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Cocaine Abuse Treatment


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Cocaine C17H21NO4is a unique chemical in that
it is both a central nervous system stimulant and an anesthetic. It is
found in the leaves of the Erthroxylum coca plant that is native to the
mountains of South America. The traditional method of coca use is to
chew the leaves, producing a mild stimulation. Outside of South America
it is generally used in its more refined and extracted forms: powder
cocaine or freebase (chemically purified cocaine) and produces much
stronger effect than chewing the leaves. It is known on the street as
“the lady”, “girl”, “white”,
“uptown” or “coke”.

As early as 3000 B.C., there is evidence of coca use in South
America. The inhabitants believed that the coca plant was a gift from
God. In the 15th century A.D. the Incas operated coca
plantations in South America. In the 1800s coca tinctures were used in
surgery and it was in the middle of that century that cocaine was first
extracted from coca leaves. In 1886, Coca-Cola was introduced,
containing cocaine and caffeine. Around the same time Parke, Davis began
to manufacture cocaine. Soon thereafter, around the turn of the century,
sniffing cocaine powder became popular. In 1914 cocaine was banned in
the U.S. under the Harrison Act which controlled the sale of opium,
opium derivatives and cocaine. 

Cocaine can be used by sniffing or injecting the powder
(dissolved in water) or by smoking a purified form (“freebase”
or “crack”) of the drug. Outside of South America, where
cocaine is chewed and absorbed by the membranes of the mouth, stomach
and intestines, cocaine is most frequently used in the form of powder.
On the street, cocaine is sold by the gram and used in greatly varying
amounts. This is due to a tolerance that builds very rapidly in regular
users. A typical dose for sniffing cocaine is between 0.05 gram and 0.20
gram. For injection and smoking the dosage amounts can differ

Cocaine increases alertness, wakefulness, elevates the mood, induces
a high degree of euphoria, decreases fatigue, improves thinking,
increases concentration, increases energy, increased irritability,
insomnia, restlessness. In large doses users often display symptoms of
psychosis with confused and disorganized behavior, irritability, fear,
paranoia, hallucinations, may become extremely antisocial and
aggressive. It increases heart rate, blood pressure, and body
temperature, temperature, pulse, and respiration, decreased sleep and
appetite, seizures, strokes, heart attacks, death.

Physical Dependence: Moderate
Psychological Dependence: Severe
Tolerance: Strong

Cocaine is highly addictive substance, at least in the psychological
sense. While the physical withdrawal is relatively short-term, the
psychological cravings associated with withdrawal can last for months.
Cocaine withdrawal symptoms include intense cravings for the drug,
hunger, irritability, apathy, severe depression, paranoia, suicidal
thoughts, loss of sex drive and insomnia or excessive sleep. Often, more
cocaine is taken to reduce these effects. More than one user of cocaine
has said that using the drug was more important than food, sex, friends,
family, or jobs. Their main concern was how to ease the undesirable
effects of being without the drug.

As noted above, cocaine is a highly addictive substance.
Additionally, because of the nature of cocaine addiction, the newly recovering
user is often in a somewhat depleted physical state. Because of this,
the first step to treatment is usually a detoxification done in a
hospital or medically supervised setting. After detoxification,
residential treatment or twelve-step programs, such as the ones listed
below are generally recommended.

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Cannabis Addiction and Abuse Treatment


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Marijuana LeafDelta-9-tetrahydrocannabinol
(THC) is the active ingredient in cannabis, known to millions as
marijuana or hemp. Cannabis is a tall, leafy plant with an odd number of
divided leaves that grows in most parts of the world. All three species
of cannabis (Cannabis sativa, Cannabis indica, and Cannabis ruderalis)
contain various cannabanoids including delta-9-tetrahydrocannabinol. The
female flowers contain the highest concentrations of these cannabinoids.

Cannabis is a very versatile plant: hemp, a strong fiber produced
from the stem, has been used to make rope, paper and cloth; the dried
leaves and flowers are used as marijuana for their psychoactive or
medicinal properties; the roots of the plant have been used medicinally;
and the seeds are used for oil and animal feed.

