At Home Drug Withdrawal

Sobriety Success

The dependence on sobriety is defined as the state of sobriety. When a person is sober, they can live on a daily basis without their thoughts and behaviors being controlled by substance dependence. They do not feel obliged to use it because they manage to live without it. They see and appreciate so much the benefits of living without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. The success product of sobriety is a step-by-step manual for everyone. The product has been said to be beneficial for many people around the world. The reason why the product is gaining so much popularity among individuals. They see and appreciate so much the benefits of life without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. This strategy encourages you to maintain the long-term vision of recovery. Recognize that this is not a one-off thing, something you try for a few weeks to several months, then return to your previous life. You will be in recovery if you decide it's the life you want to live for the rest of your life. As such, there is no immediate timeline to which you must adhere, nor should you strive to achieve goals that you are clearly not ready to face. Read more here...

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Connections Between Interval Timing Neuropharmacology And Drug Abuse

Drugs that increase the effective level of dopamine in the brain, such as cocaine and methamphetamine, are among the most commonly abused drugs today (Stahl, 2000). The connection between interval timing and drug abuse comes from the fact that dopaminergic drugs cause predictable distortions in timing and time perception. The dopamine agonist, methamphetamine, causes a leftward shift in psychophysical timing functions that is proportional in size to the duration of the interval being timed (e.g., Meck, 1983, 1996). This result is compatible with the hypothesis that increasing the effective level of dopamine in the brain causes an increase in the speed of the pacemaker or oscillatory processes used for timing if the pacemaker is caused to run faster than when a time interval was first learned, then participants will think that feedback is due earlier than it actually is, and consequently timing functions will be horizontally shifted to the left. Genetic modifications of the dopamine...

The psychostimulants cocaine and the amphetamines

Psychotropics Chemical Diagram

Cocaine is a major alkaloidal component from the Andean bush Erythroxylon coca. Leaves of this plant are chewed by Andean Indians to decrease the feeling of hunger and fatigue there is little evidence that dependence is caused by this means of administration. A major health problem arises, however, when cocaine is used in industrialized countries. Thus in the US over 20 million people are estimated to use the drug, by nasal administration (snorting), injection of the salts, or smoking the free alkaloid (crack). The main difference between cocaine and the amphetamine-like drugs lies in its shorter duration of action, the half-life for cocaine being about 50 minutes while that of amphetamine is 10 hours. Because of its widespread abuse, particularly in the US, detailed studies have recently been undertaken on the pattern of abuse of cocaine. Some 20 of those experimenting with the drug go on to become regular users (i.e. psychologically dependent). Once dependent, the individual may...

Cocaine Associated Myocardial Ischemia

Management of patients with cocaine associated myocardial ischemia focuses on reversal of coronary vasoconstriction, hypertension, tachycardia, and predisposition to thrombus formation.31 Central nervous system protection and decreased sympathetic outflow should be accomplished with the administration of benzodiazepines. Multiple animal experiments and widespread anecdotal experience in humans support the use of diazepam as the initial agent for the management of cocaine intoxicated patients. Diazepam alone will often calm the agitated patient and return abnormal vital signs to the normal range. Reduction in hypertension and or tachycardia will decrease the myocardial oxygen demand. Aspirin and or heparin should be used as they would be in patients with myocardial ischemia unrelated to cocaine, despite the lack of any clinical or experimental data. The success with platelet inhibitors and anticoagulants in traditional myocardial infarction patients and the propensity of cocaine to...

Drug Withdrawal and Seizure Relapse

Of the patients on AED treatment, 70-80 will eventually become seizure free.1 Because of the possibility of long-term side effects of drugs, it is good practice to consider drug withdrawal after a substantial remission period. There are risks of relapse, however, in doing so and several studies have addressed this issue.13-17 The probability of relapse has varied between 11 and 41 . Most studies in children have reported figures at the lower end of the spectrum while studies in adults tend towards the higher end. A number of risk factors for seizure recurrence after discontinuation of treatment have been identified.14,15 These include a long history of

Behavioral Pharmacology Of Drug Abuse

Chiatry, epidemiology, etc.) that are pursued in the hope of greater understanding of the phenomena of abuse of drugs. The present discussion will attempt to relate behavioral pharmacological matters to phenomena of drug abuse in society. It seems self-evident that in the abuse of drugs, such as intravenous injection of heroin or sniffing of cocaine base, the drug represents the reinforcer that maintains the behavior of obtaining the drug. Nevertheless, it was not until it was arranged in the laboratory for an injection of certain drugs to occur occasionally on a response, according to an appropriate schedule, that it was established scientifically that some drugs could function as reinforcers. Responding can be maintained much as with similar presentation of food, fluid, etc. These drugs include most of those that are abused on the streets notably heroin, cocaine, and amphetamines but not most of the drugs that are not abused. So-called self-administration has proved to be a useful...

Coca and Cocaine

Coca contains fourteen drugs, cocaine being the most important. The other drugs are present in smaller amounts and seem to modify the stimulating effect of the cocaine. In addition, coca leaves contain many vitamins and minerals that are probably important in the diets of Indians who use them. There are several varieties of coca some taste like green tea, some like wintergreen. Coca users put dried leaves in the mouth and work them into a large wad. They suck on this wad for thirty minutes or so, swallowing the juices, after which they spit out the residue. To get an effect from coca, a tiny amount of some alkali, such as lime (the powdered mineral) or ashes, must be added to the wad of leaves. In the late 1800s coca became very popular in Europe and America in the form of tonics and wines. Coca-Cola began as one of these early preparations. At the same time, scientists isolated cocaine from the leaves and made it available to doctors in the form of a pure white powder. As the first...

Cocaine Ingestion

Cocaine ingestion is an increasingly widespread problem. Carriers will ingest multiple small packets of cocaine in attempts to conceal the drug. A favored packet is the condom, which may hold up to 5 g cocaine. Rupture of even one such packet may be fatal. Webb recommends surgery as the safest method of recovery to avoid the likelihood of packet rupture during endoscopic retrieval. If the packet appears to be passing intact through the intestinal tract, the clinician may choose to observe the patient and wait for the packet to be delivered spontaneously through the rectum.

Drug dependence

Three factors are generally involved in drug dependence tolerance, physical dependence and psychological dependence. Regarding drugs of abuse, tissue tolerance commonly occurs to the opioids, ethanol, and the sedatives of the benzodiazepine type. Tolerance does not develop to all drugs of abuse, however. Thus cocaine and the amphetamines maintain their stimulant and euphoriant effects for a prolonged period of administration without any need to increase the dose appreciably. This term is used to describe the phenomenon in which abnormal behavioural and autonomic symptoms occur when the drug is abruptly withdrawn or its effects are terminated by the administration of a specific antagonist. Most drugs of abuse (e.g. the opioids, sedatives, alcohol) produce some physical dependence, although withdrawal symptoms are relatively mild following the abrupt withdrawal of cannabis, the stimulants, and cocaine. The nature of the withdrawal symptoms depends upon the neurotrans-mitter systems...

Paul R Stasiewicz and Kellie E Smith

The origin of the term special population can be attributed to several U.S. government agencies involved in health and human services in the mid-1970s. The term is reserved for groups whose need for substance abuse treatment programs has been under-served. The purpose was to identify subgroups in order to help with planning and evaluating the national treatment system for alcohol and drug problems. The goal was to provide funding for specialty programs, or to ensure that mainstream programs were structured to provide appropriate treatment services. Special population groups are most often defined in terms of age, race eth Ethnic and racial diversity is increasing in the United States, and according to the 1991-1993 National Household Survey on Drug Abuse members of various ethnic minorities report higher rates of substance use and related problems than do Whites. Although a need for treatment services exists, special populations often encounter barriers to obtaining treatment for...

The role of dairy products in preventing dental caries

An individual's dietary and social patterns are major contributors to one's oral health. The quality of life can be greatly impacted as a result of poor oral health leaving a negative impact on self-esteem, eating ability, and social functioning (Moynihan, 2005). Several oral diseases can be linked back to poor nutrition, and as teeth deteriorate the conditions are exacerbated. Studies (Johansson et al., 1994, Norlen et al., 1993) have shown edentulous individuals are more apt to have inadequate dietary intake (high carbohydrate, high fat, low nutrient density foods) than dentate individuals. Sugars, specifically sucrose, are recognized as being a major contributor to dental caries' etiology. Other social factors such as alcohol and tobacco use, drug abuse, poor hygiene, and poor nutrition are also cited as being major contributory factors to oral diseases.

