Sex Drugs Marriage (Contingency Plan Book 2)

A viable solution to the problem and setting these relationships back on track may be to reorient the individuals' perceptions and emotions - how one looks at or responds to situations and feels about them. Perceptions of and emotional responses to a relationship are contained within an often unexamined mental map of the relationship, also called a love map by John Gottman. These can be explored collaboratively and discussed openly. The core values they comprise can then be understood and respected or changed when no longer appropriate.

This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem and making some fundamental changes in thought and feeling. The next step is to adopt conscious, structural changes to the inter-personal relationships and evaluate the effectiveness of those changes over time.

Indeed, "typically for those close personal relations there is a certain degree in 'interdependence' - which means that the partners are alternately mutually dependent on each other. As a special aspect of such relations something contradictory is put outside: But it depends on the specific developing duties of each partner in every life phase and maturity".

Two methods of couples therapy focus primarily on the process of communicating. Each helps couples learn a method of communicating designed to create a safe environment for each partner to express and hear feelings. When the Munich Marital Study discovered active listening to not be used in the long run, [6] Warren Farrell observed that active listening did a better job creating a safe environment for the criticizer to criticize than for the listener to hear the criticism.

A Guide to Substance Abuse Services for Primary Care Clinicians.

The listener, often feeling overwhelmed by the criticism, tended to avoid future encounters. He hypothesized that we were biologically programmed to respond defensively to criticism, and therefore the listener needed to be trained in-depth with mental exercises and methods to interpret as love what might otherwise feel abusive. His method is Cinematic Immersion. After 30 years of research into marriage John Gottman has found that healthy couples almost never listen and echo each other's feelings naturally.

Such exchanges occurred in less than 5 percent of marital interactions and they predicted nothing about whether the marriage would do well or badly.

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What's more, Gottman noted, data from a Munich study demonstrated that the reflective listening exercise itself didn't help couples to improve their marriages. To teach such interactions, whether as a daily tool for couples or as a therapeutic exercise in empathy, was a clinical dead end. By contrast emotionally focused therapy for couples EFT-C is based on attachment theory and uses emotion as the target and agent of change.

Emotions bring the past alive in rigid interaction patterns, which create and reflect absorbing emotional states. As one of its founders Sue Johnson says,. Forget about learning how to argue better, analysing your early childhood, making grand romantic gestures, or experimenting with new sexual positions. Instead, recognize and admit that you are emotionally attached to and dependent on your partner in much the same way that a child is on a parent for nurturing, soothing, and protection.

The most researched approach to couples therapy is behavioral couples therapy. Licensed couple therapist may refer to a psychiatrist, clinical social workers, counseling psychologists, clinical psychologists, pastoral counsellors, marriage and family therapists, and psychiatric nurses. In both methods, the practitioner evaluates the couple's personal and relationship story as it is narrated, interrupts wisely, facilitates both de-escalation of unhelpful conflict and the development of realistic, practical solutions.

Individualistic approaches to couple problems can cause harm. The counselor or therapist encourages the participants to give their best efforts to reorienting their relationship with each other. One of the challenges here is for each person to change their own responses to their partner's behaviour. Other challenges to the process are disclosing controversial or shameful events and revealing closely guarded secrets.

Not all couples put all of their cards on the table at first. This can take time. A novel development in the field of couples therapy has involved the introduction of insights gained from affective neuroscience and psychopharmacology into clinical practice. There has been interest in use of the so-called love hormone — oxytocin — during therapy sessions, although this is still largely experimental and somewhat controversial.

Although results are almost certainly significantly better when professional guidance is utilized see especially family therapy , numerous attempts at making the methodologies available generally via self-help books and other media are available. In the last few years it has become increasingly popular for these self-help books to become popularized and published as an e-book available on the web, or through content articles on blogs and websites.

The challenges for individuals utilizing these methods are most commonly associated with that of other self-help therapies or self-diagnosis. Using modern technologies such as Skype voip conferencing to interact with practitioners are also becoming increasingly popular for their added accessibility as well as discarding any existing geographic barriers. Entrusting in the performance and privacy of these technologies may pose concerns despite the convenient structure, especially compared to the comfort of in-person meetings.

