1 2 Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014). In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it. Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...

1. 1
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Week IV, Discussion Post: Care for the Client with a Substance
Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a
sophisticated group of prescribed drugs that are used in pain
management, especially after significant surgeries.
Unfortunately, when these medications are used in an
uncontrolled manner, they have adverse addictive effects. These
drugs are specifically designed to treat severe pain and are often
prescribed following surgery or injury or for health conditi ons
that cause extensive chronic illness such as cancer. At times,
when taken in a way other than prescribed by a licensed
practitioner, they can cause euphoric and pleasurable effects,
making them a high demand on the streets. The death statistics
resulting from opioid overdose in the United States between
1999 and 2010 increased exponentially, and it was recorded that
in 2010 alone, the number of deaths recorded from opioid
overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha,
S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has
escalated in the United States (Volkow et al., 2014). The total
number of opioid prescriptions dispensed from the United States
outpatient retail pharmacies increased from 174.1 million in
2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-
prescription of opioid medications widely contributes to an
increase in opioid overdose, and this has had a massive impact
on the states. The United States has used more than 1 trillion
dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that
the total "economic burden" of prescription opioid misuse alone
in the United States is $78.5 billion a year, including the costs
of healthcare, lost productivity, addiction treatment, and
criminal justice involvement. The increase in drugs used by

2. injection has also contributed to the spread of diseases
including HIV and hepatitis C. As we have seen throughout the
history of medicine, science can be a major part of the solution
in such a public health crisis. Expanding access to effective,
evidence-based treatments for those with addiction and also less
severe substance use disorders is critical, but broader
prevention programs and policies are also essential to reduce
substance misuse and the pervasive health and social problems
caused by it.
Time and again, studies have found that there are high levels of
correlation between mental and emotional disorders and
addiction. This means that those who suffer from addiction have
a higher-than-average likelihood of also suffering from a
psychiatric disorder (Coon, Mitterer, & Martini, 2019). That
said, it is extremely important for the Psychiatric Mental Health
Nurse Practitioner (PMHNP) to recognize both physical and
mental exam findings consistent with substance abuse disorder.
The earlier a diagnosis is made, the better the prognosis.
However, use over periods of years produces physical and
psychological findings that make diagnosis much easier. Some
examples of physical symptoms and findings that ensue after
persistent use include the following:
· Malnutrition, including cachexia, but also obesity (the person
may forget to eat, not want to eat, or eat unhealthily because the
only thing that makes them feel better is drugs or alcohol).
· Systemic infections including cellulitis, sexually transmitted
diseases, HIV, hepatitis B and C, tuberculosis, and bacterial
endocarditis (the individual may use dirty needles, have
unprotected sex for drugs, live or sleep in filthy crowded areas).
· Elevated blood pressure, tachycardia, chest pain, transient
ischemic attacks, restlessness, sweating, and tremors (symptoms
consistent of withdrawal).
· Physical damage from administering a drug that involve
chronic sinus/nasal problems, worsening bronchitis from
marijuana or cocaine smoking, or "track marks" from injection
drug use

3. · The myriad systemic effects of alcoholism, including delirium,
liver enlargement or failure, ascites, anemia, thrombocytopenia
and bleeding, seizures, trauma, myopathy, and cardiomyopathy
(Alcohol damages the liver, which is responsible for filtering
out toxins and blood clotting).
· Increased aggression, irritability, personality changes,
lethargy, and depression
Every substance has slightly different effects on the brain, but
all addictive drugs, including alcohol, opioids, and cocaine,
produce a pleasurable surge of the neurotransmitter dopamine in
the basal ganglia This area is responsible for controlling
reward and our ability to learn based on rewards. As substance
use increases, these circuits adapt. They scale back their
sensitivity to dopamine, leading to a reduction in a substance’s
ability to produce euphoria or the “high” that comes from using
it (Knudson, Abraham, & Roman, 2011). This is known
as tolerance, and it reflects the way that the brain maintains
balance and adjusts to a new normal, the frequent presence of
the substance. However, as a result, users often increase the
amount of the substance they take so that they can reach the
level of high they are used to. These same circuits control our
ability to take pleasure from ordinary rewards like food, sex,
and social interaction, and when they are disrupted by substance
use, the rest of life can feel less and less enjoyable to the user
when they are not using the substance.
Management of alcohol withdrawal is directed at
alleviating symptoms and identifying and correcting metabolic
derangements. Benzodiazepines are used to control psychomotor
agitation and prevent progression to more severe w ithdrawal.
Supportive care, including intravenous fluids, nutritional
supplementation, and frequent clinical reassessment including
vital signs, is important (Spithoff et al., 2017).
Treatment with opioid agonists (methadone or buprenorphine) is
the first-line treatment for opioid use disorder (Knudson et al.,
2011).
The CDC (2020) recognizes that group therapy has been a core