Dairy consumption energy intake and body weight

The major site of action of the adiposity hormones in the brain is a discrete hypothalamic region called the arcuate nucleus (ARC) (Schwartz et al., 2000 Cummings, 2006). Functional receptors for these hormones are expressed in the ARC. Despite the differences in leptin's and insulin's signalling pathways, both hormones elicit an increase in the expression of anorexigenic (appetite-suppressing) neuropeptides and a decrease in that of orexigenic (appetite-stimulating) neuropeptides (Schwartz et al., 2000). On the other hand, the actions of ghrelin in the ARC are opposite to those of leptin and insulin (Cummings, 2006). The major anorexigenic neuropeptides are the pro-opiomelanocortin a-melanocyte stimulating hormone (POMC a-MSH) and the cocaine-amphetamine related transcript (CART), whereas the major orexigenic neuropeptides are Neuropeptide Y (NPY) and Agouti related protein (AgRP) (Schwartz et al., 2000). Neurons expressing these neuropeptides project to neighbouring hypothalamic...

Summary Episodic and Tonic Factors in the Regulation of Appetite

Mct1 Pathway

Figure 3 The integration of peripherally generated episodic and tonic signals critical to the expression of appetite. Signals generated by both meal consumption and fat deposition are integrated into a complex hypothalamic system of neuropeptides, which in turn either stimulate or inhibit subsequent food intake. Abbreviations 5-HT, serotonin aMSH, alpha melanocortin stimulating hormone AgRP, agouti-related peptide A-IV, apoliproprotein-IV ARC, arcuate nucleus CART, cocaine and amphetamine-regulated transcript CCK, cholecystokinin CRF, corticotropin releasing factor GAL, galanin GLP-1, glucagon-like peptide-1 GRP, gastric releasing peptide LH, lateral hypothalamus MC, melanocortin NPY, neuropeptide Y OX, orexin PVN, paraventricular hypothalamus POMC, pre-pro-opiomelanocortin PYY, peptide YY. Figure 3 The integration of peripherally generated episodic and tonic signals critical to the expression of appetite. Signals generated by both meal consumption and fat deposition are integrated...

TABLE 1153 Differential Diagnosis of Congestive Heart Failure Based on Age of Presentation

MYOCARDITIS AND CARDIOMYOPATHIES Myocarditis affects children of all ages and is the leading cause of end-stage cardiomyopathy requiring transplantation. Viral etiologies include enteroviruses (coxsackie, echovirus, and poliovirus), as well as mumps, influenza virus, and Varicella zoster. An emerging cause is HIV-associated myocarditis and chronic Epstein-Barr myocarditis. Many bacterial species have been associated with myopericarditis, but not myocarditis alone. Noninfectious causes include lupus erythematosus, toxins such as tricyclic antidepressants, and cocaine. Myocarditis is often preceded by a viral respiratory illness and needs to be differentiated from pneumonia. As with the latter diagnosis, presenting signs and symptoms are often respiratory distress, fever, tachypnea, and tachycardia. Clues that suggest myocarditis include generalized malaise, fever, and myalgias in age-appropriate children. 17,18

Extrapyramidal Disorders

Dystonic reactions are involuntary muscle contractions that may affect the muscles of the neck (torticollis), jaw (trismus), trunk (opisthotonos), tongue, or those surrounding the eye (oculogyric crisis). Laryngospasm, although rare, may also occur, and threaten the airway. Dystonia may involve an isolated muscle group or, more frequently, a combination of the above. Affected patients commonly exhibit evidence of adrenergic hyperactivity, including diaphoresis, tachycardia, tachypnea, and hypertension, and are often in obvious pain and quite anxious. 5 A history of therapeutic (including long-acting depot preparations of some antipsychotics such as fluphenazine and haloperidol) and illicit drug use is key dystonic reactions have been reported with a variety of agents, including tricyclics, street Valium (haloperidol), and cocaine.5 Acute treatment includes administration of diphenhydramine (Benadryl), 25 to 50 mg intramuscularly or intravenously the latter route provides the most...

Mechanisms Underlying Modality Effects In Time Perception

Pacemaker Switch Accumulator System

A large body of work in rats, and other animals, much of it interpreted within the framework of scalar timing theory, has addressed both the neural and neurochemical substrates of the pacemaker-accumulator component of the internal clock (for a detailed review of the pharmacological basis of the internal clock, see Meck, 1996). For example, Maricq and Church (1983) reported that the dopaminergic agonist methamphetamine increased the rate of the internal clock, whereas the dopaminergic antagonist haloperidol decreased the rate of the internal clock when rats timed intervals in the seconds range. The importance of the dopaminergic system for timing has also been extended to human participants (Malapani et al., 1998 Malapani and Rakitin, this volume Raamsayer, 1997a, 1997b). Although there is strong experimental evidence that both the rate of the internal clock and the latency with which timing processes are initiated are affected by pharmacological manipulations, the question of whether...

Integrating BCT with Recovery Related Medication

BCT has been used to increase compliance with a recovery-related medication. Among male opioid patients taking naltrexone, BCT patients, compared with their individually treated counterparts, had better naltrexone compliance, greater abstinence, and fewer substance-related problems. Among HIV-positive drug abusers in an outpatient drug abuse treatment program, BCT produced better compliance with HIV medications than did treatment as usual. BCT also has improved compliance with pharmacotherapy

Historical development of antidepressants

The use of cocaine, extracted in a crude form from the leaves of the Andean coca plant, has been used for centuries in South America to alleviate fatigue and elevate the mood. It was only relatively recently, however, that the same pharmacological effect was discovered when the amphetamines were introduced into Western medicine as anorexiants with stimulant properties. Opiates, generally as a galenical mixture, were also widely used for centuries for their mood-elevating effects throughout the world. It is not without interest that while such drugs would never now be used as antidepressants, there is evidence that most antidepressants do modulate the pain threshold, possibly via the enkephalins and endorphins. This may help to explain the use of antidepressants in the treatment of atypical pain syndromes and as an adjunct to the treatment of terminal cancer pain. Finally, alcohol in its various forms has been used to alleviate anguish and sorrow since antiquity. Whilst the opiates,...

Programming of the Adipoinsular Axis and Altered Adipogenesis

A range of genetic components of obesity have been identified.7072 and research on alterations in biochemical pathways caused by single gene mutations in animal models has contributed significandy towards knowledge of physiological mechanisms of obesity.73 It is well established that leptin acts at the level of the hypothalamus to regulate appetite and energy homeostasis. The long-form, or signalling form, of the leptin receptor (OB-Rb) is expressed in high levels in several cell groups of the hypothalamus and in various tissues throughout the body.48'75'76 Under normal physiological conditions, increased leptin signalling in the medial hypothalamus is associated with reduced neuropeptide Y (NPY) and agouti-related (AgRP) protein production77 but increased cocaine- and amphetamine- regulated transcript (CART) and pro-opiomelanocortin (POMC) production.7 These leptin-induced changes in neuropeptides lead to decreased food intake and increased energy expenditure.

Clinical Features

The presenting symptoms of rhabdomyolysis are usually acute in onset and include myalgias, stiffness, weakness, malaise, low-grade fever, and dark (usually brown) urine. Symptoms relating to the musculoskeletal system, however, may be present in only 271 percent of cases.7 Nausea, vomiting, abdominal pain, and tachycardia can occur in severe rhabdomyolysis. On occasion, mental-status changes are present secondary to urea induced encephalopathy. Swelling and tenderness of the involved muscle groups and hemorrhagic discoloration of overlying skin may be observed, but only in a minority of cases. Muscle swelling may not become apparent until after rehydration with intravenous (IV) fluids. The muscle groups involved may be localized or diffuse, depending on the etiology. Commonly, the postural muscles of the thighs, calves, and the lower back are involved. An important point to remember is that acute rhabdomyolysis may be present without any of these signs or symptoms, and the patient may...

Chapter References

Substance Abuse and Mental Health Services Administration, Office of Applied Studies Mid-Year Preliminary Estimates from the 1996 Drug Abuse Warning Network. Rockville, MD, US Department of Health and Human Services, 1997. 4. Harwood H Economic Costs of Alcohol and Drug Abuse. Fairfax, VA, Lewin Group, 1998. 7. Institute of Medicine Pathways of Addiction Opportunities in Drug Abuse Research. Washington, National Academy Press, 1996. 13. Weisner C, Schmidt L Expanding the frame of health services research in the drug abuse field. HSR 30 707, 1995.

The Measurement Of Treatment Fidelity

The principal alternative measure of adherence in CBT is the Cognitive Therapy Adherence and Competence Scale (CTACS Liese, Barber, & Beck, 1995), which was developed in the context of a randomized clinical trial for cocaine users. The CTACS uses Likert-type scales, which are used to first rate the extent to which various behaviors are conducted, and then to rerate each item as to how competently it was practiced. Psychometric evaluation of the CTACS in the context of a drug addiction study has been generally positive (Liese et al., 1995), and this measure warrants broader evaluation.