Some experts tout cognitive behavioral therapy as the tool of choice for intervention while many rely on acceptance and commitment therapy or cognitive analytic therapy. Often, same-sex couples do not have as many role models of successful relationships as opposite-sex couples. In many jurisdictions committed LGBT couples desiring a family are denied access to assisted reproduction , adoption and fostering , leaving them childless, feeling excluded, other and bereaved.

There may be issues with gender-role socialization that do not affect opposite-sex couples. A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage. From Wikipedia, the free encyclopedia. For the television series, see Couples Therapy TV series. Homosexuality and psychology , Sexual relationship disorder , and List of transgender-related topics. Gender, Sexuality, and Eugenics from the Turn of the century.

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.

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J Consult Clin Psychol. Even with a confirmed psychiatric diagnosis, patients with substance use disorders should be prescribed drugs with a low potential for 1 lethality in overdose situations, 2 exacerbation of the effects of the abused substance, and 3 abuse itself.

1. INTRODUCTION

Selective serotonin reuptake inhibitors SSRIs for patients with depressive disorders and buspirone for patients with anxiety disorders are examples of psychoactive drugs with low abuse potential. These medications should also be dispensed in limited amounts and be closely monitored Institute of Medicine, ; Schuckit, ; American Psychiatric Association, ; Landry, Because prescribing psychotropic medications for patients with dual diagnoses is clinically complex, a conservative and sequential three-stage approach is recommended.

For a person with both an anxiety disorder and alcohol dependence, for example, nonpsychoactive alternatives such as exercise, biofeedback, or stress reduction techniques should be tried first. If these are not effective, nonpsychoactive drugs such as buspirone or SSRIs for depression should be administered.

Only if these do not alleviate symptoms and complaints should psychoactive medications be provided. Proper prescribing practices for these dually diagnosed patients encompass the following six "Ds" Landry et al. Individual therapy uses psychodynamic principles with such modifications as limit-setting and explicit advice or suggestions to help patients address difficulties in interpersonal functioning. One approach that has been tested with cocaine- and alcohol-dependent persons is supportive-expressive therapy, which attempts to create a safe and supportive therapeutic alliance that encourages the patient to address negative patterns in other relationships American Psychiatric Association, ; National Institute on Drug Abuse, unpublished.

This technique is usually used in conjunction with more comprehensive treatment efforts and focuses on current life problems, not developmental issues. Some research studies indicate that individual psychotherapy is most beneficial for opiate-dependent patients with moderate levels of psychopathology who can form a therapeutic alliance National Institute on Drug Abuse, unpublished.

Drug counseling provided by paraprofessionals focuses on specific strategies for reducing drug use or pragmatic issues related to treatment retention or participation e. This differs from psychotherapy by trained mental health professionals American Psychiatric Association, Group therapy is one of the most frequently used techniques during primary and extended care phases of substance abuse treatment programs. Many different approaches are used, and there is little agreement on session length, meeting frequency, optimal size, open or closed enrollment, duration of group participation, number or training of the involved therapists, or style of group interaction.

Most controversial is whether confrontation or support should be emphasized. Group therapy offers the experience of closeness, sharing of painful experiences, communication of feelings, and helping others who are struggling with control over substance abuse. The principles of group dynamics often extend beyond therapy in substance abuse treatment, in educational presentations and discussions about abused substances, their effects on the body and psychosocial functioning, prevention of HIV infection and infection through sexual contact and injection drug use, and numerous other substance abuse-related topics Institute of Medicine, ; American Psychiatric Association, Marital therapy and family therapy focus on the substance abuse behaviors of the identified patient and also on maladaptive patterns of family interaction and communication.

Many different schools of family therapy have been used in treatment programs, including structural, strategic, behavioral, and psychodynamic orientations. The goals of family therapy also vary, as does the phase of treatment when this technique is used and the type of family participating e.

Family intervention, a structured and guided attempt to move a resistant and active substance abuser into treatment, can be a helpful motivator for program entry. Involved family members can help ensure medication compliance and attendance, plan treatment strategies, and monitor abstinence, while therapy focused on ameliorating dysfunctional family dynamics and restructuring poor communication patterns can help establish a more appropriate environment and support system for the person in recovery.

