Rural Emergency Medicine

This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder. For information about the series, or common abbreviations click here.

Use Abuse Dependence Addiction

Drug dependence: Symptoms when an individual continues use of a substance despite issues with usage
Drug tolerance: effect of the drug decreases with repeated use; often associated with dependence

Drugs of Abuse

  1. Male, 
  2. Genetics, 
  3. Physiological vulnerability
  4. Psychological factors (e.g. poor quality family relationships, depression)
  5. Personality (e.g. response to stress)
  6. Psychosocial factors (e.g. ↓ SES)

Drug Dependence (DSM-IV)
W ithdrawal
H arm – continued use despite harm
A ctivity - ↓ social, recreational & occupational
T olerance
D esire – persistent
A mount – more than intended
T ime – spent seeking/using/recovering

Drug Abuse (DSM-IV)
S ocial/interpersonal problems
L egal problems
U se in dangerous situations
R ole – failure to fulfil role at home, work, etc

Tx: Psychological - Motivational interviewing, 12-step programs (e.g. AA), Relapse prevention, CBT
Pharmacological - Principles behind pharmacological treatments.
  • Substitution 
  • Inhibit the drug response 
  • Aversive therapy 
  • Modification of craving
Education - Harm minimisation (e.g. safe use), mixing drugs, abstinence from all substances promoted , etc.

Consequences of Abuse: To individual, family & society.

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