Substance Abuse

Substance abuse includes a pattern of behaviors associated with using a substance (beverage, medication, etc.) for its psychologic and physiologic effects rather than for approved medical reasons. There is an overwhelming involvement in obtaining and using the substance for these effects, often interfering with normal activities of daily living. The individuals who are abuse these substances are compulsive in obtaining and using them. They often tend to relapse even after having gone through physiologic withdrawal of the substance. These types of behaviors are referred to as addictive behaviors. Although the term addiction often refers to both psychologic and physiologic dependence.

Psychologic dependence implies that the substance is being used repeatedly for personal gratification or euphoria. The repeated use will occur despite verbal statements that the substance may be harmful, or that the individual would like to stop using the substance.

The physiologic consequences of substance abuse include physical dependence on the substance and drug tolerance. However, physical dependence and drug tolerance can occur even when medications are used for appropriate reasons. Thus, physical dependence and drug tolerance are not indicative of addictive behaviors or substance abuse.

Physical dependence is a physiologic response of the body to repeated dosages of a particular medication for an extended period of time. In the case of narcotics, if the narcotic is stopped abruptly, the individual undergoes physiologic withdrawal. The symptoms are often severe enough, to require medical treatment. However, if the medication dosage is tapered down overtime, these symptoms can be avoided.

Withdrawal symptoms usually occur within a few hours after the effects of the substance have dissipated. The symptoms particularly with opiate withdrawal often include increased activity of the autonomic nervous system.

Drug tolerance is a physiologic phenomenon that occurs when the usual dosage is no longer effective. Higher dosages are needed to obtain the desired effect. Not only does drug tolerance occur with regard to pain relief, but there is also a tolerance to the concomitant respiratory depression that is seen with administration of narcotics.

Effective treatment for substance abuse must be individualized. The circumstances related to substance abuse may vary. The National Institute of Drug Abuse has specific guidelines for developing individualized treatment programs.

Study Question:

Since substance abuse is both a psychologic and physiologic illness, what medication protocols would you recommend to enable the patient to overcome his addiction?

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Ó JPFrizzell 2000