Several well-designed research studies support the effectiveness of behavioral relationship therapy in improving the healthy functioning of families and couples and improving treatment outcomes for individuals Landry, ; Institute of Medicine, ; American Psychiatric Association, Preliminary studies of Multidimensional Family Therapy MFT , a multicomponent family intervention for parents and substance-abusing adolescents, have found improvement in parenting skills and associated abstinence in adolescents for as long as a year after the intervention National Institute on Drug Abuse, Cognitive behavioral therapy attempts to alter the cognitive processes that lead to maladaptive behavior, intervene in the chain of events that lead to substance abuse, and then promote and reinforce necessary skills and behaviors for achieving and maintaining abstinence.

Research studies consistently demonstrate that such techniques improve self-control and social skills and thus help reduce drinking American Psychiatric Association, Some of the strategies used are self-monitoring, goal setting, rewards for goal attainment, and learning new coping skills. Stress management training -- using biofeedback, progressive relaxation techniques, meditation, or exercise -- has become very popular in substance abuse treatment efforts.

Social skills training to improve the general functioning of persons who are deficient in ordinary communications and interpersonal interactions has also been demonstrated to be an effective treatment technique in promoting sobriety and reducing relapse. Training sessions focus on how to express and react to specific feelings, how to handle criticism, or how to initiate social encounters Institute of Medicine, ; American Psychiatric Association, ; Landry, Behavioral contracting or contingency management uses a set of predetermined rewards and punishments established by the therapist and patient and significant others to reinforce desired behaviors.

Effective use of this technique requires that the rewards and punishments, or contingencies, be meaningful, that the contract be mutually developed, and that the contingencies be applied as specified. Some studies suggest that positive contingencies are more effective than negative ones National Institute on Drug Abuse, unpublished. Care must be taken that negative contingencies are not unethical or counterproductive e.

Contingency management is only effective within the context of a comprehensive treatment program National Institute on Drug Abuse, unpublished; Institute of Medicine, ; Landry, Relapse prevention helps patients first recognize potentially high-risk situations or emotional "triggers" that have led to substance abuse, and then learn a repertoire of substitute responses to cravings. Patients also develop new coping strategies for handling external stressors and learn both to accept lapses into substance abuse as part of the recovery process and to interrupt them before adverse consequences ensue.

Controlled studies have found relapse prevention to be as effective as other psychosocial treatments, especially for patients with comorbid sociopathy or psychiatric symptoms American Psychiatric Association, Cognitive-behavioral strategies, the improvement of self-efficacy, self-control training, and cue exposure and extinction have all been used as components of relapse prevention.

In recent years, relapse prevention has become a vital part of most treatment efforts, learned during the intensive stage of treatment and practiced during aftercare Institute of Medicine, ; American Psychiatric Association, ; Landry, While AA and related groups are widely used, the success of this technique has not been rigorously evaluated.

Nevertheless, these fellowships apparently help persons at any point in the recovery process to change old behavior patterns, react responsibly to drug cravings, maintain hope and determination to become and remain abstinent. Self-help groups can also help people build a new social network in a community of understanding peers, find satisfactory drug-free activities and recreational skills, establish healthy intimate relationships, and avoid stressful social situations and environments. The process of working through the 12 steps under the tutelage of a sponsor encourages group members to reassess past life experiences and take more responsibility for their substance use disorders.

Attendance may vary from daily to much less frequent, with more intensive involvement available whenever the recovering person feels this need. Patients who are prescribed psychotropic medications for comorbid psychiatric disorders e. Young persons, persons of color, and gays and lesbians often find more acceptance in groups where at least some members have similar characteristics.

Friends and relatives of persons in recovery and of those who refuse treatment can benefit from Al-Anon, Alateen, Nar-Anon, and similar groups that offer support and education about the disease of alcoholism or other forms of substance abuse and teach participants to curb their own "enabling" behaviors. Improvements in substance-abusing behavior among meeting participants are associated with frequent attendance, obtaining a sponsor, "working" the 12 steps, and leading meetings National Institute on Drug Abuse, ; American Psychiatric Association, ; Landry, Patients in treatment may need other primary and adjunctive services as well: These may be provided onsite or through referral to community resources.

Adjunctive services to encourage patients to enter and remain in treatment may include child care, transportation arrangements, financial assistance or welfare support, supported housing, and other supplemental help. The types of additional services supplied or arranged through a treatment program will obviously depend heavily on the characteristics of the population served. For example, persons with heroin, cocaine, or methamphetamine dependence disorders who inject these drugs will require many specialized education, identification, counseling, and health care services for HIV infection and AIDS that are not likely to be needed by programs for people with alcohol dependence.

