Symptoms of substance abuse include fatigue, poor health, personality changes, social withdrawal, and decreased interest in work, school, or social activities, among others. Effects of substance abuse include increased heart rate and blood pressure; AIDS; hepatitis; behavioral changes; hallucinations; clinical depression; sleeplessness; tremors; liver, lung, and kidney impairment; and death. The hallmark traits of addictive behaviors include: obsession on the object, activity, or substance; seeking out and engaging in the behavior despite awareness of the negative consequences; compulsive behavior; withdrawal symptoms after stopping the addictive behavior; loss of control; denial; concealing the behavior from others; episodic blackout; depression; and low self-esteem.
Alcoholism is a common, serious, and expensive disease. Alcohol affects practically every organ in the body; it affects many neurotransmitter systems in the brain including opiates, gamma-aminobutyric acid (GABA), glutamate, serotonin, and dopamine. Elevated opiate levels explain the euphoric effect of alcohol while its effects on GABA result in anxiolytic and sedative effects. When alcohol is withdrawn, the central nervous system (CNS) experiences excitability. Those who abuse alcohol are more prone to alcohol withdrawal. Long-term abuse can result in cell death and brain degeneration. Signs of alcoholism include accidents, anxiety, depression, breakdown of relationships, and insomnia, among others. In the reviewed studies, the use of drug therapy was typically part of a larger overall program, including behavioral therapy, which was all targeted toward improvement in alcohol abuse.
Commonly Prescribed (On-Label) Drugs: Disulfiram, Naltrexone
Off-Label Prescription Drugs Breakthrough Options: Baclofen, Buspirone, Citalopram, Fluoxetine, Fluvoxamine (Luvox), Ondansetron, Paroxetine, Sertraline, Topiramate
Alcohol withdrawal syndrome is characterized by early symptoms of hypertension, abnormally rapid heart rate, overstimulation of the nervous system, anxiety, and irritability. Neurologic symptoms include tremor, hallucinations, and a reduced seizure threshold. Alcohol withdrawal symptoms start within six to 24 hours after the last alcoholic drink in chronic drinkers. In some instances, alcohol withdrawal syndrome can be life threatening. Clinical management of alcohol withdrawal entails symptom relief, prevention of seizures and delirium, and a transition to a treatment program to maintain abstinence from alcohol. In the reviewed studies, the use of drug therapy was typically part of a larger overall program, including behavioral therapy, which was all targeted toward improvement in alcohol abuse.
Commonly Prescribed (On-Label) Drugs: Chlordiazepoxide, Clorazepate, Diazepam, Hydroxyzine, Oxazepam
Off-Label Prescription Drugs Breakthrough Options: Alprazolam, Atenolol, Baclofen, Buspirone, Carbamazepine, Clonidine, Divalproex, Gabapentin, Lorazepam, Midazolam
Long-term use of benzodiazepines can lead to dependency on the drug. Abrupt cessation of benzodiazepine drug use can produce withdrawal symptoms. These symptoms include anxiety, panic, hypersensitivity to sensory stimuli, depersonalization and derealization, abnormal perception of movement, appetite and weight loss, and depressed mood. Less common symptoms also include epileptic seizures and psychotic or neuropsychiatric symptoms. Even with conservative and gradual benzodiazepine dose reductions, symptoms of withdrawal have been observed in some persons. In the reviewed studies, the use of drug therapy was typically part of a larger overall program, including behavioral therapy, which was all targeted toward improvement in substance abuse.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drug Breakthrough Option: Carbamazepine
The effects of cocaine are immediate, pleasurable, and brief; the drug produces strong yet short-lived euphoria. Similar to caffeine, cocaine produces wakefulness and reduces hunger. Once the drug wears off, intense depression, anxiety, lethargy, and excessive sleeping occur. Addiction to cocaine can happen quickly and is challenging to break. Individuals who are addicted to cocaine will go to great lengths to obtain cocaine and will continue using the drug despite the negative consequences. Addicted people may have difficulty quitting cocaine because the resulting depression can be overwhelming, and will cause them to use more drug to overcome their depressed mood. In the reviewed studies, the use of drug therapy was typically part of a larger overall program, including behavioral therapy, which was all targeted toward improvement in substance abuse.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Amantadine, Baclofen (Lioresal), Carbamazepine, Desipramine, Divalproex, Gabapentin, Modafinil, Topiramate
Pathological gambling is classified as a major psychological disorder. Criteria for this disorder involves at least five of the following traits: a preoccupation with gambling; a need to gamble with increasing amounts to achieve desired excitement; repeated and unsuccessful attempts to control or stop gambling, restlessness and/or irritability when trying to stop gambling; gambling to escape problems and/or mood; lying to family members about gambling; committing illegal acts to support gambling monies; jeopardizing or losing important relationships and/or jobs; and relying on others to relieve the debts incurred by gambling. Treatment for this addictive disorder involves therapy and drug treatment.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Citalopram, Naltrexone
Despite the known risks, numerous awareness campaigns, and publication of research studies that show the health hazards of cigarette smoking, smoking continues to be a major health problem. Although most cigarette smokers who have quit have done so without treatment, the success rate per quit attempt is low — less than 5% of unassisted quit attempts lead to successful long-term abstinence from cigarette smoking. A number of therapies have been directed toward smoking cessation. These include behavioral therapies (counseling) and drug treatments. Drug treatments include nicotine replacement therapies (nicotine gum and patches) and blockade treatments. In the reviewed studies, the use of drug therapy was typically part of a larger overall program, including behavioral therapy, which was all targeted toward improvement in substance abuse.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Clonidine, Mecamylamine, Naltrexone, Nortriptyline, Selegiline
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