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Use of drugs with dependence liability
Canadian Medical Association Journal
|September 22, 1979
Summary
Understanding drug dependence is crucial. While physical dependence is rare, psychological dependence drives persistent drug use and requires careful prescribing of medications.
Area of Science:
- Pharmacology
- Psychiatry
- Addiction Medicine
Background:
- Popular press often misuses the term "addictive," conflating distinct concepts like acute/chronic tolerance, physical/psychological dependence, and withdrawal.
- Serious physical dependence on psychoactive drugs is uncommon and manageable.
- Psychological dependence is a primary driver of persistent drug use and presents significant treatment challenges.
Purpose of the Study:
- To clarify the distinctions between various forms of drug dependence.
- To emphasize the importance of psychological dependence in sustained drug use.
- To advocate for more restrictive prescribing practices for dependence-associated medications.
Main Methods:
- Conceptual analysis of drug dependence terminology.
- Review of clinical management strategies for drug dependence.
- Pharmacological comparison of sedative-hypnotics and benzodiazepines.
Main Results:
- Psychological dependence is more prevalent and harder to treat than physical dependence.
- Restrictive prescribing, including limiting duration and renewal options, can prevent long-term drug use issues.
- Benzodiazepines are recommended over barbiturates and other sedative-hypnotics for insomnia and anxiety due to a lower dependence potential.
Conclusions:
- Distinguishing between physical and psychological dependence is essential for effective treatment.
- Judicious prescribing of dependence-associated drugs, with clear indications and short durations, is paramount.
- Benzodiazepines offer a safer alternative to older sedative-hypnotics for specific conditions, reducing dependence risks.