People have cultivated cannabis in various parts of the world for
thousands of years, with records dating back to at least the 9th
century B.C. Henry Ford and Thomas Jefferson raised it, many wars have
been fought with it or over it, and in the late 1800s hashish smoking
parlors were open for business in every major American city. According
to police estimates, in 1883 there were 500 such parlors in New York
City alone. In 1914, Congress passed the Harrison Narcotics Act,
outlawing marijuana.

Hemp (usually connotes low-THC cannabis) and marijuana (high-THC
cannabis) are both derived from the cannabis plant. Generally hemp is
cannabis grown for industrial use (rope, canvas, etc.) while marijuana
is cannabis grown for recreational or medical use. Cannabis intended for
consumption is usually in the form of a greenish or brownish mixture of
dried flowers and leaves of the female plant. Sometimes it comes in a
resin form (“hashish”) or a very black or gold-colored, sticky
liquid form (“hash oil”).

Recreationally or medically, cannabis is usually consumed in one of
the following ways:

  • Smoked as a cigarette (“joint”)
  • Smoked in a pipe (“bowl”)
  • Smoked in a water pipe (“bong”)
  • Inhaling the vapors of heated cannabinoid oil (“hash oil”)
  • Cooking into food (ie. hash brownies)
  • Tinctures (can be very potent and overdose is possible)

Additionally, a synthetic form of the active ingredient (THC) in
cannabis, has been developed by Roxane Laboratories, Inc. It is marketed
under the brand name Marinol and is targeted to AIDS patients, cancer
patients and persons suffering from anorexia nervosa.

Time, color, and spatial perception distortions occur as well as a
dreamy euphoria, excitement, laughter and increased appetite (“the
munchies”). Panic attacks and paranoia sometimes occur,
particularly in new users.

Marijuana has shown promise in many areas of medicine including as an
anti-epileptic, as a treatment for nausea and other side-effects of
chemotherapy and AIDS drugs, as one of the only known treatments for
glaucoma and as a treatment for asthma. Recently, the drug has also been
used as an experimental treatment for anorexia nervosa.

The above mentioned effects of cannabis on the body increase over the following two hours after consumption. Luckily, the first effects can be felt within seconds. The first forty five minutes following consumption, the effects gradually increase. After that, the effects begin to diminish for another forty five minutes where the effects usually come to an end…depending on how much cannabis you consumed.

It should be noted for first time users; you may not feel any cannabis effects after your first couple of uses. That aside, the first effects are that of a euphoric feeling. You will begin feeling a sense of relaxation. With your new mellow state, you might find yourself chuckle every once in a while – complete happiness.

These effects will last for a while; generally an hour and half. In the meantime, your body will start having physical reactions to the drug. Your eyes will begin turning bloodshot, followed by cottonmouth. You will find yourself very hungry (munchies) and very thirsty. These reactions will increase along with the other side effects.

As the euphoric feelings begin to die down, they will be replaced with feelings of paranoia and fear. You will also experience a loss of memory along with a state of grogginess. These feelings are normal so these few negative effects of cannabis shouldn’t alarm users.

Cannabis affects the brain. There is a reason cannabis causes the symptoms that it does, has to do with simple chemical reactions that take place in the brain. Cannabis contains chemicals called “caniboids.” These caniboids, the most famous being THC, bind with receptors in the brain and body known as “anandamide.” These chemicals. Anandamide receptors play a part in pain, memory, and immune functions. When the THC joins the anandamide, it causes the brain to experience psychoactive side effects.

