LEARNING OUTCOMES
      Understanding the pharmacological basis of medications 
       used to manage dependence
      Understanding how pharmacological agents are used to 
       treat dependence
      Understanding that different medications are needed in the 
       different phases of addiction
      Describing the medications commonly prescribed in 
       dependence
    CONTEXT
      Substance dependence encompasses physical and 
      psychological problems
      Physical dependence: on cessation of a drug to which the 
      body has become adjusted, withdrawal symptoms occur.   
      This can be life-threatening
      Psychological dependence: emotional and mental 
      preoccupation with substances and craving 
     PHARMACOLOGICAL INTERVENTIONS
      Treat emergencies: overdose, seizures, dehydration, 
       hypothermia/hyperthermia, acute confusional state, 
       delirium tremens
      Treat detoxification and withdrawal syndromes: diazepam, 
       chlordiazepoxide, lofexidine, methadone, buprenorphine
      Substitution: methadone, buprenorphine, nicotine 
       replacement therapy, bupropion
      Relapse prevention: naltrexone, acamprosate, disulfiram
      Treatment of vitamin deficiency
      Treatment of comorbid psychiatric and physical disorders 
     SPECIAL ISSUES
       Patients should have the opportunity to make informed decisions 
       about their care in partnership with professionals
       Special groups will need their treatment managed appropriately 
       eg older and younger people will  need lower doses and account 
       needs to be taken of comorbid illnesses in older people
       Psychosocial interventions must be part of the package 
       A full detailed assessment, including blood, urine, saliva 
       investigations to ensure that substances have been used, has to 
       be made before decisions about pharmacological treatment can 
       be made
       Observations of withdrawal should be elicited if possible
     TYPES OF MEDICATIONS
      Antagonists at post synaptic receptor ie block synaptic 
       transmission eg naltrexone 
      Agonists have strong or 100% action on the receptor eg 
       methadone
      Partial agonists induce less effect ie less than 100% eg 
       buprenorphine 
      Partial agonists will act like an antagonist if there is a full 
       agonist present