Major medical problems and detoxification treatment of parenteral drug-abusing alcoholics.

Patients with combined addictive disease are frequently encountered in New York City. Three detoxification schedules have been developed which, alone or in combination, may be used for almost all substance abusers who require pharmacologic detoxification. Numerous factors contribute to pathogenesis of infections in parenteral drug-abusing alcoholics, including aspiration, impaired pulmonary function, immunologic abnormalities, and changes in endogenous microbial flora. The acquired immunodeficiency syndrome (AIDS) has recently emerged as a serious medical complication of parenteral substance abuse. Liver disease in parenteral drug-abusing alcoholics is also multifactorial. The direct hepatotoxic effects of alcohol, the adulterants of illicit, injectable drugs, and infections with the hepatitis B virus, non-A, non-B viruses, and the delta agent may all be contributing factors.