4. aspect of drug and alcohol addiction recovery for several
decades, and it has proven to be very effective. Clients that
participate in group therapy have a higher rate of accountability
regarding their own behaviors. Motivational interviewing and
cognitive behavioral therapies are also remarkably effective on
an individualized level (Centers of Disease Control and
Prevention, 2020).
Brown, A. R. (2018). A Systematic Review of Psychosocial
Interventions in the Treatment of Opioid Addiction. Journal of
Social Work Practice in Addictions, 28(4), 135-142. Retrieved
from www.practiceinaddictions.com
Centers of Disease Control and Prevention. (2020).
https://www.cdc.gov/drugoverdose/epidemic/index.html
Spithoff, S., Turner, S., Gomes, T., Martins, D., & Singh, S.
(2017). First-line medications for alcohol use disorders among
public drug plan beneficiaries in Ontario. Canadian family
physician Medecin de famille canadien, 63(5), e277–e283.
Volkow, N., Frieden, T., Hyde, P., & Cha, S. (2014).
Medication-assisted therapies-tackling the opioid overdose
epidemic. New England Journal of Medicine, 67(2), 181-187.
Retrieved from www.nejm.org
Discussion Question Rubric
Note: Scholarly resources are defined as evidence-based
practice, peer-reviewed journals; textbook (do not rely solely on
your textbook as a reference); and National Standard
Guidelines. Review assignment instructions, as this will provide
any additional requirements that are not specifically listed on
the rubric.

5. Discussion Question Rubric – 100 Points
Criteria
Exemplary
Exceeds Expectations
Advanced
Meets Expectations
Intermediate
Needs Improvement
Novice
Inadequate
Total Points
Quality of Initial Post
Provides clear examples supported by course content and
references.
Cites three or more references, using at least one new scholarly
resource that was not provided in the course materials.
All instruction requirements noted.
40 points
Components are accurate and thoroughly represented, with
explanations and application of knowledge to include evidence-
based practice, ethics, theory, and/or role. Synthesizes course
content using course materials and scholarly resources to
support importantpoints.
Meets all requirements within the discussion instructions.
Cites two references.
35 points
Components are accurate and mostly represented primarily with
definitions and summarization. Ideas may be overstated, with
minimal contribution to the subject matter. Minimal application
to evidence-based practice, theory, or role development.

6. Synthesis of course content is present but missing depth and/or
development.
Is missing one component/requirement of the discussion
instructions.
Cites one reference, or references do not clearly support
content.
Most instruction requirements are noted.
31 points
Absent application to evidence-based practice, theory, or role
development. Synthesis of course content is superficial.
Demonstrates incomplete understanding of content and/or
inadequate preparation.
No references cited.
Missing several instruction requirements.
Submits post late.
27 points
40
Peer Response Post
Offers both supportive and alternative viewpoints to the
discussion, using two or more scholarly references per peer
post. Post provides additional value to the conversation.
All instruction requirements noted.
40 points
Evidence of further synthesis of course content. Provides
clarification and new information or insight related to the

