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Psychoactive Drug Abuse And Dependence

The National Institute on Drug Abuse defines psychoactive drug abuse and dependence as the use of a legal or an illegal drug that causes physical, mental, emotional, or social harm. Examples of commonly abused drugs include narcotics, stimulants, depressants, anti anxiety agents, and hallucinogens. Drug abuse is a major public health problem in to­day's society.

Psychoactive drug abuse can occur at any age. Experimentation with drugs commonly begins in adolescence; recent statistics, however, document a trend toward drug use among preadolescents. Drug abuse often leads to addiction, which may involve physical or psychological dependence or both. The most dangerous form of abuse occurs when users mix several drugs simultaneously, including alcohol. The resultant interactions can complicate assessment, precipitate life-threatening complications. and delay withdrawal.

Causes

Psychoactive drug abuse commonly results from a combination of low self-esteem, peer pressure, inadequate coping skills, and curiosity. Most people who are predisposed to drug abuse have few mental or emotional resources against stress, an excessive dependence on others, and a low tolerance for frustration. Often anxious, angry, or depressed, they demand immediate relief of tension or distress. Taking the drug gives them pleasure by relieving tension, abolishing loneliness, achieving a temporarily peaceful or euphoric state, or simply relieving boredom.

Drug dependence may follow experimentation with drugs in response to peer pressure. It also may follow the use of drugs to relieve physical pain, but this is uncommon.

Treatment

The patient with acute drug intoxication should receive symptomatic treatment based on the drug ingested. Measures include fluid replacement therapy and nutritional and vitamin supplements. if indicated; detoxification with the same drug or a pharmacologically similar drug (exceptions include cocaine, hallucinogens, and marijuana, which aren't used for detoxification); sedatives to induce sleep; anticholinergics and antidiarrheal agents to relieve GI distress; antianxiety drugs for severe agitation, especially in cocaine abusers; and symptomatic treatment of complications. Depending on the dosage and time elapsed before admission, additional treatment may include gastric lavage, induced emesis, activated charcoal, forced diuresis and, possibly, hemoperfusion or hemodialysis.

Treatment of drug dependence commonly involves a triad of care: detoxification, short-and long-term rehabilitation, and aftercare; the latter means a life­time of abstinence, usually aided by participation in Narcotics Anonymous or a similar self-help group.

Detoxification, the controlled and gradual withdrawal of an abused drug, is achieved through substitution of a drug with similar action. Such gradual replacement of the abused drug controls the effects of withdrawal, reducing the patient's discomfort and associated risks.

Depending on which drug the patient has abused, detoxification may be managed on an inpatient or outpatient basis. For example, withdrawal from depressants can produce hazardous effects, such as generalized tonic-clonic seizures, status epilepticus, and hypotension; the severity of these effects determines whether the patient can be safely treated as an out­patient or requires hospitalization. Withdrawal from depressants usually doesn't require detoxification. Opioid withdrawal causes severe physical discomfort and can even be life-threatening. To minimize these effects, chronic opioid abusers commonly are detoxified with methadone.

To ease withdrawal from opioids, depressants, and other drugs, useful non-chemical measures may include psychotherapy, exercise, relaxation techniques, and nutritional support. Sedatives and tranquilizers may be administered temporarily to help the patient cope with insomnia, anxiety, and depression.

After withdrawal, rehabilitation is needed to prevent recurrence of drug abuse. Rehabilitation programs are available for both inpatients and outpatients; they usually last a month or longer and may include individual, group, and family psychotherapy. During and after rehabilitation, participation in a drug-oriented self-help group may be helpful. The largest such group is Narcotics Anonymous.


 

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