Substance misuse/dependency

Despite public misconceptions, there is little firm evidence that the typical and atypical antidepressants produce dependence in clinical users. A review of 21 case reports of antidepressant addiction revealed that 12 were associated with tranylcypromine, although 8 of these 12 had a previous history of substance misuse (Haddad, 1999). Tranylcypromine s structural similarity to amphetamine may account for the significant number of reports of its addictive potential, but even here the term (mild) discontinuation reaction rather than withdrawal reaction should be used to allay any concerns patients might have (Haddad, 1999). 

One important point is that substance dependence is a lifetime diagnosis. Once someone has substance dependence, they will always have it. It may be in a state of remission, but the risk of relapse remains indehnitely. Proper treatment, however, will enable many patients to recover from the devastating consequences of dependence. For this reason, DSM-IV includes diagnostic specihers for remission. These specihers describe both how long and to what extent the substance misuse has been in remission. Early remission is arbitrarily attained when substance use has been stopped or curtailed for 1-12 months. Remission is considered sustained when the patient has been abstinent for over 12 months. In addition, remission can be specified as full or partial. Partial remission occurs when some substance dependence symptoms are still present but the full criteria for the illness are no longer met. As a result, the remission specifiers for substance dependence include early full remission, early partial remission, sustained full remission, and sustained partial remission. 

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer s disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette s syndrome) and mental retardation (learning disabilities). 

Physical dependence on opioids appears to occur in patients who use opioids for long-term pain relief, and cases of addiction have been reported. However, rates of addiction are low and occur mainly in individuals who have a history of substance misuse. The role of longterm opioid medication in non-cancer-related chronic pain remains controversial. Opiophobia, a fear of the legitimate use of opioid analgesics because of the potential for addiction, remains a significant issue for physicians, patients, and relatives alike. The review is illustrated with a report of a 52-year-old man with multiple myeloma who displayed tolerance to oral morphine over 2 years. 

Much legislation enacted by governments relating to such matters as pollution of the atmosphere and of rivers, the monitoring of foodstuffs, the control of substances hazardous to health, the misuse of drugs, and many others are dependent upon the work of analytical chemists for implementation. 

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. 

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. 

The good news is that treatment can have a profound impact on the clinical course of substance dependence. Most patients who have been treated are eventually able to stop their pattern of compulsive misuse. Some abstain altogether while others are able to manage long periods of sobriety with only brief episodes of substance use. Those who are able to maintain periods of sustained abstinence from substance abuse and dependence also find improvement in job performance and social functioning. Those who do the best had little comorbid psychiatric illness, were able to... 

Talwin Nx Talwin Nx is intended for oral use only. Severe, potentially lethal reactions (eg, pulmonary emboli, vascular occlusion, ulceration and abscesses, withdrawal symptoms in narcotic-dependent individuals) may result from misuse of this drug by injection or in combination with other substances. 

Many victims of dependence have apparently normal backgrounds. Some simply make the mistake of trying a substance in some social situation which supports the pleasurable affects, and the substance s pharmacology merely takes over, after a variable period of misuse and abuse. Other victims may have personalities which lead them to escape life s normal pressures, therefore their need for mood enhancement or alteration of consciousness can be an additional pressure on the need to continue the substance. This may be particularly true as tolerance develops and dose increase is necessary to attain the initial effect. 

Much inhalant use is confined to early adolescence. But some users become dependent, and they continue abusing inhalants into adulthood. For other users, inhalants may be the first stop on a long path of misusing dangerous substances. 

Societal progress and development depend on the knowledge and proper use of chemical substances using a pragmatic approach—certainly not by misuse or reckless imposition of bans on chemical substances. There are no safe chemical snb-stances. Hnge amonnts of time, money, and human effort have been spent to identify... 

Substances Act (CSA) are divided into five schedules (Table A-1) individual states may have additional schedules. Criminal offenses and penalties for misuse generally depend on the schedule of a substance as well as the amount of drug in question. 

Substance abuse is the indisctiminant misuse of medication that results in a physical and/or psychological dependence on the dmg. A person is considered addicted to a dmg if over a six month period they develop dependence for the dmg, they experience withdrawal symptoms when the dmg is no longer administered, and they require increased doses of the dmg to experience the same therapeutic effect. 

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