• The abuse of alcohol and other psychoactive substances has become an endemic problem throughout all levels of society• In terms of substance abuse or dependence, a substance can be defined as a prescribed drug, an illegal drug, or a substance used in an unintended manner to produce mood or mind- altering effect (eg, inhalants, glues, or steroids).
• Substance abuse may arise unintentionally from the initial use of a substance for its approved purpose.• The individual commonly faces not only the psychological ramifications of a substance-related disorder, but also physiologic consequences resulting from substance use or abuse.• Substance abuse and dependence share certain criteria and can be difficult to distinguish from one another.
• With substance abuse, the pattern of use has lead to the development of one or more life problems• In dependence, these problems can coexist with a pattern of tolerance and physiologic or psychological dependence• Withdrawal and tolerance are significant criteria related to substance dependence; however, dependence can exist without either of these criteria being met
• Dependence has been characterized as loss of control over the use of a substance• Dual diagnosis is defined as the presence of a substance-related diagnosis along with another psychiatric disorder
Treatment Modalities• Inpatient modalities include programs of detoxification and therapy sessions designed to aid in the recognition of a substance-related disorder.• Outpatient therapies include support groups, continued therapy sessions, and the use of pharmacologic drugs to aid in the maintenance of sobriety.
Detoxification• Initial detoxification is typically provided through inpatient hospitalization.• Detoxification protocols are unique to each substance.
Detoxification • Benzodiazepine taper is utilized during detoxification from alcohol • The treatment of cocaine withdrawal may include administration of prescribed drugs that can reduce craving, such as amantadine (Symmetrel) or bromocriptine (Parlodel). • The treatment of heroin withdrawal generally involves transdermal clonidine (Catapres) along with oral administration as necessary.
Drugs for Alcohol Abuse• Disulfiram (Antabuse) is used as aversion therapy. It leads to accumulation of acetaldehyde in the blood system, causing flushing, tachycardia, vomiting, nausea, and chest pain, if alcohol is consumed.
• A nonaversion therapy, acamprosate sodium (Campral), may be used in attempts to ensure abstinence fron alcohol. It interacts with the GABA neurotransmitter system to restore balance between neuronal excitation and inhibition.• Topiramate (Topamax) an anticonvulsant, may reduce craving for alcohol. Clinical trials have demonstrated that ondansetron (Zofran) may aid in reducing drinking.
Opiate withdrawal• Administration of an opioid antagonist, such as naloxone (Narcan) and naltrexone (ReVia), reverses the effects of opioids. Injectable sustained-release formulations of naltrexone may also be used.
• Outpatient detoxification is typically focused on the administration of the opioid agonist, methadone, or levo- alpha-acetylmethadol (LAAM), a longer-lasting formulation, to substitute for the illicit drug.• Another opioid agonist, buprenorphine (Suboxone), is becoming available in the United States to treat heroin addiction.
• Psychosocial support through the use of 12-step or other treatment programs (Rational Recovery).• Psychoeducational therapy to understand triggers of substance use and prevention of relapse.• Family support and educational groups.