7. content of the peer’s post.
Response is supported by course content and a minimum of one
scholarly reference per each peer post.
All instruction requirements noted.
35 points
Lacks clarification or new information. Scholarly reference
supports the content in the peer post without adding new
information or insight.
Missing reference from one peer post.
Partially followed instructions regarding number of reply posts.
Most instruction requirements are noted.
31 points
Post is primarily a summation of peer’s post without further
synthesis of course content.
Demonstrates incomplete understanding of content and/or
inadequate preparation.
Did not follow instructions regarding number of reply posts.
Missing reference from peer posts.
Missing several instruction requirements.
Submits post late.
27 points
40
Frequency of Distribution

8. Initial post and peer post(s) made on multiple separate days.
All instruction requirements noted.
10 points
Initial post and peer post(s) made on multiple separate days.
8 points
Minimum of two post options (initial and/or peer) made on
separate days.
7 points
All posts made on same day.
Submission demonstrates inadequate preparation.
No post submitted.
6 points
10
Organization
Well-organized content with a clear and complex purpose
statement and content argument. Writing is concise with a
logical flow of ideas
5 points
Organized content with an informative purpose statement,
supportive content, and summary statement. Argument content
is developed with minimal issues in content flow.
4 points
Poor organization and flow of ideas distract from content.
Narrative is difficult to follow and frequently causes reader to
reread work.
Purpose statement is noted.

9. 3 points
Illogical flow of ideas. Prose rambles. Purpose statement is
unclear or missing.
Demonstrates incomplete understanding of content and/or
inadequate preparation.
No purpose statement.
Submits assignment late.
2 points
5
APA, Grammar, and Spelling
Correct APA formatting with no errors.
The writer correctly identifies reading audience, as
demonstrated by appropriate language (avoids jargon and
simplifies complex concepts appropriately).
Writing is concise, in active voice, and avoids awkward
transitions and overuse of conjunctions.
There are no spelling, punctuation, or word-usage errors.
5 points
Correct and consistent APA formatting of references and cites
all references used. No more than two unique APA errors.
The writer demonstrates correct usage of formal English
language in sentence construction. Variation in sentence
structure and word usage promotes readability.
There are minimal to no grammar, punctuation, or word-usage
errors.

10. 4 points
Three to four unique APA formatting errors.
The writer occasionally uses awkward sentence construction or
overuses/inappropriately uses complex sentence structure.
Problems with word usage (evidence of incorrect use of
thesaurus) and punctuation persist, often causing some
difficulties with grammar. Some words, transitional phrases,
and conjunctions are overused.
Multiple grammar, punctuation, or word usage errors.
3 points
Five or more unique formatting errors or no attempt to format in
APA.
The writer demonstrates limited understanding of formal written
language use; writing is colloquial (conforms to spoken
language).
The writer struggles with limited vocabulary and has difficulty
conveying meaning such that only the broadest, most general
messages are presented.
Grammar and punctuation are consistently incorrect. Spelling
errors are numerous.
Submits assignment late.
2 points
5
Total Points
100

11. Care for the Client with a Substance Use Diagnosis
Hi, and thank you. I only need two reply posts, one for each of
the students below. I did already complete the discussion post
itself. I highlighted the directions. It does not have to be too
extensive. Could you please just separate the two replies for me
(on different documents)?
Thank you!!
Initial Post
In a Word document, address the following prompts:
· Elaborate on etiology, stressors, problems of addiction,
dependence, and relapse in the U.S. currently.
· Discuss potential objective physical and mental examination
findings when examining a client with a substance abuse issues
with rationales.
· Discuss the neurobiological mechanism that underlies the
addictive behavior reinforcing properties.
· What are the first-line pharmacotherapy and psychotherapy
interventions with implications for monitoring (for alcohol and
for opioid abuse).
Post your completed Word document to this discussion forum.
Use APA format with reference list (two to three books and/or
articles).
Reply Posts
Reply to at least two of your peers. In your replies, write a
maximum two paragraphs for each reply with two to three
sentences each that synthesizes one to two pieces of research.
Please refer to the Grading Rubric for details on how this
activity will be graded.
The described expectations meet the passing level of 80%.
Students are directed to review the Discussion Grading Rubric
for criteria which exceed expectations
First Reply
Shannon Schaal