All the components, approaches, techniques, and settings discussed above must be monitored and adjusted as treatment progresses. Primary care clinicians should understand the following aspects of appropriate care. A variety of substance abuse treatment programs have been developed to meet the particular needs of special populations, including women, pregnant and postpartum mothers, adolescents, elderly persons, members of various minority groups, public inebriates or homeless persons, drinking drivers, and children of alcoholics.

These special programs are found in the public and private sectors and include both residential and ambulatory care settings using therapeutic community, Minnesota model, outpatient drug-free, and methadone maintenance approaches. Researchers have not confirmed that these separate programs for special populations are superior to mainstream efforts with respect to outcomes, and experts question their cost-effectiveness and applicability to heterogeneous groups with overlapping characteristics that complicate placement of a particular patient in one group over another.

Clinicians must be wary of defining any patient in relation only to age, gender, racial group membership, or functional characteristics, especially since other patient-related variables have been found to have greater implications for successful outcomes e. Nonetheless, clinical observations do indicate that treatment of special populations may be enhanced if their particular needs are considered and met. Notable components of these separate programs for special populations are as follows Institute of Medicine, ; American Psychiatric Association, ; Landry, Women are more likely than men to have comorbid depressive and anxiety disorders, including posttraumatic stress disorders as a result of past or current physical or sexual abuse.

Although women tended in the past to become involved with different substances than men e. Treatment components can address women's special issues and needs for child care, parenting skills, building healthy relationships, avoiding sexual exploitation or domestic violence, preventing HIV infection and other sexually transmitted diseases, and enhanced self-esteem.

A high ratio of female staff and same-sex groups are also thought to improve treatment retention. Pregnant and postpartum women and their dependent children have numerous special needs, including prenatal and obstetrical care, pediatric care, knowledge of child development, parenting skills, economic security, and safe, affordable housing. Pregnant women -- and those in their childbearing years -- need to know about birth control as well as the risks to pregnancy and fetal development of continuing substance use e.

Methadone maintenance throughout pregnancy and the postpartum period is often the treatment of choice for opioid-dependent women with seriously compromised lifestyles who are not likely to remain abstinent. However, many other medications used in the treatment of addiction, including disulfiram and naltrexone, should not be prescribed for pregnant substance abusers. Adolescents need treatment that is developmentally appropriate and peer-oriented. Educational needs are particularly important as well as involvement of family members in treatment planning and therapy for dysfunctional aspects.

Substance abuse among adolescents is frequently correlated with depression, eating disorders, and a history of sexual abuse American Psychiatric Association, A history of familial substance abuse and dependence is predictive of serious adolescent involvement. Elderly persons may have unrecognized and undertreated substance dependence on alcohol or prescribed benzodiazepines and sedative hypnotics that can contribute to unexplained falls and injuries, confusion, and inadvertent overdose because age decreases the body's ability to metabolize many medications.

Other coexisting medical and psychiatric conditions can also complicate treatment and compromise elderly patients' ability to comply with recommended regimens. Minority group members may identify with particular cultural norms and institutions that increase feelings of social acceptance. While early phases of treatment that focus on achieving abstinence are not likely to be affected by minority group differences, the development of appropriate, drug-free social supports and new lifestyles during more extended treatment and aftercare stages may be enhanced by support groups with similar ethnic identification and cultural patterns.

For some African-American patients, involving the church and treatment that incorporates a spiritual element may improve outcomes. Treatment programs for Native American tribes often incorporate their traditions, and a family focus as well as bilingual staff and translated written materials are important ingredients of many treatment programs for Hispanics. However, the Consensus Panel believes that culturally sensitive treatment may not be as important to individuals who do not strongly identify with an ethnic or cultural group and of less concern than socioeconomic differences, for example, in treatment retention.

Sexual addiction

One important aspect of working with or making a referral for substance abuse treatment is the legal requirement to comply with Federal regulations governing the confidentiality of information about a patient's substance use or abuse. Laws protecting the confidentiality of alcohol and drug abuse patient records were instituted to encourage patients to enter treatment without fear of stigmatization or discrimination as a result of information disclosure without the patient's express permission 42 C.

