DOCSLIB.ORG

Nicotine and Tobacco Dependence

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Nicotine and Tobacco Dependence Alan L. Peterson · Mark W. Vander Weg · Carlos R. Jaén Nicotine and Tobacco Dependence Advances in Psychotherapy Evidence-Based Practice Nicotine and Tobacco Dependence This document is for personal use only. Reproduction or distribution is not permitted. From A. L. Peterson, M. W. Vander Weg, & C. R. Jaén: Nicotine and Tobacco Dependence (ISBN 9781616763244) © 2011 Hogrefe Publishing. About the Authors Alan L. Peterson, PhD, ABPP, is a Professor and the Chief of the Division of Behavioral Medicine in the Department of Psychiatry at the University of Texas Health Science Center at San Antonio. He is a licensed clinical psychologist and is board certified in clinical health psychology by the American Board of Professional Psychology. He served on the Institute of Medicine’s Committee on Smoking Cessation in Military and Veteran Populations that pub- lished the 2009 book Combating Tobacco Use in Military and Veteran Populations by the National Academies Press. Mark W. Vander Weg, PhD, is an Associate Professor of Internal Medicine and Psychology at the University of Iowa and a Core Investigator with the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center. Carlos Roberto Jaén, MD, PhD, FAAFP, was the Vice Chair of the expert panel that published the 2008 update of the US Public Health Service’s Treating Tobacco Use and Dependence Clinical Practice Guideline. He is Professor and Chair of Family and Community Medicine, and Professor of Epidemiology and Biostatistics at the University of Texas Health Science Center at San Antonio. He is also Adjunct Professor of Public Health at the University of Texas School of Public Health. He holds doctorates in medicine and epidemiology and community health with a concentration in tobacco control from the State University of New York at Buffalo. He is a practicing family physician. Advances in Psychotherapy – Evidence-Based Practice Series Editor Danny Wedding, PhD, MPH, Professor of Psychology, California School of Professional Psychology / Alliant University, San Francisco, CA Associate Editors Larry Beutler, PhD, Professor, Palo Alto University / Pacifi c Graduate School of Psychology, Palo Alto, CA Kenneth E. Freedland, PhD, Professor of Psychiatry and Clinical Health Psychology, Washington University School of Medicine, St. Louis, MO Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL David A. Wolfe, PhD, RBC Chair in Children’s Mental Health, Centre for Addiction and Mental Health, University of Toronto, ON The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a “reader-friendly” manner. Each book in the series is both a compact “how-to-do” reference on a particular disorder for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education. The most important feature of the books is that they are practical and “reader-friendly:” All are struc- tured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls”, marginal notes, and summary boxes assist orienta- tion, while checklists provide tools for use in daily practice. This document is for personal use only. Reproduction or distribution is not permitted. From A. L. Peterson, M. W. Vander Weg, & C. R. Jaén: Nicotine and Tobacco Dependence (ISBN 9781616763244) © 2011 Hogrefe Publishing. Nicotine and Tobacco Dependence Alan L. Peterson Department of Psychiatry, Division of Behavioral Medicine, University of Texas Health Science Center at San Antonio, TX Mark W. Vander Weg Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, Departments of Internal Medicine and Psychology, University of Iowa, Iowa City, IA Carlos Roberto Jaén University of Texas Health Science Center at San Antonio, TX, University of Texas School of Public Health, Houston, TX This document is for personal use only. Reproduction or distribution is not permitted. From A. L. Peterson, M. W. Vander Weg, & C. R. Jaén: Nicotine and Tobacco Dependence (ISBN 9781616763244) © 2011 Hogrefe Publishing. LibraryLibrary of of Congress Congress Cataloging Cataloging ininformation Publication for the print version of this book is available via the Library of Congress Marc Database is available via the Library of Congress Marc Database under the LCCataloging Control Number data available 2010938060 from Library and Archives Canada Library© 2011 and by ArchivesHogrefe Publishing Canada Cataloguing in Publication http://www.hogrefe.com Peterson, Alan L. PUBLISHINGNicotine OFFICES and tobacco dependence / Alan L. Peterson, Mark W. Vander Weg, Carlos Roberto Jaén. USA: Hogrefe Publishing, 875 Massachusetts Avenue, 7th Floor, Cambridge, MA 02139 (Advances in psychotherapyPhone (866) 823-4726, - evidence-based Fax (617) practice 354-6875; series ; 20) Includes bibliographicalE-mail [email protected] references. ISBNEUROPE: 978-0-88937-324-2 Hogrefe Publishing, Merkelstr. 