Addiction Treatment Blog

If the induction of appetites and cravings, which has been hitherto seen as psychological dependence, is not in fact any more psychological than the physical dependence that underlies withdrawal, is there any other psychology involved? There almost certainly is (1). For example LSD, phencyclidine and many of the new designer drugs do not cause either type 1 or 2 physical dependence. Yet they are increasingly abused, despite evidence that many of these compounds may be fatal. Phencyclidine, for example, has led to a considerable number of fatalities and, despite not leading to any obvious euphoria, during the 1980s became for a period the second most common drug of abuse in the USA. Why?

Common to many of these drugs is the fact that they alter consciousness and, as a result, are interesting to take. On tis basis, one explanation that may account psychedelics, opiates or alcohol, there is a certain amount of playful activity. Read more…

Over the past two decades there appears to have been a shift within health care from an expectation that patients with medical problems should entrust themselves passively to the care of physicians to an expectation that they should co-operate in their own care and indeed have some responsibility for the outcome of medical procedures they undergo. The changes are reflected in the terms we used; the word patient, which means someone who endures, is being replaced by terms such as client or consumer, which suggest a more active and discriminating participant in the medical process.

Nowhere is this shift more clear than when it comes to the question of what is known as informed consent. Informed consent was not an issue in medical practice 20 years ago. Today it forms a central issue in a number of ethical codes from the Nuremberg Code to the Helsinki Code as well as Codes originating from the Food and Drugs Administration (FDA) in the United States and the US Department of Health. Read more…

Separation Liability

Liability for drug induced injuries did not become an issue of general concern until quite recently. However, a number of drug-induced problems from thalidomide in the 1960s to Opren and diethylstilbestrol in the 1970s have caused widespread public disquiet and led to increasing awareness of issues to do with liability. In psychiatry, concern in the UK focuses on the question of benzodiazepine prescribing, while in the US the paramount issue concerns the occurrence of tardive dyskinesia in individuals taking neuroleptics. The question has become an emotive one with some commentators who survey the problem referring to the appalling frequency of drug-induced injury, while others comment on its astonishing tray (1). Whatever the absolute frequencies, contrary probably to public belief, the evidence suggests that the larger the pharmaceutical company, the better its practice regarding drug safety is likely to be (2).

Drug-induced problems may stem from toxic effects of a drug, or toxic effects caused by an impure additive, or from allergic reactions to the drug or its additive. Problems may also stem from over prescribing. For instance, in the case of someone who dies from a resistant bacterial infection, a relative could claim that the subject’s death arose in part from the excessive prescription of antibiotics that in its own right brings about the production of resistant infections. In the case of neuroleptics, problems may be brought about by the overuse of these drugs but this overuse, far from being solely promoted by drug companies stems in part from the current politics of mental health – deaths have stemmed from rapid tranquillisation often by harassed staff in psychiatric units. Read more…

Dependence

Before considering this in detail, we must exclude a type of physical dependence that occurs with a great number of drugs and ordinarily is of little consequence. Many drugs will cause rebound symptoms once they are discontinued. This happens particularly if they block receptors. This blockade leads to the blocked receptors becoming hypersensitive. When the blocking drug is then removed, these receptors are flooded with the normal neurotransmitter and they respond vigorously. It may take 48-72 hours for them to settle back down to normal.

Examples of this are the rebound phenomena that may occur with beta-blockers, such as propranolol, and the cholinergic rebound that may happen after stopping antidepressants with marked anticholinergic effects. Propranolol rebound may lead to palpitations, sweating and flushing. Cholinergic rebound may produce poor sleep and nausea or vomiting. These syndromes are not serious, and high doses of the relevant compounds are stopped abruptly. Read more…

Dependence

The issues of dependence and withdrawal have come up repeatedly through the previous articles we published. They are a primary concern of any taker of psycho-active medication. Some outline of current thinking on these issues therefore seems called for.

