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TITLE PAGEYOUR NAMEINSTITUTIONETC.Francis S. is a 40-year-old local businessman who was arrested for prescription fraud after airport security found him in possession of a large quantity of OxyContin and other painkillers. Francis S. was briefly hospitalized after a car accident 3 years ago and sustained injuries to his neck and back. His doctor prescribed painkillers for these injuries. The doctor told him that he should only take the painkillers for a few months, but Francis started finding it hard to get through the day without the painkillers and continued using them. He exaggerated the amount of pain he was feeling to his doctor so that he could continue receiving the painkillers. When his doctor told him that he would no longer prescribe the painkillers, he began to go "doctor shopping" and lied to doctors about his level of pain to get them to prescribe painkillers. Francis told himself that the painkillers helped him deal with his stress at work and be more productive, but in fact, he started missing deadlines at work, making poor business decisions, and putting his work in jeopardy.His wife also noticed a difference in his behavior, saying that he was much more irritable and likely to start arguments over minor issues that had not been a problem in the past. Francis started taking larger doses of the painkillers because he had stopped feeling their effects at the smaller doses. At one point, Francis tried again to stop using the painkillers but found that he was experiencing problems such as headaches, blurred vision, and anxiety when he was not taking them. When he could not find doctors to prescribe sufficient pills, he stole a prescription pad and forged a prescription. DRUG USE AND DRUG ABUSEThe most commonly considered symptom of substance abuse or substance dependence is the overwhelming craving for the substance regardless of the consequences, or the difficulties. The DSM-IV-TR does not recognize that as a specific symptom, but does list the following general symptoms:Substance use while engaging in hazardous activities. Substance use which results in legal problems. Continued substance use even after negative consequences due to the using. Substance use which negatively has affected work, school, or home life. The criteria listed by the DSM-IV to disguish between substance abuse and substance dependence is based on clusters of behaviors and physiological effects which are observed within a specific period of time. In this context, if each criteria of substance dependence is met, according to the DSM-IV, substance abuse is not then considered. A diagnosis of abuse is made only if DSM-IV criteria for dependence cannot be documented. (Ashworth, 1997)There are clear differences between substance abuse and substance dependence as defined by the DSM-IV. Substance dependence is indicated by identifying at least three of the particular indicators. One is an increased tolerance for the substance, resulting in an increase in usage. Another sign is that the substance itself must be taken regularly to alleviate withdrawal symptoms. The inability to stop using the substance after repeated attempts indicates dependence, as does the substance being taken in ever larger amounts. (American Psychiatric Association, 2000)The following are more indicators of substance dependence: Substance taken in larger amount and for longer period than intendedMuch time is expended obtaining drugs, getting money for drugs, etc. Activities and social events are avoided, due to drug useAbuse of the drugs continues even when there are continuing adverse consequences. Repeated use of the drugs is causing the person to not be faithful to his or her personal responsibilities. Repeated use of drugs while driving, or in other potentially dangerous situations. Recurrent legal problems caused by the use of substances. Continuing to use drugs despite repeated social or other problems. Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substances. (American Psychiatric Association, 2000)Regular exposure to a drug sometimes results in physiological dependence which is reflected by withdrawal symptoms when the drug is discontinued suddenly, or even if the amount of the drug taken is greatly reduced. CITATION OBi05 \l 1033 (O'Brien, 2005) Another phenomenon, tolerance, can result if a person is regularly exposed to a certain drug. Tolerance is the reduced effect of the drug over the course of time, and the resulting need to increase the amount taken to keep getting the same effects. CITATION OBi05 \l 1033 (O'Brien, 2005)The signs of withdrawal depends on the characteristic symptoms for that specific drug, and that taking the same drug relieves the symptoms. Determining withdrawal from a substance would depend on the specific withdrawal characteristics of that particular drug, and the relief from those symptoms if the drug is taken. CITATION CGe97 \l 1033 (Ashworth, 1997)The drug, Lorazepam, is in a group of drugs called benzodiazepines. It is a common prescription medication used in the treatment of things like anxiety, and insomnia. Withdrawal from Lorazepam abruptly could result in seizures and psychosis and could actually result in death if the withdrawal is not done under controlled conditions. The reason is that all doses of this medication are potent doses, and therefore the blood level cannot be stabilized. Another, similar drug should be added during controlled withdrawal to minimize the possibility of severe outcomes. Withdrawal from OxyContin could also result in some very serious medical conditions, especially if the level ingested has been very high for a long time. Here is a list of some of the possible withdrawal symptoms:DiarrheaJoint and muscle painDry mouth or sore throatWatery eyes and excessive yawningHeadachesInsomniaFatigueCoughingHeart palpitations CITATION CGe97 \l 1033 (Ashworth, 1997)The withdrawal symptoms of this drug are similar to withdrawal from alcohol, heroin and several other drugs. Due to the nature of OxyConTin, psychological withdrawal is one of the most prominent characteristics of withdrawal. CITATION OBi05 \l 1033 (O'Brien, 2005)Francis S. clearly suffers from substance dependence. His symptoms and behaviors reflect almost every indicator of substance dependence. He was arrested for drug fraud, a legal problem. He was involved in a car accident and was hospitalized. Even under these adverse consequences, he continued to use the drug. Eventually, he turned to lying to obtain drugs when his doctor would not continue to prescribe them. He tried to stop, but began experience headaches and other symptoms, so continued to use. He began to show personality changes, which affected his personal and social life. A doctor might prevent a patient from becoming addicted to prescription drugs by closely monitoring their use and by making sure that each patient knows the consequences of over use. A central registry, at least locally, could be utilized to make sure there is a minimum of “doctor shopping.” Much care must be taken by doctors to balance the attempt to reduce pain or other symptoms with the potential misuse of the prescription drug. References BIBLIOGRAPHY \l 1033 American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorder. Ashworth, C. G. (1997). ABC of mental health. Addition and dependence. BMJ.Atack, J. (2003). Anxioselective compound acting at the GABA(A) receptor benzodiazepine binding site. Current drug targets. O'Brien, C. (2005). Benzodiazepine use, abuse, and dependence. Joural of Clinical Psychiatry , 66 Supple 2:28-33. ................
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