3, 37085 Göttingen, Germany Phone +49 551 99950-0, Fax +49 551 99950-425, 1. NicotineE-mail addiction--Diagnosis. [email protected] 2. Nicotine addiction--Treatment. I. Vander Weg, Mark W. II. Jaén, CarlosSALES Roberto & DISTRIBUTION III. Title. IV. Series: Advances in psychotherapy--evidence-basedUSA: Hogrefe Publishing, practice Customer ; 20 Services Department, 30 Amberwood Parkway, Ashland, OH 44805 RC567.P48 2010Phone (800) 616.86’5075 228-3749, Fax (419) C2010-906522-0281-6883, E-mail [email protected] UK : Hogrefe Publishing c/o Marston Book Services Ltd, PO Box 269, Abingdon, OX14 4YN, UK Phone +44 1235 465577, Fax +44 1235 465556, © 2011 by HogrefeE-mail Publishing [email protected] EUROPE: Hogrefe Publishing, Merkelstr. 3, 37085 Göttingen, Germany Phone +49 551 99950-0, Fax +49 551 99950-425, PUBLISHING E-mailOFFICES [email protected] USA: Hogrefe Publishing, 875 Massachusetts Avenue, 7th Floor, Cambridge, MA 02139 Phone (866) 823-4726, Fax (617) 354-6875; E-mail [email protected] EUROPE:Copyright InformationHogrefe Publishing, Rohnsweg 25, 37085 Göttingen, Germany The e-book, includingPhone all+49 its 551 individual 49609-0, chapters, Fax +49 is 551 protected 49609-88, under E-mail international [email protected] copyright law. The unau- thorized use or distribution of copyrighted or proprietary content is illegal and could subject the purchaser to SALESsubstantial & DISTRIBUTION damages. The user agrees to recognize and uphold the copyright. USA: Hogrefe Publishing, Customer Services Department, License Agreement30 Amberwood Parkway, Ashland, OH 44805 The purchaser is Phonegranted (800) a single, 228-3749, nontransferable Fax (419) 281-6883,license for E-mailthe personal [email protected] use of the e-book and all related EUROPE:files. Hogrefe Publishing, Rohnsweg 25, 37085 Göttingen, Germany Making copiesPhone or printouts +49 551 and 49609-0, storing Fax a backup +49 551 copy 49609-88, of the e-bookE-mail [email protected] another device is permitted for private, personal use only. OTHEROther OFFICES than as stated in this License Agreement, you may not copy, print, modify, remove, delete, augment, CANADA:add to, publish, transmit,Hogrefe sell,Publishing, resell, create 660 Eglinton derivative Ave. works East, from, Suite or119-514, in any wayToronto, exploit Ontario, any of M4G the e-book’s 2K2 SWITZERLAND:content, in whole Hogrefe or in part, Publishing, and you Länggass-Strassemay not aid or permit 76, CH-3000 others to Bern do so. 9 You shall not: (1) rent, assign, timeshare, distribute, or transfer all or part of the e-book or any rights granted by this License Agreement to Hogrefeany other Publishing person; (2) duplicate the e-book, except for reasonable backup copies; (3) remove any proprietary Incorporatedor copyright and notices, registered digital in thewatermarks, Commonwealth labels, ofor Massachusetts,other marks from USA, the ande-book in Göttingen, or its contents; Lower (4) Saxony, transfer Germanyor sublicense title to the e-book to any other party. These conditions are also applicable to any audio or other files belonging to the e-book. No part of this book may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfi lming, recording or otherwise, without written permission from the publisher.Format: PDF ISBN 978-1-61676-324-4 Printed and bound in the USA ISBN: 978-0-88937-324-2 This document is for personal use only. Reproduction or distribution is not permitted. From A. L. Peterson, M. W. Vander Weg, & C. R. Jaén: Nicotine and Tobacco Dependence (ISBN 9781616763244) © 2011 Hogrefe Publishing. Preface In the 20th century, tobacco use killed an estimated 100 million people world- wide, making tobacco use the leading preventable cause of death in the world (World Health Organization [WHO], 2008). Tobacco is the only legally avail- able consumer product which kills people when it is used entirely as intended (Walton, Barondess, & Lock, 1994). That is why it has practically become a mantra in the health care field that the single most important thing a person can do to improve his or her health is to quit tobacco. Similarly,
