Polydrug Abuse Pharmacotherapy

Although many individuals present with abuse or dependence upon a single Psychoactive Substance, increasing numbers of drug users are pre senting with dependencies upon two or more such substances. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) and the International Classification of Diseases of the World Health Organization (ICD-10) define a condition called ''polydrug dependence'' or ''multiple drug dependence,'' in which there is dependence on three or more psy-choactive substances at one time. Polydrug dependence is particularly common among adolescents and young adults. However, if one includes Nicotine and Caffeine dependence, over half of patients with psychoactive-substance dependence are polydrug-dependent.

The use of specific, preferred combinations of drugs is typically seen in polydrug users. Opioids and Cocaine are often used together, as are Alcohol and cocaine or nicotine and alcohol. Alcohol, Benzodiazepines, and cocaine are often used together by opiate users, especially Methadone users. Illicit-drug users often show nicotine and caffeine dependence. Some individuals will use whatever psychoactive substances are available. One useful distinction is the difference between simultaneous and concurrent polydrug use. In simultaneous polydrug use, the drugs are used together at the same time for a combined effect, such as heroin and cocaine mixed and injected as a ''speedball.'' In concurrent polydrug use, the various drugs are used regularly but not necessarily together. An example is a heroin user who uses benzodiazepines and alcohol to get another kind of high. In other cases, the polydrug abuser may self-medicate with one drug to offset the side effects of another. Cocaine abusers often take diazepam (Valium) to relieve the irritability that follows cocaine binges. Heroin addicts sometimes take benzo-diazepines to relieve the anxiety that characterizes the early stages of opioid withdrawal. A more recent development is the abuse of antidepressant medications among heroin users. The tricyclics appear to be abused more frequently than either the SSRIs or the MAO inhibitors.

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