Principles of addiction treatment

Approaches to treating nicotine dependence

About 90% of smokers quit independently, without medical assistance. Medical intervention is indicated in cases where previous attempts have failed. A clinical marker of established dependence is an intense craving for a cigarette in the morning on an empty stomach (primarily to relieve morning cough).

Treatment is based on two main areas:

• Psychotherapy: techniques for controlling sensations and experiences (e.g., keeping a journal) are used, as well as the "nicotine fading" method, which involves a gradual reduction in substance consumption.
• Pharmacotherapy: includes replacement therapy (patches and chewing gums containing nicotine) and short-term symptomatic support. The latter aims to improve sleep, stabilize mood, and suppress irritability and cough that occur during withdrawal syndrome.

Alcoholism treatment and withdrawal management

In the Russian Federation, the majority of patients in narcological clinics undergo treatment specifically for alcohol dependence. Treatment largely depends on the stage of the disease. At Stage I, the patient loses quantitative control over alcohol intake, whereas at Stage II, physical dependence develops and pseudodipsomania appears.

The development of alcohol withdrawal syndrome (WS) requires mandatory medical intervention:

1. Symptom management: typical manifestations of withdrawal include pronounced tremor and seizures. To manage them, benzodiazepine tranquilizers must be prescribed.
2. Neuroprotection: patients in a state of alcohol WS must be administered thiamine (vitamin B1). This protects the brain and serves as prevention against a severe complication — Wernicke's encephalopathy.

Particular attention is required for alcoholic delirium (delirium tremens). It is important to understand that it occurs against the background of alcohol cessation (at the peak of withdrawal syndrome), rather than while intoxicated. Prodromal signs include persistent insomnia and anxiety. In severe cases (high risk of complications), hyperthermia and dehydration are observed.

Treatment of opioid and other types of substance use disorders

Management tactics depend on the type of psychoactive substance. The main sign of an established disease is the continued use of PAS despite severe consequences for health and social status (e.g., detection of HIV or viral hepatitis with intravenous administration).

• Opioid dependence: opioid intoxication is characterized by bradypnea (respiratory center depression) and miosis. At the remission-building stage, therapy focuses on maintenance treatment. For this purpose, naltrexone, an opioid receptor antagonist, is used.
• Barbiturate dependence: the specificity of treatment lies in the fact that physicians do not recommend abrupt drug cessation due to the severity of consequences. It should be noted that patients with alcoholism often develop cross-tolerance to barbiturates.
• Inhalation of volatile solvents: the toxic effect of these substances causes the most pronounced encephalopathy (compared to LSD, cocaine, or morphine), which requires prolonged recovery of CNS functions.

Class and exam questions

What else to study on this topic

• Pathological intoxication: alteration of consciousness and its differences
• Korsakoff's amnestic psychosis and fixation amnesia
• Specific symptoms of cocaine and cannabinoid intoxication
• Indirect laboratory and somatic signs of alcoholism
• Mechanism of the toxic effect of nicotine on the CNS

Other topics in «Chapter 21. Disorders due to use of alcohol and other psychoactive substances»

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