Load more

Recommended publications
  • Substance Abuse and Dependence
    9 Substance Abuse and Dependence CHAPTER CHAPTER OUTLINE CLASSIFICATION OF SUBSTANCE-RELATED THEORETICAL PERSPECTIVES 310–316 Residential Approaches DISORDERS 291–296 Biological Perspectives Psychodynamic Approaches Substance Abuse and Dependence Learning Perspectives Behavioral Approaches Addiction and Other Forms of Compulsive Cognitive Perspectives Relapse-Prevention Training Behavior Psychodynamic Perspectives SUMMING UP 325–326 Racial and Ethnic Differences in Substance Sociocultural Perspectives Use Disorders TREATMENT OF SUBSTANCE ABUSE Pathways to Drug Dependence AND DEPENDENCE 316–325 DRUGS OF ABUSE 296–310 Biological Approaches Depressants Culturally Sensitive Treatment Stimulants of Alcoholism Hallucinogens Nonprofessional Support Groups TRUTH or FICTION T❑ F❑ Heroin accounts for more deaths “Nothing and Nobody Comes Before than any other drug. (p. 291) T❑ F❑ You cannot be psychologically My Coke” dependent on a drug without also being She had just caught me with cocaine again after I had managed to convince her that physically dependent on it. (p. 295) I hadn’t used in over a month. Of course I had been tooting (snorting) almost every T❑ F❑ More teenagers and young adults die day, but I had managed to cover my tracks a little better than usual. So she said to from alcohol-related motor vehicle accidents me that I was going to have to make a choice—either cocaine or her. Before she than from any other cause. (p. 297) finished the sentence, I knew what was coming, so I told her to think carefully about what she was going to say. It was clear to me that there wasn’t a choice. I love my T❑ F❑ It is safe to let someone who has wife, but I’m not going to choose anything over cocaine.
    [Show full text]
  • GABA Systems, Benzodiazepines, and Substance Dependence
    Robert J. Malcolm GABA Systems, Benzodiazepines, and Substance Dependence Robert J. Malcolm, M.D. Alterations in the γ-aminobutyric acid (GABA) receptor complex and GABA neurotransmission influence the reinforcing and intoxicating effects of alcohol and benzodiazepines. Chronic modulation of the GABAA-benzodiazepine receptor complex plays a major role in central nervous system dysregulation during alcohol abstinence. Withdrawal symptoms stem in part from a decreased GABAergic inhibitory function and an increase in glutamatergic excitatory function. GABAA recep- tors play a role in both reward and withdrawal phenomena from alcohol and sedative-hypnotics. Although less well understood, GABAB receptor complexes appear to play a role in inhibition of moti- vation and diminish relapse potential to reinforcing drugs. Evidence suggests that long-term alcohol use and concomitant serial withdrawals permanently alter GABAergic function, down-regulate ben- zodiazepine binding sites, and in preclinical models lead to cell death. Benzodiazepines have substan- tial drawbacks in the treatment of substance use–related disorders that include interactions with alco- hol, rebound effects, alcohol priming, and the risk of supplanting alcohol dependency with addiction to both alcohol and benzodiazepines. Polysubstance-dependent individuals frequently self-medicate with benzodiazepines. Selective GABA agents with novel mechanisms of action have anxiolytic, anticonvulsant, and reward inhibition profiles that have potential in treating substance use and with- drawal and enhancing relapse prevention with less liability than benzodiazepines. The GABAB receptor agonist baclofen has promise in relapse prevention in a number of substance dependence dis- orders. The GABAA and GABAB pump reuptake inhibitor tiagabine has potential for managing alcohol and sedative-hypnotic withdrawal and also possibly a role in relapse prevention.