Altered Mental Status

Stroke syndromes have been well-reported complications secondary to low-flow states during heroin intoxication, hypertensive hemorrhage from amphetamines, phencyclidine, or cocaine, and embolized vegetations from infectious endocarditis. Delayed leukoencephalopathies, both hypoxia-related and unrelated to hypoxia, have been reported in IVDUs but are rare.25

Postsynaptic Effect of NE and LC Stimulation

Several pharmacological agents are able to modify the noradrenergic transmission. a-Methyltyrosine inhibits tyrosine hydroxylase (TH). Reserpine provokes the release of NE from the synaptic vesicles. Desipramine and cocaine inhibit NE re-uptake by the NE transporter (NET). Amphetamine promotes reverse transport through the NET. Pargyline and many antidepressants (called MAOI for monoamine oxidase inhibitors) block the degradation of NE by monoamine oxidase (MAO). Prazosin, yohimbine, and propranolol (among others) inhibit the action of NE on al-, a2-, and b-adrenergic receptors, respectively. Phenylephrine, clonidine, and isoproterenol stimulate al-, a2-, and b-adrenergic receptors, respectively. The action of clonidine or yohimbine on a2-adrenergic autoreceptors also results in the inhibition or activation, respectively, of noradrenergic neuron firing and NE release. Finally, morphine inhibits noradrenergic neuron firing via somatodendritic m-opiate...

The Alcoholabusing Patient

Although alcoholism by itself is not a medical emergency, alcohol abuse and dependence are common threads in the presentation of many conditions in the emergency department. Such presentations include trauma, infections, acute alcohol intoxication and withdrawal, hepatitis, and pancreatitis. Alcohol is often used with other drugs, including cocaine, benzodiazepines, and marijuana. Emergency physicians should recognize alcoholism as both a contributor to a patient's presenting problems and as an underlying problem requiring care itself.

Aortic Insufficiency In Plax Color Flow

Plax Aortic Dissection Ultrasound

In the aortic isthmus distal to the ligamentum arterio-sum. Cardiac surgery is also associated with a risk of aortic dissection, in particular bypass surgery and aortic valve replacement. Patients with Takayasu's disease and other inflammatory collagen vascular diseases are also at increased risk. Corticosteroid use has also been associated with increased risk of dissection. Aortic dissection has also been reported to occur in association with cocaine use, particularly crack cocaine, presumably owing to abrupt elevations in systemic blood pressure. Cocaine abuse

Oral diseases and cariogenicity

Oral refers to the mouth, and includes the teeth and gums (gingival) and their supporting tissues, the hard and soft palate, the mucosal lining of the mouth and throat, the lips, salivary glands, chewing muscles, and upper and lower jaw bones. Digestion begins in the oral cavity, and there are numerous supporting structures for the mouth including the nervous, vascular, and immune systems. Humans contract oral diseases for a number of reasons including genetics, poor hygiene, poor nutrition, alcohol and tobacco use, drug abuse (Shaner et al., 2006), and complications from other diseases such as diabetes (Sandberg et al., 2000, Twetman et al., 2002), cancer (Woo et al., 1993), obesity (Ritchie and Kinane, 2003), and osteoporosis (Norlen et al., 1993). Oral infections themselves may play a role in progressing pathogenesis of many systemic diseases in healthy individuals, ill patients, and those immunocompromised (Ridker et al., 1998). The theory is that oral infections, specifically...

And Etiological Profile in Developing Countries

Acute symptomatic seizures may be single or repetitive. Single seizure may be brief or prolonged. Repetitive seizures may be serial, clustered, or crescendo. Status epilepticus may be the presenting feature. In our study, of the 572 patients, 7 had single seizure, 90 had two or more seizures and 3 developed status epilepticus. Repetitive seizures included seizure clusters.5 Seizure type can be simple partial, complex partial (CPS) with or without secondary generalization, or generalized tonic-clonic seizures (GTCS). The most common seizure type is GTCS (including secondary generalization). In particular, alcohol or drug withdrawal, drug toxicity, or systemic metabolic disorders typically present as GTCS. Whereas patients with acute primary CNS insult may trigger simple or complex partial seizures depending on the site of pathology.

Clinical Presentation

Bilateral dilated, fixed pupils may be secondary to endogenous sympathetic discharge following periods of diffuse anoxia or to the release of exogenous catecholamines. Dilated pupils are also seen in glu-tethimide-induced coma and overdosage with tricyclic antidepressant or other atropine-like agents. In coma due to amphetamine, cocaine, and LSD overdosage, the pupils are large but reactive. Midposition, fixed pupils are indicative of midbrain failure and loss of both sympathetic and parasympathetic pupillary tone, whether caused by structural or metabolic disease. A unilateral, dilated fixed pupil suggests damage to parasympathetic fibers of the external portion of the third cranial nerve.

Chemicals as Emetogenic Stimuli

Finger down the throat has a similar effect, irritating the mechanoreceptors in the pharynx.) The alkaloid ipecacuanha has well-known emetic effects and acts by stimulating chemoreceptors in the area postrema. It has also been used in subemetic doses in some paracetamol tablets to prevent self-poisoning a person taking an excessive number of tablets would finally receive an emetic dose of ipecacuanha, which would expel the paracetamol from the stomach. A different use was found for disulfiram in the treatment of alcoholism. If taken with alcohol, it leads to an accumulation of acetaldehyde, which induces nausea and sickness. It was used as an aversion therapy for drug abuse apomorphine was used as an alternative treatment. With these exceptions, drug-induced emesis is unwanted but occurs with many different types of medical treatments. It can vary from a transient effect of little consequence to a persistent and chronic effect to severely reduce the quality of life.

Membranoproliferative Glomerulonephritis

Cryoglobulin

Vague substructure of deposits, with short, curved, vaguely fibrillar deposits (Fig. 3.6) (suggestive of mixed cryoglobulinemia), or rarely microtubu-lar substructure, strongly PAS-positive cryo-plugs in capillary lumina (Fig. 3.9), vasculitis, predominant IgM deposits, sometimes with clonality (13). Cryoglobulinemia is commonly associated with hepatitis C, an RNA virus (14,15). Approximately 150,000 cases of hepatitis C infection occur per year in the United States. Of these, approximately half have liver disease, with 15,000 developing chronic active hepatitis and or cirrhosis. The prevalence of hepatitis C infection is approximately 0.6 in the United States, reaching up to 6 in Africa. In one large series of hepatitis C-positive cases affecting the kidney, 40 patients with an average age of 46 years were studied. The most common risk factors for infection in this series were intravenous drug abuse, and blood transfusion. The mixed type 2 cryoglobulinemia associated with various...

Vaginal Bleeding during the Second Half of Pregnancy

ABRUPTIO PLACENTAE Abruptio placentae, the premature separation of the normally implanted placenta from the uterine wall, accounts for 30 percent of bleeding in the second half of pregnancy. This complication can occur either spontaneously or as the result of trauma to the abdomen. The spontaneous form is far more common, with hypertension the most common risk factor. Other risk factors include hypertension, increased maternal age, multiparity, smoking, cocaine use, and previous abruptions. Abruption can be complete, partial, or concealed. In concealed abruption, there is little or no vaginal bleeding. However, shock may ensue as the actual blood loss is not evident, and establishing the diagnosis may be delayed. The diagnosis of abruption may be difficult, since clinical signs and symptoms depend on the size of the abruption and the amount of blood loss. Many known factors are associated with preterm labor. More common ones include PROM, abruptio placentae, drug abuse (particularly...

Description of the Model

Evidence for functional similarity between rats' timing processes and their counting processes comes from several experiments. First of all, methamphetamine increases rats' perceptions of duration and numerosity by exactly the same factor, suggesting that the same mechanism is affected in both cases. This effect could

Special Considerations

Recent clinical experience with heroin-cocaine (i.e., Speedball) and heroin-scopolamine (e.g., Polo, Homicide, Sting, and others) mixtures has raised issues regarding the blind administration of naloxone. Often naloxone unmasks the underlying cocaine or scopolamine intoxication. Cocaine has a relatively short duration of action, but the same is not true of scopolamine. Unmasked scopolamine overdoses often require control with benzodiazepines. Administration of physostigmine, to reverse scopolamine toxicity, can be considered but is best left to experienced physicians familiar with the use of this antidote. 8

The Physiological Differences of Addiction

Defining drugs as substances other than those required for normal health is a way of finessing this attribution of unnaturalness (Johns 1990 5). As I have argued elsewhere, it puts in place a distinction between therapeutic substances like insulin, which work to restore health in cases of disease, and recreational drugs. However, identifying normal health and normal biology, and assessing whether a drug is being used to restore or disrupt function, is based on normative judgments about proper and improper bodies as well as proper and improper substances (Keane 2002 18-19). Is a body in pain functioning normally or in a disrupted state Is pain relief a disruption of normality or a restoration of normal functioning Does it depend on whether the analgesic is aspirin or heroin and whether it has been medically prescribed or self-prescribed How are drug therapies for conditions like social anxiety different from the routine use of alcohol and cocaine to deal with lack of self-esteem and...

