Diseases, Disorders information

Slightly more complex is dependence and the dependence criteria. There are seven different categories but only three criteria to make the diagnosis. So the first two are physiologic – tolerance and withdrawal – but the others are strictly behavioral. You need to know that only three of the behavioral ones can be sufficient to make the dependence diagnosis. You don’t have to have withdrawal. You don’t have to have tolerance.
I have a lovely woman who tells me, “I never get drunk. I do not have increasing use of alcohol. I can control my alcohol. I never have more than three or four drinks and nobody ever says it’s a problem.” “So why are you here?” “Well, my doctor thinks that my diabetes is off the wall and blames my drinking and it’s true my weight is up. He says I’m tremulous from it. So what if I am.” So we make the diagnosis, she substantially cuts down but is not completely abstinent on a more than two week basis at a time but what she notices is that her golf game has shaved ten points so she says, “Gee, there must be something to that.” So it does not have to be a physiologic syndrome to make the diagnosis. Canadian pharmacy with special discounts.
By the way, is there anybody familiar with absolute or relative tolerance? The meaning of those terms. Let me just clarify that because that is something that it’s not nit picking. There is a meaning to it. Absolute tolerance is to get a certain high that I’m seeking I have to drink two drinks initially, then after I’m a full member of the fraternity I have to drink four drinks and by the time I’m an officer I have to drink a six pack or two. That’s absolute tolerance. Relative tolerance is when I joined the fraternity I was drinking two beers, I got tipsy, I was all over the place. I threw up once. I was very sensitive to it. Now I drink two beers nothing happens to me. I don’t even notice it. That’s relative tolerance. We haven’t increased the quantity but the effects on the body have become tolerant.
Another thing to review for the boards is on page 280, that table at the top of urine toxicology. One of these years I gave this lecture and one of the questions was how do you know how long the substances last in the urine? It’s a beautiful board’s question so take a look at that and circle these two items. Phencyclidine which can last up to week, phencyclidine PCP and the last one in the cannabinoid group, the principal active ingredient in marijuana delta-9-THC circle because that can be found in chronic users for up to a month. Hgh online at online canadian pharmacy.
There are a number of models to try and explain addiction and also to clue us into good treatment and these models are in some cases conflicting, in other cases contributory. Since the conceptual understanding of all the different drugs of abuse unifies them, it’s good to understand what that means. The first model I want to condemn and that is the addictive personality. There is no evidence that there is a single developmental fixation that leaves people with an oral phase gratification need that promotes alcoholism or addiction. No evidence to support that. The self medication hypothesis, we’ll talk more about that tonight in the seminar but I’ll just say the data does not support that as an etiology. However, it is relevant clinically in that patients explain or rationalize their substance use in the sense of self medication. So it has some value in our clinical work but on the boards, not substantiated by the data.
What is substantiated by data? The behavioral model is extremely powerful. It’s a laboratory model and it teaches us not just how all the drugs of abuse tend to be similar but also routes to treating. So if we look at pleasure, most of the drugs of abuse make us feel good. That’s positive and so we do it again and again. That’s reinforcement. That’s all we mean by positive reinforcement. Many drugs of abuse, though not all, have a withdrawal syndrome that’s upsetting and painful. Some are physiological painful like alcohol withdrawal, others are emotionally painful like cocaine withdrawal but during the withdrawal it feels bad, therefore I keep doing that substance. So that’s negative. It feels bad therefore I keep doing the substance. So that’s negative. I feel bad. Reinforcement. I keep doing it. That’s all there is to self medication in the sense of negative reinforcement. Drugs information
Often people quit using the substances but they still have an urge, a habit. Think of smokers who like to fidget with their fingers or do something with their mouth. Why do they do that? There’s an important reason and it comes from behavioral theory. Fidgeting with the fingers in a smoker is a conditioned positive “it makes me feel good” reinforcement. Therefore I’d like to do it again. Other habits are when the weekend comes I have many patients who find it’s very hard to resist doing drugs. The weekdays when they’re working and busy they don’t have time to think about it, they do great. But the free time of the weekend is a disaster. Why? I feel bad. I’m lonely. I’m bored. Maybe I might not have a date. That is a conditioned cue. It’s not a drug if you don’t have a date but it is connected to the urge to use the drug because then you don’t care if you have a date and you are reinforced to use.