    [Show full text]
  • Barriers and Solutions to Addressing Tobacco Dependence in Addiction Treatment Programs
    Barriers and Solutions to Addressing Tobacco Dependence in Addiction Treatment Programs Douglas M. Ziedonis, M.D., M.P.H.; Joseph Guydish, Ph.D., M.P.H.; Jill Williams, M.D.; Marc Steinberg, Ph.D.; and Jonathan Foulds, Ph.D. Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients. KEY WORDS: Alcohol and tobacco; alcohol, tobacco, and other drug (ATOD) use, abuse, dependence; addiction care; tobacco dependence; smoking; secondhand smoke; nicotine; nicotine replacement; tobacco dependence screening; tobacco dependence treatment; treatment facility-based prevention; co-treatment; treatment issues; treatment barriers; treatment provider characteristics; treatment staff; staff training; AODD counselor; client counselor interaction; smoking cessation; Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey obacco dependence is one of to the other. The common genetic vul­ stance use was considered a potential the most common substance use nerability may be located on chromo­ trigger for the primary addiction.
    [Show full text]
  • Is Cannabis Addictive?
    Is cannabis addictive? CANNABIS EVIDENCE BRIEF BRIEFS AVAILABLE IN THIS SERIES: ` Is cannabis safe to use? Facts for youth aged 13–17 years. ` Is cannabis safe to use? Facts for young adults aged 18–25 years. ` Does cannabis use increase the risk of developing psychosis or schizophrenia? ` Is cannabis safe during preconception, pregnancy and breastfeeding? ` Is cannabis addictive? PURPOSE: This document provides key messages and information about addiction to cannabis in adults as well as youth between 16 and 18 years old. It is intended to provide source material for public education and awareness activities undertaken by medical and public health professionals, parents, educators and other adult influencers. Information and key messages can be re-purposed as appropriate into materials, including videos, brochures, etc. © Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2018 Publication date: August 2018 This document may be reproduced in whole or in part for non-commercial purposes, without charge or further permission, provided that it is reproduced for public education purposes and that due diligence is exercised to ensure accuracy of the materials reproduced. Cat.: H14-264/3-2018E-PDF ISBN: 978-0-660-27409-6 Pub.: 180232 Key messages ` Cannabis is addictive, though not everyone who uses it will develop an addiction.1, 2 ` If you use cannabis regularly (daily or almost daily) and over a long time (several months or years), you may find that you want to use it all the time (craving) and become unable to stop on your own.3, 4 ` Stopping cannabis use after prolonged use can produce cannabis withdrawal symptoms.5 ` Know that there are ways to change this and people who can help you.
    [Show full text]
  • Can Tobacco Dependence Provide Insights Into Other Drug Addictions? Joseph R
    DiFranza BMC Psychiatry (2016) 16:365 DOI 10.1186/s12888-016-1074-4 DEBATE Open Access Can tobacco dependence provide insights into other drug addictions? Joseph R. DiFranza Abstract Within the field of addiction research, individuals tend to operate within silos of knowledge focused on specific drug classes. The discovery that tobacco dependence develops in a progression of stages and that the latency to the onset of withdrawal symptoms after the last use of tobacco changes over time have provided insights into how tobacco dependence develops that might be applied to the study of other drugs. As physical dependence on tobacco develops, it progresses through previously unrecognized clinical stages of wanting, craving and needing. The latency to withdrawal is a measure of the asymptomatic phase of withdrawal, extending from the last use of tobacco to the emergence of withdrawal symptoms. Symptomatic withdrawal is characterized by a wanting phase, a craving phase, and a needing phase. The intensity of the desire to smoke that is triggered by withdrawal correlates with brain activity in addiction circuits. With repeated tobacco use, the latency to withdrawal shrinks from as long as several weeks to as short as several minutes. The shortening of the asymptomatic phase of withdrawal drives an escalation of smoking, first in terms of the number of smoking days/ month until daily smoking commences, then in terms of cigarettes smoked/day. The discoveries of the stages of physical dependence and the latency to withdrawal raises the question, does physical dependence develop in stages with other drugs? Is the latency to withdrawal for other substances measured in weeks at the onset of dependence? Does it shorten over time? The research methods that uncovered how tobacco dependence emerges might be fruitfully applied to the investigation of other addictions.
