1. Three interacting key factors give rise to dependence—psychopathology of the individual; frustrating environment; and availability of powerful, addicting, and temporarily satisfying drug.
2. According to conditioning principles, substance abuse and dependence proceed in several phases:
1. Use of sedatives-hypnotics, CNS stimulants, hallucinogens, and narcotics for relief from daily tensions and discomforts or anticipated withdrawal symptoms.
2. Habit is reinforced with each relief by drug use.
3. Development of dependency—drug has less and less efficiency in reducing tensions.
4. Dependency is further reinforced as addict fails to maintain adequate drug intake—increase in frequency and duration of periods of tension and discomfort.

1. Abuse:
1. Hallucinogens (lysergic acid diethylamide [LSD], marijuana, ecstasy, STP, PCP, peyote): euphoria and rapid mood swings, flight of ideas; perceptual impairment, feelings of omnipotence, "bad trip" (panic, loss of control, paranoia), flashbacks, suicide.
2. CNS stimulants (amphetaminesand cocaine abuse): euphoria, hyperactivity, hyperalertness, irritability, persecutory delusions; insomnia, anorexia → weight loss; tachycardia; tremulousness; hypertension; hyperthermia → convulsions.
3. Narcotics (opium and its derivatives morphine, heroin, codeine, meperidine HCl [Demerol]): used by "snorting," "skin popping," and "mainlining." May lead to abscesses and hepatitis. Decreased pain response, respiratory depression; apathy, detachment from reality; impaired judgment; loss of sexual activity; pinpoint pupils.
4. Sedatives-hypnotics (barbiturate abuse): similar to alcohol-induced behavior (e.g., euphoria) followed by depression, hostility; decreased inhibitions; impaired judgment; staggering gait; slurred speech; drowsiness; poor concentration; progressive respiratory depression.
2. Withdrawal symptoms:
1. Narcotics (e.g., heroin): begin within 12 hours of last dose, peak in 24 to 36 hours, subside in 72 hours, and disappear in 5 to 6 days.
1. Pupil dilation.
2. Muscle: twitches, tremors, aches, pains.
3. Gooseflesh (piloerection).
4. Lacrimation, rhinorrhea, sneezing, yawning.
5. Diaphoresis, chills.
6. Potential for fever.
7. Vomiting, abdominal distress.
8. Dehydration.
9. Rapid weight loss.
10. Sleep disturbance.
2. Barbiturates: may be gradual or abrupt ("cold turkey"); latter is dangerous or life-threatening; should be hospitalized.
1. Gradual withdrawal reaction from barbiturates:
1. Postural hypotension.
2. Tachycardia.
3. Elevated temperature.
4. Insomnia.
5. Tremors.
6. Agitation, restlessness.
2. Abrupt withdrawal from barbiturates:
1. Apprehension.
2. Muscular weakness.
3. Tremors.
4. Postural hypotension.
5. Twitching.
6. Anorexia.
7. Grand mal seizures (a.k.a. generalized seizures).
8. Psychosis-delirium.
3. Amphetamines: depression, lack of energy, somnolence.
4. Marijuana: psychological dependency includes craving the "high," and irritability without the drug. Physical withdrawal occurs with heavy daily use; symptoms include: insomnia, anxiety, and loss of appetite.
3. Difference between alcohol and other abused substances (e.g., opioid).
1. Other abused substances may need to be obtained by illegal means, making it a legal and criminal problem as well as a medical and social problem; not so with alcohol abuse and dependency.
2. Opium and its derivatives inhibit aggression; whereas alcohol releases aggression.
3. As long as the client is on large enough doses to avoid withdrawal symptoms, abuser of narcotics, sedatives, or hypnotics is comfortable and functions well; whereas chronically intoxicated abuser of alcohol cannot function normally.
4. Direct physiological effects of long-term opioid abuse and dependence on other abused substances are much less critical than those with chronic alcohol dependence.

1. Risk for altered physical regulation processes (cardiac, circulatory, gastrointestinal, sleep pattern disturbance) related to use of mind-altering drugs.
2. Risk for injury due to altered judgment related to misinterpretation of sensory stimuli and low frustration tolerance.
3. Altered conduct/impulse processes related to rebellious attitudes toward authority.
4. Altered social interaction (manipulation, dependency) related to hostility and personal insecurity.
5. Altered feeling states (denial) related to underlying self-doubt and personal insecurity.

generally the same as in treating antisocial personality and alcohol abuse and dependence.

1. Maintain safety and optimum level of physical comfort. Supportive physical care: vital signs, nutrition, hydration, seizure precautions.
2. Assist with medical treatment and offer support and reality orientation to reduce feelings of panic.
1. Detoxification (or dechemicalization)—give medications according to detoxification schedule.
2. Withdrawal—may be gradual (barbiturates, hypnotics, tranquilizers) or abrupt ("cold turkey" for heroin). Observe for symptoms and report immediately.
3. Methadone (Dolophine)—person must have been dependent on narcotics at least 2 years and have failed at other methods of withdrawal before admission to program of readdiction by methadone.
1. Characteristics:
1. Synthetic.
2. Appeases desire for narcotics without producing euphoria of narcotics.
3. Given by mouth.
4. Distributed under federal control (Narcotic Addict Rehabilitation Act).
5. Given with urinary surveillance.
2. Advantages:
1. Prevents narcotic withdrawal reaction.
2. Tolerance not built up.
3. Person remains out of prison.
4. Lessens perceived need for heroin or morphine.
3. Participation in group therapy—goals: peer pressure, support, and identification.
4. Rehabilitation phase:
1. Refer to halfway house and group living.
2. Support employment as therapy (work training).
3. Expand client's range of interests to relieve characteristic boredom and stimulus hunger.
1. Provide structured environment and planned routine.
2. Provide educational therapy (academic and vocational).
3. Arrange activities to include current events discussion groups, lectures, drama, music, and art appreciation.
5. Achieve role of stabilizer and supportive authoritative figure; this can be achieved through frequent, regular contacts with the same client.
6. Health teaching: how to cope with pain, fatigue, and anxiety without drugs.