Treatment of Alcohol Use Disorders

In general, treatment for substance dependence involves a combination of several psychosocial interventions, which can be combined with pharmacological interventions. Treatment of AUDs can be preceded by a detoxification, depending on severity of alcohol dependence. Personality and Substance Misuse and Pharmacotherapy of Addiction are discussed in depth in site. A short description and discussion of psychological and pharmacological interventions in AUDs are presented below. Detoxification: Symptoms, Medication The first stage of treatment for alcohol dependence often consists of alcohol detoxification, in order to prevent complications during detoxification, and to diminish symptoms and adverse effects associated with detoxification. Symptoms can develop within several hours after last alcohol use, and usually show a peak 24–36 h after abstinence. Symptoms that can be experienced during alcohol detoxification are anxiety, restlessness, sleeplessness, sweating, nausea, vomiting, tremors, heightened blood pressure, and an increased heart rate. Alcohol detoxification is estimated to take a week, although sleep disturbances and psychological withdrawal symptoms can persist much longer. Monitoring of alcohol-dependent Read more […]

Drug Preference in Humans: Lorazepam

A drug’s capacity to reinforce behavior in a laboratory setting usually correlates with its dependence potential in the general population. In laboratory tests, diazepam is not an effective positive reinforcer, either in laboratory animals using drug self-administration tests () or in normal human volunteer subjects using a choice test (). The failure to find evidence for a positive reinforcing effect of diazepam in these experimental tests is inconsistent with clinical reports that diazepam is used excessively by some people. The failure to demonstrate the positive reinforcing efficacy of diazepam in an experimental situation may be due in part to the drug’s long duration of action (half-life = 24 – 48 hours). In animal self-administration studies that test the reinforcing efficacy of drugs, it has been found that benzodiazepines that have shorter durations of action are also more effective reinforcers (). In the present study, human subjects were tested for preference for lorazepam, a benzodiazepine with effects similar to diazepam but with a shorter half-life than diazepam (half-life = 12-15 hours). Method Subjects. Twelve normal healthy volunteers, aged 21 to 27 (4 males, 8 females) participated in this study. Read more […]

Benzodiazepines in the Treatment of Alcoholism

This post comprises three sections that cover the main aspects of benzodiazepines and alcohol: (1) the basic pharmacology of benzodiazepines; (2) use of benzodiazepines in the treatment of withdrawal; and (3) the use of benzodiazepines in treating alcoholics. The basic studies suggest that a major site of action of alcohol may be the GABA/benzodiazepine receptor complex and that compensatory alterations in this complex may underly withdrawal. In the section on alcohol withdrawal, interactions between the GABA/benzodiazepine receptor complex, sympathetic nervous system, and hypothalamic-pituitary-adrenal axis are discussed. Use of benzodiazepines in the treatment of the alcohol withdrawal syndrome are reviewed, including the possibility that the benzodiazepines may prevent withdrawal-induced “kindling”. Lastly, we review indications for, and efficacy of, benzodiazepines in long-term treatment of patients with alcoholism. Benzodiazepines are not indicated for the treatment of alcoholism. Furthermore, they have very few indications in alcoholics and their dependency-producing potency has to be appreciated when they are used in patients with alcoholism. The benzodiazepines () are a group of compounds that were first Read more […]

Alcohol and Panic Attacks

Panic attacks with and without agoraphobia are more common among alcoholics than the rest of the population. The simplest explanation may be that certain patients with panic attacks drink alcohol to alleviate anticipatory anxiety. The relationship between panic attacks and alcoholism may, however, be complex. Both alcohol withdrawal and panic attacks have been demonstrated to be associated with noradrenergic overactivity. Furthermore, tolerance to alcohol seems to be partly conditioned, at least in experimental animals, and it involves physiological changes compatible with sympathetic activation. Tolerance is not maintained in experimental animals with central noradrenergic lesions. Thus, noradrenergic activation may play an important role both in conditioning tolerance and panic attacks. Another phenomenon pertinent to alcohol withdrawal, with implications for panic attacks, is kindling. Repeated alcohol withdrawals may lead to kindling. This was first postulated based on a retrospective chart review of patients with alcohol dependence which showed that repeated withdrawals became progressively more severe. More recently, it was demonstrated that blunted responsiveness of noradrenergic a2-autore-ceptors was positively Read more […]

Benzodiazepines in the Treatment of Alcoholism: Future Directions

The above treatment recommendations emphasize that minimal signs and symptoms of ethanol withdrawal can generally be treated without pharmacotherapy. The repeated experience of untreated ethanol withdrawals, however, may produce a “kindling” effect over time. Kindling is the “progressive increase in neural responsivity produced by spaced and repeated epileptogenic stimulation of certain brain structures.” The kindling hypothesis suggests that each additional episode of withdrawal will elicit increasingly severe signs and symptoms. Preclinical studies in which the severity of the ethanol withdrawal syndrome increased in rats subjected to repeated episodes of ethanol withdrawal or following kindling induced by electroshock, metrazol injections, or amygdaloid stimulation indicate that such a process may take place. In addition, a retrospective study in alcoholics reported that periods of heavy drinking and dependence on ethanol were associated with an exacerbation of agoraphobia and social phobias, and that subsequent periods of abstinence were associated with substantial improvements in these phobic anxiety states. A recent study demonstrated that patients with panic disorder and alcohol dependence do not distinguish Read more […]