Physical Dependence: None
Psychological Dependence: Moderate
Tolerance: Moderate
Source: The Merck Manual: Sixteenth Edition, published 1992

Cannabis (marijuana) is a mild to moderately habit-forming substance
with no physical addiction. It should be noted, though, that virtually
any substance can be addictive, to a greater or lesser degree, depending
on the user. It is a generally accepted notion among treatment
professionals that the addiction, whether physical or psychological, is
the problem, not the specific substance. Below are some treatment
programs that may be useful for cannabis users as well as others seeking
help with an addiction:

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Caffeine Addiction


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Cup of CoffeeCaffeine
(C8H10N4O2) is a very common
substance that is contained in chocolate, soft drinks, tea, coffee, and
can also be purchased as capsules, tablets, or powder. Far and away,
though, the way most people use caffeine is through coffee. It is a
central nervous system stimulant and is used in most instances to
alleviate fatigue or aid concentration.

The first historical record of caffeine use was by the Aztec
Indians from the time of Montezuma. Caffeine was used in the form of a
hot drink made with cacao (the ‘chocolate’ tree) leaves and various
herbs and spices. Montezuma was said to have drunk up to 50 cups a day.
Chocolate, in the form of the chocolate bar, was first introduced by the
company Fry & Son in 1847. Coffee, however, proved to be a far more
popular form of caffeine intake. It is mentioned in the Koran, the holy
book of the Moslem religion and originates from Africa and the Middle
East. It was introduced into the United Kingdom originally as a medicine
but became extremely fashionable between 1670 and 1730, when there was a
massive increase in the number of coffee houses.

As noted above, over the years, coffee, teas and soft drinks
have been the most popular methods of taking caffeine. In recent
decades, however, over-the-counter “medications” containing
caffeine, such as Vivarin and NoDoz have become fairly
widespread. Common doses of caffeine range from 50mg. on the low end to
800mg. on the extreme upper end of the spectrum. Comparatively, a cup of
coffee contains about 100-150mg. of caffeine.

Caffeine increases heartbeat, respiration, metabolic rate,
and the production of stomach acid and urine; and it relaxes smooth
muscles, including the bronchial muscle. These changes vary among people
and depend upon the individual’s sensitivity to this drug, their
metabolism and whether the consumer habitually uses or rarely uses
caffeine (ie. their tolerance to the drug). How long the effects last is
influenced by the person’s hormonal status, whether he/she uses tobacco
or takes medications or if they have a disease that impairs liver

These effects can begin as early as 10-20 minutes after ingestion.
Maximum effects are reached in about 30-60 minutes.

There is some evidence linking caffeine heart problems, fibrocystic
breast disease(FBD), ulcers and other stomach disorders in regular
users. It has also been suggested as a possible cause of cancer and
birth defects.
Source: The Health
Consequences of Caffeine, by P. Curatolo; D. Robertson Annals of
Internal Medicine
, Vol 98 (part 1) May 1983; 641-653

Regular caffeine consumption creates a tolerance to caffeine.
When the caffeine intake is then reduced, blood pressure drops
dramatically, causing an excess of blood in the head (though not
necessarily on the brain), leading to a headache.

This headache, well known among coffee drinkers, usually lasts from
one to five days, and can be alleviated with over-the-counter analgesics
such as aspirin. It can also be alleviated with caffeine intake. Many
analgesics, in fact, contain some caffeine.

Other symptoms can include irritability, nervousness, and feeling
sleepy, as well as having the caffeine headache.
Source: Caffeine and Health.
J. E. James, Academic Press, 1991. Progress in Clinical and Biological
Research Volume 158. G. A. Spiller, Ed. Alan R. Liss Inc, 1984. 

Physical Dependence: Moderate
Psychological Dependence: Moderate
Tolerance: Moderate

While there are a few treatment programs designed specifically
for caffeine, most treatment models treat the addiction, not the
specific substance. Below are some treatment programs that may be useful
for caffeine users as well as others who feel that they may need
professional help relating to addiction:

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Buprenorphine Abuse Treatment


Buprenorphine (C29H41NO4) is the chemical structural formula for the brand name opioids, Suboxone and Subutex, manufactured by Reckitt-Benckiser. A derivative of thebaine, its chemical name is 17-(Cyclopropylmethyl)-alpha-(1,1-dimethylethyl)-4,5-epoxy-18,19-dihydro- 3-hydroxy-6-methoxy-alpha-methyl-6,14-ethenomorphinan-7-methanol.

