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For the chapter in the Wells Handbook, please go to Chapter 71. Substance-Related Disorders.



  • image Problems related to abuse of chemical substances can occur acutely (eg, respiratory arrest from using heroin) or after some length of time (eg, dependence or withdrawal from continued use of an opiate). The treatment approach is distinctly different depending on the type of problem.

  • image Certain drugs of abuse are marketed via the Internet and other unregulated outlets using names that would not immediately identify the substance as a dangerous drug. Health professionals must stay abreast of the latest marketing ruse to conceal the true nature of the substance.

  • image Synthetic chemists are constantly developing new drugs of abuse with pharmacology that mimics that of established controlled substances. Often, the dangers of these substances are greater than that of the parent compound.

  • image For a few drugs, there is a specific antidote that can be used in cases of overdoses. For others, treatment is symptomatic and supportive. Early recognition and treatment of acute drug intoxications can make a huge difference in the ultimate outcome for the patient.

  • image Withdrawal from certain classes of drugs (eg, benzodiazepines or barbiturates) can be life-threatening, and steps must be taken to ensure that discontinuation or dose reduction is gradual and that it takes place in closely supervised settings.

  • image While there is much research focusing on drugs to treat the underlying addictive processes, to date the successes have been few. Whereas methadone, levo-α-acetylmethadol (LAAM), and buprenorphine are used for narcotic maintenance, the logical approach at present should center on prevention and using pharmacotherapies like buprenorphine to wean patients off of opioids altogether.

  • image While the goal of therapy for substance dependence is to wean patients from a drug or drug category altogether, this is often difficult to do. For some, the treatment strategy is to manage the chemical dependency to allow the patient to lead as normal a life as is possible. This may require the substitution of one drug for the primary drug of dependency.

  • image Pharmacotherapy of substance-related disorders is most often adjunctive to other modes of therapy such as counseling and intense psychotherapy.

The book of Ecclesiastes wisely reminds us that “[W]hat has been will be again, what has been done will be done again; there is nothing new under the sun.”1 It is doubtful that the author of these sage words was referring to the repeating cycle of substance abuse, but when it comes to this subject there rarely is anything new under the sun, and this metaphor aptly applies.

Psychoactive drug use dates back to prehistoric times and the Neolithic era (8,500-4,000 BC) where the earliest human use of psychoactive substances consisted almost exclusively of plants and fruits whose mood-altering qualities were accidentally discovered but subsequently deliberately grown.2

Ancient civilizations (4,000 ...

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