of several lOM studies, which have covered a whole host of issues related to the topic, including federal regulation of methadone treatment, the development of medications for the treatment of opiate and cocaine additions, and community-based research to find better ways to treat people who abuse drugs. 

Greenstein RA, Fudala PJ, O Brien CP. Alternative pharmacotherapies for opiate addiction. In Lowinson JH, Ruiz R Millman RB, Langrod JG, eds. Substance Abuse A Comprehensive Textbook, 3rd ed. Baltimore, Wilhams Wilkins, 1997 415 25. 

Benzodiazepine abuse is different from other substance abuse disorders (opiates, amphetamines, and nicotine) because benzodiazepines cause much less euphoria and do not activate the classic reward systems that are activated with other substances (mainly the mesolimbic and mesocortical dopaminergic projections). In fact, most people do not find the subjective effects of benzodiazepines pleasant beyond their therapeutic anxiolytic or sleep-inducing effects. Therefore, abuse of benzodiazepines is usually secondary to other substance-abuse disorders, with the benzodiazepine being taken for relief from symptoms induced by the use of another drug. As potential drugs of abuse, short-acting benzodiazepines seem to be preferred among addicts because of the rapidity of their onset of action (aiprazoiam, fiunitrazepam, and iorazepam). 

G. Gerra, A. Mercato, R. Caccavari, B. Fontanesi, R. Delsignore, G. Fertonani, P. Avanzini, P. Rustichelli, and M. Passeri, Cloni-dine and Opiate Receptor Antagonists in the Treatment of Heroin Addiction. J. Substance Abuse Treatment, 12,35 1,1995. 

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