Outpatient Treatment and Outcome of Prescription Drug Abuse

Forty-six consecutive patients who voluntarily sought outpatient treatment for abuse of one or more prescription drugs were studied. Barbiturates, amphetamines, and diazepam were the most common drugs abused. Desired treatments by patients included counseling, medical withdrawal, or medical maintenance with the drug of abuse or a chemically related drug. Twenty-two (47.8 percent) patients left treatment and relapsed within one month; another eight (17.4 percent) patients relapsed between one and three months after entering treatment. Only 13 (28.3 percent) reported abstinence 90 days after entering treatment. This experience suggests that a wide range of medical, social, and psychologic resources are required to treat prescription drug abuse, and that long-term drug abstinence is difficult to achieve with all patients. Treatment of prescription drug abuse has dealt primarily with drug complications such as overdose, toxic reactions, and techniques for medical withdrawal. Other reports describe behavior patterns of prescription drug abuse and often refer to it as poly-drug abuse, since many persons frequently abuse more than one drug. Some reports emphasize the clinical complexity of poly-drug abuse and particularly Read more […]

Treatment of Alcoholism

Apparently because of the lack of knowledge of the physiological basis for what is now known as the acute alcohol withdrawal syndrome, there has been an enormous variety of therapies advocated and employed in their treatment. All workers know of, and probably many have used: alcohol itself, in tapering-off doses, paraldehyde, adrenal extract, thiamine, insulin, oxygen, nicotinic acid, magnesium sulphate, intravenous fluids, dehydration, etc. In the mid-1950s, reserpine, and then the phenothiazines, were hailed as the drugs of choice in the treatment of the alcohol withdrawal states. Although early reports were enthusiastic, controlled studies subsequently found these agents less than ideal in this indication. Reserpine, in the large doses required, added to the gastro-intestinal woes of these patients, and often also led to serious hypotensive episodes. Fortunately, it rather quickly lost favour; I have seen no recent references to its use in alcohol withdrawal. The phenothiazines as a group have been found to lower the convulsive threshold, a severe handicap in the treatment of a condition in which the convulsive threshold is already low. That this is not merely an interesting theoretical consideration is evidenced Read more […]