ALCOHOL AND CROSS-ADDICTION: WITHDRAWALJust as tolerance develops for alcohol, so can it also develop for some other psychotropic medications. The list of abuse-able drugs mentioned earlier included a number of drugs that produce tolerance. These include the barbiturates, sedatives, and the minor tranquilizers. Just as with alcohol, as use continues, more of the substance is required to keep doing the same job. This is reinforced by the ail-American viewpoint that discomfort is pointless when chemical comfort is only a swallow away. When tolerance develops, withdrawal symptoms may accompany abstinence. Several of these will be briefly described.Barbiturates have been around since the beginning of this century. Central nervous system depressants like alcohol, they have an abstinence syndrome very similar to that of alcohol. At lower doses, withdrawal symptoms will most likely be limited to anxiety and tremulousness. At high levels, more serious withdrawal symptoms may develop. These can include convulsions and a “DT-like” syndrome of delirium, disorientation, hallucinations, and severe agitation. Barbiturate withdrawal presents a medical situation as serious, and potentially as life threatening, as that accompanying alcohol withdrawal.Drugs included within the category of minor tranquilizers can be subdivided into different groups depending on their chemical compositions. These differences are important when it comes to withdrawal and potential problems of abuse. Librium and Valium both belong to the subgroup known as the benzodiazepines. When drugs of this subgroup are abused, withdrawal symptoms may be present if use is abruptly stopped. Withdrawal symptoms can include anxiety, tremulousness, sweating, insomnia, nausea and vomiting, muscular weakness, confusion, psychosis, and possibly convulsions. A full-blown “DT-like” picture is generally not associated with the benzodiazepines. However, it is increasingly recognized that physical dependence is not a casual issue. Clinically, more individuals are presenting for treatment following a longstanding use of Librium or Valium and more recently Xanax. Even if the symptoms of physical withdrawal associated with these substances are not as dramatic as those of alcohol or barbiturates, getting off these medications is no easy matter. For other subgroups of drugs in the minor tranquilizers category, withdrawal can be much more serious. Be particularly alert to abuse of Miltown or Equanil (the brand names for meprobamate) and Doriden (glutethimide). Withdrawal symptoms for these can be as dangerous as those associated with alcohol or barbiturates. (Doriden may have been prescribed for sleep. Don’t overlook “just a few sleeping pills” in pursuing a drug history.)*178\331\2*
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