摘要:

AbstractOpiate reinforcement processes can be described within the context of operant conditioning theory. Both positive and negative reinforcing effects may motivate drug‐taking behavior, although the strongest evidence attributes drug‐taking to a simple positive reinforcement process. Empirical research has focused largely on a positive reinforcement mechanism involving the ventral tegmental dopamine system, but three additional reinforcement mechanisms can be argued on logical grounds. These other mechanisms involve neuroadaptive changes produced by chronic opiate administration and may contribute to the strong motivational impact of opiates following long‐term dru

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03739.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractIn both animals and man, stimulants such as the amphetamines and cocaine are reinforcing and thus motivate repeated drug‐taking behaviour and leading to abuse. Although this class of drugs seems to act by different biological mechanisms in the central nervous system, it has been suggested that their action to increase dopaminergic neurotransmission is crucial to the reinforcing properties of these compounds. However, increasing evidence suggests that a number of other neurotransmitters/neuroregulators, possibly in conjunction with dopamine, are pan of the complex neurochemical systems which underlies various aspects of stimulant abuse behaviours. Examples of possible influences of noradrenaline and corticosterone will be discusse

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03740.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractKey points are highlighted from five papers that address biological processes underlying the actions of opiates, CNS stimulants, nicotine, alcohol, and benzodiazepines. It is noteworthy that: (1) positive and negative reinforcement are common processes underlying actions of drugs of dependence; (2) dopaminergic systems in the ventral tegmental area of the brain seem to be involved in the positive reinforcement of drugs of dependence; (3) GABA also may be involved in this positive reinforcement; (4) receptor sensitization and desensitization may be involved in the actions of drugs of dependence; (5) noradrenalin, 5–HT, ACh, NMDA and corticosteroids also may be involved in drug dependence; (6) motivational systems and processes in addition to positive and negative reinforcement deserve increased research attention; and (7) there may be genetic–based individual differences in drug dependence proces

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03741.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractMarkedly differing views can be found among both clinicians and researchers regarding whether alcohol withdrawal is a phenomenon of any practical or theoretical importance. Evidence has mounted that alcohol withdrawal, even in a severe form, is rarely life–threatening and the great majority of cases can be managed in non–medical settings, including the home. There is also a widely held view among clinicians that withdrawal symptoms have little motivational significance and may be best regarded as but epiphenomena of prolonged heavy drinking. There are also experimental data from both human and animal laboratory studies to the effect that withdrawal symptoms do not readily trigger further alcohol consumption. Against this most unpromising background a case is presented for alcohol withdrawal being but one manifestation of important biological and psychological adaptive processes which occur almost whenever alcohol is consumed with any regularity. It is proposed that understanding this more general phenomenon is critical to a better understanding of the factors which maintain heavy and problematic drinking. Recent evidence also suggests that minor alcohol withdrawal symptoms are far more common in the general population than had previously been realized, and that this has important implications for prevention pol

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03742.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractPhysiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes. Instances are also reported within the high‐dosage category of more serious developments such as seizures and psychotic reactions. Withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns. The most common is a short‐lived “rebound” anxiety and insomnia, coming on within 1‐4 days of discontinuation, depending on the half‐life of the particular drug. The second pattern is the full‐blown withdrawal syndrome, usually lasting 10–14 days; finally, a third pattern may represent the return of anxiety symptoms which then persist until some form of treatment is instituted. Physiological dependence on benzodiazepines can occur following prolonged treatment with therapeutic doses, but it is not clear what proportion of patients are likely to experience a withdrawal syndrome. It is also unknown to what extent the risk of physiological dependence is dependent upon a minimum duration of exposure or dosage of these drugs. Withdrawal phenomena appear to be more severe following withdrawal from high doses or short‐acting benzodiazepines. Dependence on alcohol or other sedatives may increase the risk of benzodiazepine dependence, but it has proved difficult to demonstrate unequivocally differences in the relative abuse potential of individua

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03743.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractMany of the symptoms of nicotine withdrawal are similar to those of other drug withdrawal syndromes: anxiety, awakening during sleep, depression, difficulty concentrating, impatience, irritability/anger and restlessness. Slowing of the heart rate and weight gain are distinguishing features of tobacco withdrawal. Although nicotine withdrawal may not produce medical consequences, it lasts for several weeks and can be severe in some smokers. Like most other drug withdrawals, nicotine withdrawal is time‐limited, occurs in non‐humans, is influenced by instructions/expectancy and abates with replacement therapy and gradual reduction. Unlike some other drug withdrawal syndromes, protracted, neonatal or precipitated withdrawal does not occur. Whether nicotine withdrawal is associated with tolerance, acute physical dependence, greater duration and intensity of use, rapid reinstatement, symptom stages, cross‐dependence with other nicotine ligands, reduction by non‐pharmacological interventions and genetic influences is unclear. Whether nicotine withdrawal plays a major role in relapse to smoking has not been established but this is also true for other drug withdrawal sy

