Dr.M.J Bazos, MD
Patient Handout
ABUSE,
DRUG
About Your
DiagnosisThe abuse of prescription and
illicit drugs is a major problem in this country. To understand some of the
aspects of drug abuse, it is important to define the following three terms:
tolerance, physical addiction, and psychological addiction. Tolerance is present
when a drug abuser needs ever-increasing amounts of the drug to achieve the same
effect as before, or to avoid having withdrawal symptoms. Tolerance is a major
feature of physical drug addiction. However, it is important to remember that
tolerance can be lost. For instance, an individual abusing heroin who has a high
tolerance to the drug decides to stop using it for a matter of months. If he
then starts using the same amount he was using when he stopped, the amount could
be fatal because tolerance may be lost. Physical addiction is present when some
degree of tolerance exists. An individual with physical addiction to a drug will
have withdrawal symptoms when the drug is stopped. Symptoms of withdrawal
include piloerection (gooseflesh), nausea, vomiting, abdominal cramps, diarrhea,
a rapidly beating heart, sweating, insomnia, and strong feelings of anxiety.
Withdrawal from drugs such as benzodiazepines (including Librium, Valium, and
Ativan), barbiturates, and alcohol can be life-threatening. Generally, the
withdrawal from drugs that are depressants is much more severe than withdrawal
from drugs that are stimulants, such as phencyclidine (PCP) and cocaine.
Psychological addiction is present when an individual has a severe craving for a
drug and engages in such drug-seeking behavior as forging prescriptions, faking
illnesses, and even committing acts of violence to obtain the drug. Drugs
causing psychological addiction often do not produce physical withdrawal when
stopped. Cocaine, for instance, is extremely psychologically addicting, whereas
alcohol and Valium are very strongly psychologically and physically
addicting.Living With Your
DiagnosisThere is no typical drug
abuser. Drug abusers can be found among housewives and businessmen, inner-city
dwellers and rural inhabitants, and include individuals of all races and creeds.
In the past, more men have sought treatment for drug abuse; however, that is
changing. More women are being admitted to drug abuse programs, probably because
of more awareness of the problem among women. There are basically five
categories of drugs that are abused: depressants, stimulants, hallucinogens,
inhalants, and PCP. Depressants are drugs that make individuals feel down
in the dumps and slowed down when they are used. They include alcohol,
barbiturates (e.g., phenobarbital and Seconal), opiates (e.g., heroin, Dilaudid,
morphine, and codeine), other pain killers (e.g., Demerol and Talwin), and drugs
like meprobamate. Depressants are very strongly physically addicting, and
withdrawal from these drugs can be life-threatening. Stimulants are drugs
that produce a “high” and can have the unwanted effects of causing
severe insomnia, as well as a feeling of restlessness and an inability to sit
still. Cocaine is a stimulant that is used in a number of forms, including the
purified form, which is often smoked (“crack” cocaine). Other drugs
in this group include the amphetamines, such as methamphetamine (often known as
crank); caffeine; various over-the-counter stimulants, including Sinex
preparations that contain a drug called phenylpropanolamine; and diet pills,
including the popular FenPhen diet pill, which has recently been associated with
lung and heart problems and taken off the market. Hallucinogens are drugs
that cause individuals to see things, hear things, or feel things that are not
actually there, or cause individuals to misinterpret things. For instance,
individuals may see intravenous tubing going into their arm and believe it is
asnake, or hear leaves rustling outside
and believe that someone is whispering about them. These misperceptions are
called illusions. The hallucinogens were once very popular in the 1960s, and
unfortunately they have made a comeback since the 1980s. They include lysergic
acid (LSD), mescaline (the active ingredient of the peyote cactus), and
Psilocybin, or the magic mushrooms. These drugs are very unpredictable and
extremely dangerous because of behaviors individuals exhibit while using them.
Inhalants are drugs that are commonly huffed, snorted, or sniffed.
Examples of inhalants include gasoline, cleaning products, anesthetics such as
chloroform, nitrous oxide, and halothane, hair sprays, bug sprays, spray paints,
solvents such as toluene (toulu), airplane glue, typewriter correction fluid,
and kero-sene. The inhalant drugs are very commonly used among teenagers and can
cause severe physical damage, including kidney disease, blood disease, and a
dementia or mental disorder similar to Alzheimer’s. One of the major
problems with these drugs, in terms of stopping the abuse, is that they are
usually inexpensive, are often found in the workplace or at corner drug stores,
and produce only mild physical withdrawal. However, there is strong
psychological dependency or drug craving and drug-seeking behavior associated
with them. Phencyclidine (PCP) is usually considered separately from the
other drugs because it has so many different features. Formerly called
“angel dust,” it is a drug that can produce psychosis or depression.
It can cause individuals to overestimate their own strength because it does have
some pain-killing properties. In addition, PCP can be stored in the body and
released at another time, even without individuals using the drug again. This
episode, called a “flashback,” is fairly common with PCP. One drug
that we have not mentioned is marijuana. Marijuana, similar to PCP, has a number
of different properties. It will often make individuals who are already
depressed more depressed, and it may cause paranoia in some individuals. Many
individuals consider marijuana to be a gateway drug; that is, it is often the
first drug that individuals use on their way to using even stronger agents.
There are other drugs that are abused, too many to discuss in this chapter.
However, two other drugs of abuse are worth mentioning: the so-called
“designer drugs,” which have some hallucinogenic properties; and
GHB, which is a drug that has gathered notoriety as a “date-rape”
drug.TreatmentThere
are many different ways to treat drug abuse, but they involve one basic
principle: discontinue the use of the drug. For those drugs such as the
depressants that are associated with a strong physical addiction, and therefore
withdrawal, the drugs should not be stopped all at once. When alcohol is the
abused drug, other drugs such as Librium, Valium, and Ativan are used to slowly
decrease alcohol intake in individuals who have been using alcohol for a number
of years. In cases of benzodiazepine abuse, the doses of these drugs are
gradually decreased. When opiates such as morphine and Dilaudid are abused,
sometimes methadone is substituted and tapered for detoxification. If you are
abusing a drug, especially a depressant drug, do not try to stop the medication
all at once without consulting with your doctor. A second very important phase
of treatment after detoxification is education. Most treatment programs have a
very strong education component, because often individuals cannot recognize the
triggers that lead to their drug abuse and cannot recognize relapse warning
signs. This education is often done in peer support groups that involve other
drug abusers, who can be confrontational and who are aware of some of the signs
of drug abuse and denial that the counselor may not recognize. This peer support
usually involves participation in some group fashioned along the lines of
Alcoholics Anonymous. There are such groups for cocaine abusers (CA) and for
other depressant abusers. It is strongly suggested that someone who detoxifies
from drugs or alcohol go to 60 AA or NA (Narcotics Anonymous) meetings in 60
days. Patients should also obtain a sponsor, someone who has had years of clean
time, and once selected, patients should call their sponsor during times when
they feel they are at high risk for relapse. So a detoxification that is often
medical that looks for medical complications of drug use, provides tapering of
drugs if possible, education process and a peer support process are the most
common stages of the treatment of drug abuse. Thus the stages of drug abuse
treatment involve: (1) a medical detoxification if indicated, (2) education and
maintenance of drug-free state, and (3) peer support counseling (AA, CA, or
NA).It should also be mentioned that there
is a group of individuals who have what is called a “dual
diagnosis”; that is, they have a psychiatric condition and drug abuse,
such as major depression and alcohol abuse, or anxiety disorder and stimulant
abuse, or schizophrenia and alcohol abuse. In the individual with dual
diagnosis, usually the psychiatric disorder is made worse by the drug use, and
the drug use is more likely because of the psychiatric disorder. Therefore if
you have a dual diagnosis, it is very important that you are treated for both
conditions, that you stay on your medication prescribed for your psychiatric
disorder, and that you follow the 12-step recovery program for substance abuse.
There are some AA-type groups called “double trouble” groups where
all the members also have psychiatric disorders. If you have a dual diagnosis,
you might choose a sponsor who also has a dual diagnosis, who will be able to
understand your need for psychiatric care and recovery. In some AA or NA groups,
there is a very strong bias against medication, so you may have to look around
to find a group in which you feel comfortable. It is very important to
participate in a recovery program and stay on medication if you have a dual
diagnosis.The
DOsIt is very important for the
individual who has been detoxified from drugs and is in a recovery program to
follow some simple common-sense
steps.• You should inform your
doctor or any emergency room physician that you are a recovering drug abuser, so
they will not give you medication that might jeopardize your
sobriety.• You should remember that
you will probably have strong urges during your sobriety to see whether you can
use drugs again or use them in a social setting. These are signs of denial and
relapse; if you experience them, you should definitely contact your sponsor. It
probably is more common to have these kind of symptoms after anniversaries,
especially the first year anniversary of
sobriety.• During your recovery,
such basic things as eating well, getting plenty of fluids, getting plenty of
rest, exercising moderately, and reducing stress will all play a major role in
your attempts to continue your
sobriety.The
DON’TsYou should not see those
friends and relatives who still abuse drugs or remind you of when you were
abusing drugs. Your new community should revolve around your sponsor and your AA
or Narcotics Anonymous (NA)
members.When to Call Your
DoctorYou should contact your
counselor or sponsor for any relapse warning sign. You should contact your
physician if you notice any physical consequences of your drug use or of
withdrawal, such as seizures, psychosis, or suicidal thoughts. You should also
notify your doctor before you take any medications, including over-the-counter
drugs, because many of these agents have properties similar to drugs of
abuse.Websites:http://www.well.com/www/woaNational
Clearinghouse of Alcohol and Drug
Information:http://www.health.drgHabit
Smart: http://www.cts.com/~habtsmrtAlcoholics
Anonymous Information: http://www.csic.com/aaThe
Big Book: http://www.recoveryorg/aa/bigbook/ww/index.htm/Cocaine
Anonymous: http://www.ca.orgNarcotics
Anonymous: http://www.wsoinc.comYou
can even attend a live AA meeting online at http://www.cr/.com/~pac/aa.