ELDER TIP Because the older patient may be more sensitive to these drugs, withdrawal may take longer (weeks or months) and be more severe than in a younger adult.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are helpful. In AA, a self-help group with more than 1 million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA’s members stay sober as long as 5 years, and 30% stay sober longer than 5 years.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Substance abuse and induced disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The patient with acute drug intoxication should receive symptomatic treatment based on the drug ingested. Measures include fluid replacement therapy and nutritional and vitamin supplements, if indicated; detoxification with the same drug or a pharmacologically similar drug (exceptions include cocaine, hallucinogens, and marijuana, which aren’t used for detoxification); sedatives to induce sleep; anticholinergics and antidiarrheal agents to relieve GI distress; antianxiety drugs for severe agitation, especially in cocaine abusers; and symptomatic treatment of complications. Depending on the dosage and time elapsed before admission, additional treatment may include gastric lavage, induced emesis, activated charcoal, forced diuresis and, possibly, hemoperfusion or hemodialysis.
Treatment of drug dependence commonly involves a triad of care: detoxification, short- and long-term rehabilitation, and aftercare; the latter means a lifetime of abstinence, usually aided by participation in Narcotics Anonymous (NA) or a similar self-help group.
Detoxification, the controlled and gradual withdrawal of an abused drug, is achieved through substituting a drug with a similar action. Such gradual replacement of the abused drug controls the effects of withdrawal, thereby reducing the patient’s discomfort and associated risks.
Depending on which drug the patient has abused, detoxification may be managed on an inpatient or outpatient basis. For example, withdrawal from depressants can produce hazardous adverse reactions, such as generalized tonic-clonic seizures, status epilepticus, and hypotension. The severity of these reactions determines whether the patient can be safely treated as an outpatient or if he requires hospitalization. Withdrawal from depressants usually requires detoxification because abrupt or poorly managed withdrawal from barbiturates can cause death.
Opioid withdrawal causes severe physical discomfort and can be life threatening. To minimize these effects, chronic opioid abusers commonly are detoxified with methadone.
To ease withdrawal from opioids, depressants, and other drugs, useful nonchemical measures may include psychotherapy, exercise, relaxation techniques, and nutritional support. Sedatives and tranquilizers may be administered temporarily to help the patient cope with insomnia, anxiety, and depression.
After withdrawal, the patient needs to participate in a rehabilitation program to prevent a recurrence. Rehabilitation programs are available for inpatients and outpatients; they usually last a month or longer and may include individual, group, and family psychotherapy. During and after rehabilitation, participation in a drug-oriented self-help group may be helpful. The largest such group is NA.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Alcoholism:
Treatment
(Handbook of Diseases)
Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous, may produce good long-term results.
Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding. Acute withdrawal is also treated with oral multiple B vitamins, including thiamine. Administer fluids as needed, but avoid overhydrating the patient.
CLINICAL TIP: The possibility of intoxication with other drugs should be considered and a blood or urine sample sent for toxicology as appropriate.
Treatment of chronic alcoholism involves counseling, education, and cognitive techniques; psychotherapy (consisting of behavior modification techniques, group therapy, and family therapy); and appropriate measures to relieve associated physical problems.
Aversion, or deterrent, therapy may involve a daily oral dose of disulfiram to prevent compulsive drinking. (See Avoiding the risks of disulfiram therapy.)
UNDER STUDY: The opioid-antagonist drug naltrexone has been shown to reduce the ability to return to drinking and shorten periods of relapse. Longer-term trials are needed.
Tranquilizers, particularly the benzodiazepines, are used to decrease withdrawal symptoms of the central nervous system and are administered routinely to decrease risk of seizures. These drugs are administered and decreased over 3 to 5 days. Status epilepticus should be treated aggressively; initial treatment with lorazepam I.V. is effective.
Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are also helpful.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Drug abuse and dependence:
Treatment
(Handbook of Diseases)
The patient may first need treatment for drug intoxication, followed by long-term therapy to combat drug dependence.
Drug intoxication
The patient with acute drug intoxication should receive symptomatic treatment based on the drug ingested. Measures include fluid replacement therapy and nutritional and vitamin supplements, if indicated, and detoxification with the same drug or a pharmacologically similar drug. (Exceptions include cocaine, hallucinogens, and marijuana, which aren’t used for detoxification.)
Medications include sedatives to induce sleep; anticholinergics and anti-diarrheals to relieve GI distress; anti-anxiety drugs for severe agitation, especially in cocaine abusers; and symptomatic treatment of complications.
Depending on the dosage and time elapsed before admission, additional treatments may include gastric lavage, induced vomiting, activated charcoal, forced diuresis and, possibly, hemoperfusion or hemodialysis.
Drug dependence
Treatment of drug dependence commonly involves a triad of care: detoxification, short- and long-term rehabilitation, and aftercare. The latter means a lifetime of abstinence, usually aided by participation in Narcotics Anonymous or a similar self-help group.
Detoxification, the controlled and gradual withdrawal of an abused drug, is achieved through substitution of a drug with similar action, which is then gradually decreased. Such gradual replacement of the abused drug controls the effects of withdrawal, thereby reducing the patient’s discomfort and associated risks.
Depending on which drug the patient has abused, detoxification may be managed on an inpatient or outpatient basis. For example, withdrawal from CNS depressants can produce hazardous adverse reactions, such as generalized tonic-clonic seizures, status epilepticus, and hypotension.
The severity of these reactions determines whether the patient can be safely treated as an outpatient or requires hospitalization. Withdrawal from CNS depressants usually doesn’t require detoxification.
Opioid withdrawal causes severe physical discomfort and can even be life-threatening. To minimize these effects, chronic opioid abusers commonly are detoxified with methadone.
To ease withdrawal from opioids, depressants, and other drugs, useful nonchemical measures may include psychotherapy, exercise, relaxation techniques, and nutritional support. Sedatives and tranquilizers may be administered temporarily to help the patient cope with insomnia, anxiety, and depression.
After withdrawal, the patient needs to participate in a rehabilitation program to prevent a recurrence of drug abuse. Rehabilitation programs are available for both inpatients and outpatients; they usually last a month or longer and may include individual, group, and family psychotherapy. During and after rehabilitation, participation in a drug-oriented self-help group may be beneficial. The largest such group is Narcotics Anonymous.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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