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Substance-Related Disorders

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify the prevalence of abuse for commonly used substances (i.e., alcohol, opioids, central nervous system [CNS] stimulants, and nicotine) in the U.S. population.

  2. Explain the commonalities of action of abused substances on the reward system in the brain.

  3. Identify the typical signs and symptoms of intoxication and withdrawal associated with the use of alcohol, opioids, CNS stimulants, and nicotine.

  4. Determine the appropriate treatment measures to produce a desired outcome after episodes of intoxication and withdrawal.

  5. Determine when a patient meets criteria for substance dependence.

  6. Choose specific pharmacotherapeutic options based on patient-specific factors.

  7. Recommend a comprehensive medication treatment and monitoring program to help maintain recovery and prevent relapse to substance abuse.

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KEY CONCEPTS

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  • Image not available. Pharmacotherapy has been shown to have a role in treatment of some substance-related disorders, including intoxication, withdrawal, and long-term relapse prevention. These substances include alcohol, opioids, CNS stimulants, and nicotine.

  • Image not available. Virtually all abused substances appear to activate the same brain reward pathway, which is highlighted by dopaminergic neurotransmission arising in the ventral tegmental area and projecting to the nucleus accumbens and prefrontal cortex.

  • Image not available. Although activation of the reward pathways explains the pleasurable sensations associated with acute substance use, chronic use of abused substances, which may result in addiction and withdrawal, may be related to neuroadaptive effects occurring within the brain.

  • Image not available. Individuals with a pattern of chronic use of commonly abused substances should be assessed to determine if they meet the Diagnostic and Statistical Manual, fourth edition, text revision, criteria for substance dependence or withdrawal.

  • Image not available. The treatment goals for acute intoxication of ethanol, CNS stimulants, and opioids include (a) management of psychological and psychiatric manifestations of intoxication, such as aggression, hostility, and psychosis and (b) management of medical manifestations of intoxication, such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, and stroke.

  • Image not available. The treatment goals for withdrawal from ethanol, CNS stimulants, and opioids include (a) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (b) management of other medical manifestations, and (c) referral to the appropriate program for long-term substance abuse treatment.

  • Image not available. A multimodal and comprehensive approach is usually preferred when treating individuals with substance use disorders given the heterogeneous nature of addiction. Pharmacologic treatment is always adjunctive to psychosocial therapy.

  • Image not available. Certain pharmacologic agents have been shown to be helpful for long-term maintenance in patients with substance dependence. Typically, these medications exert their effects by one of the following theorized mechanisms: (a) drug substitution therapy with an agonist, (b) blocking drug effects with an antagonist, and (c) miscellaneous relapse prevention medications with indirect mechanisms of action.

  • Image not available. A major component of successful treatment of addiction is to continue monitoring the use of medications and to identify a mechanism for long-term support of sobriety that might be appropriate, such as Alcoholics Anonymous (AA) or recovery programs for professionals such as doctors, nurses, or pharmacists.

  • Image not available. Clinicians ...

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