Bernard E Bulwer MD MSc and Scott D Solomon MD

At the time of presentation, his medications included captopril, lasix, digoxin, potassium chloride, aspirin, multivitamins, and unspecified dietary supplements. He had no known drug allergies. His family history was significant for coronary heart disease. He smoked more than two packs of cigarettes daily for more than 20 yr, and averaged almost a quart of alcoholic beverages of various descriptions. He admitted no intravenous drug use, but occasionally used cocaine.

Biochemistry Of Ne

Biochemistry The Brain

Involving the production of new TH enzyme occurs at the level of transcription and translation in response to various stimuli via three main second messengers cyclic AMP, diacylglycerol, and calcium. Nerve growth factor and cell-cell contacts are important during development to promote and maintain the catecholaminergic phenotype, and neurotransmitters and glucocorticoids mediate the activation of TH in response to environmental changes such as stress and exposure to certain drugs such as reserpine, nicotine, or cocaine.

Neurotensin Receptor Implication in Brain Functions

Interesting is the treatment of stress and drug abuse. On the one hand, SR48692 has been shown to blunt stress-induced DA release and stimulation of the hypothalamo-pituitary adrenal axis on the other hand, very recent data clearly report that NT neurons play a key role in the modulation of DA mesolimbic system in reward, blockade of NTS1 by SR 48692 inducing an inhibition of both amphetamine and cocaine-induced increase in locomotor activity and addiction.

Classification And Properties

Ornithine-derived alkaloids include the tropanes (atropine, Z-hyoscyamine, -scopolamine, and cocaine), the Senecio alkaloids, and nicotine. Cocaine. Cocaine is a potent central nervous system (CNS) stimulant and adrenergic blocking agent. It is extracted from South American cocoa leaves or prepared by converting ester alkaloids to exgonine, followed by meth-ylation and benzoylation. It is too toxic to be used as an anesthetic by injection, but the hydrochloride is used as a topical anesthetic. It has served as a model for a tremendous synthetic effort to produce an anesthetic of increased stability and reduced toxicity.

The Political Reality in the Early 2000s Lopsided Policies

The United States and many other countries have experienced recurring moral panics in recent decades concerning illicit drug use and have invested substantial resources in efforts to prevent such use. These resources have been invested largely in two areas a particular preventive strategy interdicting the illicit market and the provision of treatment. The first strategy has received the greatest investment of government resources. There was a substantial decrease in illicit drug use in North America in the late 1980s and early 1990s, but it was followed by a rise in the 1990s. At the other extreme the goals for an illicit drug treatment system have been highly ambitious In theory, in the mid-1970s and again in the late 1980s, the United States aspired to provide treatment to every unincarcerated addict. Quite explicitly, treatment for illicit drug use has been seen as a form of social control, and a high degree of coercion has been taken for granted (Gerstein and Harwood). On occasion...

Impact Of Catecholamines On Behavior

The role of catecholamines in substance abuse has received substantial attention. Most drugs of abuse behaviorally work on the premise of being strong positive reinforcers. These include agents such as nicotine, morphine, cocaine, and the amphetamine group. Increased dopamine levels in mesocortical regions have been identified with the use of amphetamines, cocaine, and even nicotine. In the case of cocaine and the stimulants, the increase is produced by blocking the dopamine transporter system. As discussed previously, dopamine has also been implicated in the production of hallucinations. Many of the agents that increase dopamine levels, such as l-dopa, amphetamines, and cocaine, are also capable of inducing hallucinations.

Midbrain Thalamic Disorders Associated with Hallucinations

Associated with hallucinations, usually in the setting of sleep disorders such as narcolepsy or insomnia. Hypnagogic hallucinations occur prior to falling asleep, whereas hypnopompic hallucinations occur upon awakening. Both are generally multimodal, vivid, and emotionally charged. Common examples are the feeling or experience of being about to fall into an abyss or attacked, of being caught in a fire, or of sensing a presence in the room. Hallucinations in the settings of delirium and sedative drug withdrawal are also associated with disturbances in sleep and arousal.

Nature And Significance Of Insomnia

Acute medical or environmental factors. However, slightly over one-third of the adult population complains of recurring, intermittent sleep difficulties whereas 9 to 10 endure chronic, unrelenting insomnia problems. Although many health care professionals as well as the lay public may minimize its significance, insomnia may have notable short- and long-term consequences. At a minimum, insomnia results in daytime fatigue, decreased mood, and general malaise. In more protracted cases it may cause impaired occupational and social functioning. In addition, there is substantial evidence that insomnia dramatically increases risks for medical complaints, alcohol and drug abuse, and serious psychiatric illnesses. Moreover, insomnia alone contributes to increased health costs and utilization among affected individuals and, in turn, escalates health care costs for society in general. Indeed, insomnia sufferers may collectively spend well over 285 million per year for prescription sleeping pills...

Young Adults with Stroke

Particular care should be exercised when evaluating the young adult (ages 15 to 50) with acute stroke. In this group, arterial dissection accounts for 20 percent of all ischemic strokes and may often be preceded by only minor trauma. The young adult with a cardioembolic event may have mitral valve prolapse, rheumatic heart disease, or paradoxical embolism as the originating cause. Migrainous stroke in this age group is a potential, with a female predominance. Air embolism should be considered in patients with a history of recent scuba diving or an invasive medical procedure. Such patients should be placed in a left lateral decubitus position and also placed on 100 oxygen. Emergent recompression in a hyperbaric chamber should be arranged. Finally, this population is at risk for ischemic stroke from substance abuse, with heroin, cocaine, and amphetamines often implicated. Any drug with sympathomimetic effects increases the risk of hemorrhagic stroke.

Third Trimester Bleedingplacental Abruption

Premature separation of the placenta from the wall of the uterus is called placental abruption. Abruption can be severe or mild, acute or chronic, and retroplacental or marginal. Abruption causes varying degrees of pain and bleeding. Severe acute abruption classically causes severe, unremitting pain and vaginal bleeding, but bleeding may be mild or absent. Small abruptions may present as vaginal bleeding with little or no pain. Abdominal trauma, maternal hypertension, vascular disease, diabetes, smoking, fibroids, fetal anomalies, and cocaine use are thought to predispose patients to placental abruption. Abruption is found in about 5 percent of all placentas on pathologic examination however, most small hematomas are asymptomatic and the clinical symptoms of abruption complicate only about 1 percent of all pregnancies. Sonography has very poor sensitivity for diagnosing placental abruption and lack of sonographic evidence certainly does not rule out abruption. However, a clinical...

TABLE 992 Pregnancy Related Contraindications of Some Frequently Used Antibiotics

ANESTHETICS Proper use of most agents for local or regional anesthesia, including subcutaneous infiltration of lidocaine, has not been associated with detrimental fetal effects. Combination preparations such as TAC (tetracaine, adrenaline-epinephrine, and cocaine) and LAT (lidocaine, adrenaline, and tetracaine) should not be used due to the potential risks of absorbed cocaine and adrenaline-epinephrine.

Defensive Techniques Theory

Tions toward exercising counternormative actions. In another viewpoint, R. C. Ziller argues that persons learn to associate indi-viduation with rewarding conditions and dein-dividuation with potentially punishing conditions. Thus, whenever the person expects punishment, there will be tendency to diffuse responsibility by submerging oneself into a group, whereas when one learns to expect rewards for jobs well done, she or he wants to appear uniquely and solely responsible for such behaviors. P. G. Zimbardo's deindividua-tion theory postulates that the expression of normally inhibited behavior may include creative and loving behavior as well as negative or counternormative behaviors. Zimbardo proposes that a number of factors may lead to deindividuation, in addition to focus on the group and avoidance of negative evaluation of moral responsibility anonymity, group size, level of emotional arousal, altered time perspectives, novelty ambiguity of the situation, and degree of involvement...

The Control of Drugs and Alcohol

Control of opiates and cocaine initially took a different turn because, by the late nineteenth century, the licensing of physicians and pharmacists had become widespread in the United States. As a result, the first form of control over those drugs, after a period of free access, consisted of making them available by prescription only, although commonly a small amount would be permitted in an over-the-counter remedy. During the Progressive Era (approximately 1890-1920), reformers worked to give the central government more power, so that the benefit of uniform national laws could be applied to problems such as tainted meat, adulterated medicines, the destruction of forests, and drug abuse. With regard to drug abuse, the knotty constitutional problem was addressed by basing the Harrison Act of 1914, which was meant to regulate the distribution of opiates and cocaine, on the federal power to tax. Each transaction, from importation to retail purchase, had to be recorded, and a small tax...

Amphetamines and Related Drugs

Amphetamines are synthetic stimulants that were invented in Germany in the 1930s. Their chemical structures resemble those of adrenaline and noradrenaline, the body's own stimulants. Their effects resemble those of cocaine but are much longer lasting. A single oral dose of amphetamine usually stimulates the body for at least four hours. Amphetamines are more toxic than cocaine and, when abused, cause worse problems. The body has a great capacity to metabolize and eliminate cocaine the liver can detoxify a lethal dose of cocaine every thirty minutes. It cannot handle amphetamines as efficiently. At the same time, people can establish stable relationships with amphetamines more easily than they can with cocainc, probably because the intensely pleasureful but very short effect of cocaine is more seductive and invites repetitive dosing. There are a number of different amphetamines, but all have the same basic effect. Plain amphetamine (Benzedrine) was the first to become popular....

