Pharmacological Interventions And Treatment Implications

In summary, the various biological models of drug addiction are complementary and broadly applicable to chemical addictions. We next illustrate how long-term pharmacotherapies for opioid dependence, such as methadone, nal-trexone, and buprenorphine, can counteract or reverse the abnormalities underlying dependence and addiction. These agents are particularly informative, because they are an agonist, antagonist, and partial agonist, respectively. We do not review short-term treatments for...

Contributors

Acosta, PhD, Department of Psychiatry, St. Luke's-Roosevelt Hospital Center, New York, New York D. Andrew Baron, PhD, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania David A. Baron, DO, MSEd, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania Steven H. Baron, PhD, Department of Social Sciences, Montgomery County Community College, Blue Bell, Pennsylvania Judith S. Beck, PhD, Beck Institute...

Psychological Processes Integral To Substance Abuse

Cognitive processes encompass both cognitive style and cognitive capacity. Both aspects are relevant to understanding substance abuse. Cognitive style refers to the general strategy an individual uses to process information. For example, substantial evidence indicates that substance abusers are more inclined than the general population to analyze perceptual stimuli in a global, inarticulate manner (Sugerman & Schneider, 1976). This stable trait is referred to as perceptual field dependence....

Discontinuation of Benzodiazepine

Discontinuation of sedatives and hypnotics, including the benzodiazepines, can be divided into three categories (1) long-term low-dose benzodiazepine use, (2) high-dose benzodiazepine abuse and multiple drug abuse, and (3) high-dose abuse of nonbenzodiazepine sedatives and hypnotics (especially intermediate-acting barbiturates). The first group of patients can usually be discontinued on an outpatient basis. Some of the second and even the third group can be treated as outpatients, but most will...

Preparation And Routes Of Administration

Cocaine is the most potent stimulant of natural origin. It is a benzoyl-methylecgonine, an ester of benzoic acid and a nitrogen-containing base. Cocaine occurs naturally in the leaves of Erythroxylon coca and other species of Erythroxylon indigenous to Peru, Bolivia, Java, and Columbia. There are several basic routes to cocaine administration chewing the leaves, cocaine sulfate (paste), cocaine hydrochloride, freebase cocaine, and crack cocaine. South American natives who chew coca leaves...

Psychiatric Disturbance

Substance abuse can occur conjointly with virtually any Axis I or Axis II psychiatric disorder. This has important treatment implications, the most obvious of which is that for some individuals, alcohol or drug consumption may constitute an attempt at self-medication. Hence, treatment of the primary disorder may in some circumstances be sufficient to ameliorate the substance use disorder. Alternatively, prolonged drug abuse may precipitate a psychiatric disturbance, either directly by inducing...

Treatment Considerations

At its simplest, treatment of patients with chronic multiple SUDs requires a focus upon each disorder separately, in addition to providing patients with a coherent overall rationale and approach to addiction treatment. Although multiple SUDs have a net negative impact on treatment outcome, Abellanas and McLellan (1993) have shown that patients with multiple SUDs report generally similar motivation for change across drugs of abuse, meaning that their desire to modify their substance use remains...

Drug Abuse Dependence

A common comorbidity associated with alcohol use disorders is co-occurring drug use disorders. In 2001, the National Household Survey on Drug Abuse found that among teenagers who binge drink, two-thirds were also abusing drugs. In contrast, one in 20 teenagers who did not drink abused drugs. Drawing upon the ECA and NCS data, it has been determined that one in five individuals with an alcohol use disorder will also have a drug use disorder. A breakdown of the NCS data indicates that those with...

Treatment

Given the high rates of placebo response often observed in treatment trials of PG, the treatment section focuses on findings from double-blind, placebo-controlled trials (see Table 13.2). SRIs are the most well-studied pharmacotherapy for PG. In a double-blind study with one subject, 125 mg day of clomipramine resulted in significant improvement. The patient sustained improvement for 28 weeks on a dose of 175 mg day (Grant, Kim, & Potenza, 2003). Fluvoxamine has demonstrated mixed results in...

Drug Tolerance Dependence And Withdrawal

From a clinical standpoint, withdrawal can be one of the most powerful factors driving dependence and addictive behaviors. This seems particularly true for opioids, alcohol, benzodiazepines, nicotine, and to a lesser extent stimulants such as cocaine. For hallucinogens, cannabinoids, or inhalants, withdrawal symptoms seem of more limited importance. Treatment of the patient's withdrawal symptoms is based on understanding how withdrawal is related to the brain's adjustment to these drugs after...

Integration Of Psychotherapy And Pharmacotherapy For Dually Diagnosed Patients

Integrated psychosocial treatments are increasingly accepted and provided to patients as more and varied evidence accrues regarding their benefits. However, there continue to be few trials that integrate novel psychosocial treatments with novel pharmacotherapies. Instead, most treatments either focus on new pharmacological or new psychosocial interventions. Despite this, more recent research has emphasized the importance of integrating pharmacological and psychotherapeutic treatment options. In...

Testing Methodologies

A multitude of methods are available to aid in the detection of drug use in humans. The most common drug testing technologies are listed in Table 4.1. The most popular initial test screen is an enzyme immunoassay EIA analysis of a urine sample. If this is positive, a confirmatory gas chromatography-mass spectroscopy GC-MS test is performed on the split sample. Given the greater sensitivity of GC-MS over EIA, the cutoff levels are reduced. The most commonly used analytic technique for a...

Linking Assessment And Treatment The Decisiontree Procedure

A three-stage evaluation procedure provides a systematic framework for connecting assessment and treatment. The first stage involves brief screening using the DUSI-R Tarter, 1990 . At this stage, the areas of disturbance that point to the need for comprehensive evaluation are identified. In the second stage, a diagnostic evaluation is performed in the identified problem areas. This information in turn is applied to a focused, in-depth evaluation to formulate a multi-disciplinary treatment plan....