Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1979 Sep 22;121(6):717-722, 724.

Use of drugs with dependence liability

Moire S Jacob, Edward M Sellers
PMCID: PMC1704261  PMID: 42479

Abstract

The term addictive as used by the popular press frequently confuses the more precise concepts of acute and chronic tolerance, physical dependence and withdrawal, and psychologic dependence. Serious physical dependence on psychoactive drugs is rare and is easily managed. In contrast, psychologic dependence, the most important reason for persistent drug use, is much more common and is difficult to treat. Some tactics are available — for example, confrontation and discussion with the patient about how a drug is not going to be effective over long periods. Treating the symptom of a complex problem should, of course, not be expected to solve the problem. The most important tactic is to prescribe dependence-associated drugs only when clearly indicated, when the problem is responsive to drug therapy and for the shortest period necessary, without the option for renewing the prescription. Many problems related to drug use long after the period of expected benefit is past can be avoided by far more restrictive drug prescribing. Barbiturates and nonbarbiturate sedative hypnotics (e.g., ethchlorvynol, glutethimide, meprobamate, methaqualone and methyprylon) should not be prescribed for insomnia, acute reactive anxiety, chronic anxiety neurosis or depressive illnesses, since the safer and equally effective benzodiazepines, which are less associated with dependence, are available.

Full text

PDF
717

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartle W. R. Tartrazine-containing drugs. Can Med Assoc J. 1976 Aug 21;115(4):332–333. [PMC free article] [PubMed] [Google Scholar]
  2. Berkowitz B. A. The relationship of pharmacokinetics to pharmacological activity: morphine, methadone and naloxone. Clin Pharmacokinet. 1976;1(3):219–230. doi: 10.2165/00003088-197601030-00004. [DOI] [PubMed] [Google Scholar]
  3. Cooperstock R. A review of women's psychotropic drug use. Can J Psychiatry. 1979 Feb;24(1):29–34. doi: 10.1177/070674377902400107. [DOI] [PubMed] [Google Scholar]
  4. Giles H. G., MacLeod S. M., Wright J. R., Sellers E. M. Influence of age and previous use of diazepam dosage required for endoscopy. Can Med Assoc J. 1978 Mar 4;118(5):513–514. [PMC free article] [PubMed] [Google Scholar]
  5. Goldstein A. Heroin addiction and the role of methadone in its treatment. Arch Gen Psychiatry. 1972 Apr;26(4):291–297. doi: 10.1001/archpsyc.1972.01750220001001. [DOI] [PubMed] [Google Scholar]
  6. Greenblatt D. J., Shader R. I. Dependence, tolerance, and addiction to benzodiazepines: clinical and pharmacokinetic considerations. Drug Metab Rev. 1978;8(1):13–28. doi: 10.3109/03602537808993775. [DOI] [PubMed] [Google Scholar]
  7. Kalant H., LeBlanc A. E., Gibbins R. J. Tolerance to, and dependence on, some non-opiate psychotropic drugs. Pharmacol Rev. 1971 Sep;23(3):135–191. [PubMed] [Google Scholar]
  8. Koch-Weser J., Sellers E. M., Kalant H. Alcohol intoxication and withdrawal. N Engl J Med. 1976 Apr 1;294(14):757–762. doi: 10.1056/NEJM197604012941405. [DOI] [PubMed] [Google Scholar]
  9. MacLeod S. M., Giles H. G., Patzalek G., Thiessen J. J., Sellers E. M. Diazepam actions and plasma concentrations following ethanol ingestion. Eur J Clin Pharmacol. 1977;11(5):345–349. doi: 10.1007/BF00566531. [DOI] [PubMed] [Google Scholar]
  10. Moertel C. G., Ahmann D. L., Taylor W. F., Schwartau N. A comparative evaluation of marketed analgesic drugs. N Engl J Med. 1972 Apr 13;286(15):813–815. doi: 10.1056/NEJM197204132861504. [DOI] [PubMed] [Google Scholar]
  11. Sellers E. M. Addictive drugs: disposition, tolerance, and dependence interrelationships. Drug Metab Rev. 1978;8(1):5–11. doi: 10.3109/03602537808993774. [DOI] [PubMed] [Google Scholar]
  12. Sellers E. M. Clinical pharmacology and therapeutics of benzodiazepines. Can Med Assoc J. 1978 Jun 24;118(12):1533–1538. [PMC free article] [PubMed] [Google Scholar]
  13. Smart R. G. Drug abuse and its treatment in Canada. Addict Dis. 1977;3(1):5–10. [PubMed] [Google Scholar]
  14. Sturner W. Q., Garriott J. C. Deaths involving propoxyphene. A study of 41 cases over a two-year period. JAMA. 1973 Mar 5;223(10):1125–1130. doi: 10.1001/jama.223.10.1125. [DOI] [PubMed] [Google Scholar]
  15. Zilm D. H., Sellers E. M. The quantitative assessment of physical dependence on opiates. Drug Alcohol Depend. 1978 Nov;3(6):419–428. doi: 10.1016/0376-8716(78)90014-5. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES