Advertisement

Pharmacologic Office-Based Interventions

Abstract

Most, if not all, primary care physicians will be faced with the question of how to manage the addicted/alcoholic patient. In this chapter, we discuss how to (1) determine when you should utilize inpatient versus outpatient detoxification; (2) become knowledgeable regarding various methods of outpatient detoxification for each of the specific drugs of abuse; (3) manage patients pharmacologically after discharge from an inpatient detoxification setting; and (4) use the various medications available for your patients to assist in minimizing their relapse potential.

Keywords

Withdrawal Symptom Methadone Maintenance Treatment Comorbid Psychiatric Disorder Opiate Withdrawal Urine Drug Screen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dupont RL, Gold MS. Withdrawal and reward: implications for detoxification and relapse prevention. Psychiatr Ann 1995;25(11): 663–668.Google Scholar
  2. 2.
    Adinoff B, O’Neill HK, Ballenger JC. Alcohol withdrawal and limbic kindling: a hypothesis of relapse. Am J Addict 1995;4: 5–17.CrossRefGoogle Scholar
  3. 3.
    Saitz R. Unhealthy alcohol use. N Engl J Med 2005;352: 596–607.PubMedCrossRefGoogle Scholar
  4. 4.
    Heilig M, Egli M. Pharmacological treatment of alcohol dependence: target symptoms and target mechanisms. Pharmacol Ther 2006;111: 855–876.PubMedCrossRefGoogle Scholar
  5. 5.
    Miller L, Greenblatt DJ, et al. Chronic benzodiazepine administration I: tolerance is associated with benzodiazepine receptor down regulation and decreased GABA receptor function. J Pharmacol Exp Ther 1988;246(1): 170–176.PubMedGoogle Scholar
  6. 6.
    Miller L, Greenblatt DJ, et al. Chronic benzodiazepine administration II: discontinuation syndrome is associated with up regulation of GABA receptor complex binding and function. J Pharmacol Exp Ther 1988;246(1): 177–181.PubMedGoogle Scholar
  7. 7.
    Miller L. Chronic benzodiazepine administration: from patient to gene. J Clin Pharmacol 1991;31: 492–495.PubMedGoogle Scholar
  8. 8.
    Graham AW, Schultz TK, eds. Principles of Addiction Medicine, 2nd ed. Chevy Chase, MD: American Society of Addiction Medicine; 1998.Google Scholar
  9. 9.
    Gold M, Redmond DE, Kleber HD. Clonidine blocks acute opiate withdrawal symptoms. Lancet 1978;2: 599–600.PubMedCrossRefGoogle Scholar
  10. 10.
    Gold MS, Pottash AC, Sweeney DR, Kleber HD. Opiate withdrawal using clonidine. JAMA 1980;243: 343–346.PubMedCrossRefGoogle Scholar
  11. 11.
    Ahmadi-Abhari SA, Akhondzadeh S, Assadi SM, Shabestari OL, Farzanehgan ZM, Kamlipour A. Baclofen versus clonidine in the treatment of opiates withdrawal, sideeffects aspect: a double-blind randomized controlled trial. J Clin Pharm Ther 2001;26: 67–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Drug Addiction Treatment Act of 2000 (DATA 2000). Title XXXV, Section 3502 of the Children’s Health Act of 2000. Waiver Authority for Physicians Who Dispense or Prescribe Certain Narcotic Drugs for Maintenance Treatment or Detoxification Treatment. Public Law 106–310 106th Congress, An Act. Available at: http:// buprenorphine.samhsa.gov/fulllaw.html.Google Scholar
  13. 13.
    Johnson RE, Jones HE, Fischer G. Use of buprenorphine in pregnancy: patient management and effects on the neonate. Drug Alcohol Depend 2003;70: S87–S101.PubMedCrossRefGoogle Scholar
  14. 14.
    Johnson RE, Strain EC, Amas L. Buprenorphine: how to use it right. Drug Alcohol Depend 2003;70: 559–577.CrossRefGoogle Scholar
  15. 15.
    InfoFacts: Cigarettes and Other Tobacco Products. Bethesda, MD: National Institute on Drug Abuse. Revised July 11, 2006. Available at: http://www.drugabuse.gov/infofacts/tobacco.html.Google Scholar
  16. 16.
    The Office on Smoking and Health. Tobacco Information and Prevention Source. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. 2006. Available at: http://www.cdc.gov/tobacco/issue.htm.Google Scholar
  17. 17.
    Schroeder SA. What to do with a patient who smokes. JAMA 2005;294(4): 482–487.PubMedCrossRefGoogle Scholar
  18. 18.
    Gold MS, Edwards DW. Treating cigarette smokers in 2000. Your Patient Fitness 2000;14(4);6–11.Google Scholar
  19. 19.
    Leshner AI. Drug abuse and mental disorders: co-morbidity is reality [director’s column]. NIDANotes 1999;14(4).Availableat: http://www.nida.nih.gov/NIDA_Notes/ NNVol14N4/DirRepVol14N4.html.Google Scholar
  20. 20.
    Krestan J-A. Bridges to Recovery: Addiction, Family Therapy and Multicultural Treatment. New York: The Free Press; 2000.Google Scholar
  21. 21.
    Straussner SLA, ed. Ethnocultural Factors in Substance Abuse Treatment. New York: The Guilford Press; 2002.Google Scholar
  22. 22.
    Primm B, Brown L Jr, Primm A, Friedman J. Tobacco, alcohol and drugs. In Satcher D, Pamies R, eds. Multicultural Medicine and Health Disparities. New York: McGraw-Hill; 2006.Google Scholar
  23. 23.
    Cooper L. Drug Use Among Racial/Ethnic Minorities. Bethesda, MD: National Institute on Drug Abuse, provided scientific oversight, critical review, and substantive comments for this publication, revised 2003. For questions or comments on this documents, please send an e-mail to De. Leslie Cooper at: lc58q@nih.gov. Available at: www.drugabuse.gov.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Personalised recommendations