The Pharmacotherapy of Substance Abuse

In his article titled "Recent Developments in the Pharmacotherapy of Substance Abuse", Charles O'Brien discusses the symptoms of addiction to several drugs and the treatment of addiction depending on the drug of addiction. The article is helpful to an understanding of addiction primarily through his analysis of how treatment must be tailored to the particular needs of substance abusers based on the substance of abuse.

O'Brien reveals physical dependence is a state of adaptation to the presence of the drug so the user needs the drug continually to function normally, and if the drug is stopped suddenly, the user experiences symptoms of a withdrawal syndrome (O'Brien, 1996, p. 677). However, regardless of the particular substance being abused, O'Brien maintains effective treatment of addiction requires a long-term approach to reducing the risk of relapse and improving the ability of patients to function in society rather than focusing on the treatment of withdrawal symptoms (O'Brien, 1996, p. 677).

The basis for O'Brien's argument is the understanding that substance use and abuse is a behavioral disorder as well as a physical condition (O'Brien, 1996, p. 677). The treatment of withdrawal is no longer considered to be the instrumental factor in the long-term outcome of the addictive disorder because these symptoms can be effectively treated with medication. O'Brien argues against early theories of treatment that treated all

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ncreased arousal, improved performance on tests requiring alertness, and a sense of self-confidence and well-being (O'Brien, 1996, p. 681). Generally, the feeling of euphoria can be intensified by higher doses and O'Brien notes this feeling is usually followed by a desire for more cocaine (1996, p. 681). O'Brien's article seems to indicate the problems of addiction to cocaine only become prevalent once the user escalates to high or repeated doses. For example, he notes involuntary motor activity, stereotyped behavior, and paranoia occur after high or repeated doses (O'Brien, 1996, p. 681). Cocaine is often involved in drugs-for-sex exchange, and an association between HIV infection and cocaine use has been documented (O'Brien, 1996, p. 681). Furthermore, O'Brien notes an unknown proportion of cocaine users loses control and become addicts; however, the variables that influence this loss of control are not known specifically although clinical data suggest they include availability, route of administration, dose, frequency and preexisting vulnerability to addiction (O'Brien, 1996, p. 681). O'Brien notes recent studies on brain reward mechanisms have yielded important information on the ways cocaine affects behavior. For exampl

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