12. Substance abuse is defined as the hazardous or harmful
use of psychoactive substances, including alcohol and illicit
drugs (World Health Organization, 2020). Substance abuse is
characterized by overindulgence in an addictive substance.
From 1999 to 2016, over 630,000 people have died from a drug
overdose (Centers for Disease Control and Prevention, 2020).
Substance abuse has become an epidemic in the United States.
Increased numbers of individuals are dying every day due to
overdoses. Approximately 66% of all drug overdose deaths in
2016 involved an opioid (Centers for Disease Control and
Prevention, 2020). Barry, Sherman, and McGinty (2018) report
that opiate overdoses are the leading cause of injury related
death in the United States and contribute to reversals in life
expectancy gains. On average, 115 Americans die daily from an
opioid overdose (Centers for Disease Control and Prevention,
2020). Access to drugs is becoming easier and easier.
Individuals are beginning drug use at younger ages. Drug
addiction can destroy a person’s life. Substance abuse can lead
to poor family dynamics, domestic violence, child abuse,
vehicle accidents, loss of employment, and even death. The
purpose of this discussion is to review the etiology of substance
dependence, discuss objective physical and mental examination
findings for a substance abuse patient, and discuss the
neurobiological mechanism that underlies addictive behavior.
This discussion will also review first-line pharmacological and
psychotherapeutic interventions for substance abuse.
There are multiple factors that contribute to the
etiology of substance use disorders including psychodynamic
factors, genetic factors, and neurochemical factors. Sadock,
Sadock, and Ruiz (2014) report that addiction has been
described as a “brain disease”, and that the critical processes
that transform voluntary drug-using behavior to compulsive
drug use are changes in the structure and neurochemistry of the
brain of the drug user. Drug availability, social acceptability,
and peer pressures may be the major determinants of initial drug
use; however, other factors such as personality and individual

13. biology play a key role in how the effects of a given drug are
perceived and the degree to which repeated drug use produces
changes in the central nervous system (Sadock et al., 2014).
Other factors, including the particular actions of the drug, may
be primary determinants of whether drug use progresses to drug
dependence, whereas still others may be important influences on
the likelihood that drug use (1) leads to adverse effects or (2)
leads to successful recovery from dependence (Sadock et al.,
2014). As with treatment for other chronic diseases, treatment
for addiction does not offer a cure. The chronic nature of
addiction means that for some people relapse,or a return to drug
use after an attempt to stop, can be part of the process (National
Institute on Drug Abuse, 2020). Recent drug relapse statistics
show that more than 85% of individuals relapse and return to
drug use within the year following treatment (American
Addiction Centers, 2020). Researchers estimate that more than
two thirds of individuals in recovery relapse within weeks to
months of beginning addiction treatment (American Addiction
Centers, 2020). These statistics reinforce the importance of
addiction treatment programs and access to treatment.
There are several objective physical and mental
examination findings which can indicate the presence of a
substance use disorder. Mersy (2013) reports that physical exam
findings that can suggest the presence of a substance use
disorder include tremor (suggestive of withdrawal from alcohol
or opiates), odor of alcohol on breath, enlarged or tender liver,
nasal irritation (suggestive or snorting substances), labile blood
pressure or tachycardia (suggestive of intoxication or
withdrawal from multiple substances), presence of hepatitis B
or C, or presence of HIV infection (suggestive of possible
needle sharing). Mental examination findings suggestive of a
substance use disorder include insomnia, history of frequent
trauma, frequent absences from work/school, sexual
dysfunction, and presence of other mental health disorders
(Mersy, 2013). A high prevalence of additional psychiatric
disorders is found among persons seeking treatment for

