Abused Drugs

Drugs of addiction are a complicated group of stimulants, depressants, hallucinogenic substances, and sedative-hypnotics (Tables 10.3 to 10.6). These substances can be taken orally, by nasal insufflation (snorting), placed rec-tally, inhaled, injected under the skin (skin popping), injected in mucous membranes, injected intravenously (mainlining), or applied by a skin patch as

Table 10.1. Criteria for substance dependence (DSM IV)._

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same 12-month period:

1. Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect b. Markedly diminished effect with continued use of the same amount of the substance

2. Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the substance b. The same or closely related substance is taken to relieve or avoid withdrawal symptoms

3. The substance is often taken in larger amounts or over a longer period than was intended

4. There is a persistent desire or unsuccessful effort to cut down or control substance use

5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

6. Important social, occupational, or recreational activities are given up or reduced because of substance use

7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance

Source: Data from American Psychiatric Association (7).

Table 10.2. Criteria for substance abuse (DSM-IV)._

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrent use resulting in a failure to fulfill major role obligations at work, school, or home

2. Recurrent substance use in situations in which it is physically hazardous

3. Recurrent substance-related legal problems

4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the consequences of the substance

Source: Data from American Psychiatric Association (7).

in the case of Fentanyl addiction. Several substances, such as the opiates and methamphetamines, have medical uses so that any drug testing program must allow for a review to determine if the substance is being taken legally. Some substances, such as PCP, once had a legal use in the United States and are still used in some countries. Legality of the substances varies by country; for example, heroin, illegal in the United States, is used as an analgesic in treatment of cancer in Great Britain and other countries (8,9).

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