Dopamine And Neuropsychiatric Disorders

Many lines of evidence suggest a role for dopamine in neuropsychiatric disorders such as PD, schizophrenia, attention deficit hyperactivity disorder (ADHD), and drug abuse. The first evidence for dopamine's involvement in these disorders came from either postmortem histological neurochemical studies or the observation that the drugs used to treat these disorders either increased or blocked dopamine neurotransmission in the brain. Since the advent of neuroimaging techniques such as positron emission topography (PET), a majority of the current human studies use this technique to further define the role of dopamine in these disorders.

Cannabis and the cannabinoids

Chronic cannabis users frequently exhibit the ''amotivational syndrome'', characterized by apathy, impaired judgement, memory defects and loss of interest in normal social pursuits. Whether chronic cannabis abuse leads to more permanent changes in brain function is uncertain, but it is known that chronic administration to animals results in permanent damage to the hippocampus. Regular use of cannabis by adolescents frequently predisposes them to other types of drug abuse later. This may reflect the social pressures placed upon them rather than the pharmacological consequences of abusing cannabis.

Dopamine Related Genes

Gene expression studies have also shown that the anterior cingulate cortex is highly sensitive to environmental stress. Anoxia, maternal separation, amyloid protein expression, and drug abuse all induce hypo-metabolism, gliosis, and programmed cell death in the anterior cingulate cortex. Exposure to stress induces the expression of glucocorticoid receptor (GR), a transcription factor that mediates the cellular response to stress as shown by Bruce McEwen of Rockefeller University. Stress-induced excitatoxic damage has

Functions Of The Cingulate Cortex A Associative Attention

Exposure to Cocaine in Utero Exposure of human fetuses to cocaine during gestation is associated with a variety of developmental, neurocognitive deficits, including impaired attention, habituation, arousal, recognition memory, and language development. Adult rabbits exposed to cocaine in utero (4 mg kg of cocaine given intravenously twice daily to gestating dams) exhibited morphological and biochemical abnormalities in the anterior cingulate cortex relative to controls exposed to saline injections. No changes were found in the visual cortices of the subjects exposed to cocaine. In addition, exposure to cocaine was associated with attenuated anterior cingulate cortical training-induced discriminative neuronal activity and deficient avoidance learning. Specifically, when brief (200-msec) and therefore nonsalient discriminative stimuli (CS+ and CS) were employed for training, cocaine-exposed rabbits performed significantly fewer learned responses than saline-exposed controls in the...

TABLE 1872 Risk Factors for Serious Heat Injury Heatstroke

Alcohol and drug abuse can lead to decreased heat dispersal. Alcohol inhibits antidiuretic hormone and leads to a relative dehydration that can contribute to heat illness. The influence of alcohol can also blunt the stimulation to leave a hot area and seek a cooler environment. Other drugs such as heroin and cocaine can predispose individuals to heat injury. Endogenous endorphins and adrenocorticotropic hormone are likely involved in the body's adaptation to heat. Chronic abusers of heroin, cocaine, or alcohol have disruption of the endorphin response to thermal stress, predisposing them to heat injury. 15

Challenges in Studies of the Postmortem Human Brain

Microarray studies have unequivocally proven that in rodents environmental enrichment significantly shapes the brain transcriptome (Rampon et al., 2000), and this is undoubtedly even more pronounced in the human brain (Francis et al., 2002). The lifetime experiences from our surroundings constantly shape our transcriptome profile. This process starts from the intrauterine formation of the CNS and continues until death. Some of these influences will leave behind long-lasting structural changes that are obvious many years after the removal of the primary insults (Stanwood et al., 2001), whereas others are rapidly reversible and related to environmental influences relatively close to the time of death. Smoking, drug abuse, physical activity, and many other lifestyle events are all potent modulators of the CNS transcriptome, and these influences interact with gene expression diversity that occurs as a result of differences in age, sex, and race.

Drug Triggers The Brain Learns

Unlike opiate and alcohol withdrawal, symptoms of cocaine withdrawal are relatively mild and disappear relatively quickly. This dearth of withdrawal symptoms helps to explain the episodic pattern of use reported by many cocaine addicts Periods of intense bingeing alternate with intervals of abstinence. The intense craving and high relapse rate associated with cocaine use appear to derive more from a desire to repeat a pleasurable experience than to avoid the discomfort of withdrawal. significant role in the treatment of addiction. Treatment strategies aimed at eliminating one specific form of addiction, such as cocaine abuse, without addressing other mood-altering substances, have usually failed. The addict who abuses only one drug is very rare. The Epidemiologic Catchment Area study of over 20,000 respondents found that 16 percent of the general population experienced alcoholism at some point during their lifetime with 30 percent of these alcoholics also abusing other drugs....

Status Of Behavioral Pharmacology

Modify genetic makeup is more advanced for mice than for other species, it is likely that mice will increasingly become subjects for behavioral pharmacologists. Thus emergent extensions of behavioral pharmacology are also occurring. Funding agencies support behavioral pharmacology for its contributions to mental health research and the problems of drug abuse. Unsentimental drug companies support behavioral pharmacology for its contributions to understanding psychoses and neuroses and to discovery of remedies for their treatment. The future prospects for behavioral pharmacology are bright indeed.

Historical Context of Interest in Drugs

Biomedicine and its power to discover palliatives and topical remedies have exercised strong influence on the place of drug use in Western life. By the time anthropology was emerging as a discipline, the European pharma-copia included numerous remedies derived from plants, many of which were not native to Europe. Opium and its tinctures had many uses in 19th-century English medical practice, and cocaine hydrochloride, a water-soluble transformation of a single alkaloid extracted from coca leaves, appeared in scores of patent medicines marketed in Europe and the United States (Morgan, 1981 Musto, 1987). Avant-garde artistic enthusiasm for some drugs arose in 19th-century Europe and England, exemplified by Coleridge's enthusiasm for laudanum (a tincture of opium) and Baudlaire's Club Les Hachichins (a group of French literati who took hashish, or concentrated Cannabis resin, as a source of inspiration). Hazards of Drug Use. A perception of the hazards presented by these and other drugs...

Medical Psychological Aspects of Transgender

Axis II disorders such as schizophrenia can play a part in a person's self-perception and therefore need to be ruled out, along with environmental factors such as drug abuse, depression, etc. Depression does not rule out GID as a diagnosis, but needs to be considered within the GID diagnostic context. Multiple personality disorder issues must be resolved, so that all the different personalities agree on the sex change procedures. Axis III disorders are also critical and need to be rigorously addressed before GID diagnostic assignment. A recent study from Scandinavia (Haraldsen & Dahl, 2000) has demonstrated that transsexual persons selected for sex reassignment show a relatively low level of self-rated psychopathology before and after treatment.

Emergency Department Recognition of Substance Abuse

The percentage of ED patients who test positive for blood alcohol at the time of the visit ranges from 6 to 34 percent for injured patients and 1 to 19 percent for the noninjured.8 At the time of an urban ED visit, 17 percent of patients were found to meet stringent criteria for alcohol abuse and 19 percent for alcohol dependency, while only 9 percent of the study group were breath alcohol positive, and only 14 percent reported a drinking problem. Among a 1-year sample of more than 7100 patients presenting to another urban ED, 41 percent (n 2931) screened positive for alcohol or drug abuse on a health-needs history.9 Rates of substance abuse as high as 50 percent have been reported among trauma patients,10 and alcohol is a major risk factor for virtually all categories of injury. 11 Patients with alcohol and drug problems are primarily encountered in the medical, rather than the treatment, system. According to the Institute of Medicine, more than 5 million Americans currently need...

Potential Causes Of Recurrent Miscarriage

We've all heard about the dangers of tobacco, alcohol, and street drugs. They just aren't part of a healthy lifestyle. This is especially true as you try to conceive and also during your pregnancy. If you smoke during pregnancy, you are more likely to experience vaginal bleeding and miscarriage. Women who drink excessive alcohol or engage in illicit drug use have a definite increased risk of miscarriage.

Pharmacogenetics and psychopharmacology

Molecular genetic studies have been particularly fruitful in evaluating the neurochemical basis of the disorder. Genes involved in the dopaminergic system were considered to be important as the most effective symptomatic treatment of the condition has been methylphenidate and dextroampheta-mine, drugs which potentiate the release, and inhibit the reuptake, of dopamine. In addition, the involvement of dopamine in ADHD is further implicated by the increased vulnerability of these patients to drug abuse. As discussed in Chapter 15, the dopaminergic system has been implicated in reward mechanisms so the search for abnormalities in the genes encoding for different aspects of them seems a reasonable start.