It has been traditional to distinguish between physical dependence and psychological dependence. Physical dependence is the state that produces withdrawal syndromes – of which the classic instances are alcohol induced delirium tremens and opiate-induced cold turkey. This is assumed to be physical because withdrawal syndromes are usually intensely physical states with shakes, palpitations, sweating and sometimes even convulsions and death. Some have argued that many individuals are trapped into continuing use of drugs out of a terror at the prospect of withdrawal. Read more…

Effects of Drugs on Sex

Table of Contents

• Potency
• Orgasm
• Libido
• Aphrodisiacs
• Yohimbine
• Trazodone
• Nefazodone and Cyproheptadine
• Glyceril Trinitrate
• Transcutaneous Absorption
• Intracaversonal Injections
• Bethanecol
• Dyspareunia and Orgasm
• Libido
• Anaphrodisiacs
• Sex Addiction Treatment Clinic
• Do You Need Help?

Read more…

The range of sexual difficulties can be devastating.

Table of Contents

• Potency
• Ejaculation and Orgasm
• Libido
  • Sexual Orientation, Objects and Practices
  • The Female Sexual Response
• Sex Addiction Treatment Available
• Do you need help?

Potency

The sexual problem in men that is most likely to lead a request for medical assistance is a disorder of erectile function, leading to impotence. This refers to an inability to achieve or to sustain an erection, and may derive from either an organic or psychogenic source.

The organic causes of impotence stem from either problems with the nervous supply to blood vessels of the penis (neurogenic causes), or problems with the blood vessels themselves (vasculogenic causes). There are a number of other illnesses or disorders which may play a part, from local diseases of the penis, Peyronie’s disease, which involves excessive curvature of the penis (few penises are entirely straight when erect) to diseases which affect the whole body, such as liver or kidney disease. Read more…

Dementia Treatment

It is not clear yet that damage to the cholinergic pathway is the central deficit in Alzheimer’s dementia. Indeed, it has recently become clear that a number of other neurotransmitters are affected in both Alzheimer’s and other cortical dementias. It is also clear that, because of the interactions between various neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter without affecting the others.

Finally, from the vantage point of the 1990s, it seems that many cortical dementias may involve cell protective mechanisms that have been thrown out of gear. Normally, there are a range of mechanisms within cells for neutralizing toxins of various sorts. These often involve the binding of a protein to the toxin, which labels it so that the cell’s own degredative processes destroy the offending agent. In the dementias, however, such mechanisms seem to have been stimulated to the point where the large amounts of cell-protective proteins are produced, to the point where large amounts of cell-protective proteins are produced, to the point that they themselves poison the cell. Whether the stimulus is genetic, viral, toxic (as in aluminium) or some combination of these and other factors is uncertain. The treatment options are to find compounds that will switch off the process or else compounds that will compensate for it. Read more…

Dementia

Part of the problem in finding drugs which may be effective for dementia is that our ideas about what constitutes dementia have been undergoing radical change in recent years. It had been traditional to distinguish between Alzheimer’s dementia, or senile dementia of the Alzheimer’s type (SDAT) and multi-infarct dementia (MID), which is theoretically caused by small strokes which insidiously pick off brain tissue to the point where an individual’s cognitive function is compromised. Read more…

Barbiturates

Concerns about the over-prescription of benzodiazepines in recent years have led some prescribers to look at alternative hypnotic agents – either older compounds such as members of the barbiturate or chloral families, antidepressants, or neuroleptics with a sedative profile. There are a number of problems with such prescriptions as will become clear.

Chloral Compounds

Chloral compounds (see the table below) were first produced in 1869. Their sedative effects were quickly recognised, leading to their use as hypnotics among other things. A number of factors militated against their widespread use. One was the difficulty in making them in other than foul tasting liquid formats. The subsequent discovery of the barbiturates, just before the First World War, largely put paid to them. Before that, however, many patients admitted to mental hospitals were treated with chloral draughts and would appear to have done well. Read more…