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Buprenorphine, a derivative of thebaine was first marketed in the United States as the Schedule V parenteral analgesic Buprenex. In 2002, after a review of evidence about the potential for abuse, diversion, addiction, and side effects, the DEA reclassified buprenorphine from a Schedule V to a Schedule III narcotic.

Both Subutex and Suboxone are approved for the treatment of opiate dependence and pain relief. The active ingredient buprenorphine hydrochloride, reduces the symptoms of opiate dependence. Suboxone is a combination of two proven medications, buprenorphine and naloxone. Buprenorphine, a partial opioid agonist, reduces withdrawal symptoms and blocks the effects of subsequently administered opioids, suggesting it might help reduce illicit opioid use. Due to the presence of naloxone, Suboxone is very likely to produce severe withdrawal symptoms if misused intravenously. When used as prescribed, no such effect is likely.

Subutex and Suboxone are the first opiate addiction treatments approved for in-office prescribing under the federal Drug Addiction Treatment Act of 2000 (DATA). Other buprenorphine brand names are Temgesic and Buprenex.

In October 2002, Reckitt Benckiser received FDA approval to market two products: Subutex, a buprenorphine monotherapy product, and Suboxone, a buprenorphine/naloxone combination product. These two products are indicated for use in opioid addiction treatment, with Suboxone designed to reduce injection abuse. Both drugs are currently the only Schedule III, IV, or V medications with FDA approval for this purpose.

The FDA approval of these buprenorphine formulations does not alter the status of other medication-assisted opioid addiction treatments, such as methadone and LAAM (levo-alpha-acetyl-methadol), both only available within the context of an Opioid Treatment Program.

Buprenorphine is used as a pain reliever and to treat opiate addiction. It produces less of a “high” than other opioids, such as codeine and morphine. For this reason, it is less susceptible to abuse and may be easier to stop taking.

Candidates for opioid addiction treatment with buprenorphine need to meet the following criteria:

· objective diagnosis of opioid addiction
· willing to comply with treatment safety precautions
· likely to comply with treatment guidelines
· no contraindications to buprenorphine

Buprenorphine’s primary action is to prevent withdrawal symptoms, enabling people addicted to an opioid drug to stop taking the drug. Only doctors experienced in the use of buprenorphine can determine if it is the right choice for a the opiate addicted patient. CSAT (Center for Substance Abuse Treatment) maintains a database to help patients locate qualified doctors.

The two buprenorphine drugs approved for use in treating opiate addiction are:

Subutex, the initial product formulation, contains only buprenorphine hydrochloride. It is generally given during the first few days of treatment.
Suboxone contains an additional ingredient called naloxone to prevent abuse. Suboxone is indicated for the maintenance phase of treatment and is used in the majority of patients.

Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets. The half-life of buprenorphine is 24–60 hours. Tablets should not be chewed or swallowed or they will not work properly and may cause withdrawal symptoms.

Injecting buprenorphine is dangerous and may result in severe withdrawal symptoms. In addition, buprenorphine may cause withdrawal symptoms if taken too soon after a dose of morphine, methadone or another opiate agonist.

Only qualified doctors with the necessary DEA (Drug Enforcement Agency) identification number can prescribe these medications.

Never increase the amount or frequency without your doctor’s approval, or take this drug for any reason other than the one prescribed.

Simply put, as a partial opioid agonist, buprenorphine reduces withdrawal symptoms and blocks the effects of subsequently administered opioids. Suboxone also exhibits a “ceiling effect” on respiratory depression, thereby decreasing the danger of overdose compared to other opioids.

As an opioid partial agonist, buprenorphine produces typical opioid agonist effects and side effects such as euphoria and respiratory depression. However, its maximum effects are less than those of full agonists like heroin and methadone. At low doses, buprenorphine provides satisfactory agonist effect for opioid-addicted individuals to discontinue the abuse of opioids and avoid withdrawal. In fact, in high doses and under certain circumstances, buprenorphine blocks the effects of full opioid agonists, precipitating withdrawal symptoms if administered to an opioid-addicted individual while a full agonist is in the bloodstream.