Empirical Studies A Efficacy of Exposure

Recent research shows that a good predictor of relapse from combined exposure and drug treatment is the degree to which patients attribute their improvement to their antianxiety drugs rather than to their own efforts. Patients who attribute improvement to their drugs tend to be less confident about coping and have more severe withdrawal symptoms during the drug taper period. Withdrawal symptoms may further lead patients to attribute treatment gains to their drugs (instead of their own efforts) and also lead patients to expect to relapse once the medication is withdrawn. Attributing improvement to effective self-initiated action (i.e., self-directed exposure exercises), rather than to an external agent like a drug, may reduce the chances of relapse. This is because attributing improvement to self-initiated action encourages the person to persist with exposure exercises even while experiencing drug withdrawal effects. People who attribute their gains to the drug are less likely to enter...

Empirical Basis For

Meta-analytic reviews of randomized studies show more abstinence with family-involved treatment than with individual treatment in drug abuse (Stanton & Shadish, 1997) and in alcoholism (O'Farrell & Fals-Stewart, 2001). Overall the effect size favoring family-involved treatments over individual-based treatments was classified as a medium-size effect. BCT is the family therapy method with the strongest research support for its effectiveness in substance abuse (Epstein & McCrady, 1998). Research shows that BCTpro-duces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Details of the following studies are provided elsewhere (O'Farrell & Fals-Stewart, 2000, 2002, 2003).

What Is Behavioral Pharmacology

The drugs that are studied by behavioral pharmacologists naturally depend on the environment, interests, and purposes of the particular investigators. In academic laboratories, well-established drugs that have been extensively studied pharmacologically and behaviorally continue to be studied in the search for coherent principles of behavioral pharmacology. In recent years, however, more new drugs have been studied that were created to have affinity for particular known receptors or for selected mechanism. Such studies enrich aspects of both neuroscience and behavioral pharmacology. Academic investigators also study new drugs begining clinical use to establish how their behavioral effects fit into the context of what is known about the behavioral pharmacology of previously studied drugs. Finally, there is currently a great effort to understand the behavioral pharmacology of drugs that are important socially because they are abused cocaine, amphetamines, heroin, and the other street...

Mood Anxiety and Somatoform Disorders

The cooccurrence of migraine and psychiatric disorders has been studied extensively in several population-based and longitudinal surveys. Migraine is associated with both affective and anxiety disorders. Breslau and colleagues reported on the association of International Headache Society (IHS)-defined migraine with higher lifetime rates of affective disorder, anxiety disorder, illicit drug use disorder, and nicotine dependence. Migraine with aura was associated with an increased lifetime prevalence of both suicidal ideation and suicide attempts, controlling for sex, major depression, and other concurring psychiatric disorders. The relative risk for the first onset of major depression in migraineurs after the onset of migraine versus no prior migraine was 4.1 (95 CI, 2.2-7.4), whereas the relative risk for the first onset of migraine in persons with prior major depression versus no history of major depression was 3.3 (95 CI, 1.6-6.6). These data indicate that the lifetime association...

TABLE 344 Common Fraudulent Techniques Used by Drug Seekers and Their Management

Patients should be examined for signs of intravenous drug addiction, including needle marks and healed or active superficial cutaneous abscesses, and the heart should be examined for evidence of a new murmur and other signs of endocarditis. Patients attempting to simulate nephrolithiasis can falsify hematuria by biting their buccal mucosa and spitting into the urine sample or by pricking their finger and dipping it into the urine sample. Patients who are suspected of factitious hematuria should be examined for these findings. Patients with factitious acute injury may massage old deformities to create the appearance of erythema and swelling, but this will dissipate over time if the clinician stops the patient from holding the extremity. Patients may self-mutilate, usually with the dominant hand, and seek narcotics. Patients may have evidence of chronic pain or, most commonly, have completely normal physical examination findings. Finally, it is widespread anecdotal experience that such...

Hanging During Incarceration

Imprisoned suicide victims had made a prior suicide attempt, about two-thirds had made at least one attempt during their imprisonment, and about two-thirds had a history of alcohol and substance abuse (88). Other studies have shown a similar high incidence of drug abuse and suicide attempts (76,83). Lack of access to alcohol and drugs may reduce the ability of the inmate to deal with the stresses of prison life (88). The majority (60 ) of prisoners in a British study killed themselves within the first 3 mo of incarceration (89). Studies have shown that many hanging suicides tended to happen between midnight and 8 00 am, when supervision was reduced (80-82,87). Some suicides occur during the day with the expectation by the victim that imminent resuscitation by staff is possible (89). An inmate may stage a hanging to stimulate apparent unconsciousness. Consequent hospitalization can provide a means of escape (78). The majority of victims are male

Choice And Definition Of Problems To Be Studied

Prostitutes in general (CDC, 1987 Cohen et al Rosser, 1994) and African-American women as prostitutes in particular. Several studies have also revealed that practitioners recognize and report at higher rates crack-cocaine abuse in African-American women and alcohol abuse in American Indian women, compared to white women seeking prenatal care. An American Civil Liberties Union study revealed that in forty-seven out of fifty-three cases brought against women for drug use during pregnancy in which the race of the woman was identifiable, 80 percent were brought against women of color (Pattrow, p. 2).

Dietary Factors That Lower Blood Pressure

Additional trials have documented that modest weight loss can prevent hypertension by approximately 20 among overweight, prehypertensive individuals and can facilitate medication step-down and drug withdrawal. Lifestyle intervention trials have uniformly achieved short-term weight loss, primary through a reduction in total caloric intake. In some instances, substantial weight loss has also been sustained over 3 or more years.

Miscellaneous Applications

As mentioned in an earlier section, it was a report of the successful use of a treatment protocol involving NF with a group of alcoholic clients that stimulated revival of interest in NF during the late 1980s. There continue to be reports of the successful use of that protocol and others involving NF with alcohol and drug addiction. However, to the author's knowledge, there have been no published reports of controlled research on this topic. As with NF treatment of dissociative disorders, most of the treatment protocols have included other procedures, and the relative contribution of NF to treatment success is unknown.

Timothy J OFarrell and William Fals Stewart

Keywords alcoholism, drug abuse, couples therapy, behavioral contracts, communication skills training Although alcoholism and drug abuse have been historically viewed as individual problems best treated on an individual basis, there has been a growing recognition over the last three decades that couple and family relationship factors often play a crucial role in the maintenance of substance misuse. The relationship between substance abuse and couple relationship problems is not unidirectional, with one consistently causing the other, but rather each can serve as a precursor to the other, creating a vicious cycle from which couples that include a partner who abuses drugs or alcohol often have difficulty escaping. * Preparation of this article was supported by grants to the first author from the National Institute on Alcohol Abuse and Alcoholism (K02AA0234) and to the second author from the National Institute on Drug Abuse (R01DA14402)), and by the Department of Veterans Affairs. A...

TABLE 1383 Case Definition of Streptococcal Toxic Shock Syndrome

STSS associated with GAS invasive infections, in contrast to previous reports of GAS bacteremia, most commonly affects individuals between the ages of 20 and 50 without predisposing illnesses.10 There is regional variability in populations at risk for developing STSS and necrotizing fasciitis from GAS infections. Extremes of age, diabetes, alcoholism, drug abuse, and immunodeficiency appear to be risk factors for GAS invasive infections. 1 ,12

Social Cost Outcomes and Benefitto Cost Ratio

Three BCT studies (two in alcoholism and one in drug abuse) have examined social costs for substance abuse-related health care, criminal justice system use for substance-related crimes, and income from illegal sources and public assistance. The average social costs per case decreased substantially in the 1-2 years after as compared to the year before BCT, with cost savings averaging 5000- 6500 per case. Reduced social costs after BCT saved more than 5 times the cost of delivering BCT, producing a benefit-to-cost ratio greater than 5 1. Thus, for every dollar spent in delivering BCT, 5.00 in social costs is saved. In addition, BCT was more cost-effective when compared with individual treatment for drug abuse and when compared with interactional couples therapy for alcoholism.

Personality Differences by Gender

Many psychological problems are gender specific. While boys and men tend to suffer from aggression-related problems, women are more apt to experience depression. Substance abuse and alcoholism are also gender specific. While men form the majority of heavy drinkers and alcoholics, women form the majority of psychiatric drug abusers. While male alcoholics attract public attention because they usually behave noisily and aggressively,

Excessive Alcohol Consumption during Pregnancy

FAS is only seen in infants born to women who are excessive drinkers, but it is not an inevitable result of heavy drinking in pregnancy, and even children born to mothers who are active alcoholics may not show it. This differing susceptibility of fetuses to the syndrome is thought to reflect the interplay of genetic factors, social deprivation, nutritional deficiencies, and tobacco and other drug abuse, along with alcohol consumption.