Benzodiazepine Treatment of the Ethanol Withdrawal Syndrome

The objective of drug treatment in ethanol withdrawal is the relief of subjective symptoms, the prevention or treatment of more serious complications such as seizures or delirium tremens, and the preparation for long-term rehabilitation with minimal hazard of new dependence problems or direct toxicity related to drug treatment. The ideal drug for alcohol withdrawal should have a rapid onset and long duration of action, wide margin of safety, metabolism not dependent on liver function, and absence of abuse potential. The various benzodiazepines offer many of these advantages; the selection of the most appropriate benzodiazepine will depend on the clinical situation. Withdrawal severity can be quickly and reliably determined upon admission by measuring breath alcohol concentration and administering an objective rating scale, such as the CIWA-A (Clinical Institute Withdrawal Assessment of Alcohol). Patients in mild ethanol withdrawal (CIWA-A<20) and without a prior history of withdrawal seizures can generally be treated conservatively (fluids, multivitamins, reassurance, antacids, thiamine). Treatment without medication offers the patient an opportunity to exercise nonpharmacological control over his or her life Read more […]

A Study of the Effects of Certain Tranquilizers and Small Amounts of Alcohol on Driving Performance

STUDY: Clayton, A.B., T.A. Betts, and G.M. Mackay. A Study of the Effects of Certain Tranquilizers and Small Amounts of Alcohol on Driving Performance. European J. Toxicol., 5:254-257. 1972. Site: Departments of Transportation, Environmental Planning, and Psychiatry, University of Birmingham, United Kingdom. Subjects: The 50 males and 50 females were mostly students, the mean age being 28.1 years. Their driving experience varied, and none normally took prescribed psychotropic medications. Method: Subjects performed closed-course driving-tests under controlled conditions. They were generally tested in groups of six, using a fixed routine. On Wednesday afternoon, subjects practiced for 1 hour on all driving tests at the driving site. They then received two unmarked bottles – one containg five drug tablets, the other five placebo tablets – along with directions of how and when to take them. (Both bottles used by the control group contained placebos.) One bottle was to be used first – one tablet Friday evening; three on Saturday (at intervals); and the fifth Sunday morning. Random double-blind administration techniques were used. On Sunday morning, subjects performed three runs on test 1, three runs on Read more […]

Benzodiazepines: Drug Discrimination and Physiological Dependence

The benzodiazepines are among the most widely used of all prescribed drugs. Concern about abuse of these drugs has prompted the development of preclinical methods for assessing various pharmacological effects of diazepam-like drugs which are relevant to their abuse and dependence liability. This abstract describes results from a series of ongoing experiments to assess discriminative stimulus effects and physiological dependence-producing properties of benzodiazepines. Drug discrimination: In drug discrimination procedures, animals are trained to respond differentially depending on the nature of drug pretreatment. The procedure can provide information analogous to a human testing situation in which subjects categorize drugs with respect to their subjective effects. In ongoing drug discrimination experiments, four baboons were trained to discriminate lorazepam (1.0 mg/kg) and two baboons were trained to discriminate pentobarbital (5.6 mg/kg) in a two-lever drug versus no-drug discrimination procedure. Food delivery depended on 20 consecutive responses on one lever in sessions preceded by an intramuscular injection of the training drug (60-min pretreatment time), and on 20 consecutive responses on the other lever Read more […]

The Effects of Law Enforcement Activity on a Population of Opiate Abusers

This study examined the effect of police action against heroin pushers on clients of methadone programs in metropolitan Denver. On November 10, 1979, twenty suspected drug dealers and buyers were arrested and another twenty were under investigation in a vice squad operation in metropolitan Denver. The operation involved an undercover agent who mingled with addicts and bought opiates over an extended period from dealers, who were later arrested within a 48-hour period. Newspaper reports indicated that most of those arrested had been selling heroin in the vicinity of the outpatient clinic operated by Addiction Research and Treatment Services (ARTS) of the University of Colorado School of Medicine. Although linked to the clinic by the press, only two of those arrested were known to clinic personnel. In this study we examined the patterns of opiate use of the clients enrolled in that clinic as reflected by the presence of opiate metabolites in their urine samples collected before and after the drug bust. The clinical course of a sample of clients who abused opiates before, but not after the bust was examined. In addition, urine data from the other two methadone programs in the city were examined. Metropolitan Denver Read more […]

Treatment of Behavioral and Psychiatric Problems Associated With Opiate Dependence

Diverse problems and challenges confront the staff members of programs/clinics intended to treat individuals with histories of opiate use and associated problems. The clinic sponsored and staffed by the Philadelphia Veterans Administration Medical Center and University of Pennsylvania provides numerous examples of the merits and problems of such treatment programs. The clinic’s patient population over the past decade has varied from two to four hundred patients. A range of services is provided along with pharmacological interventions including opiate-specific treatments such as methadone, LAAM, naltrexone, and a variety of psychotherapeutic agents administered in treatment of diverse presenting disorders. It should be noted that the clinic differs in some respects from “standard” clinics insofar as it includes numerous associated ongoing basic and applied research projects. There may therefore be more options and staff available from time to time but there may also be considerable variability uncharacteristic of other clinics. In any case the clinic appears to have many of the problems reported to prevail in other nonresearch clinics. It can therefore be used as a reference in the sorts of issues which do arise. Patients Read more […]