Skinner M H, Thompson D A
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-6205.
South Med J. 1992 Dec;85(12):1207-19. doi: 10.1097/00007611-199212000-00013.
Drug and alcohol abuse continue to be commonly encountered problems in most patient populations. To deal effectively with these problems, the primary care physician must have a thorough knowledge of the pharmacology of commonly abused drugs and the adjunctive agents used in treatment. Management of alcoholism may involve a range of medical interventions, including the treatment of alcohol intoxication, the use of benzodiazepines for alcohol withdrawal, and possibly the short-term administration of disulfiram to maintain sobriety. Successful management of cocaine or amphetamine abuse requires an understanding of the powerful reinforcing properties of these drugs and the unique problems that arise in the recovery period. Barbiturate intoxication and withdrawal are potentially life-threatening events requiring skilled in-patient treatment. Prolonged use of benzodiazepines can lead to drug dependence; successful withdrawal involves gradual dosage reduction. Acute intoxication from marijuana or hallucinogenic drugs may occasionally result in adverse reactions requiring medical intervention, but significant withdrawal reactions are rare. Management of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid antagonists. Promising new pharmacologic approaches are now being successfully applied to the management of opioid dependence. An acceptance of nicotine as the addictive component of tobacco smoke has led to the development of nicotine gum as substitution therapy for cigarette smoking. Successful pharmacologic management of overdose or withdrawal is often the prerequisite for effective long-term treatment and recovery.
药物和酒精滥用在大多数患者群体中仍然是常见问题。为了有效应对这些问题，初级保健医生必须全面了解常见滥用药物的药理学以及治疗中使用的辅助药物。酒精中毒的管理可能涉及一系列医学干预措施，包括治疗酒精中毒、使用苯二氮䓬类药物进行酒精戒断，以及可能短期使用双硫仑以保持清醒。成功管理可卡因或苯丙胺滥用需要了解这些药物强大的强化特性以及康复期出现的独特问题。巴比妥类药物中毒和戒断是潜在的危及生命的事件，需要熟练的住院治疗。长期使用苯二氮䓬类药物会导致药物依赖；成功戒断需要逐渐减少剂量。大麻或致幻药物的急性中毒偶尔可能导致需要医学干预的不良反应，但明显的戒断反应很少见。阿片类药物过量的管理，无论是非法的还是医源性的，都需要迅速且熟练地使用阿片类拮抗剂。有前景的新药理学方法目前正成功应用于阿片类药物依赖的管理。将尼古丁视为烟草烟雾中的成瘾成分已导致开发尼古丁口香糖作为吸烟的替代疗法。成功的药物过量或戒断管理通常是有效长期治疗和康复的先决条件。
