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  • Image not available. Problems related to abuse of chemical substances can occur acutely (e.g., respiratory arrest from using heroin) or after some length of time (e.g., dependence or withdrawal from continued use of an opiate).
  • Image not available. Pharmacotherapy of substance-related disorders is most often adjunctive to other modes of therapy such as counseling and intense psychotherapy.
  • Image not available. Withdrawal from certain classes of drugs (e.g., benzodiazepines or barbiturates) can be life-threatening, and steps must be taken to ensure that withdrawal is gradual and that it takes place in closely supervised settings.
  • Image not available. While there is much research focusing on drugs to treat the underlying addictive processes, to date the successes have been few. Prevention is the key. Because of their knowledge of pharmacology and the actions of drugs on the body, health professionals can play a key role in education of young people on the dangers of recreational drug use.

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Upon completion of the chapter, the reader will be able to:

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  • 1. List the various ways in which the use/abuse of alcohol, tobacco, and other drugs impacts adversely on our society, both personally and economically.
  • 2. Differentiate between physical dependence and addiction to drugs and other substances.
  • 3. Recite the extent of abuse of various substances by different groups of persons and the recent trends in drug abuse.
  • 4. Recognize the signs and symptoms associated with the abuse of the central nervous systems depressants, including benzodiazepines, gamma hydroxybutyrate, and the opiates.
  • 5. Recommend appropriate treatment for abuse and dependence on the various central nervous system depressants.
  • 6. Compare and contrast crack cocaine and powdered cocaine in terms of chemistry, pharmacologic effects, onset, and duration of action.
  • 7. Recognize the signs and symptoms of abuse of central nervous stimulants such as cocaine and methamphetamine.
  • 8. Compare the chemistry, pharmacology, and toxicology of gamma-hydroxy butyric acid, butyrolactone, and 1,4-butandione.
  • 9. Teach young persons the long-term dangers associated with the recreational use of MDMA (Ecstasy).
  • 10. List the adverse health consequences of marijuana use.
  • 11. Recite the definitions of tolerance, dependence, and withdrawal from the various drugs of abuse and the pharmacotherapy available for dealing with dependence and withdrawal from each type of drug.
  • 12. Explain how drugs get diverted from legal to illegal supplies and the magnitude of the problem of drug diversion.
  • 13. Explain the concept of rapid opiate detoxification for a specific patient.
  • 14. Outline the circumstances under which office-based opiate detoxification and maintenance would be appropriate using buprenorphine.
  • 15. Advise other health professionals and laypersons on the dangers associated with abuse of over-the-counter cough medicines, especially dextromethorphan.

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In 2001, the Schneider Institutes for Health Policy at Brandeis University1 boldly declared that the abuse of alcohol, tobacco, and other drugs (ATOD) was the nation's number one health problem. Sadly, not much has changed since then to change their assessment. There are more deaths, illnesses, and disabilities from substance abuse than from any other preventable health condition. A recent report from the National Center ...

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