Drug and alcohol abuse continue to be commonly encountered problems in most 
patient populations. To deal effectively with these problems, the primary care 
physician must have a thorough knowledge of the pharmacology of commonly abused 
drugs and the adjunctive agents used in treatment. Management of alcoholism may 
involve a range of medical interventions, including the treatment of alcohol 
intoxication, the use of benzodiazepines for alcohol withdrawal, and possibly 
the short-term administration of disulfiram to maintain sobriety. Successful 
management of cocaine or amphetamine abuse requires an understanding of the 
powerful reinforcing properties of these drugs and the unique problems that 
arise in the recovery period. Barbiturate intoxication and withdrawal are 
potentially life-threatening events requiring skilled in-patient treatment. 
Prolonged use of benzodiazepines can lead to drug dependence; successful 
withdrawal involves gradual dosage reduction. Acute intoxication from marijuana 
or hallucinogenic drugs may occasionally result in adverse reactions requiring 
medical intervention, but significant withdrawal reactions are rare. Management 
of opioid overdose, whether illicit or iatrogenic, requires the prompt and 
skillful use of opioid overdose, whether illicit or iatrogenic, requires the 
prompt and skillful use of opioid antagonists. Promising new pharmacologic 
approaches are now being successfully applied to the management of opioid 
dependence. An acceptance of nicotine as the addictive component of tobacco 
smoke has led to the development of nicotine gum as substitution therapy for 
cigarette smoking. Successful pharmacologic management of overdose or withdrawal 
is often the prerequisite for effective long-term treatment and recovery.