Although highly active antiretroviral therapy (HAART) has extended survival time, evidence suggests that the gains are not equal when comparing gender and status as a person who uses injection drugs. Poundstone and colleagues (2001) concluded that women who inject drugs do not benefit as much as men and women who do not use injectable drugs. CDC (1998) reports that antiretroviral drugs administered to pregnant women and their newborns have been shown to reduce greatly the risk of perinatal mother-to-child HIV/AIDS transmission. Aggressive combinations of drugs currently are recommended, but the specific regimens that can both treat a client’s HIV/AIDS infection and reduce perinatal transmission depend on many factors. The ability to provide effective health care to women who are HIV positive can be influenced significantly by their use of substances and adherence to therapy (Lucas et al. 2006). Once women are in treatment, counselors need to ensure that they are provided with or referred for medical and prenatal care as soon as possible to prevent medical complications.
According to reviews of several studies conducted during the late 1980s and early 1990s, there are a variety of adverse effects of cocaine use during pregnancy (Zuckerman et al. 1995; Burkett et al. 1994). Studies reported that cocaine-exposed infants had smaller head circumference; lower birth weight and length; irritability; poor interactive abilities; and an increased incidence of stillbirth, prematurity, and sudden infant death syndrome (SIDS; Bell and Lau 1995). Other studies dispute many previously reported severe effects of prenatal exposure of cocaine on the offspring. Frank and colleagues’ review (2001) of the literature found that the most consistent effects were small size and less-than-optimal motor performance. Eyler and colleagues (2001) found no evidence of the previously reported devastating effects of prenatal cocaine exposure.
4.6. Other environmental and cultural factors
Therefore, it is helpful from a clinical perspective to subdivide dependence into categories of mild, moderate and severe. People with mild dependence (those scoring 15 or less on the Severity of Alcohol Dependence Questionnaire [SADQ]) usually do not need assisted alcohol withdrawal. People with moderate dependence (with an SADQ score of between 15 and 30) usually need assisted alcohol withdrawal, which can typically be managed in a community setting unless there are other risks. People who are severely alcohol dependent (with an SADQ score of 31 or more) will need assisted alcohol withdrawal, typically in an inpatient or residential setting. In this guideline these definitions of severity are used to guide the selection of appropriate interventions.
Oxcarbazepine has been shown to be equivalent in efficacy to acamprosate101 and naltrexone102 in open-label studies comparing time to first relapse. At higher doses, 1,500–1,800 mg daily, oxcarbazepine was superior to naltrexone in a number of patients who remained alcohol-free.102 There are currently no placebo-controlled blinded studies testing oxcarbazepine’s place in alcohol dependence. The DSM-5, physiological dependence on alcohol which was released in May 2013, has combined criteria for alcohol dependence and abuse into a single term (AUD). Craving was added as a diagnostic criteria and at least two target conditions are now required for diagnosis of AUD.3 New International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes that correspond to DSM-5 will be used beginning in October 2014.
Alcohol Dependence, Withdrawal, and Relapse
Alcohol dependence is characterized by fundamental changes in the brain’s reward and stress systems that manifest as withdrawal symptoms when alcohol consumption is stopped or substantially reduced. These changes also are purported to fuel motivation to reengage in excessive drinking behavior. Repeated bouts of heavy drinking interspersed with attempts at abstinence (i.e., withdrawal) may result in sensitization of withdrawal symptoms, especially symptoms that contribute to a negative emotional state.
- Some 70% of men who assault their partners do so under the influence of alcohol (Murphy et al, 2005).
- Liaison with criminal justice services is necessary to ensure that appropriate co-ordination of care and effective communication and information-sharing protocols are in place.
FAS is characterized by abnormal facial features, growth deficiencies, and central nervous system problems (Jones and Smith 1973). Symptoms can include hyperactivity and attention problems, learning and memory deficits, and problems with social and emotional development. Infants who show only some of these features were previously identified as having fetal alcohol effects (FAE).
Anxiety Disorders
If you can’t function properly in the morning without your cup of coffee, it could be that you are caffeine-dependent. When you miss your morning cup, you might develop physical withdrawal symptoms, like a headache, fatigue, difficulty concentrating, and more. The separate notions of physical dependence and psychological dependence are artificial and represent a myth regarding addictive behaviors. This myth is actually detrimental to the understanding and treatment of any substance use disorder. However, this condition does not generally occur with withdrawal from opiate drugs, which are also considered to be extremely physically addicting. Numerous drugs of abuse are described as having both physical and psychological withdrawal symptoms and fostering both forms of dependence.
