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Neuropsychiatric Effects of Prescription Drug Abuse

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Abstract

Prescription drugs have become a major category of abused substances, and there is evidence that the prevalence of prescription drug abuse may soon overtake that of illicit drugs. Study of prescription drugs has been hampered by vague terminology, since prescription drugs are only separated from other drugs of abuse by social and legal constructs. Reviewed herein is published literature on the abuse of four major categories of abused prescription drugs: sedative-hypnotics, stimulants, anabolic steroids, and anticholinergics. The review emphasizes evidence regarding the effects of these drugs on neural systems. Other abused prescription drugs that fall outside of the major categories are also briefly addressed.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Lucy A. Epstein, Davin K. Quinn, Jonathan R. Stevens & Theodore A. Stern

  2. Behavioral Health Services, UPH Hospital - Kino Campus, 5th Floor, 2800 E. Ajo Way, Tucson, AZ, USA

    Jason P. Caplan

  3. Department of Psychiatry, University of Arizona, Tucson, AZ, USA

    Jason P. Caplan

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Correspondence to Jason P. Caplan.

Appendices

Appendix

DSM-IV Diagnostic Criteria for Substance Abuse/Dependence

Substance Abuse

Substance use resulting in significant impairment or distress, as manifested by at least one of the following, within a 12-month period:

  1. 1.

    recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance; absences, suspensions, or expulsions from school; neglect of children or household)

  2. 2.

    recurrent substance use in physically hazardous situations (e.g., driving while intoxicated)

  3. 3.

    recurrent substance-related legal problems

  4. 4.

    continued substance use despite persistent social or relational problems (e.g., arguments with spouse, physical fights)

The symptoms have never met the criteria for Substance Dependence for this class of substance.

Substance Dependence

Substance use, resulting in significant impairment or distress, as manifested by at least three of the following, occurring at any time in the same 12-month period:

  1. 1.Tolerance,

    as demonstrated by:

    1. (a)

      a requirement for increased amounts of the substance to achieve intoxication or desired effect

    2. (b)

      diminished effect with continued use of the same amount of the substance

  2. 2.

    Withdrawal, as demonstrated by either of the following:

    1. (a)

      the characteristic withdrawal syndrome for the substance

    2. (b)

      the substance, or a similar substance, is taken to relieve or avoid withdrawal symptoms

  3. 3.

    The substance is used in larger amounts or over a longer period than intended

  4. 4.

    A persistent desire or unsuccessful efforts to diminish or control substance use

  5. 5.

    Significant time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors, driving long distances), use the substance, or recover from its effects

  6. 6.

    Important social, occupational, or recreational activities are reduced or discontinued because of substance use

  7. 7.

    Substance use is continued despite knowledge of a physical or psychological problem that is likely to have been caused or exacerbated by the substance

Adapted from: Diagnostic and statistical manual of mental disorders, fourth edition, text-revision (DSM-IV-TR). (2000). Washington, D.C.: American Psychiatric Association.

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Caplan, J.P., Epstein, L.A., Quinn, D.K. et al. Neuropsychiatric Effects of Prescription Drug Abuse. Neuropsychol Rev 17, 363–380 (2007). https://doi.org/10.1007/s11065-007-9037-7

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