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Query: UMLS:C0278080 (physical dependence)
 1,658 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hospital-wide rumors and anecdotal reports had suggested that there was a potentially serious problem of alcohol and drug abuse among the psychiatric patients of this hospital. The authors describe a systematic, evaluative approach which gave direct and detailed information on the nature and extent of the problem thus permitting effective administrative solutions. Results of the study indicated that there were two qualitatively different populations of substance abusing patients. A considerable population of patients were routinely using alcohol and "soft" drugs on the hospital grounds, while another disturbing percentage of patients gave evidence of psychological or physical dependence on alcohol or hard drugs. Data from the evaluation was instrumental in implementing additional security measures to deal with casual substance abuse and additional, confidential treatment resources to deal with the more serious substance abuse problems in patients and staff.
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PMID:Evaluation of substance abuse problems in a psychiatric hospital. 64 Oct 22

The clinical characteristics of a series of patients who developed physical dependence to triazolam has not previously been described. We report five cases of high-dose triazolam abuse in which the daily dosage ranged from 5 to 15 mg (100-300 mg diazepam equivalent) and the duration of use ranged from 3 months to 5 years. Physical dependence usually occurs in the context of a history of alcohol or other drug abuse, a history of panic attacks or anxiety disorder, substitution of triazolam for a longer-acting benzodiazepine, or inappropriate use of triazolam as an anxiolytic agent given as multiple daily doses. A rational approach to the pharmacotherapy of triazolam withdrawal is described. Treatment to replace the triazolam with a long half-life CNS depressant and strategies for this pharmacologic therapy are discussed. The abuse liability of triazolam may be no greater and is most likely less than that of some other benzodiazepines.
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PMID:Detoxification for triazolam physical dependence. 131 43

Using a structured pro forma, 728 out of 775 medical undergraduates at a Nigerian university were surveyed for the prevalence and pattern of drug use. An operational definition of substance abuse was made, and 28 percent of students fell within that criterion. Male abusers (81 percent) exceeded female abusers (19 percent). Substances most commonly abused were alcohol (60 percent), minor tranquilizers (48 percent), tobacco (35 percent), and narcotics (29 percent), particularly codeine. Only 11 percent abused cannabis. While most students were polydrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56 percent was found. Drugs consumed on a daily basis were alcohol (2 percent) and tobacco (6 percent). The prevalence of drug use was highest among the fourth and final year students. The majority of students were occasional abusers; there was no evidence of physical dependence.
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PMID:Drug abuse among medical students at a Nigerian university: Part 1. Prevalence and pattern of use. 325 27

Zopiclone is a cyclopyrrolone which is chemically unrelated to the benzodiazepines and is thought to act on the GABAA receptor complex at a site distinct from, but closely related to, the benzodiazepine binding site. The hypnotic efficacy of zopiclone administered as single oral doses has been demonstrated in patients undergoing next-day surgery and in patients with insomnia, and these studies have established an optimal dose of 7.5mg for elderly patients. Using this dose, clinical studies have shown that zopiclone improved sleep in elderly patients to a similar extent as triazolam 0.125 to 0.5mg, flurazepam 15mg, and nitrazepam 5mg. Studies that also included younger patients have shown that zopiclone 7.5mg is at least as effective as triazolam 0.25 or 0.5mg, and on most sleep parameters is comparable to temazepam 20mg, nitrazepam 5mg, flunitrazepam 2mg, and flurazepam 20mg. Zopiclone causes minimal impairment to psychomotor performance and mental alertness the morning after night-time administration. The drug is generally well tolerated by patients of all ages; the most frequently reported adverse effects being bitter taste and dry mouth. Treatment withdrawal due to adverse effects is seldom required and reports of rebound insomnia after zopiclone withdrawal are rare. While symptoms of physical dependence have not been observed in clinical studies, there have been isolated reports of physical dependence in patients with a history of substance abuse. Although the latter finding should be kept in mind, it appears that zopiclone has a low dependence liability. Thus, with its short duration of action and good tolerability profile, zopiclone is a well established alternative to the benzodiazepine hypnotics and may be particularly beneficial in those patients unable or unwilling to tolerate the residual effects associated with many other hypnotic agents.
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PMID:Zopiclone. A review of its pharmacological properties and therapeutic efficacy as an hypnotic. 824 8

This paper reviewed heroin use data from the US government's epidemiologic monitoring system for substance abuse. The monitoring system has multiple components, i.e., the Drug Abuse Warning Network of reporting emergency rooms (9), annual surveys of high school and post-high school youth (3, 4), annual National Household Surveys of Substance Abuse (7, 8, 50), Drug Use Forecasting (51), the Community Epidemiology Work Group (52), and law enforcement systems not reviewed here. These monitoring systems should identify any major increase in heroin incidence in this country relatively early. This is important, because the early stages of heroin epidemics are often hidden from society, and the epidemics are already full-blown by the time health and other agencies become aware of the size of the affected population and are required to respond. The hidden or underground nature of heroin epidemics is caused by 1) the need of each user to hide an illegal activity and 2) the delay between the time when heroin is first used and the onset of physical dependence and other adverse consequences, which bring new heroin addicts to the attention of treatment and enforcement systems. Despite an epidemiologic surveillance system which should rapidly identify large-scale heroin spread in this country, our treatment and law enforcement systems are not organized to respond rapidly to contain an epidemic. Substance abuse treatment services are not structured for rapid expansion and contraction based on fluctuating need. Apart from HIV prevention programs, we do not have outreach teams attached to treatment programs that could quickly identify local outbreaks and involve new heroin abusers in treatment (10).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heroin epidemics revisited. 852 47

