Substance abuse opioids

Indications Substance abuse, opioid dependence, alcohol dependence... 

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-... 

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... 

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. 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Reward Therapy. A similar (yet nonspecific) approach is to use a medication that stimulates the brain s reward centers. Reward medications usually do not work in quite the same way as the substance of abuse however, the net effect in the final common pathway (i.e., the reward centers) may be the same. For the most part, these reward centers are activated by either dopamine or endogenous opioid agonists. One common feature of most abused drugs is that they stimulate these reward centers. This lies at the heart of their addictive potential. Some attempts have been made to use medications that activate these reward centers in place of the abused substance. The hypothesis is that the addict will have less intense craving for his/her preferred substance of abuse in the presence of these other agents. This is, of course, a relatively nonspecific approach that could theoretically be used to treat the abuse of many different substances. It has not yet, however, demonstrated any utility in the treatment of substance abuse. 

Opioid antagonists have been used with mixed results in adults with PTSD. No clinical trials with these agents have been published in children and adolescents with PTSD. The opioid antagonists such as naltrexone may have limited utility in treating debilitating self-mutilative behavior and perhaps in reducing substance abuse comorbidity in adolescent patients with PTSD. 

Florentine R Anglin MD (1996). More is better counselling participation and the effectiveness of outpatient drug treatment. Journal of Substance Abuse and Treatment, 13, 341-8 Fischer G (2000). Treatment of opioid dependence in pregnant women. Addiction, 102, 264-70... 

Flynn PM, Joe GW, Broome KM, Simpson DD Brown BS (2003). Recovery from opioid addiction in DATOS. Journal of Substance Abuse Treatment, 25, 177-86... 

In the United States and other developed countries, illicit opium derivatives such as heroin or licit synthetic opioids such as Vicodin have generally replaced the use of smoked or eaten opium. According to Drug Abuse Warning Network (DAWN) data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), there were more than 82,000 emergency department admissions for narcotic analgesics/narcotic analgesic combinations in 2000. Only 167 of these visits were for opium and opium combinations. 

Prescription opioids are often the drugs of choice for physicians and other health care professionals who become substance abusers. Their jobs often grant them easy access... 

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