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INTRODUCTION

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  • The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) divides substance-related disorders (encompassing 10 separate classes of drugs) into (1) substance use disorders and (2) substance-induced disorders (eg, intoxication, withdrawal, and substance-induced mental disorders).

  • The diagnosis of substance use disorder is based on a pathologic pattern of behaviors related to use of the substance. Diagnostic criteria fall into the categories of (1) impaired control, (2) social impairment, (3) risky use, and (4) pharmacological criteria, including tolerance and withdrawal.

  • DSM-5 does not separate the diagnoses of substance abuse and substance dependence. Criteria are provided for substance use disorder, accompanied by criteria for intoxication, withdrawal, substance-induced disorders, and unspecified substance-related disorders in some cases.

  • Addiction: A primary chronic neurobiologic disease characterized by one or more of the following five Cs: chronicity, impaired control over drug use, compulsive use, continued use despite harm, and craving.

  • Intoxication: Development of a substance-specific syndrome after recent ingestion and presence in the body of a substance; it is associated with maladaptive behavior during the waking state caused by effects of the substance on the central nervous system (CNS).

  • Physical dependence: A state of adaptation manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

  • Substance dependence: The characteristic feature is a continued maladaptive pattern of substance use in spite of repeated adverse consequences related to the repeated use.

  • Tolerance: A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

  • Withdrawal: A substance-specific syndrome occurring after cessation of or reduction in intake of a substance that was used regularly.

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CENTRAL NERVOUS SYSTEM DEPRESSANTS

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ALCOHOL

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  • Table 71–1 relates the effects of alcohol to the blood alcohol concentration (BAC).

  • Signs and symptoms of alcohol intoxication include euphoria, slurred speech, ataxia, incoordination, sedation, nystagmus, impaired judgment, impaired memory, unconsciousness, nausea, vomiting, respiratory depression, and coma. Signs and symptoms of alcohol withdrawal include tachycardia, diaphoresis, hyperthermia, hallucinations, delirium, and seizures.

  • Alcohol withdrawal includes (1) a history of cessation or reduction in heavy and prolonged alcohol use and (2) the presence of two or more of the symptoms of alcohol withdrawal.

  • There is 14 g of alcohol in 12 oz of beer, 5 oz of wine, or 1.5 oz (one shot) of 80-proof whiskey. This amount will increase the BAC by approximately 20 to 25 mg/dL (4.3–5.4 mmol/L) in a healthy 70 kg (154 lb) man. Deaths generally occur when BACs are greater than 400 to 500 mg/dL (87–109 mmol/L).

  • Absorption of alcohol begins in the stomach within 5 to 10 minutes of ingestion. Peak concentrations are usually achieved 30 to 90 minutes after finishing the last drink.

  • Alcohol is metabolized by alcohol dehydrogenase to acetaldehyde, which is metabolized to carbon ...

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