The objective of this study was to assess the perceptions and reported practices of osteopathic physicians in the diagnosis and treatment of addiction. Copies of survey questions were sent to the 344 members of the West Virginia Osteopathic Society. A total of 176 (51.2%) physicians responded; of these responses, 166 surveys were used for analysis. Respondents included 130 practicing physicians and 36 physicians in internship or residency training programs. Of those responding, 133 were men and 33 were women, and ages ranged from 24 to 81 years with a mean of 41.6 years. Respondents who were graduates of the West Virginia School of Osteopathic Medicine numbered 132 (79.5%), and 99 (59.6%) were in family practice. Characteristics most commonly attributed to addiction were a chronic nature and psychological or physical dependence. More than half of the test subjects did not consider addiction to be a primary disease independent of other factors or psychiatric conditions. Respondents reported a mean addiction prevalence of 20.4%, with the most common substances reported as tobacco, alcohol, and benzodiazapines, respectively. Individual prevalence reports varied from 0% to 95% (SD +/- 20.4%). The most commonly used diagnostic tools were the CAGE (Cut down, Annoyed, Guilty, and Eye-opener) test, DSM III-R (Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised) or DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria, and quantity and frequency questions. Medical sequelae such as jaundice or emphysema were the most likely reasons for the respondents to address a substance abuse problem. For referral resources, respondents were most likely to use inpatient or outpatient treatment. A mean success rate of 27.7% was reported by the 133 physicians responding. The wide variance in reported prevalence and the low success rate reported in comparison to that demonstrated in published treatment studies indicate that there is a need for further education of both physicians in training and those presently in practice. Medical sequelae are frequently irreversible signs of late-stage addiction, and physicians should be urged to include such tools as the CAGE test in each regular physical to facilitate earlier intervention.
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PMID:Perceptions and reported practices of osteopathic physicians in diagnosing and treating addiction. 1052 83

This article presents a perspective on addiction that not only substantiates why group therapy is the treatment of choice for addiction, but also integrates diverse perspectives from 12-step abstinence-based models, self psychology, and attachment theory into a complementary integrative formula. Attachment theory, self psychology, and affect regulation theory characterize addiction as an attachment disorder induced by a person's misguided attempt at self-repair because of deficits in psychic structure. Vulnerability of the self is the consequence of developmental failures and early environmental deprivation leading to ineffective attachment styles. Substance abuse, as a reparative attempt, only exacerbates that condition because of physical dependence and further deterioration of existing physiological and psychological structures. Prolonged stress on existing structures leads to exaggerated difficulty in the regulation of affect, which leads to inadequate modulation of appropriate behavior and self-care and increased character pathology.
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PMID:Addiction as an attachment disorder: implications for group therapy. 1119 96

At a recent seminar on pain management in Atlanta, researchers reported that health care providers do poorly when it comes to recognizing and managing the pain suffered by patients with AIDS. This lack of adequate attention is reflected in the lack of relevant studies about pain management in the medical literature. As with cancer, AIDS pain increases with disease progression. However, patients with AIDS tend to be more depressed than cancer patients, and have a higher rate of suicidal thoughts. Experts at the seminar discussed the obstacles involved in treating pain in AIDS patients who have a history of substance abuse. According to one study, pain medication addiction is rare in patients. Providers must distinguish between tolerance and physical dependence. Guidelines for managing pain in substance abusers include respecting the patient's reports of pain, and setting clear goals and conditions for opioid therapy. Using a team approach that recognizes pharmacological and non-pharmacological interventions, and that pays attention to psychosocial issues will also lead to greater success in treating patients with pain. The most common painful illnesses are HIV-related headaches, herpes simplex, peripheral neuropathy, back pain, herpes zoster, and throat pain.
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PMID:Clinicians not providing necessary pain relief for AIDS patients. 1136 81

The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids. With increasing use of opioids for treatment of pain and the availability of sublingual buprenorphine in the United States for treatment of opioid dependence, clinical assessment of opiate withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high level of opioid dependence who are not experiencing opioid withdrawal. Since development of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal scales have been used in clinical and research settings. This article reviews the history of opiate withdrawal scales and the context of their initial use. A template version of the COWS that can be copied and used clinically is appended. PDF formatted versions of the COWS are also available from the websites of the American Society of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated Substance Abuse Programs, and AlcoholMD.com.
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PMID:The Clinical Opiate Withdrawal Scale (COWS). 1292 48

Successful pain management in the recovering addict provides primary care physicians with unique challenges. Pain control can be achieved in these individuals if physicians follow basic guidelines such as those put forward by the Joint Commission on Accreditation of Healthcare Organizations in their standards for pain management as well as by the World Health Organization in their stepladder approach to pain treatment. Legal concerns with using pain medications in addicted patients can be dealt with by clear documentation of indication for the medication, dose, dosing interval, and amount provided. Terms physicians need to be familiar with include physical dependence, tolerance, substance abuse, and active versus recovering addiction. Treatment is unique for 3 different types of pain: acute, chronic, and end of life. Acute pain is treated in a similar fashion for all patients regardless of addiction history. However, follow-up is important to prevent relapse. The goal of chronic pain treatment in addicted patients is the same as individuals without addictive disorders-to maximize functional level while providing pain relief. However, to minimize abuse potential, it is important to have 1 physician provide all pain medication prescriptions as well as reduce the opioid dose to a minimum effective dose, be aware of tolerance potential, wean periodically to reassess pain control, and use nonpsychotropic pain medications when possible. Patients who are at the end of their life need to receive aggressive management of pain regardless of addiction history. This management includes developing a therapeutic relationship with patients and their families so that pain medications can be used without abuse concerns. By following these strategies, physicians can successfully provide adequate pain control for individuals with histories of addiction.
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PMID:Successful Pain Management for the Recovering Addicted Patient. 1501 19


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