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



  • image Tobacco is the number one preventable cause of death in the United States.

  • image In the United States from 2010 to 2012, alcohol poisoning was attributed to an estimated 6 deaths per day in men between the ages of 35 to 64.

  • image Pharmacogenomic studies have identified genotypic and functional phenotypic variants that either serve to protect patients or predispose them toward alcohol dependence.

  • image Except at very high and very low blood concentrations, the metabolism of alcohol is considered to follow zero-order pharmacokinetics, and this has important implications for the time course in which alcohol can exert its effects.

  • image Disulfiram, naltrexone, and acamprosate are FDA-approved drug therapies for the treatment of alcohol dependence. The clinical utility of these agents to improve sustained abstinence remains controversial. Relapse is common.

  • image More than three quarters of smokers are nicotine dependent. Tobacco dependence is a chronic condition that requires repeated interventions.

  • image A systematic Cochrane review completed in 2012 showed all forms of nicotine replacement therapy were effective in reducing the amount smoked and achieving abstinence.

  • image It has been suggested a quit date should be set 1 week following initiating varenicline therapy. Studies now show a flexible quit date is efficacious and safe.

  • image Caffeinism is the term coined to describe the clinical syndrome produced by acute or chronic overuse of caffeine. As many as one in five adults consume doses of caffeine generally considered large enough to cause clinical symptoms.

  • image Energy drinks are now popular particularly among adolescents and emerging adults. There are now safety concerns surrounding the use of these drinks due to the doubling of emergency room visits from 2000 to 2011 secondary to adverse reactions.

image Alcohol, nicotine, and caffeine are considered by most to be socially acceptable drugs, yet they impose an enormous social and economic cost on our society. Approximately 480,000 deaths in the United States each year are attributable to tobacco use, making tobacco the number one preventable cause of death and disease the United States.66 The three leading causes of death attributable to smoking include lung cancer, chronic obstructive pulmonary disease, and ischemic heart disease.1

image In 2013, heavy drinking was reported by 6.3% of the population aged 12 or older, or 16.5 million people.2 Approximately one quarter (22.9%) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the National Survey on Drug Use and Health (NSDUH) in 2013 which is very similar to the 23% reported in 2012.2 The World Health Organization estimates that in 2012, there were approximately 3.3 million people worldwide who died from alcohol consumption.3 Long-term alcohol abuse often leads to chronic disease. A causal relationship between alcohol abuse and at least 200 types of chronic ...

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