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 […]

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 […]

Types of Alcoholics

Eight reviews of studies of the “alcoholic” personality have concluded that research has failed to establish the existence of any single constellation of personality traits in alcoholics that would predispose a person to alcoholism. The most recent reviewer, Barnes, concluded that alcoholics present a fairly common personality pattern when they arrive for treatment but acknowledged that the evidence for a prealcoholic personality is limited to reports from one group of researchers. Most research on the clinical alcoholic personality has been successful in characterizing how alcoholics are different from normal subjects or psychiatric patients, but it has not satisfied those clinicians who have been impressed with the subgroupings of personality within alcoholism treatment populations. The following review is organized around five themes in the research literature about subdivision of alcoholics into types as follows: (1) essential versus reactive alcoholics; (2) primary versus affective disorder alcoholics; (3) psychiatric syndrome groups: depressed versus neurotic versus psychopathic alcoholics; (4) clustered personality trait type alcoholics; (5) successful and unsuccessful “life style” alcoholics. In order Read more […]

A Contingency Analysis of Family Treatment and Drug Abuse

Historically, there has been relatively little interchange between family therapists and behavior analysts or therapists, although there are subareas with greater overlap, including teaching parents to use operant approaches with their children (), and teaching couples behavioral skills and communication and problem-solving (). The aim of this chapter is to demonstrate that there is a family treatment approach to drug abuse () that is based on sound behavioral principles and to articulate these principles so that they can be applied to any treatment program wishing to increase family involvement. The chapter will deal with three major topics: (1) evidence of the power. of the family to influence treatment outcome; (2) engagement of the family in treatment; (3) development of a treatment plan which includes the family. Much of the material presented relates to the process of initial engagement of the family in treatment and the broad contingencies affecting the degree of family participation. Specific principles will be presented which can dramatically increase the degree of family participation in treatment. Less emphasis is placed upon specific family therapy techniques which have been discussed in detail by 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 […]

Multimodality Treatment of Narcotic Addiction: Pharmacologic Therapies

Narcotic substitution The single therapy that has had the greatest impact on narcotic addiction appears to be methadone maintenance. Unlike drug-free approaches, it is acceptable to a large number of addicts (). It is medically safe, has minimal side effects and no toxicity when given to tolerant individuals, even for long periods of time (). Though the results of methadone treatment vary among programs, there is strong evidence that it provides a way to control narcotic addiction. Most patients who remain in methadone treatment have a marked decrease in heroin use, an increase in employment rates, and demonstrate improved personal adjustment (). At present there are approximately 80,000 people being treated with methadone in the United States (), but despite methadone’s wide applicability and effectiveness, it leaves much to be desired. It has been controversial since the beginning, and many aspects of methadone programs have been criticized (). One problem has been an inability to demonstrate that methadone treatment increases the long term cure rate for addiction. This is a disappointment, as many had hoped that the social rehabilitation obtained via methadone maintenance would lay the groundwork for successful Read more […]

Drug-Drug Interactions of Cannabinoids

Alcohol Additive psychoactive effects sought by users may be achieved by combinations of cannabis and alcohol, but at the same time the ability of THC to induce microsomal enzymes will increase the rate of metabolism of alcohol and so reduce the additive effects. Anticholinergic drugs The anticholinergic effects of cannabis may result in interactions with other drugs with anticholinergic effects, such as some antidysrhythmic drugs. Barbiturates, short-acting Additive psychoactive effects sought by users may be achieved by combinations of cannabis and short-acting barbiturates, but at the same time the ability of THC to induce microsomal enzymes will increase the rate of metabolism of barbiturates and so reduce the additive effects. Disulfiram Concurrent administration with disulfiram is associated with hypomania. Indinavir The effects of smoked marijuana (3.95% tetrahydrocan-nabinol; up to three cigarettes per day) and oral dronabi-nol (2.5 mg tds) on the pharmacokinetics of indinavir 800 mg 8-hourly (n =28) have been evaluated in a randomized, placebo-controlled study in HIV-infected patients. On day 14, marijuana reduced the 8-hour AUC of indinavir by 15%, the Cmax by 14%, and the Cmin by 34%. However, only Read more […]

Alcohol-Related Disorders

Workers in the addiction field have attempted to more clearly define alcohol use problems, and accuracy is especially important for making a diagnosis in a medical setting. Several hospitalizations for alcohol-related illness can occur before a direct connection is made between a patient’s alcohol use and medical problems. Alcoholic patients tend to experience many alcohol-related problems before seeking professional help or attending AA meetings. Stigma associated with the term alcoholism frequently inhibits physicians and patients from exploring the connections between abuse and biopsychosocial consequences. Psychiatrists participating in a hospital survey positively identified alcohol abuse two-thirds of the time, whereas physicians treating gynecology patients diagnosed the disorder only 10% of the time. In primary care settings similar underdiagnosis is common; however, in studies that rely on chart review or screening instruments, investigators may underestimate what physicians really suspect to be the case. The official psychiatric nomenclature for alcohol abuse and dependence evolved from the view of alcoholism as a personality disorder (American Psychiatric Association 1952), through recognition of episodic, Read more […]