Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 37 Drug Abuse I: Basic Considerations

2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Drug Abuse  Knowledge of abuse needed by healthcare members  Diagnosis and treatment of acute toxicity  Diagnosis and treatment of secondary medical complications of drug abuse  Facilitating drug withdrawal  Providing education and counseling to maintain long-term abstinence

3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Definitions  Drug abuse: using a drug in a fashion inconsistent with medical or social norms  Drug addiction: disease process characterized by continued use of a specific psychoactive substance(s) despite physical, psychologic, or social harm

4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Other Definitions  Tolerance  Psychologic dependence  Physical dependence  Cross-dependence  Withdrawal syndrome

5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Diagnostic Criteria for Substance Abuse and Substance Dependence  DSM-IV  See Table 37-1 DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Factors That Contribute to Drug Abuse  Reinforcing properties of drugs  Physical dependence  Psychologic dependence  Social factors  Drug availability  Vulnerability of the individual

7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Neurobiology of Addiction  Voluntary users can become compulsive users as a result of molecular changes in the brain  Reward circuit (system that normally serves to reinforce behaviors essential for survival) is activated  Major transmitter is dopamine

8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Principles of Addiction Treatment  With therapy, 40%–60% can reduce drug use  Ideal goal of treatment is complete cessation of drug use  Change from compulsive to moderate will be beneficial  Sustained moderation is very difficult for opioid, cigarette, and alcohol abuse

9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. The Controlled Substances Act  Comprehensive Drug Abuse Prevention and Control Act of 1970  Record keeping  DEA Schedules I through V  Prescriptions  Labeling  State laws DEA = Drug Enforcement Agency.