    [Show full text]
  • Patient-Focused Drug Development Meeting on Opioid Use Disorder
    Patient-Focused Drug Development Meeting on Opioid Use Disorder April 17, 2018 FDA will be streaming a live audio recording of the meeting with the presentation slides, which is open to the public at: https://collaboration.fda.gov/pfdd041718/. The audio recording and presentation slides, along with a meeting transcript and summary report, will also be made publicly available after the meeting. Because of the sensitive nature of the meeting topic, and the importance of gathering candid, meaningful input from individuals who have come forward to speak about living with opioid use disorder, no other audio recording, video recording, and/or photography will be allowed at this Patient-Focused Drug Development meeting. FDA is asking for your cooperation and strongly requests that you respect the privacy of all attendees. #PFDD Wi-Fi Network: FDA-Public Password: publicaccess Welcome Sara Eggers, PhD Office of Strategic Programs Center for Drug Evaluation and Research April 17, 2018 U.S. Food and Drug Administration Agenda • Opening Remarks • Setting the context – Overview of Opioid Use Disorder – Road from PFDD Meetings to Clinical Trial Endpoints – Overview of Discussion Format • Discussion Topic 1 • Lunch • Discussion Topic 2 (with a short break) • Open Public Comment • Closing Remarks 3 3 No Recording or Photography • FDA is streaming a live audio recording of the meeting with the presentation slides, which is open to the public – Access the live stream: https://collaboration.fda.gov/pfdd041718/. – The audio recording and presentation slides, along with a meeting transcript and summary report, will also be made publicly available after the meeting. • Because of the sensitive nature of the meeting topic, and the importance of gathering candid, meaningful input from individuals who have come forward to speak about living with opioid use disorder, no other audio recording, video recording, and/or photography will be allowed at this Patient-Focused Drug Development meeting.
    [Show full text]
  • Negative Reinforcement Learning Is Affected in Substance Dependence
    Drug and Alcohol Dependence 123 (2012) 84–90 Contents lists available at SciVerse ScienceDirect Drug and Alcohol Dependence journa l homepage: www.elsevier.com/locate/drugalcdep Negative reinforcement learning is affected in substance dependence a,c b a,c a,d Laetitia L. Thompson , Eric D. Claus , Susan K. Mikulich-Gilbertson , Marie T. Banich , a,c e e a,c,e,∗ Thomas Crowley , Theodore Krmpotich , David Miller , Jody Tanabe a University of Colorado School of Medicine, Department of Psychiatry, 13001 E. 17th Place, Mail Stop F546, Aurora, CO 80045, USA b The Mind Research Network, 1101 Yale Blvd. N.E., Albuquerque, NM 87106, USA c University of Colorado School of Medicine, Division of Substance Dependence, 12469 E. 17th Place, Mail Stop F478, Aurora, CO 80045, USA d University of Colorado at Boulder, D420 Muenziger Bldg., Campus Box 345, Boulder, CO 80309, USA e University of Colorado School of Medicine, Department of Radiology, 12700 E. 19th Avenue, Mailstop C278, Aurora, CO 80045, USA a r t i c l e i n f o a b s t r a c t Article history: Background: Negative reinforcement results in behavior to escape or avoid an aversive outcome. With- Received 17 May 2011 drawal symptoms are purported to be negative reinforcers in perpetuating substance dependence, but Received in revised form 15 October 2011 little is known about negative reinforcement learning in this population. The purpose of this study was to Accepted 20 October 2011 examine reinforcement learning in substance dependent individuals (SDI), with an emphasis on assessing Available online 10 November 2011 negative reinforcement learning.
