Dr.M.J Bazos, MD Patient Handout


About Your Diagnosis
The 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 Diagnosis
There 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 a
snake, 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.

There 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 DOs
It 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’Ts
You 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 Doctor
You 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.

National Clearinghouse of Alcohol and Drug Information:http://www.health.drg
Habit Smart: http://www.cts.com/~habtsmrt
Alcoholics Anonymous Information: http://www.csic.com/aa
The Big Book: http://www.recoveryorg/aa/bigbook/ww/index.htm/
Cocaine Anonymous: http://www.ca.org
Narcotics Anonymous: http://www.wsoinc.com
You can even attend a live AA meeting online at http://www.cr/.com/~pac/aa.