Nonetheless, records containing information about substance use disorders should always be handled with discretion. If referral is made by the primary care clinician for a substance abuse assessment or to a specialized treatment program, written permission of the patient is required before any information or records can be disclosed or redisclosed in which the patient's identity is revealed, except in cases of medical emergency or reporting suspected child abuse to the proper authorities.

Often, treatment programs will want to coordinate a patient's treatment with the primary care provider -- such collaboration is essential for certain patients, such as chemically involved pregnant women. See Appendix B for a detailed discussion of confidentiality. As already noted, all primary care clinicians have important roles to play in identifying, screening, and referring patients with substance use disorders for in-depth assessment or treatment and in delivering brief interventions to patients with milder substance-related problems.

In addition, the clinician has an array of options, depending on time and resources available, for offering ongoing support and encouragement to patients who do enter the formal treatment system. Completing specialized treatment is only the beginning of the patient's recovery process. Primary care clinicians should continue to ask their patients about the problem they were treated for at every office or clinic visit.

During these visits, the clinician can monitor the potential for relapse and take any necessary steps to prevent slips from occurring Brown, The primary care clinician also has a responsibility to patients who refuse to accept referral to treatment or drop out before completion. In such cases, the primary care clinician should. Turn recording back on. National Center for Biotechnology Information , U. Directories of Local Substance Abuse Treatment Systems The first step in understanding local resources is to collect information about the specialized drug and alcohol treatment currently available in the community.

Goals and Effectiveness of Treatment While each individual in treatment will have specific long- and short-term goals, all specialized substance abuse treatment programs have three similar generalized goals Schuckit, ; American Psychiatric Association, Reducing substance abuse or achieving a substance-free life. No single treatment approach is effective for all persons with alcohol problems, and there is no overall advantage for residential or inpatient treatment over outpatient care.

Therapist and patient and problem characteristics, treatment process, posttreatment adjustment factors, and the interactions among these variables also determine outcomes. Patients who significantly reduce alcohol consumption or become totally abstinent usually improve their functioning in other areas Institute of Medicine, Treatment Dimensions The terminology describing the different elements of treatment care for people with substance use disorders has evolved as specialized systems have developed and as treatment has adapted to changes in the health care system and financing arrangements.

Treatment Models and Approaches Historically, treatment programs were developed to reflect the philosophical orientations of founders and their beliefs regarding the etiology of alcoholism and drug dependence. The three historical orientations that still underlie different treatment models are A medical model, emphasizing biological and genetic or physiological causes of addiction that require treatment by a physician and utilize pharmacotherapy to relieve symptoms or change behavior e.

A psychological model, focusing on an individual's maladaptive motivational learning or emotional dysfunction as the primary cause of substance abuse. This approach includes psychotherapy or behavioral therapy directed by a mental health professional. A sociocultural model, stressing deficiencies in the social and cultural milieu or socialization process that can be ameliorated by changing the physical and social environment, particularly through involvement in self-help fellowships or spiritual activities and supportive social networks.

Treatment authority is often vested in persons who are in recovery themselves and whose experiential knowledge is valued. The Minnesota model of residential chemical dependency treatment incorporates a biopsychosocial disease model of addiction that focuses on abstinence as the primary treatment goal and uses the AA Step program as a major tool for recovery and relapse prevention. Although this approach, which has evolved from earlier precursors i. The new hybrid, used extensively by public and private sector programs, blends Step concepts with professional medical practices.

Skilled chemical dependency counselors, often people in recovery as well as mental health and social work professionals, use a variety of behavioral and reality-oriented approaches. Psychosocial evaluations and psychological testing are conducted; medical and psychiatric support is provided for identified conditions; and the inpatient program utilizes therapeutic community concepts. Although a disease model of etiology is stressed, the individual patient has ultimate responsibility for making behavioral changes. Pharmacological interventions may be used, particularly for detoxification; extensive education about chemical dependency is provided through lectures, reading, and writing; and individual and group therapy are stressed, as is the involvement of the family in treatment planning and aftercare Institute of Medicine, ; Gerstein and Harwood, ; Landry, Drug-free outpatient treatment uses a variety of counseling and therapeutic techniques, skills training, and educational supports and little or no pharmacotherapy to address the specific needs of individuals moving from active substance abuse to abstinence.