    [Show full text]
  • HHS Guide for Clinicians on the Appropriate Dosage Reduction Or
    This HHS Guide for Clinicians on the Appropriate Dosage HHS Guide for Clinicians on the Reduction or Discontinuation of Long-Term Opioid Analgesics provides advice to clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation Appropriate Dosage Reduction of long-term opioid therapy for chronic pain. In each case the clinician should review the risks and benefits of the or Discontinuation of current therapy with the patient, and decide if tapering is appropriate based on individual circumstances. Long-Term Opioid Analgesics After increasing every year for more than a decade, annual needs.2,3,4 Coordination across the health care team is critical. opioid prescriptions in the United States peaked at 255 million in Clinicians have a responsibility to provide or arrange for 2012 and then decreased to 191 million in 2017.i More judicious coordinated management of patients’ pain and opioid-related opioid analgesic prescribing can benefit individual patients as problems, and they should never abandon patients.2 More well as public health when opioid analgesic use is limited to specific guidance follows, compiled from published guidelines situations where benefits of opioids are likely to outweigh risks. (the CDC Guideline for Prescribing Opioids for Chronic Pain2 At the same time opioid analgesic prescribing changes, such and the VA/DoD Clinical Practice Guideline for Opioid Therapy as dose escalation, dose reduction or discontinuation of long- for Chronic Pain3) and from practices endorsed in the peer- term opioid analgesics, have potential to harm or put patients at reviewed literature. risk if not made in a thoughtful, deliberative, collaborative, and measured manner.
    [Show full text]
  • Treatment of Benzodiazepine Dependence
    The new england journal of medicine Review Article Dan L. Longo, M.D., Editor Treatment of Benzodiazepine Dependence Michael Soyka, M.D.​​ raditionally, various terms have been used to define substance From the Department of Psychiatry and use–related disorders. These include “addiction,” “misuse” (in the Diagnostic Psychotherapy, Ludwig Maximilian Univer­ 1 sity, Munich, and Medical Park Chiemsee­ and Statistical Manual of Mental Disorders, fourth edition [DSM-IV] ), “harmful use” blick, Bernau — both in Germany; and T 2 3 Privatklinik Meiringen, Meiringen, Switzer­ (in the International Classification of Diseases, 10th Revision [ICD-10] ), and “dependence.” Long-term intake of a drug can induce tolerance of the drug’s effects (i.e., increased land. Address reprint requests to Dr. Soyka at Medical Park Chiemseeblick, Rasthaus­ amounts are needed to achieve intoxication, or the person experiences diminished strasse 25, 83233 Bernau, Germany, or at effects with continued use4) and physical dependence. Addiction is defined by com- m . soyka@ medicalpark . de. pulsive drug-seeking behavior or an intense desire to take a drug despite severe N Engl J Med 2017;376:1147-57. medical or social consequences. The DSM-IV and ICD-10 define misuse and harm- DOI: 10.1056/NEJMra1611832 ful use, respectively, on the basis of various somatic or psychological consequences Copyright © 2017 Massachusetts Medical Society. of substance use and define dependence on the basis of a cluster of somatic, psychological, and behavioral symptoms. According to the ICD-10, dependence is diagnosed if 3 or more of the following criteria were met in the previous year: a strong desire or compulsion to take the drug, difficulties in controlling drug use, withdrawal symptoms, evidence of tolerance, neglect of alternative pleasures or interests, and persistent drug use despite harmful consequences.
