Addiction and the Medical Complications of Drug Abuse PDF

Preface

Substance misuse is often considered to be an unpopular subject with many doctors, partly because of the frequent relapse experienced by addicts and partly because of the behavioral problems that can occur when drug users interact with substance misuse treatment services.

Many clinical drug treatment services are dominated by the prescribing of methadone to those dependent on heroin (diacetylmorphine). Methadone maintenance treatment (MMT) has been the most rapidly expanding treatment for heroin dependence over the last 30 years with increasingly large numbers of countries providing such treatment for extensive treatment populations. Even more recently buprenorphine, a partial agonist, has been introduced into drug treatment services and has provided an alternative to methadone. Many doctors involved with addiction problems will see themselves as having only a prescribing role whereas specialists in the field will, in addition, require a repertoire of psychotherapy skills.

Prescribing for patients who may have a dependence on a number of drugs, who may wish to conceal the extent of their substance use, and who may have a marked tolerance to some classes of drug is discussed in order to help inform the practitioner.

The first six chapters of this volume provide an overview, primarily for the nonspecialist. Topics discussed in detail include the psychology of addiction, substitute prescribing, and the identification and management of withdrawal symptoms, both sedative and stimulant. Chapter 7 is a brief discussion of toxicological testing, primarily for the purpose of assessing compliance. Chapters 8 and 9 examine the specific clinical syndromes associated with drugs of abuse.