Binge Drinking and Social Alcohol Consumption during Pregnancy

The question of whether moderate or occasional alcohol consumption is safe during pregnancy has been widely debated. Currently, there is little evidence that modest drinking (< 10 units per week) has any harmful effects. Although there is general agreement that women should not drink alcohol excessively during pregnancy, a consensus opinion of a safe limit to drink has not been established at any stage of pregnancy, and advice differs between countries. Many studies are confounded by factors such as cigarette smoking, social class, drug abuse, very high levels of caffeine intake, and different crosscountry categorization of 'light,' 'moderate,' and 'heavy' drinking. A review of the evidence by the Royal College of Obstetricians and Gynaecologists in the United Kingdom concluded that alcohol consumption of more than 3 drinks per week during the first trimester increases the risk of spontaneous abortion, and consumption of more than 15 units per week can have a small negative effect...

Can Substance Misuse Trigger a Premature Onset of the Prepsychotic Prodromal Stage

In the ABC Schizophrenia Study, the lifetime prevalence of alcohol abuse until age at first admission was 24 for the first-episode sample and 12 for matched controls from the same population 119,136,137 , and that of drug abuse 14 for patients and 7 for controls. Studies on the topic almost invariably show a preponderance of men in substance abuse. We found a cumulative prevalence (until first admission) of any type of substance abuse of 39 for men and 22 for women. Cannabis was the most frequently abused substance (88 ), followed by alcohol (58 ). In this study, 35 of the patients with drug abuse and 18 of those with alcohol abuse started with the abuse behaviour in the same month as the onset of schizophrenia occurred. In this small group, precipitation of illness onset by substance abuse cannot be excluded, especially since these patients were significantly younger (8 years) at illness onset than non-abusing patients. In contrast, we could not support in our study the...

Addiction and dependence

While addiction has been called a victimless crime, nothing could be further from the truth. Research consistently demonstrates that acts of violence against self and others, accidents, decreased productivity, health problems, and a number of other social ills have links to alcohol and drug abuse and addiction. Every day we read about, hear about, or know someone who is a victim of a crime caused by those who use or seek drugs. For some, it is tempting to ignore the ravages of addiction by rationalizing their lack of substance use. However, much like recent findings on secondhand smoke, researchers are identifying other deleterious secondhand effects of substance abuse and dependence. These events include dealing with noise from intoxicated partiers, assault from intoxicated persons, and encountering intoxicated drivers (Wechsler, Lee, Nelson et al.). trauma centers testing positive for alcohol has declined by about one-third. However, during this same period, the number of patients...

Serotonin and drugs of abuse

Regarding other types of drugs of abuse, the 5-HT3 antagonist MDL 72222 has been shown to block place preference conditioning induced in rodents by morphine or nicotine without affecting the preference for amphetamine. It is possible that these effects of 5-HT3 antagonists are associated with the reduction in dopamine release as it is well established that the rewarding effects of many drugs of abuse are due to increased dopaminergic activity in limbic regions. On the strength of the experimental findings, it has been proposed that 5-HT3 antagonists might be useful in treating drug abuse in man. Only appropriate placebo-controlled studies of 5-HT3 antagonists will clarify the therapeutic value of such agents in different types of drug abuse.

Cultural Overview

Manufacturing grew rapidly in the 1950s and 1960s, but has struggled since then. The most valuable export over the past five decades has been bauxite ore and its refined derivative alumina, the basis for aluminum. Jamaica became a major supplier of marijuana to North America in the 1970s, as well as a trans-shipment point for cocaine from South America in the 1980s. Tourism, which began with banana boats over 100 years ago, reached 1.2 million visitors in 1998.

Step 3 Strong opioids

A range of alternative strong opioids to morphine (methadone (Physeptone), pethidine, levorphanol (Dromoran) papaveretum (Omnopon)) are available but have no advantage over morphine. Diamorphine (heroin) is a semisynthetic derivative of morphine which, as its solubility in fat is greater, crosses the blood-brain barrier more readily than morphine. When given parenterally it is 2.5 times more potent than morphine, but when given by mouth it is equipotent. As it is a pro-drug for release of morphine, and does not itself bind to opioid receptors, its only advantage over morphine is that its greater solubility in water allows smaller volumes to be used when parenteral medication is required. Such traditional remedies as the Brompton cocktail (morphine or diamorphine, cocaine and alcohol), Schlessinger's solution (morphine, ethyl-morphine and hyoscine) and nepenthe (alcoholic tincture of opium) are no better than oral morphine sulphate in controlled-release form.

The abuse potential of designer drugs

Structures of some ''designer drugs'' of abuse. Compare the structure of alpha-methyl fentanyl with that of fentanyl, MMP+ with that of pethidine, and ecstasy with that of methamphetamine. Figure 15.5. Structures of some ''designer drugs'' of abuse. Compare the structure of alpha-methyl fentanyl with that of fentanyl, MMP+ with that of pethidine, and ecstasy with that of methamphetamine.

Cardiovascular System

Most local anaesthetic agents (except cocaine) relax vascular smooth muscle causing vasodilatation. In addition, centrally administered drugs cause asodilatation by sympathetic blockade. Direct cardiovascular toxicity occurs due to the membrane stabilizing activity of the drugs on myocardial muscle, by blocking voltage-gated fast sodium channels. This reduces the maximum rate of rise of the cardiac action potential and reduces the duration of the action potential. Conduction of the action potential through the myocardium is slowed. Cardiac toxicity may result in any of the following effects

Urine Alarm Plus Medications

Doleys, which was referred to earlier, several medications including dex-amphetamine sulfate (Dexadrine), methamphetamine hydrochloride (Methadrine), and imipramine (Tofranil) were used in the treatment of nocturnal enuresis. When dexamphetamine, methamphetamine, or imipramine was combined with the standard urine alarm protocol the duration of treatment was shorter although sometimes by a very small number of nights. However, the relapse rate was higher. In an analysis of the data, Gordon Young and Keith Turner indicated that the shorter duration of treatment was probably not clinically significant and amounted to perhaps one or two trials. This fact, combined with the indication of the possibility of misuse of the drugs by children in the absence of proper safeguards, resulted in the conclusion that there was little distinct advantage to adding these preparations to the urine alarm procedure.

The Secrets in My Genes Genetic Discrimination and Privacy

The definition of disability in the act is broad, and has been interpreted just as widely. In a recent case, Marsden v HREOC and Coffs Harbour & District Ex-Servicemen and Women's Memorial Club 2000 FCA LEXIS 992 the federal court of Australia found that this definition of disability extended to drug dependence. In Marsden, the complainant alleged that the club had discriminated against him by refusing to serve him alcohol. Mr. Marsden used prescribed methadone to manage his heroin addiction. His use of methadone meant that he sometimes was unsteady on his feet, slurred his words, was uncoordinated, and appeared intoxicated. The club made Mr. Marsden's membership dependent on his not consuming alcohol because they were concerned, without medical evidence, that alcohol should not be consumed on a methadone program. The federal court found that addiction was a form of disability, and that it continued to be a disability even if it were satisfactorily treated and no symptoms were...

Intracranial Arterial Disease and Stroke

Intracranial arterial disease may lead to ischemic and hemorrhagic strokes. Aneurysms and arteriovenous malformations (AVMs), intracranial atherosclerosis, and vasculitis are some of the major diseases of intracranial arteries producing stroke. Approximately 80 of nontraumatic subarachnoid hemorrhage is due to ruptured intracranial aneurysm. Arteriovenous malformations carry a 40-50 lifetime risk of rupture with subsequent fatal or disabling hemorrhagic stroke. Central nervous system vasculitis may occur with or without coexisting systemic vasculitis. Fibromuscular dysplasia rarely affects intracranial arteries. Cerebral amyloid angiopathy may lead to both ischemic and hemorrhagic stroke. Migraine may cause sufficient constriction of intracranial arteries to produce ischemia and infarction. Vasospasm (constriction of vessels due to contraction of vascular smooth muscle) is common following subarachnoid hemorrhage. Toxic substances such as cocaine and other stimulants may lead to...

Central Nervous System

An array of neurologic syndromes are described in association with cocaine abuse, most commonly seizures, intracranial infarctions, and hemorrhages. Pathology results from the hyperadrenergic tone, inducing severe transient hypertension, hemorrhage, or focal vasospasm and sometimes, exacerbation of underlying abnormalities of cerebral blood vessels. In their studies using a dog model, Catravas and Waters demonstrated that lethal doses of intravenous cocaine initially induced seizures, lactic acidosis, hyperthermia, and death.9 Progression of toxicity could be prevented by sedation and cooling. These authors also demonstrated that diazepam was an optimal sedative because it prevented hyperthermia and seizures in the cocaine-poisoned dog and thereby improved survival. Although coronary vasospasm has been well documented in humans exposed to cocaine, a recent study using magnetic resonance angiography also demonstrated cerebral vasoconstriction following cocaine administration. Other CNS...