14. substance abuse; and some studies have shown that up to 50%
of those suffering from addiction have a comorbid psychiatric
disorder (Sadock et al., 2014). Additionally, positive results on
various screening tools can be suggestive of the presence of a
substance use disorder.
Understanding the neurobiological mechanism is
critical in understanding addiction. Researchers have identified
particular neurotransmitters and neurotransmitter receptors
involved with most substances of abuse. The major
neurotransmitters involved in developing substance abuse and
substance dependence are the opioid, catecholamine
(particularly dopamine), and GABA systems (Sadock et al.,
2014). Even in a person with completely normal receptor
function and neurotransmitter concentration, the long-term use
of a particular substance of abuse may eventually modulate
receptor systems in the brain so that the presence of the
substance in needed to maintain homeostasis (Sadock et al.,
2014).
There are various pharmacological treatments available
for substance use disorders. Saxon, Strain, and Peavy (2020)
report that first-line pharmacological treatment for patients with
an opioid use disorder include treatment with an opioid agonist
or an opioid antagonist. Examples of these medications include
methadone, subutex, and suboxone. The use of methadone
requires close monitoring. Most patients using methadone are
required to visit clinics daily to receive dosage administration.
Subutex and suboxone are available by prescription.
Medications used during alcohol withdrawal include
benzodiazepines, phenobarbital, anticonvulsants, clonidine, and
beta blockers (Sadock et al., 2014). Most clinicians choose
benzodiazepines for safety (Sadock et al., 2014). Patients
withdrawing from alcohol should be monitored for the duration
of detoxification, which is typically five to seven days for most
patients. If detoxification from alcohol has been completed and
the patient does not have a comorbid mental health condition,
little evidence favors prescribing psychotropic medications for

15. the treatment of alcoholism (Sadock et al., 2014). However,
certain medications can be prescribed to blunt the rewarding
effects of drinking and decrease alcohol cravings. These
medications include naltrexone and campral.
There are various psychotherapeutic treatments
available for substance use disorders. Dickerson et al. (2018)
report that motivational interviewing is one of the best studied
evidence-based treatments for substance use disorders.
Motivational interviewing is described as a directive, client-
centered counselling style for eliciting behavior change by
helping clients to explore and resolve ambivalence (Rollnick &
Miller, 2013). Another effective psychotherapy method for
treatment of substance use disorders is cognitive behavioral
therapy (CBT). Easton, Crane, and Mandel (2018) report that
CBT utilizes social learning theory, classical conditioning, and
operant conditioning to help individuals acquire healthier,
prosocial behaviors to replace established maladaptive
behaviors. Easton et al. (2018) further report that ample
evidence across several randomized controlled trials supports
the effectiveness of CBT at decreasing alcohol and drug use.
Research indicates an enhanced treatment outcome and longer
period of recovery with the combined treatment of motivational
interviewing and cognitive behavioral therapy when compared
with either treatment alone (Khattra et al. 2017)
Second Reply
Priscilla Asonye
According to National Survey on Drug Use and Health (2018)
(NSDUH, in 2017, about 19.7 million American adults aged (12
and older battled a substance use disorder with almost 74%
suffering from alcohol use disorder and about 38% battled illicit
drug use disorder. In 2017, about 8.5million American adults
were reported to have suffered from both a mental health
disorder and a substance use disorder, or co-occurring disorders
with drug abuse and addiction costing American society more
than $740billion annually in lost workplace productivity,

