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» Addiction to chemical substances usually includes dependence on psychoactive agents that results in pleasure or modifies thinking and perception

. » Almost every drug of abuse harms some tissue or organ in addition to the brain; some health problems are caused by the effects of specific drugs or from the behaviors associated with addiction. » Long-term management of addiction is often provided in specialized treatment facilities that provide both drug and behavior therapies.

» The most common addictive behavior is tobacco use. The complications associated with the use of tobacco (nicotine) are related to dose and method of ingestion. » Smoking is the most harmful method of nicotine use and can injure nearly every organ in the body. » The effects of nicotine on the brain are identical to those of other highly addictive stimulant drugs, including cocaine. » Tobacco use is the leading cause of preventable illness and death in the United States. » The advice and motivation of health care professionals can be a powerful force in smoking cessation. » A variety of nicotine replacement products can be used to reduce the amount of the craving and withdrawal symptoms associated with tobacco cessation.

» Alcoholism is viewed as a progressive, potentially fatal disease if untreated. » Alcohol affects almost all cells of the body and has complex effects on neurons in the central nervous system (CNS). Its effects are related to the concentration of alcohol and individual susceptibility to the drug. » Acute alcohol toxicity may occur with binge drinking or the use of alcohol with other CNS depressants. It manifests as an emergency primarily because of the narrow range between the intoxicating, the anesthetic, and the lethal doses of alcohol. » In alcoholics, abrupt withdrawal may have life-threatening effects. Persons who abuse alcohol often have a number of health problems.

» In addition to nicotine, stimulants that are frequently abused include cocaine and amphetamines. » Cocaine and amphetamine overdose is frequent, and deaths have occurred. At high levels of overdose the patient experiences restlessness, paranoia, agitated delirium, confusion, and repetitive stereotyped behaviors. » Withdrawal from cocaine and amphetamines usually causes few physical symptoms; the craving for the drug is intense and can continue for weeks.

» In addition to alcohol, commonly abused depressants include sedative-hypnotics and opioids. With the exception of alcohol and some federally regulated drugs, most CNS depressants are medically useful. » Commonly abused sedative-hypnotic agents include barbiturates, benzodiazepines, and barbiturate-like drugs. Barbiturates are preferred as recreational drugs because they more frequently produce euphoric effects. » Among abused opioids, heroin and fentanyl (Sublimaze) are commonly used street drugs, but the IV use of controlled-release oxycodone (OxyContin) has become epidemic.

» Unintentional overdose frequently occurs with recreational use of depressants because of the unpredictability in potency and purity. If multiple substances have been ingested, a complex and potentially confusing clinical picture can result. » You must be alert to the possibility of withdrawal in any patient who has a history of substance abuse. Withdrawal from CNS depressants is the most dangerous withdrawal syndrome and may be lifethreatening.

» Cannabis, or marijuana, is the most widely used illicit drug in North America. Patterns of use are similar to alcohol in that there is occasional use, misuse resulting in temporary problems, and abuse or dependence potential. » At low to moderate doses, THC produces fewer physiologic and psychologic alterations than other psychoactive drugs, including alcohol.

» Early recognition and identification of a patient with substance dependence is crucial to successful treatment outcomes for any health problem. » The overall goals are that the patient with addictive behaviors will have normal physiologic functioning, acknowledge a substance abuse problem, explain the psychologic and physiologic effects of substance use, abstain from the use of addicting substances, and cooperate with a proposed treatment plan.

» Acute intoxication, overdose, and withdrawal may be seen in acute care situations. Intoxication and overdose may require physiologic support until detoxification can occur. »

» An individual who abuses substances is more likely to have accidents and injuries that require surgery. All trauma victims must be carefully assessed for signs and symptoms of substance overdose and withdrawal that could lead to adverse drug interactions with analgesics or anesthetics. » There is no evidence that providing opioid analgesia to substance-abusing patients worsens their addictive disease. In fact, the stress of unrelieved pain may contribute to relapse in the recovering patient or increased drug use in the patient who is actively using or abusing drugs.

» You are in a unique position to motivate and facilitate addictive behavior change while caring for patients in primary and acute care settings. When patients seek care for health problems related to substance abuse or when hospitalization interferes with the patient’s usual pattern of substance use, the patient’s awareness of problems associated with addictive behaviors is increased.

» Substance misuse, abuse, and dependence are much less likely to be recognized in older adults and may be mistaken for medical conditions. » Smoking and tobacco use contributes to and exacerbates many chronic illnesses; cessation at this age is beneficial.