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03744.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractOpiate withdrawal is one of the longest studied and most well described withdrawal syndromes. Opiate withdrawal has been described as akin to a moderate to severe flu‐like illness. Opiate withdrawal is appropriately described as subjectively severe but objectively mild. This paper describes the mechanisms of opiate dependence and opiate withdrawal and reviews the available instruments for the measurement of withdrawal. The time course of assisted and unassisted withdrawal is described and the range of options for the management of assisted withdrawal are described. This review concludes that the most effective and least time‐ and resource‐consuming approach to opiate withdrawal will substantially contribute to the overall social management of opiate depen

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03745.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe current paper is a review of the literature on abstinence symptomatology after stimulant use. The studies performed indicate biological and physical changes during abstinence. One outpatient study suggests a phasic model of stimulant abstinence which is characterized by a ‘crash’, ‘withdrawal’, and ‘extinction’ phase. However, two inpatient studies do not confirm these findings. In contrast, these latter two studies did not find a crash phase and reported a gradual improvement of mood during these 21‐day and 28‐day inpatient stays. Biological measures suggest changes in receptor, endocrinological and neurochemical activity. One study found hyperprolactinemia throughout the 4‐week period, while another study using PET and FDG ([18FJ‐Fluorodeoxyglucose) found increased brain glucose metabolism in the dopamine‐rich areas of the basal ganglia and orbitofrontal cortex. Another study using PET and F18‐Methylspiroperidol found decreased dopamine D2 receptor binding during cocaine withdrawal and also a separate study using PET and F‐18‐Dopa discovered low dopaminergic brain activity. To date, few studies have been performed, and the lack of clear‐cut physical withdrawal symptoms as seen in alcohol, sedative, and opiate withdrawal makes it difficult to demonstrate definitively the presence of withdrawal during stimulant abstinence. Amphetamine withdrawal has been less studied, but empirical data suggest that the symptoms are similar to cocaine withdrawal. Further studies are needed to better delineate the presence of acute ver

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03746.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractWhereas early formulations of addictive behaviour placed great emphasis upon withdrawal as a defining feature, current views focus more upon compulsive use as as central characteristic. However, the withdrawal syndrome continues to occupy an important place in the study of the addictions. It is interesting both in its own right and in relation to the development and maintenance of the compulsive use of drugs. Despite the attention devoted to withdrawal phenomena over many years, precise demarcation of the withdrawal symptoms associated with drugs of dependence has proved difficult to achieve. Withdrawal from all drugs of dependence appears to lead to mood disturbances although the extent to which these are due to the pharmacological actions of like drugs or to other physiological or psychological processes is unclear. Sleep disturbance is also common, although again direct links with the pharmacological actions of the withdrawn drug are yet to be established. Withdrawal from alcohol, benzodiazepines and opiates is often associated with somatic symptoms. In the former two cases, these can involve sweating, tremor and occasionally seizures. Perceptual disturbances have also been reported. In the case of opiates, flu‐like symptoms are often reported, including muscle aches and gastric disturbances. In the case of nicotine, heightened irritability has been established as a direct pharmacological withdrawal effect. Characterization of stimulant withdrawal is still uncertain. There is little evidence of somatic symptoms but depression may occur as a result of a physiological rebound. There is also uncertainty over what role pharmacological withdrawal symptoms play in maintaining compulsive use. Further advances in our understanding of the nature and significance of withdrawal symptoms will depend on using precise operational definitions of features of withdrawa

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03747.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractPreventive strategies for alcohol‐related problems need to be in keeping with their socio‐political context. Prohibition is inappropriate except where it has widespread support within the culture. Preventive strategies focus on the population and/or high risk groups and behaviours. Primary prevention can be achieved by control policies, education and provision of alternatives. Fiscal measures are of proven value. Legislative approaches influence availability and context of drinking, such as drinking and driving. Advertising control, server training and server liability are further approaches. Encouraging the provision of alternative beverages and promoting alcohol‐free environments is a further approach which should be seen as pan of an integrated community response. Secondary prevention linked with early recognition of hazardous drinking at primary level is of known efficacy and would form part of a coordinated str

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03748.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY