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

RFs:
  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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