This is the least standardized treatment approach and varies considerably in both intensity, duration of care, and staffing patterns. Most of these programs see patients only once or twice weekly and use some combination of counseling strategies, social work, and Step or self-help meetings. Some programs now offer prescribed medications to ameliorate prolonged withdrawal symptoms; others stress case management and referral of patients to available community resources for medical, mental health, or family treatment; educational, vocational, or financial counseling; and legal or social services.

Optimally, a comprehensive continuum of direct and supportive services is offered through a combination of onsite and referral services. High rates of attrition are often a problem for drug-free outpatient programs; legal, family, or employer pressure may be used to encourage patients to remain in treatment Landry, ; American Psychiatric Association, ; Gerstein and Harwood, Methadone maintenance -- or opioid substitution -- treatment specifically targets chronic heroin or opioid addicts who have not benefited from other treatment approaches.

Contingency (Covenant of Trust #1) by Paula Wiseman

Such treatment includes replacement of licit or illicit morphine derivatives with longer-acting, medically safe, stabilizing substitutes of known potency and purity that are ingested orally on a regular basis. The methadone or other long-acting opioid, when administered in adequate doses, reduces drug craving, blocks euphoric effects from continued use of heroin or other illegal opioids, and eliminates the rapid mood swings associated with short-acting and usually injected heroin.

The approach, which allows patients to function normally, does not focus on abstinence as a goal, but rather on rehabilitation and the development of a productive lifestyle. A major emphasis in recent years has been on reducing HIV infection transmission rates among patients who remain in treatment and stop injection drug use. Individual and group counseling in addition to pharmacotherapy and urine testing are the mainstay of most programs, but more comprehensive and successful programs also offer psychological and medical services, social work assistance, family therapy, and vocational training.

Methadone maintenance treatment, which is more controversial and extensively evaluated than any other treatment approach, has consistently been found to be effective in reducing the use of illicit opioids and criminal activity as well as in improving health, social functioning, and employment Gerstein and Harwood, ; Landry, ; National Institute on Drug Abuse, Therapeutic community residential treatment is best suited to patients with a substance dependence diagnosis who also have serious psychosocial adjustment problems and require resocialization in a highly structured setting.

Treatment generally focuses on negative patterns of thinking and behavior that can be changed through reality-oriented individual and group therapy, intensive encounter sessions with peers, and participation in a therapeutic milieu with hierarchical roles, privileges, and responsibilities. Strict and explicit behavioral norms are emphasized and reinforced with specified rewards and punishments directed toward developing self-control and social responsibility.

Tutorials, remedial and formal education, and daily work assignments in the communal setting or conventional jobs for residents in the final stages before graduation are usually required. Enrollment is relatively long-term and intensive, entailing a minimum of 3 to 9 months of residential living and gradual reentry into the community setting.

Contingency

While patients who stay in therapeutic communities for at least a third to half the planned course of treatment usually have markedly improved functioning in terms of reduced criminal activity and drug consumption and improved rates of employment or schooling and graduates do even better , the biggest drawback to therapeutic communities is the large percentage of enrollees 75 percent or more who never complete treatment Gerstein and Harwood, ; Landry, Treatment Settings Substance abuse treatment is delivered in two basic settings or environments: Treatment Techniques Within each treatment approach, a variety of specialized treatment techniques also known as elements, modalities, components, or services are offered to achieve specified goals.

However, the principal elements are Pharmacotherapies, which discourage continuing alcohol or other drug use, suppress withdrawal symptoms, block or diminish euphoric effects or cravings, replace an illicit drug with a prescribed medication, or treat coexisting psychiatric problems see Appendix A for more information on specific pharmacotherapies.

Psychosocial or psychological interventions, which modify destructive interpersonal feelings, attitudes, and behaviors through individual, group, marital, or family therapy. Behavioral therapies, which ameliorate or extinguish undesirable behaviors and encourage desired ones. Self-help groups for mutual support and encouragement to become or remain abstinent before, during, and after formal treatment. Pharmacotherapy Medications to manage withdrawal take advantage of cross-tolerance to replace the abused drug with another and safer drug in the same class. Diagnosis is essential and should be confirmed by a careful history, thorough examination, and appropriate tests before prescribing psychotropic medications.