Statistically, more than 2/3 of people ages 18-25 have at one time qualified for a diagnosis of abuse of an illegal substance. More than 15% of the U.S. population older than 18 years old have significant substance abuse issues. Of these, 2/3 primarily abuse alcohol and 1/3 primarily abuse other substances. Abuse of the benzodiazepines or minor tranquilizers such as Xanax, opiates such as Vicodin and muscle relaxants such as Soma either separately or in combination is of epidemic proportions and Houston, Texas is unfortunately a regional center for fraudulent pain clinics and unscrupulous script writing offices. Also, doctor shopping, that is, obtaining multiple medications from multiple overlapping sources, is not yet illegal in Texas.
Treatment includes a comprehensive psychiatric examination, a detailed substance abuse history, computerized psychological testing, urine drug screening as well as periodic monitoring and referral to board certified family physicians for physical examination and laboratory screening. Treatment of co-morbid psychiatric conditions frequently improves the probability of successful management. When necessary, outpatient detoxification procedures can be used to either supervise withdrawal from opiates or provide carefully supervised prescriptions of long acting benzodiazepines over 4 to 6 weeks with careful weekly reduction in dosage to prevent lowering the seizure threshold and provoking a grand mal seizure. Patients are closely monitored for the onset of an anxiolytic withdrawal syndrome characterized by pulse rates greater than 100, hand tremor, insomnia, nausea or vomiting, transient visual, tactile or auditory hallucinations or illusions, psychomotor agitation and anxiety.