The document discusses substance abuse and dependence. It notes that substance abuse has become a widespread problem and defines substance abuse as the use of prescribed, illegal, or unintended substances to alter mood or mind. Substance abuse can develop from initial appropriate use and causes psychological and physical consequences. Substance dependence is characterized by problems developing from use, tolerance, and physiological or psychological dependence. Treatment involves inpatient or outpatient modalities like detoxification, support groups, and pharmacotherapy to aid sobriety maintenance.

1. Substance Abuse
and Dependence
Sheila Lechado, RN

2. OVERVIEW

3. • The abuse of alcohol and other
psychoactive substances has become an
endemic problem throughout all levels
of society
• In terms of substance abuse or
dependence, a substance can be defined
as a prescribed drug, an illegal drug, or
a substance used in an unintended
manner to produce mood or mind-
altering effect (eg, inhalants, glues, or
steroids).

4. • Substance abuse may arise
unintentionally from the initial use of a
substance for its approved purpose.
• The individual commonly faces not only
the psychological ramifications of a
substance-related disorder, but also
physiologic consequences resulting
from substance use or abuse.
• Substance abuse and dependence share
certain criteria and can be difficult to
distinguish from one another.

5. • With substance abuse, the pattern of use
has lead to the development of one or
more life problems
• In dependence, these problems can
coexist with a pattern of tolerance and
physiologic or psychological
dependence
• Withdrawal and tolerance are significant
criteria related to substance dependence;
however, dependence can exist without
either of these criteria being met

6. • Dependence has been characterized as
loss of control over the use of a
substance
• Dual diagnosis is defined as the
presence of a substance-related
diagnosis along with another psychiatric
disorder

7. MANAGEMENT

8. Treatment Modalities
• Inpatient modalities include programs of
detoxification and therapy sessions
designed to aid in the recognition of a
substance-related disorder.
• Outpatient therapies include support
groups, continued therapy sessions, and
the use of pharmacologic drugs to aid in
the maintenance of sobriety.

9. Detoxification
• Initial detoxification is typically
provided through inpatient
hospitalization.
• Detoxification protocols are unique to
each substance.

10. Detoxification
• Benzodiazepine taper is utilized during
detoxification from alcohol
• The treatment of cocaine withdrawal may
include administration of prescribed drugs
that can reduce craving, such as amantadine
(Symmetrel) or bromocriptine (Parlodel).
• The treatment of heroin withdrawal
generally involves transdermal clonidine
(Catapres) along with oral administration as
necessary.

11. Drugs for Alcohol Abuse
• Disulfiram (Antabuse) is used as
aversion therapy. It leads to
accumulation of acetaldehyde in the
blood system, causing flushing,
tachycardia, vomiting, nausea, and chest
pain, if alcohol is consumed.

12. • A nonaversion therapy, acamprosate
sodium (Campral), may be used in
attempts to ensure abstinence fron
alcohol. It interacts with the GABA
neurotransmitter system to restore
balance between neuronal excitation and
inhibition.
• Topiramate (Topamax) an
anticonvulsant, may reduce craving for
alcohol. Clinical trials have
demonstrated that ondansetron (Zofran)
may aid in reducing drinking.

13. Opiate withdrawal
• Administration of an opioid antagonist,
such as naloxone (Narcan) and
naltrexone (ReVia), reverses the effects
of opioids. Injectable sustained-release
formulations of naltrexone may also be
used.

14. • Outpatient detoxification is typically
focused on the administration of the
opioid agonist, methadone, or levo-
alpha-acetylmethadol (LAAM), a
longer-lasting formulation, to substitute
for the illicit drug.
• Another opioid agonist, buprenorphine
(Suboxone), is becoming available in
the United States to treat heroin
addiction.

15. • Psychosocial support through the use of
12-step or other treatment programs
(Rational Recovery).
• Psychoeducational therapy to
understand triggers of substance use and
prevention of relapse.
• Family support and educational groups.