- 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). The treatment approach is distinctly different depending on the type of problem.
- Certain drugs of abuse are marketed via the Internet and other unregulated outlets using names that would not immediately identify the substances as a dangerous drug. Health professionals must stay abreast of the latest marketing ruse to conceal the true nature of the substance.
- 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.
- 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.
- 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.
- 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 now buprenorphine are used for narcotic maintenance, the logical approach at present should center on prevention.
- 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.
- Pharmacotherapy of substance-related disorders is most often adjunctive to other modes of therapy such as counseling and intense psychotherapy.
On completion of the chapter, the student will be able to:
List the various ways in which the use/abuse of alcohol, tobacco, and other drugs impacts adversely on our society, both personally and economically.
Differentiate between physical dependence and addiction to drugs and other substances.
Describe the extent of abuse of various substances by different groups of persons and the recent trends in drug abuse.
Recognize the signs and symptoms associated with the abuse of the CNS depressants, including benzodiazepines, carisoprodol, and the opiates.
Recommend appropriate treatment for abuse and dependence on the various CNS depressants.
Compare and contrast crack cocaine and powdered cocaine in terms of chemistry, pharmacologic effects, onset, and duration of action.
Recognize the signs and symptoms of abuse of CNS stimulants such as cocaine and methamphetamine.
Compare the chemistry, pharmacology, and toxicology of synthetic cathinone derivatives.
Teach young persons the long-term dangers associated with the recreational use of the drug MDMA (Ecstasy).
List the adverse health consequences of marijuana use.
Define tolerance, dependence, and ...