    [Show full text]
  • Benzodiazepine Abuse and Dependence: Misconceptions and Facts
    CLINICAL REVIEW Benzodiazepine Abuse and Dependence: Misconceptions and Facts Michael G. Farnsworth, MD St Paul, Minnesota Benzodiazepines can be prescribed for a number of medical conditions. Many physi­ cians are reluctant to prescribe benzodiazepines out of fear of producing depen­ dence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treat­ ment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are pre­ scribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational us­ ers of benzodiazepines are young men. Documentation of indication for use, collec­ tion of drug-abuse history, close monitoring, and drug holidays can improve the man­ agement of this class of medication. J Fam Pract 1990; 31:393-400. enzodiazepines, as a class of psychotherapeutic med­ barbiturates and meprobamate, introduced in 1955, re­ B ications, have enjoyed widespread use since their US mained as dominant anxiolytic drugs. Physicians, how­ introduction in the early 1960s. These medications are ever, were concerned with the propensity of barbiturates used to treat some of the most prevalent emotional and to induce tolerance, physical dependence, drug interac­ physical disorders seen in medical practice, which include tions, and potential for a lethal withdrawal syndrome. anxiety, insomnia, seizure disorders, muscle spasms, and Accordingly, chlordiazepoxide was synthesized and mar­ alcohol withdrawal.
    [Show full text]
  • Phenomenology Epidemiology
    Phenomenology DEFINITIONS Intoxication: reversible, substance-specific physiological and behavioral changes due to recent exposure to a psychoactive substance. Addiction: compulsion to use a drug, usually for its psychic, rather than therapeutic, effects Tolerance: the decline in potency of an opioid experienced with continued use, so that higher doses are needed to achieve the same effect. This is a receptor mediated effect, typical of many psychoactive drugs. Physical Dependence: refers to the development of withdrawal symptoms once a drug is stopped. Withdrawal: a physiological state that follows cessation or reduction in the amount of a drug used. Generally these effects are the opposite of the drugs normal effects. Substance Dependence (DSM version): A maladaptive pattern of substance use with adverse clinical consequences. Substance Abuse (DSM version): A maladaptive pattern of use that causes clinically significant impairment. Alcoholism: A repetitive, but inconsistent and sometimes unpredictable loss of control of drinking which produces symptoms of serious dysfunction or disability. Clearly there is a wide range of findings possible on the mental status exam, however any exam should look for typical signs of regular substance use. Epidemiology Use of psychoactive substances is common in society, and is often socially acceptable or at least tolerated. Historically, psychoactive substance has served a variety of purposes, including medicinal, social, recreational and religious. In the U.S., 90% people report some alcohol use, 80% report some caffeine use, 25% report use of tobacco products, and 37% report having used illicit substances (at least once in life). Dependence and Abuse are also very common (13.6% in ECA). Over 10 million Americans are alcoholics, over 8 million are "Problem drinkers." Only 3% of alcoholics are on skid row.
    [Show full text]
  • Nicotine Pharmacology and Addictive Effects
    Chapter 8 Pharmacology and Markers: Nicotine Pharmacology and Addictive Effects Jack E. Henningfield and Leslie M. Schuh INTRODUCTION Dosing characteristics of cigarette brands are estimated using machines that smoke representative cigarettes from each brand according to a protocol termed the Federal Trade Commission (FTC) method (Peeler, this volume; Pillsbury, this volume). This technology and methodology provide tar- and nicotine-dosing estimates of cigarettes that are misleading to consumers and do not accurately predict what level of tar and nicotine intake consumers will obtain by smoking a given brand of cigarettes (Henningfield et al., 1994). An understanding of the dependence-producing and other behavior-modifying effects of cigarette smoke is necessary to understand why the FTC method is a poor predictor of the nicotine, tar, and carbon monoxide levels people obtain from cigarettes. Cigarette smoking behavior is influenced by nicotine dose, and smokers tend to maintain nicotine intake within upper and lower boundaries (Kozlowski, 1989). In brief, nicotine produces dose-related tolerance, physical dependence, and discriminative effects (i.e., effects that people can feel, which modify mood and physiology), and smokers change their behavior in response to these effects. Unlike human smokers, machines are not nicotine dependent, nor do they modify their behavior based on the flavor of the smoke. The FTC method was developed in the 1960's to provide a relative ranking of nicotine, tar, and carbon monoxide yields from various cigarettes (Peeler, this volume; Pillsbury, this volume). This ranking has provided consumers with the false sense that they can tell precisely the amount of these substances they will obtain from a given cigarette.
    [Show full text]