ABSTRACT
Psychoactive Substance Dependence has been redefined by new criteria in DSM-III-R. The essential feature is a cluster of cognitive, behavioral, and physiologic symptoms that constitute a dependence syndrome, indicating that the person has impaired control of psychoactive substance use and continues its use in spite of adverse consequences. Detoxification and treatment of psychiatric complications of alcoholism were discussed elsewhere. The psychotherapeutic approach is primarily supportive with many patients; the therapist plays an active and nurturing role while maintaining clear boundaries of separateness and setting firm limits that discourage acting out and enforce the abstinence rule. Treatment programs for the opioid addict include methadone maintenance, maintenance with opioid antagonists, therapeutic communities, and various abstinence-oriented recovery programs. In general, cocaine treatment programs use the methods of Alcoholics Anonymous, contingency contracting, and urine monitoring. In contrast to other substance use disorders, Nicotine Dependence alone is not associated with impairment in social or occupational functioning.