16. healthcare expenses, and crime-related cost National Institute
on Drug Abuse (2017)
Etiology:
Both the Substance Abuse and Mental Health Service
Administration (SAMHSA) and the National Institutes of
Health(NIH) similarly describe addiction as a long- term and
relapsing condition characterized by the individual
compulsively seeking and using drugs despite adverse
consequences. Presently the prevailing view regarding
prediction of whether an individual will become addicted to
substance is that interaction of the person’s unique biology and
environment both influence how the drug will impact a person’s
susceptibility to becoming addicted National Institute on Drug
Abuse (NIDA (2018) According to NIDA (2018), Biological
factors impacting addiction accounts for between 40%-60% of
an individual’s risk for addition, this includes, genes and
epigenetics, gender, ethnicity and stage of development, home
environment, family dynamics, friends and school. According to
NIDA (2018) people get addicted to drugs for many reasons but
one of the major factors behind why drugs are so addictive is
the rewarding, euphoric high they bring about as drugs have the
potential to significantly impact the systems in the brain
relating to pleasure and motivation and making it difficult for
other natural pleasures to compare. Dopamine is one of the
brain chemicals often discussed in the addictive power of
substances. Scientist believe that when a rewarding event
occurs, the brain releases dopamine to signal the experience and
encourage repetition. Dopamine tells the brain that the
experience of using a drug is important and should be repeated
and programed the brain to remember the people, place, things
associated with the use, so it will be easier for the person to
repeat the situation. With repetition, these burst of dopamine
tells the brain to value drugs more than natural reward, and the
brain adjust so that the reward circuit becomes less sensitive to
natural rewards. This can make a person feel depressed or
emotionally “flat” at a time they are not using drug NIDA

17. (2018) Over time, the desire for drug becomes a learned reflex-
so that the person can be triggered to use by people, place, and
things that are alike to their drug use just as someone might get
hungry driving by sight or smell of food NIDA (2018).
Discuss potential objective physical and mental examination
finding s when examining a client with a substance abuse issues
with rationale
According to Johnson and Vanderhoef (2016) substance abuse
or dependence produces many physical symptoms which are
usually a result of sequelae of use or abuse and depending on
whether if the patient is in the intoxicating or withdrawal
stages. Physical finding related to alcohol/substance use
disorders include drastic weight loss or gain, changes in
appearance and or hygiene, dilated or constricted pupils, red
eyes, slurred speech/problem with motor coordination HEENT,
poor oral health Johnson & Vanderhoef (2016)
Specifically, patients going through alcohol cessation or
reduction in substance use has been heavy or prolonged are
known to exhibit the following symptoms, within several hours
or days of reduction or cessation of substance intake: hand
tremor, insomnia, sweating, increase heart rate and increased
BP due to autonomic hyperreflexia Johnson and Vanderhoef
(2016) Patient also exhibits behavior such as hallucination or
illusions, psychomotor agitation, anxiety and may have seizure
also due to autonomic hyperreflexia. For other street drugs and
opioids, different drug use result to different behaviors for
example, stimulants: agitation, anxiety, irritability, mood
swings and elevated mood. Opioids: mood swing, aggression,
disinhibition, impaired cognition, slurred speech and
psychomotor slowing etc. Johnson &Vanderhoef (2016)
Discuss the neurobiological mechanisms that underlies the
addictive behavior reinforcing properties. Positive rewards of
reinforcement result in the social rewards commonly associated
with drug use such as disinhibition, euphoric mood, and anxiety
reduction. Drug- specific alterations in the normal level and

18. function of neurotransmitters occur as the body adapts to the
chronic presence of the substance of abuse. Neuroadaptive
process becomes very significant when the person tops
substance use. Neuroadaptive change may be more enduring in
some person, possibly lasting for years, thus increasing their
potential for relapse. This concept helps to explain why, after a
long period of sobriety, a person who return to substance abuse
often picks up at the same level they stop. Johnson &
Vanderhoef (2016)
What are the first line pharmacotherapy and psychotherapy
intervention with implications for monitoring (for alcohol and
for opioid abuse. According to Johnson and Vanderhoef (2016)
pharmacological treatments are symptom specific. E.g. for acute
alcohol withdrawal (detox agents replace uncontrolled use of
substance with slow tapering of controlled substance such as
benzoes are scheduled and gradually used to minimized
neuroadaptive rebound.
Also polytherapy is newer approach that matches drugs required
for safe and effective withdrawal with neurotransmitter deficiet
created by the substance use. Medication used are SSRI, Opioid
antagonist (naltrexone, anti –seizure meds such as tegretol and
valproic acid, adrenergic medication and anti- craving
medication such as naltrexone and multimodality treatment
possibly for life time treatment often required Johnson and
Vanderhoef (2016)