Side Effects:
Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation. Buprenorphine can expedite opioid withdrawal with symptoms including, but not limited to: depression, nausea or vomiting, muscle aches and cramps, runny eyes and nose, dilated pupils, sweating, diarrhea, yawning, low fever, insomnia, cravings, and irritability.

Cautionary Notes:
Fast Facts:
* Buprenorphine can cause a potentially fatal overdose if mixed and injected with a tranquilizer.
* Buprenorphine can cause drug dependence, resulting in withdrawal symptoms if the medicine is suddenly stopped. Withdrawal symptoms may also occur at the start of treatment due to dependence on another drug.
* Buprenorphine may seriously impair your ability to drive a car or operate machinery.
* Avoid alcohol while taking buprenorphine because alcohol can dramatically increase the drowsiness and dizziness associated with this medication.

Possible Food and Drug Interactions when taking this Medication:

Buprenorphine may dramatically increase the effects of other drugs that cause drowsiness. These include antidepressants, alcohol, antihistamines, sedatives, pain relievers, anxiety medicines, and muscle relaxants. Make sure your doctor knows about all medications you are using, including over-the-counter medicine and herbal products.

It is especially important to check with your doctor before combining buprenorphine with the following:

· Benzodiazepines (Valium, Ativan, Xanax, etc.)
· Erythromycin; clarithromycin (Biaxin)
· Itraconazole (Sporanox) or ketoconazole (Nizoral)
· HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir) or saquinavir (Fortovase, Invirase); rifampin (Rifadin, Rimactane), rifapentine (Priftin), or rifabutin (Mycobutin)
· Phenytoin (Dilantin)
· Carbamazepine (Tegretol)
· Barbiturates such as phenobarbital, mephobarbital (Mebaral), and others

Do not take Buprenorphine without telling your doctor if you have lung problems or difficulty breathing; a head injury; liver or kidney problems; adrenal gland problems, such as Addison’s disease; hypothyroidism; enlarged prostate gland; a curve in the spine that affects breathing; severe mental problems or hallucinations; or alcoholism.


Buprenorphine overdoses can lead to dangerous opiate-overdose symptoms. Some evidence suggests that addiction and habituation can be a problem for some users. Symptoms of a overdose include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, tiredness, cold and clammy skin, and constricted pupils.

While buprenorphine’s primary purpose is to treat opiate addiction, it can still cause drug dependence. Due to its opioid agonist effects, buprenorphine can be abused, particularly by those not physically dependent on opioids. With Suboxone, naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product.

When patients no longer require buprenorphine, they should work with their physician to set a gradual taper schedule to avoid acute withdrawal.

Both Suboxone and Subutex can cause drug dependence which can result in withdrawal symptoms if the medicine is suddenly stopped. Since buprenorphine is a partial agonist, withdrawal is less severe than with full agonists. If a patient has a dependence on another opiate, he may experience withdrawal symptoms at the beginning of treatment. These drugs are not for irregular use and should never be stopped without first consulting your doctor. Generally, doctors will gradually reduce the dose to avoid or minimize withdrawal symptoms.

Buprenorphine is a partial agonist at the mu-opioid receptor and chronic administration produces dependence similar to the opioid type, characterized by moderate withdrawal upon abrupt discontinuation or rapid taper.

To avoid severe withdrawal symptoms, chronic Suboxone/Subutex users should taper down slowly under a knowledgeable physician’s care. Dependence resulting from even a few weeks of regular use can usually be handled under a physician’s supervision with minimal discomfort.

However a person chooses to free themselves from the clutches of a drug, there is one constant each needs: Support. Narcotics Anonymous remains a successful choice for many addicts, with world-wide availability. The “information age” has produced numerous on line support forums, popular with many recovering addicts, useful to some addicts as their sole means of support and for others, as adjunct therapy. Drug addiction is treatable, with help out there for everyone.

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