During the initial treatment of polysubstance abuse and dependence, the primary goals include cessation of substance use and the establishment of a substance-free state. If necessary, detoxification occurs, as well as management of medical and psychiatric problems. Detoxification is the removal of the drug in a fashion that minimizes signs and symptoms of withdrawal. It can be pharmacological or drug free. Pharmacological methods for detoxification include (1) a slow decrease in the dose of the drug or of a cross-tolerant agent (e.g., methadone for heroin withdrawal, diazepam for alcohol withdrawal, Nicotine Gum for smoking cessation) and (2) stopping the drug and using an alternative agent to suppress signs and symptoms of withdrawal (e.g., Clonidine for opioid withdrawal, atenolol for alcohol withdrawal). For many drugs, pharmacologically assisted detoxification is not necessary. Simple alcohol withdrawal can be treated with supportive care. However, the presence of polysubstance dependence usually increases the need for pharmacological agents to assist in withdrawal.

There are few controlled studies on the clinical course and optimal therapies for detoxification from multiple psychoactive substances. Patients can be detoxified from all psychoactive substances together, or maintained on one or more drugs while being detoxified from others. When the drugs used are all part of the same class (e.g., alcohol and sedatives; methadone, Codeine, and heroin), a complete detoxification is more common. When the drugs used are from different classes, partial or sequential detoxification usually occurs. An example of the latter situation is an opioid, cocaine, alcohol, and nicotine user who is detoxified from alcohol and cocaine, but maintained on methadone and allowed to continue tobacco use. Sometimes a partial detoxification is indicated because of the need for continued psychotropic medication for medical or psychiatric illnesses, such as continued opioids for chronic pain or benzodiazepines for anxiety.

Given the cross-tolerance of most Sedative-Hypnotics with ethanol, methods that are effective for the detoxification from alcohol or sedatives alone are usually effective for the combinations of alcohol and sedatives. Loading techniques, with long-acting benzodiazepines, such as diazepam or Chlordiazepoxide, or with Barbiturates, such as Phenobarbital, are well documented as effective. The advantages of these methods include matching the medication used for withdrawal to the individual patient's tolerance and the avoidance of overmedication. The anticonvulsant car-

bamazepine (Tegretol) has been shown to be effective for the treatment of combined alcohol and sedative withdrawal.

Although the mechanisms of action of various drugs differ, there are common neurological substrates of certain behavioral effects and of withdrawal signs and symptoms. The autonomic hyperactivity and some of the CNS excitation common to several withdrawal syndromes are mediated by the locus ceruleus of the brain. Medications such as alpha-2 antagonists (clonidine) and benzodiaze-pines, which inhibit locus ceruleus activity, have been shown to attenuate the symptoms of nicotine withdrawal. However, clonidine will not block the seizures that result from alcohol or sedative withdrawal.

The Smoker's Sanctuary

The Smoker's Sanctuary

Save Your Lungs And Never Have To Spend A Single Cent Of Ciggies Ever Again. According to a recent report from the U.S. government. Centers for Disease Control and Prevention, more than twenty percent of male and female adults in the U.S. smoke cigarettes, while more than eighty percent of them light up a cigarette daily.

Get My Free Ebook

Post a comment