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Chapter 37

Chapter 37. Drug Abuse I : Basic Considerations. Drug Abuse. Knowledge of abuse needed by healthcare members Diagnosis and treatment of acute toxicity Diagnosis and treatment of secondary medical complications of drug abuse Facilitating drug withdrawal

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Chapter 37

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  1. Chapter 37 Drug Abuse I: Basic Considerations

  2. Drug Abuse • Knowledge of abuse needed by healthcare members • Diagnosis and treatment of acute toxicity • Diagnosis and treatment of secondary medical complications of drug abuse • Facilitating drug withdrawal • Providing education and counseling to maintain long-term abstinence

  3. Definitions • Drug abuse: using a drug in a fashion inconsistent with medical or social norms • Drug addiction: disease process characterized by continued use of a specific psychoactive substance(s) despite physical, psychologic, or social harm

  4. Other Definitions • Tolerance • Psychologic dependence • Physical dependence • Cross-dependence • Withdrawal syndrome

  5. Diagnostic Criteria for Substance Abuse and Substance Dependence • DSM-IV • See Table 37-1 DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

  6. Factors That Contribute to Drug Abuse • Reinforcing properties of drugs • Physical dependence • Psychologic dependence • Social factors • Drug availability • Vulnerability of the individual

  7. Neurobiology of Addiction • Voluntary users can become compulsive users as a result of molecular changes in the brain • Reward circuit (system that normally serves to reinforce behaviors essential for survival) is activated • Major transmitter is dopamine

  8. Principles of Addiction Treatment • With therapy, 40%–60% can reduce drug use • Ideal goal of treatment is complete cessation of drug use • Change from compulsive to moderate will be beneficial • Sustained moderation is very difficult for opioid, cigarette, and alcohol abuse

  9. The Controlled Substances Act • Comprehensive Drug Abuse Prevention and Control Act of 1970 • Record keeping • DEA Schedules I through V • Prescriptions • Labeling • State laws DEA = Drug Enforcement Agency.

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