Use of psychotropic drugs in specific childhood disorders

This is a heterogeneous disorder of inattention, hyperactivity and impulsivity that starts in childhood and may persist into adulthood. Children with the disorder can be identified by their inattention which leads to daydreaming, distractability and difficulty in sustaining an effort to complete a task. Their impulsivity makes them accident prone and disruptive while their hyperactivity, combined with excessive talking, is poorly tolerated particularly in schools. As teenagers, the hyperactivity and impulsivity tend to diminish but other symptoms persist. The adolescent with ADHD often has low self-esteem, poor relationships with peers and often becomes subject to drug abuse. To what extent ADHD persists into adulthood is open to debate, but some longitudinal, family and genetic studies would favour this view. ADHD is often co-morbid with conduct, depressive, bipolar and anxiety disorders. Evidence of fronto-limbic dysfunction with poor inhibitory control of the cortex over the limbic...

TABLE 2711 Causes of Rhabdomyolysis

Consider hereditary causes in patients with a history of recurrent rhabdomyolysis and exercise intolerance. Patients in coma are at risk for development of rhabdomyolysis due to immobility from unrelieved pressure upon gravity-dependent body parts. In one study, the most common positions leading to rhabdomyolysis were the lateral decubitus, lithotomy, sitting, knee-chest, and prone positions. 4 Alcohol consumption can result in rhabdomyolysis secondary to coma-induced muscle compression and a direct toxic effect. Nutritional compromise and hypophosphatemia, both common in alcoholics, increase the risk of rhabdomyolysis. Alcohol is considered to be a causative or contributory factor in approximately 20 percent of all cases of rhabdomyolysis. 5 Drugs of abuse that have commonly been implicated in acute rhabomyolysis include cocaine, amphetamines, LSD, heroin, and phencyclidine (PCP). Common medications associated with the development of rhabdomyolysis include diuretics, narcotics,...

Values Inherent in Health Economics Output versus Input

An alternative does not view health care as a final output, but as one input among many others that contribute to a final outcome termed good health. In this view improvements in health can be the result not only of treatment services, but also prevention programs such as health education, lifestyle change, pollution reduction, and even research and improved training of providers. There is no doubt that the good health that has resulted in the tremendous increase in longevity in the last hundred years is not only the consequence of improved medical care, but also the result of such factors as a safe food and water supply and inoculations. At the present time most poor health and disability results from lifestyles reflecting stress, poor eating habits, lack of exercise, alcohol and drug abuse, tobacco use, and automobile accidents.

Nonsystemic Pharmacologic Agents

Nonsystemic topical, local and regional techniques are of great value in the management of painful conditions or procedures fvor the pediatric ED patient and may minimize the need for use of narcotics and sedatives. The amide and ester local anesthetic medications (lidocaine, bupivacaine, prilocaine, and procaine) and refrigerant agents are the most commonly used nonsystemic agents. Techniques range from topical applications such as tetracaine, adrenaline, and cocaine (TAC) lidocaine, epinephrine, and tetracaine (LET) eutectic mixture of local anesthetic (EMLA) and ethyl chloride, local infiltration of LA, peripheral nerve block, hematoma block, and IV Bier's block. The general discussion of these agents as well as specific comments regarding their use in children is found in Chap 32.

Change in Attitudes Beliefs and Practices Regarding Gender

Increases in population, out-migration, communication, and transportation throughout the 20th century have drawn rural people into more relationships with the rest of the world. The Bolivian and Peruvian Aymara were as affected as their compatriots by the political and economic turmoil of the late 20th century. Terrorism in Peru, the growing, trading, and processing of coca and cocaine in the Bolivian lowlands and its trade through Peru, dizzying rates of inflation, and many changes in governments have affected many aspects of Aymara life including gender roles.

Noradrenaline Reuptake and Metabolism

Neurotransmission in noradrenergic synapses. Transport of NE by the neuronal NE transporter (NET) is dependent on extracellular Na+ and Cl_. cDNAs of a series of neurotransmitter transporters have been cloned, and the NET has been shown to be a member of the superfamily of structurally related Na + - and Cl -dependent transporters for monoamines (dopa-mine, serotonin, and NE) and certain amino acids such as GABA and glycine. Transporters of this family are structurally characterized by 12 transmembrane domains, intracellular amino and carboxy termini, and a large second extracellular loop (Fig. 4). Three consensus sequences for phosphorylation by protein kinase C are found one in the second intracellular loop and two in the carboxy-terminal end. Phosphorylation of NET by protein kinase C results in down-regulation of NE transport, presumably corresponding to a diminution of the number of transporters expressed to the membrane. NET is one of the different pharmacological targets of...

Emerging valve disease

Cardiac disease is not a common complication of AIDS, but the incidence of AIDS related heart involvement will increase as this infection becomes more prevalent and patients live longer.10 11 Valve involvement is less common than myocardial or pericardial disease in AIDS patients, unless a predisposing factor such as intravenous drug abuse exists.12 In these cases, endocarditis is caused by Staphylococcus aureus or Streptococcus pneumoniae, but can also be caused by fungi or HACEK (Haemophilus species, Actinobacillus actinomycetencomitans, Car-diobacterium hominis, Eikenella corrodens, and Kingella species). It has been reported that the degree of immunosupression caused by the HIV infection increases the severity of valve disease and the resulting mortality.13

Associated Factors And Correlates Of Hiv Neurocognitive Complications

In terms of risk factors, contrary to expectation, there is no clear-cut association between injection drug use and heightened risk of neurocognitive complications. Although the rates of neuropsychological impairment tend to be higher among injection drug users generally, there does not seem to be an interaction between drug abuse and HIV status. An exception to this rule may be dependence on central stimulant drugs, especially methamphetamine. Preliminary observations suggest that history of methamphetamine dependence may enhance the likelihood of HIV-associated neurocognitive impairment perhaps because of some commonalities in mechanisms of neural injury that involve excitotoxicity.

Explanatory Behavioral Models

Finally, if this type of coping style exists, any additional factors that may decrease behavioral self-control, such as alcohol or drug abuse, may be important contributing factors (Nezu, Nezu, & Dudek, 1998). As such, theories that focus on impulse control may also partially explain the problem.

Dopamine And The Internal Clock

FIGURE 12.1 Dopamine and clock speed. (A) An information-processing model of interval timing. (Adapted from Gibbon, J. et al., Annals of the New York Academy of Sciences Timing and Time Perception, New York Academy of Sciences, New York, 1984, pp. 52-77.) (B) The scalar property as implemented in the information-processing model the peak time response function is twice as wide when subjects time a 40-sec interval as when they time a 20-sec interval. (C) Theoretical increase in speed of accumulation of temporal units by indirect dopamine agonist methamphetamine and theoretical decrease in speed of accumulation of temporal units by dopamine antagonist haloperidol. Effects on the peak time of responding are predicted to be proportional to criterion interval. (D) Effect of systemic administration of MAP and HAL on the peak time of responding. (Adapted from Meck, W.H., Cognit. Brain Res., 3, 227-242, 1996.) MAP produces a proportional leftward shift of the response function, and HAL...

Danish Research Project In Clinical Setting

The patient group participating in the Danish part of the study suffers from chronic schizophrenia and regular drug abuse, and participants display significantly higher levels of psychopathology and poorer social skills than other patient groups. Patients with dual diagnoses also often experience a multitude of comorbid difficulties including anxiety, depression, and disturbances in personality.

Applications in Biology and Medicine

Winograd and co-workers have pioneered the adoption of fast-freezing and in situ freeze-fracture methodology in SSIMS analysis of frozen hydrated specimens using a variety of liposome and cellular systems (9,37-39). Using characteristic phospholipid fragments, they observed fusion and mixing events between DPPC and cholesterol-containing liposomes using imaging TOF-SIMS (9). The same freeze-fracture methodology was applied to successfully image components of the outer membrane and organelles of frozen hydrated red blood cells (9,38) and to image the distribution of cocaine doped into the single-celled organism Paramecium (39) TOF-SIMS imaging has been combined with bright-field and fluorescence microscopy to image frozen hydrated, freeze-fractured rat pheochromocytoma (PC12) cells (40,41). This integrated approach aids identification of the fracture plane and subsequent interpretation of the TOF-SIMS data. Recently, the group used TOF-SIMS and PCA to demonstrate the heterogeneous...

The Social Force of Diagnosis

Historical perspective can increase our awareness that medical practitioners and researchers have tended to discover what already was assumed. More recent political uses of disease concepts (e.g., in psychiatry) have been closely connected with repressive goals and political agendas of certain governments. Social employment of disease definitions is often meant to be benevolent, however, such as advocating a view of alcoholism and drug addiction as diseases so as to recruit the forces of medicine to aid in their control. Moreover, such conditions may be termed diseases in order to relieve alcoholics and drug addicts of the social opprobria that attend what is often viewed as immoral behavior.

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